Last updated: August 2026 | Verified against the CMS Nationwide Quality Rating System Public Use File, Plan Year 2026
Quick Answer: UnitedHealthcare’s Louisiana marketplace plan holds the lowest overall HealthCare.gov star rating in the country for 2026, at 1 star. Molina Healthcare of Mississippi and Cigna Health and Life Insurance Company’s Mississippi plan also rank among the 10 lowest-scoring plans nationally, both at 2 stars. All three scored just 1 star on Medical Care specifically, the most heavily weighted component of the rating. These scores apply to a specific state plan, not the company nationwide.
Every year, CMS quietly publishes a dataset almost nobody outside the insurance industry ever opens. It scores every marketplace health plan in the country on a 5-star scale, the same stars you see on HealthCare.gov when you shop for coverage. We opened it.
Our research team downloaded and analyzed the full 2026 Nationwide Quality Rating System Public Use File directly from CMS, covering 298 rated marketplace plans across 51 states and territories. This guide names the specific companies and states behind the lowest scores in the country, and explains exactly what dragged them down.
What the HealthCare.gov Star Rating Actually Measures
The Quality Rating System is a 5-star scale CMS assigns to each Qualified Health Plan sold on HealthCare.gov and state exchanges. A plan’s overall rating combines three components. Medical Care measures clinical quality, things like cancer screening rates, diabetes management, and mental health follow-up care, and carries the heaviest weight of the three. Member Experience measures how enrollees rate their own care and service. Plan Administration measures customer service, appeals handling, and network accuracy.
CMS assigns star ratings using fixed score thresholds. A score of 90 or above earns 5 stars, 80 to 89 earns 4 stars, 70 to 79 earns 3 stars, 60 to 69 earns 2 stars, and below 60 earns 1 star. Across the entire country in 2026, only 21 of 298 rated plans earned 5 stars, while just 2 plans earned the lowest possible score of 1 star.
The 3 Lowest Scoring Major Companies in 2026
Ranked against all 298 rated plans nationwide, these three major insurers posted the steepest overall scores of any recognizable national brand in the country.
| Company | State Plan | National Rank (of 298) | Overall Score | Star Rating |
|---|---|---|---|---|
| UnitedHealthcare Insurance Company | Louisiana | #1 (lowest in the nation) | 59.7 | 1 star |
| Molina Healthcare of Mississippi | Mississippi | #6 | 61.5 | 2 stars |
| Cigna Health and Life Insurance Company | Mississippi | #10 | 62.8 | 2 stars |
Source: CMS Nationwide Quality Rating System Public Use File, Plan Year 2026, analyzed directly by our research team.
UnitedHealthcare’s Louisiana plan is the single lowest-scoring marketplace plan of any kind in the entire country this year. Its score of 59.7 sits just below the 60-point cutoff for 2 stars.
Why These Specific Scores Are So Low
The overall number hides an important detail. All three companies scored identically poorly on one specific component.
Each of these three plans received exactly 1 star on Medical Care, the component measuring clinical quality metrics like cancer screenings, chronic disease management, and behavioral health follow-up. Since Medical Care carries the heaviest weight in the overall formula, a poor score here drags the whole rating down even if other areas hold up better.
Plan Administration told a different story for each company. UnitedHealthcare’s Louisiana plan actually scored 5 stars on Plan Administration, meaning its customer service and network accuracy metrics were strong even as its clinical quality score was the worst in the country. Cigna’s Mississippi plan scored 3 stars on Plan Administration, while Molina’s Mississippi plan scored 2 stars. None of the three had enough survey responses to generate a scored Member Experience rating this year, marked in the CMS data as insufficient data rather than a poor score.
What This Data Does Not Tell You
These scores apply to one specific state plan for each company, not the entire company nationwide. A company can operate dozens of separately rated plans across different states, and CMS rates each one independently. UnitedHealthcare’s plans in other states are not automatically low-rated because its Louisiana plan scored poorly this year, and the same applies to Molina and Cigna’s other state operations. Quality ratings are one input worth checking alongside how often an insurer denies claims before you enroll.
This dataset also only covers plans sold on HealthCare.gov and the federal platform. It does not include employer-sponsored coverage, Medicare Advantage, or state-based exchanges that do not rely on the federal platform for plan management.
How to Check Your Own State’s Plan Rating
- Visit HealthCare.gov and enter your ZIP code to see available plans in your area.
- Look for the star rating displayed next to each plan during the shopping process.
- If you want the underlying detail behind a rating, the CMS Quality Rating System page explains the methodology and links to the full public dataset.
- Compare the specific plan and state combination you are shopping for, not just the company name, since ratings vary by state.
A low star rating is one input worth weighing alongside your own priorities. Reviewing common health insurance mistakes can help you avoid picking a plan on price alone without checking quality signals like these. If cost is your main concern this year, our breakdown of why premiums are rising in 2026 covers the other side of that decision.
Frequently Asked Questions
What is the lowest rated health insurance plan on HealthCare.gov in 2026?
UnitedHealthcare Insurance Company’s Louisiana marketplace plan holds the lowest overall star rating in the country for 2026, scoring 59.7 out of 100 and earning 1 star. This is the single lowest score among all 298 rated plans nationwide in the CMS Quality Rating System.
Does a low star rating mean a company provides bad coverage everywhere?
No. Star ratings apply to a specific plan in a specific state, not the company as a whole nationwide. A company with a low-rated plan in one state can have highly rated plans elsewhere, since CMS scores each state plan independently based on that plan’s own clinical and service data.
What causes a health plan to receive a low star rating?
Low ratings typically stem from poor performance on Medical Care measures, which carry the heaviest weight in the overall score. These include cancer screening rates, chronic disease management, and behavioral health follow-up care. A plan can still score well on Plan Administration or Member Experience while posting a low overall rating driven by Medical Care.
How many health plans get the lowest possible star rating?
Very few. Out of 298 rated marketplace plans nationwide in 2026, only 2 received the lowest possible 1-star rating. The vast majority of plans, 114, received 3 stars, while 21 plans achieved the top 5-star rating.
Where can I find my own health plan’s star rating?
Star ratings are displayed directly on HealthCare.gov when you shop for a plan during open enrollment. The underlying dataset behind these ratings is also published publicly by CMS through the Marketplace Quality Initiatives program for anyone who wants to review the full detail.
The Bottom Line
UnitedHealthcare’s Louisiana plan, Molina Healthcare of Mississippi, and Cigna’s Mississippi plan posted the lowest overall HealthCare.gov star ratings among major national insurers in 2026, each dragged down specifically by Medical Care scores rather than administrative failures. These ratings apply to one state plan per company, not a verdict on the company everywhere it operates. Check the specific plan and state you are shopping for before assuming a rating applies broadly.
This guide provides general insurance education only and reflects one year of CMS Quality Rating System data. Ratings are recalculated annually and can change from year to year. Verify current ratings directly on HealthCare.gov before enrolling, and consult a licensed insurance professional for guidance on your specific situation.
Content reviewed: August 2026. Data reflects the CMS Nationwide Quality Rating System Public Use File for Plan Year 2026, published October 2025, analyzed directly by our research team.
