URAC vs. NCQA for Medicare Advantage Accreditation — A Direct Comparison
Last updated: April 2026
Medicare Advantage plans evaluating accreditation pathways frequently encounter two names: URAC and NCQA. Both are CMS-recognized accrediting bodies with Medicare Advantage deeming authority — but their scope, eligible plan types, and compliance value are substantially different. This comparison is written for compliance officers, plan executives, and operational leaders choosing the right pathway for their organization.
IHS has over 25 years of expertise with both organizations. Our practice is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC.
URAC Medicare Advantage Organization Accreditation — Defined
URAC Medicare Advantage Organization Accreditation is a standalone CMS-approved program that grants deeming status to Medicare Advantage HMOs and local preferred provider organizations. CMS renewed URAC's deeming authority in 2025 through July 2031.
URAC's deeming authority covers five Part C regulatory domains:
- Quality Improvement
- Anti-Discrimination
- Confidentiality and Accuracy of Enrollee Records
- Information on Advance Directives
- Provider Participation Rules
Accreditation is awarded for a three-year term. A Special Needs Populations pathway is available for D-SNP, I-SNP, and C-SNP plans. No other URAC accreditation is required as a prerequisite.
NCQA Medicare Advantage Deeming — Defined
NCQA's Medicare Advantage deeming authority applies specifically and exclusively to Special Needs Plan (SNP) Model of Care (MOC) requirements. It does not cover the five Part C regulatory domains that URAC's program addresses.
Under NCQA's SNP MOC deeming, CMS accepts NCQA's determination that a plan's Model of Care satisfies the required MOC elements for D-SNPs, I-SNPs, and C-SNPs. If CMS audits the plan, it can bypass auditing the MOC requirements because NCQA has already validated them.
NCQA also offers a broader Health Plan Accreditation (HPA) program — widely required by commercial insurers, Medicaid managed care contracts, and employer groups — but that program has separate, non-MA-deeming purposes and should not be conflated with NCQA's Medicare Advantage deeming pathway.
Side-by-Side Comparison
| Dimension | URAC Medicare Advantage Organization Accreditation | NCQA Medicare Advantage Deeming (SNP MOC) |
|---|---|---|
| CMS deeming authority | Yes — renewed through July 2031 | Yes — for SNP Model of Care only |
| Eligible plan types | MA HMOs, local PPOs, MA-PD plans under those structures; SNP pathway also available | Special Needs Plans only (D-SNP, I-SNP, C-SNP) |
| Deemable domains | Quality Improvement, Anti-Discrimination, Confidentiality of Enrollee Records, Advance Directives, Provider Participation Rules | Special Needs Plan Model of Care requirements only |
| Covers non-SNP plans | Yes — primary pathway for non-SNP MA HMOs and PPOs | No |
| Covers SNP plans | Yes — via Special Needs Populations pathway | Yes — MOC deeming only |
| Prerequisite programs required | None — standalone program | None — but plan must operate a qualifying SNP contract |
| Accreditation term | Three years | Annual MOC review cycle tied to CMS SNP contract |
| Process modality | Email, calls, web conferencing — no required on-site visit | Structured application and review process |
| Performance measure compatibility | Compatible with CAHPS, HEDIS, HOS, Star Ratings | Aligned with SNP MOC care coordination and outcome requirements |
| Commercial/Medicaid contract requirements | Not typically required for commercial/Medicaid contracts | NCQA Health Plan Accreditation (separate program) widely required for commercial and Medicaid contracts |
| IHS capability | Full end-to-end consulting — gap analysis through RFI response | Full end-to-end consulting — MOC design through NCQA submission |
When URAC Is the Right Choice
URAC Medicare Advantage Organization Accreditation is the appropriate pathway when:
- Your organization operates a non-SNP MA HMO or local PPO and wants CMS-recognized deeming for the five Part C domains
- You are a new MA market entrant seeking to demonstrate regulatory maturity and reduce initial CMS audit exposure
- Your organization wants to differentiate in the MA market — accreditation signals quality to brokers, employer groups, and state regulators
- You already hold other URAC accreditations (Health Plan, Utilization Management, Case Management) and want to leverage existing compliance infrastructure
- Your compliance team needs a structured framework to build or improve Quality Improvement program infrastructure that also supports Star Ratings performance
- Your organization operates MA-PD plans with prescription drug coverage under an HMO or local PPO structure
When NCQA Is the Right Choice (or Required)
NCQA Medicare Advantage deeming (SNP MOC) is the appropriate pathway when:
- Your organization operates a Special Needs Plan (D-SNP, I-SNP, or C-SNP) and wants CMS-accepted validation of your Model of Care
- CMS or your state Medicaid agency has specifically required NCQA MOC review as a condition of your SNP contract
- Your organization also holds or is pursuing NCQA Health Plan Accreditation for commercial or Medicaid contracts, and wants to consolidate accreditation relationships
Note: NCQA Health Plan Accreditation (separate from NCQA's MA deeming program) is widely required by commercial insurers and state Medicaid managed care contracts. If your organization has commercial or Medicaid lines of business, NCQA HPA requirements are driven by those contracts — not by Medicare Advantage.
When Both Are Needed
Organizations that operate both SNP and non-SNP Medicare Advantage product lines may need both URAC and NCQA accreditation. The programs address different compliance obligations and are not substitutes for each other:
- URAC — satisfies Part C deeming for the five deemable domains across HMO and PPO plan types, including any SNP lines
- NCQA SNP MOC — satisfies the specific Model of Care deeming requirement for SNP contracts
IHS advises on sequencing and can manage both accreditation tracks concurrently for organizations with complex plan portfolios.
The IHS Perspective: Choosing Based on Compliance Obligation, Not Prestige
Both URAC and NCQA are rigorous, CMS-recognized accrediting bodies. The choice between them — or the decision to pursue both — should be driven entirely by your organization's plan types, CMS contract requirements, and state regulatory obligations, not by general brand recognition.
NCQA has historically had higher brand recognition in commercial health plan markets. URAC has operated longer in specialized managed care domains including utilization management, pharmacy, and Medicare Advantage deeming. Neither is universally superior — the right accreditation is the one that satisfies your actual compliance and market obligations.
IHS has worked extensively with both accrediting bodies across our 25-year history. Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC, leads our practice with insider knowledge of how URAC standards are designed and applied. Our NCQA practice covers Health Plan Accreditation, HEDIS, and SNP MOC engagements. We can provide honest guidance on which pathway — or which combination — serves your organization's specific situation.
Not Sure Which Pathway Is Right for Your Organization?
IHS can assess your plan portfolio, contract requirements, and existing compliance infrastructure to give you a direct recommendation — not an options menu. Contact us for a conversation with Thomas G. Goddard, JD, PhD.
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