Health Insurance Marketplace Quality Initiatives

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The Health Insurance Exchanges - also known as Health Insurance Marketplaces - help millions of Americans and small employers shop for, compare, and enroll in high-quality, affordable private health insurance plans each year.

The Marketplace Quality Initiatives (MQIs) are four programs established by the Affordable Care Act (ACA). These programs are required for Qualified Health Plans (QHPs) offered in all Marketplaces and are designed to promote quality, transparency, and patient safety. The MQIs include: 

  • The Marketplace Quality Rating System (QRS)
  • QHP Enrollee Experience Survey (QHP Enrollee Survey)
  • Quality Improvement Strategy (QIS)
  • Patient Safety standards

Scroll down to Program Overview for detailed descriptions of each initiative.

Spotlight News

QRS and QHP Survey

  • Draft 2026 Call Letter for the QRS and QHP Enrollee Survey (February 2026) (PDF): CMS requests comments on proposed refinements to the QRS and QHP Enrollee Survey included in the Draft 2026 Call Letter for the Quality Rating System and the Qualified Health Plan Enrollee Experience Survey. CMS encourages interested parties to submit comments to Marketplace_Quality@cms.hhs.gov and reference “Marketplace Quality Initiatives (MQI)-Draft 2026 Call Letter” in the subject line by the close of the comment period (March 20, 2026).
  • Plan Year 2026 Public Use Files (PUFs) (October 2025): CMS posted the Enrollee Survey PUF for Plan Year 2026, Plan Year 2026 Nationwide QRS PUF, and Plan Year 2026 Quality PUF to the CMS MQI Downloads page. The Nationwide QRS PUF outlines underlying measure data as well as star ratings for all eligible QHP issuers, operating in all Exchange types, that received QRS star ratings. The Quality PUF includes star ratings assigned to plans that will be available on HealthCare.gov. Additionally, CMS released the Health Insurance Exchanges QRS Program for Plan Year 2026: Results-at-a-Glance (PDF) document, which summarizes the nationwide QRS results for the 2026 Plan Year, including a summary of QRS reporting and QRS eligibility for the 2026 Plan Year.
  • QRS and QHP Enrollee Experience Survey Technical Guidance for 2026 (September 2025) (PDF): CMS posted the QRS and QHP Enrollee Survey: Technical Guidance for 2026. The Technical Guidance provides QHP issuers certified to offer coverage through the Exchanges in 2026 with the QRS and QHP Enrollee Survey guidance required as a condition of certification.
  • 2026 Quality Rating System Measure Technical Specifications (September 2025) (PDF): CMS has posted an updated version of the 2026 Quality Rating System Measure Technical Specifications, which includes guidance on the finalized data submission requirements for the 2026 QRS measure set. Specifically, CMS added callout boxes summarizing the final decision regarding measures and/or measure rates proposed for addition and those proposed for removal in the Draft 2025 Call Letter and finalized in the Final 2025 Call Letter.
     

Program Overview

Quality Rating System - QRS

The Quality Rating System (QRS) is a 5-star rating system used to rate QHPs based on clinical quality, member experience, and plan administration. The goals of the QRS are to provide comparable and useful information to consumers, facilitate oversight of QHPs, and provide actionable information to QHPs to improve quality and performance.

QHP Enrollee Survey

The QHP Enrollee Survey assesses consumer experience with QHPs offered through the Exchanges. The goals of the QHP Enrollee Survey are to provide comparable and useful information to consumers about the quality of health care services and enrollee experience with QHPs offered through the Exchanges. A subset of the survey results feed into the QRS star ratings.

Quality Improvement Strategy - QIS

The Quality Improvement Strategy (QIS) program requires QHPs to implement payment structures providing increased reimbursement or other incentives to improve health outcomes, reduce hospital readmissions, improve patient safety and reduce medical errors, reduce health and health care disparities, and implement wellness and health promotion activities.

Patient Safety

Patient Safety standards require QHPs to contract with certain hospitals that use patient safety evaluation systems (PSES) and implement comprehensive hospital discharge programs. QHPs are also required to contract with health care providers who implement health care quality improvement mechanisms.

Upcoming Deadlines and Events for Issuers

  • QRS/QHP Enrollee Survey Deadlines:
    • May 15, 2026: HHS-approved QHP Enrollee Survey vendor securely submits the QHP Enrollee Survey response data to CMS (on behalf of the QHP issuer).
    • June 15, 2026: QHP issuer submits the validated QRS clinical measure data, with attestation, to CMS via NCQA’s Interactive Data Submission System (IDSS).

Marketplace Service Help Desk (MSD)

QHP issuers and Exchanges with questions regarding the QRS, QIS, patient safety requirements, or the QHP Enrollee Survey should contact the MSD
CMS_FEPS@cms.hhs.gov or 1-855-CMS-1515 (1-855-267-1515) and reference “Marketplace Quality Initiatives” or “MQI”.

Resources

 

Page Last Modified:
02/12/2026 12:06 PM
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