The news magazine ranked health insurance plans for its second annual Best Health Plans list. Nevada HMO plans rank low. Painfully low.

There's Health Plan of Nevada, the HMO run by Sierra Health Services, at No. 209. PacifiCare of Nevada is at No. 207.

The plans are ranked among 246 nationally. But all plans ranked below those two had a 15-point penalty because they were not accredited by the organization behind the study, the National Committee for Quality Assurance.

Could it really be that Nevada HMOs are the worst in the country?

Industry officials, not surprisingly, say "no." But they also say there are clear reasons why Nevada plans reside at the bottom of the list.

"Boy, I sure wish all of our plans could be rated in the Top 50," said Ted Decorte, president of the Clark County Association of Health Underwriters. "I don't foresee that happening, just because the basics are not there in our community. The infrastructure is not there to provide everyone the access in a timely manner."

Look to any health industry report to prove his point. Nevada ranks among the lowest in availability of family doctors, surgeons and nurses. As the fastest-growing city in the nation, Las Vegas' medical community struggles to keep up.

Massachusetts is not struggling. It boasts 11 health plans that are highly ranked, including the top two best plans.

"It is interesting to note that the majority of the plans that have high rankings in the publication's list have been in business for a much longer period of time than Health Plan of Nevada," said Jenny Des Vaux Oakes, spokeswoman for Sierra Health. "Additionally, they are situated in older, more established areas in the eastern United States. In comparison, they enjoy more stable demographics."

Issues in Nevada include more transients and non-English speakers, along with higher rates of smoking and obesity, she said.

The questions asked by the survey reflect those thoughts. The plans are ranked on a scale of "5" (its highest score) for access to care, overall member satisfaction, prevention and treatment.

As seen online at www.usnews.com, Health Plan of Nevada scored the lowest (a "1") on all four main categories. Its highest rankings in the subcategories were "3s" on prevention concerning women's reproductive health and treatment of diabetes.

PacifiCare scored lowest on all main categories except treatment, for which it scored a "2." The regional PacifiCare recently merged with UnitedHealthcare, a national insurer that was not included among Nevada plans in the magazine's report.

Other Nevada HMO plans not included in the report are those from NevadaCare, Aetna and Anthem Blue Cross Blue Shield.

Anthem, which just won half of Nevada's Medicaid contract, did not participate in the report because it is not accredited by NCQA, spokeswoman Sally Vogler said. The company is accredited by an organization called URAC, formerly the Utilization Review Accreditation Commission.

Although the U.S. News & World Report list is incomplete, it is significant.

As health care costs rocket, individuals are being urged to look carefully at the cost and quality of medical care they purchase.

This is just the second year that the magazine has published the report conducted by NCQA. NCQA had conducted a similar study in the 1990s, but it had stopped, said committee spokesman John Friedman.

The current study also ranked Medicare and Medicaid plans, but not PPO plans.

The reports show that national competition among health plans leads to better care, Friedman said.

"It empowers consumers to make choices on quality rather than cost," he said.

National companies have had their eye on Nevada. UnitedHealthcare bought PacifiCare and is expanding in Nevada.

Anthem, which is known nationally as Wellpoint following a 2004 merger, is also looking to grow its market share. Anthem's corporate office in Colorado recently appointed a president for Nevada.

"We're the No. 1 health care player in the country, and we intent to be that in Nevada," said Mike Murphy, who took the role as president in November.

Another example of increased competition was in the recent bidding for Medicaid proposals. It was the first time that Nevada-based companies faced competition, and not only from Anthem. Three national companies that only handle government-sponsored programs bid, including Virginia-based Amerigroup Corp., California-based Molina Healthcare and Missouri-based Centene Corp.

"It's a competitive market, but probably not as competitive as other markets across the country," Murphy said. "I've had the opportunity to talk to brokers, talk with some hospital administrators and doctors, and the general opinion is folks are looking for more partners in the market to drive some change."

And even though the study by U.S. News & World Report is imperfect, and does not include his company, Murphy said it is helpful for consumers.

"People are thirsting for information," he said. "I don't think there's one single source with an absolute golden seal of approval for validation anywhere."