Once again, if you need to have health insurance, Western New York is a pretty good place to be.

The region's three dominant insurance carriers are all in the top tier of an annual ranking of the best commercial, Medicare and Medicaid plans across the nation.

Independent Health Association, traditionally the leader among the three local plans in the annual National Committee for Quality Assurance rankings, found itself in second place in each area, behind either HealthNow New York or Univera Healthcare. And Rochester-based Excellus Health Plan, the parent of Univera and the largest health insurer in upstate New York, generally beat all three.

Independent Health said that it has been the only local plan to be included among the highest-ranked plans for all lines of business - among the Top 50 for commercial and Top 25 for Medicare and Medicaid - for four straight years.

"Independent Health's NCQA rankings are very impressive on a national level, especially considering the significant increase in the number of plans reporting in the last few years," John R. Rodgers, chief operating officer of Independent Health, said, noting that 78 more private or commercial plans were ranked this year versus last year because of the addition of preferred provider organizations.

"At the same time, we realize this year's rankings are not up to our expectations. We will continue to work to improve quality and customer service, while maintaining a laser focus on reducing the medical cost trend to help make care more affordable in our community."

All the local plans were among the top in the country out of 561 private commercial plans, 227 Medicaid plans and 465 Medicare plans.

"We pretty much share the same physician network, so you would expect there would be similarities in how care is managed from one health plan to another," said Cheryl A. Howe, executive vice president of operations at HealthNow. "Western New Yorkers should be pleased that they can count on good quality care.

The annual rankings by NCQA, an independent, private nonprofit, are widely watched in the industry as a benchmark of performance. Most insurers are now accredited by the Washington-based group.

NCQA ranked the plans based on clinical quality, customer satisfaction and the agency's evaluation of their health care processes that contribute to quality improvement.

Plans are ranked if they have agreed to publicly report their quality information. Of the 561 private commercial plans, 474 were actually ranked, because the others either provided incomplete data or no data. Of the 227 Medicaid plans, 115 were ranked, while 395 of the 465 Medicare plans were ranked.

Buffalo-based HealthNow, parent of BlueCross BlueShield of Western New York, came in 45th among commercial plans offered through employers and directly to individuals. On a 100-point scale, it scored 86.5, with the second-highest level out of five for consumer satisfaction and treatment, and the highest, a "5," for prevention. Last year, it was 49th, scoring 86.

Independent Health came in three spots below, at No.?48, with 86.4. That's down from 28th last year, with 87.2. It posted a "3" for consumer satisfaction, a "4" for treatment, and a "5" for prevention.

Univera was at No.?67, although its score was not much lower, at 85.2. It also posted a "3" for satisfaction and a "4" for both treatment and prevention.

Excellus was 37th, scoring 86.8. Albany-based Capital District Physicians Health Plan and Schenectady-based MVP Health Care were also both higher than the Buffalo plans, coming in at 25th and 44th, respectively.

Among Medicaid plans, HealthNow came in 16th, scoring 85.1 out of 100, with a "4" in all three measures. Independent Health was 21st, with a score of 83.9. It posted a "3" in satisfaction and a "4" in the other two. Univera Community Health did not report data.

But again, Excellus beat all three, ranking 11th with a score of 86.2. In Medicare, Univera took the top spot locally for its HMO, ranking 20th, at 86.1. Independent Health was 23rd, with 85.9 for its HMO. HealthNow, which offers both a PPO and an HMO, ranked 34th and 40th, respectively, at 85 and 84.8.