Health Plans Get Only So-So Reviews

With health-care reform center stage in Washington, one question in the debate is whether people's current health insurance coverage will suffer. But guess what? Consumers aren't that enthralled with their current insurance to begin with.

In a recent Consumer Reports survey, only 64 percent of readers said they were very or completely satisfied with their plan. That's a lukewarm response and a slight drop from the 67 percent who responded the same way in CR's 2007 report. In the context of all the services that CR rates, that puts consumer satisfaction with health insurance below pharmacies and real estate agents.

These findings from the Consumer Reports National Research Center were based on responses from 37,481 subscribers who reported on their experiences over the course of a year. The numbers do not represent the experience of the population as a whole, but they do provide a good benchmark for two kinds of managed-care plans: health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Of the survey respondents, 84 percent have an employer-based plan that they could keep under most proposals now before Congress.

Reform or not, the survey suggests that some people might welcome a change. Eighteen percent of respondents complained that they had trouble getting an appointment to see a plan doctor at some point during the year. And among users of some lower-rated plans, as many as 16 percent said it was either difficult or impossible to get needed care.

The real news this year is that choosing an HMO over a PPO seems like a smarter choice than in the past. Previously, HMO members who were seriously ill had difficulty accessing care. But according to this latest survey, there was little difference. Another advantage is that HMOs are usually cheaper. Those in HMOs paid less for premiums than people in PPOs ($1,466 compared with $2,003) and less out-of-pocket for medical bills.

Rating the Plans

HMO: Seattle's Group Health Cooperative and Health Alliance Plan, serving southeast Michigan, were among the highest-rated HMOs in this survey and also rated in the top 10 in CR's 2006 survey. Members of these plans reported fewer problems than people in other plans in obtaining the care they needed. And Health Alliance Plan members were a bit more satisfied than people in other plans with their choice of doctors and the care received.

Also among the top-rated HMOs were several Kaiser Permanente plans around the country; Preferred Care, based in Rochester, N.Y.; Harvard Pilgrim Health Care, based outside of Boston; and Independent Health of Buffalo.

At the bottom of the HMO list were Oxford Health Plans in Connecticut, New Jersey and New York, and the Aetna Health HMO of Florida. (Oxford also operates in Delaware, Pennsylvania and Rhode Island, but there were not enough responses to include in these ratings.) Members of these plans gave them lower ratings because they had fewer options in choosing providers. Oxford members also reported more problems getting the care they needed, and Aetna Florida members reported more problems getting access to doctors.

PPO: Anthem Blue Cross and Blue Shield of Connecticut was among the top-rated PPOs, as was the case in past surveys as well. Members remain very pleased with their providers and care. Other top-rated plans include Blue Cross and Blue Shield plans in Alabama, Illinois and Massachusetts, Excellus Blue Cross Blue Shield of New York and Independence Blue Cross of Pennsylvania.

On the other hand, members of New York's Group Health Inc., Great-West Healthcare of Colorado and Health Net's California plan, based in Woodland Hills, rated their choice of doctors worse than did people in other PPOs.

Copyright 2009. Consumers Union of United States Inc.

For further guidance, go to ConsumerReportsHealth.org. More-detailed information -- including CR's ratings of prescription drugs, conditions, treatments, doctors, hospitals and healthy-living products -- is available to subscribers to that site.