Critics of health-care insurance overhaul legislation, currently being debated in the U.S. Senate, have charged that any change to the existing system will result in greater numbers of unhappy patients. A new survey of satisfaction among consumers with health coverage, however, shows promise that it is possible to cover everyone and still have satisfied patients.

Latest rankings by U.S. News show that four of the top ten commercial health plans offered were available in Massachusetts, the only state that currently mandates that all of its residents buy health insurance. The state has done so since 2008. Topping the rankings of the magazine's Best Health Insurance Plans 2009-10 survey was Harvard Pilgrim Health Care, which earned a high score of 91.1 out of 100. The plan is also offered in Maine.

In second place was Harvard Pilgrim Health Care of New England, which is offered solely in New Hampshire. Others top plans available in the Bay State: Tufts Associated Health Maintenance Organization (also offered in New Hampshire and Rhode Island); Fallon Community Health Plan; Health New England (also available in Connecticut). The plans placed third, seventh and eighth, with scores of 89.9, 88 and 87.9, respectively.

The rankings are based on data collected and analyzed by the National Committee for Quality Assurance (NCQA), which accredits and sets standards for the managed-care industry. Overall scores reflect member satisfaction, achievement in preventing and treating illness relative to other plans and NCQA accreditation.

All of the top commercial plans, with three exceptions, were offered as both HMO or point-of-service plans. POS plans are similar to HMOs but generally come with fewer restrictions and may mandate higher out-of-pocket costs.

Also in the top 10 commercial plans were Grand Valley Health Plan, an HMO offered in Michigan, in fourth place; Capital Health Plan, a Florida HMO at no. 5; Geisinger Health Plan, a Pennsylvania plan that offers HMO and POS plans, in sixth place; Cigna Health Care of New Hampshire, HMO/POS at no. 9; and Group Health Cooperative of South Central Wisconsin, an HMO, at no. 10.

The survey also looked at Medicare and Medicaid plans, which are sold to older and poor Americans. The top 2 Medicare plans were Kaiser Foundation Health Plan of Colorado, followed by Fallon Community Health Plan, offered in Massachusetts. The plans, both HMOs, achieved scores of 89 and 88.8, respectively. Rounding out the top five Medicare HMO plans were: Geisinger Health Plan, Pennsylvania (88.1); Tufts Associated HMO, Massachusetts (88); and Capital Health Plan, Florida (87.6).

Among the best Medicaid plans, Kaiser Foundation Health Plan of Hawaii ranked highest with an 89.4 score, followed by three Massachusetts plans: Boston Medical Center HealthNet Plan (89.3); Fallon Community Health Plan (89.3); and Neighborhood Health Plan (88.2). In fifth place was Blue Cross and Blue Shield of Rhode Island (87.7), the only POS plan among the top five Medicaid plans.