Consumer Reports Insights: How to pick an insurance plan
The health-care overhaul law will trigger a seismic shift in health insurance. Early rumblings can be heard this fall as many people with employer-based insurance enter the open-enrollment period, the time when they can easily change plans.
The law's first major changes went into effect Sept. 23. For example, insurers can no longer cancel your coverage just because you get sick, impose financial barriers to emergency care or put a lifetime dollar limit on your coverage.
But those initial changes do not address consumer satisfaction with their coverage or plans' success at treatment and disease prevention. To help fill this information gap, Consumer Reports published rankings produced by the nonprofit National Committee for Quality Assurance, the main U.S. group that sets standards for health insurance, accredits plans, measures the quality of care they achieve and publicly reports its findings.
The top three plans, each of which scored about 90 points on a 100-point scale, operate in New England. The best performer in the Washington area was Cigna HealthCare Mid-Atlantic, which earned 86 points, good enough for 39th place among the 227 plans evalulated.
Trends this year include the following:
l Large companies dominate. Many of the top performers are owned and/or operated by some of the nation's largest insurers: Aetna, Cigna, Humana, Kaiser Permanente, UnitedHealthcare and WellPoint. That's not surprising. These big companies have more resources than smaller insurers do for quality improvements, often ones that target specific NCQA measures. Even so, plans owned by big insurers also appear at the bottom of the rankings.
l Smaller plans compete. Most of the 25 top-ranked individual HMOs are fairly large, but some, such ConnectiCare in Massachusetts and Connecticut and Grand Valley Health Plan in Michigan, have fewer than 40,000 enrollees.
l You can't rely on brand alone. Plans with the same brand name can vary in quality and even be owned by different companies. For example, some of the nation's 39 Blue Cross Blue Shield plans are among the top-ranked. But a few are at the bottom of the list or not ranked at all.
l Quality doesn't ensure satisfaction. The fact that a plan scores highly overall or produces superior results in treating patients or preventing disease doesn't guarantee its members are satisfied with the way they experience the plan or its doctors. This year, 10 of the 100 top-ranked plans, including Kaiser's California, Colorado, Mid-Atlantic and Northwest plans, had low scores on a composite measure of consumer satisfaction but much higher scores on preventive care and disease treatment.
How to pick a good plan
In 2014, the major provisions of the new health-care law kick in. Insurers will be required to offer comprehensive plans and accept all customers regardless of any preexisting conditions. All Americans will be required to have health coverage (subsidized for lower-income households) except in cases of severe financial hardship.
Until then, though, insurers can operate by many of the old rules. You'll want to avoid plans that are thin on coverage, exclude certain services or refuse to publicly report on consumer satisfaction and health-care outcomes.
Here are ways to evaluate a health-insurance plan:
l Make sure everything's covered. Insurance should cover hospitalization, doctor visits, emergency services, diagnostic tests and prescription drugs. Verify that there are no major exclusions listed.
l Ask your employer. Your human resources department may be able to help you choose an appropriate plan.
l Consult HealthCare.gov, a site managed by the federal government. Some 5,500 products from about 1,000 insurers are listed by state. The site is scheduled to add cost information and plan-comparison tools as of October.
l Run the numbers. With the employee share of group insurance continuing to rise, your job is to select a health-insurance plan that balances cost, coverage and quality of care. One basic trade-off to consider is this: A higher deductible or out-of-pocket limit can lower your monthly premium.
l Check the detailed rankings. At www.consumerreportshealth.org, subscribers can compare up to five plans and get more detailed information about plans.
(c) Copyright 2010. Consumers Union of United States Inc.