Making Best Health Plan Choices Is Now Easier--Still Time to Enroll

WASHINGTON, Jan. 8, 2016 /PRNewswire-USNewswire/ -- The Affordable Care Act states that the new Health Insurance Marketplaces (Exchanges) will "assist consumers in making easy health insurance choices." That goal has not generally been achieved in the past. It has now been achieved in four states and the District of Columbia, which have in place plan-comparison tools developed for them by Consumers' Checkbook, a nonprofit organization with 40 years of experience helping consumers choose health plans, doctors, hospitals, and other providers.

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These tools, each with some different features, are available in Illinois, Missouri, Minnesota, Vermont, and DC. Links to the tools are available through state exchanges or through www.HealthPlanRatings.org.

There is still time for consumers to enroll in plans in state and federally facilitated marketplace exchanges during the open enrollment period that ends January 31, 2016. But consumers need help. Studies show that consumers "dread" shopping for insurance. Many don't understand the difference between coinsurance and copayments, don't know how much providers charge for various services, and can't figure out which plans offer a good choice of doctors. No wonder they make mistakes.

For example, one St. Louis family of four using the federal government's HealthCare.gov exchange to choose a plan might choose the plan that has the lowest available premium, $1,020 per year, but the Checkbook tool, also found on the CoverMissouri.org website, shows that this family could save $2,800 per year if they chose a different plan with a substantially higher $2,172 per year premium because out-of-pocket costs will be much lower with the higher-premium plan.

Checkbook's plan comparison tool at CoverMissouri.org shows the consumer immediately for each plan the key information the consumer needs to make a good plan choice:

    --  A single dollar-amount actuarial estimate of average total cost in the
        plan (premium, after any available government subsidy, plus
        out-of-pocket) for someone with the same family size, ages, health
        status, and other characteristics as the user;
    --  Risk in the plan--the cost if the user's health care usage in a year
        turns out to be very high and the chances of having such a year;
    --  An overall measure of the quality of care and service in the plan; and
    --  If the consumer types in names of desired doctors, which of those
        doctors are in each plan.
    --  The size of the network of available doctors available in the plan
        compared to all other available plans.

(Checkbook's tool has the critical cost information in all the states where it is provided, but does not have the full doctor-availability information in Minnesota and Vermont.)

These pieces of information address what consumers care most about. Yet none of these key facts has in the past been shown to shoppers on the federal Marketplace website at HealthCare.gov (though the Federal website is much improved this year) or in most state-sponsored marketplaces.

Consumers who now have access to Checkbook's plan comparison tool can quickly see and sort the essential information on all available plans and make an excellent plan choice within five minutes--although they can drill down for much more extensive information if they wish.

In past years, most marketplace websites have just shown the consumer a long list of coverage details--deductibles, copayment amounts and/or coinsurance percentages for various types of services and products, and other policy terms.

But "a consumer just can't figure out: is a plan with the $200 deductible and a $10,000 out-of-pocket limit better for me than a plan with a $2,000 deductible and $4,000 out-of-pocket limit--and how about differences in copays, coinsurance, etc.," said Robert Krughoff, president of the nonprofit Consumers' Checkbook organization. "Even health insurance experts can't figure out which is best without a helpful tool. People don't know how much various health services cost or their likelihood of needing different services."

Consumers also want to be able to see doctors they like or may need. But in the past, most marketplace websites have not made it easy to know whether such doctors will be available in each plan. And narrow networks have proliferated, catching many consumers by surprise after enrollment. When shopping for plans, consumers have had to follow a link to the website of each insurance company, find the right provider directory, and look up each desired doctor. This has been quite time-consuming, and often it is not clear which of an insurance company's provider directories goes with the plan the consumer is trying to check out.

When using Checkbook's tool in Illinois, Missouri, and DC, as soon as a consumer types in the names of any desired doctors, the display shows which plans include those doctors. A new feature of the tool going live in some of the states will also let consumers see how deep each plan's network of doctors is compared to other plans--an indicator of whether they will be able to find good doctors they don't yet know they will want.

Also, many consumers want at least some reassurance about the quality of a plan--whether members get the care they need, whether claims are paid fairly, how much customer service hassle there is, etc. Neither the federal Marketplace website nor most state Marketplaces have any substantial information on that front. It is expected that this kind of information will become more and more available in the future. Checkbook's plan comparison tool in Illinois and Missouri already includes such quality measures and lets the consumer decide how much weight to give to each aspect of quality to come up with a personalized overall quality score for each plan.

About CHECKBOOK: Consumers' Checkbook/Center for the Study of Services (see www.Checkbook.org) is a nonprofit organization whose mission is to inform and educate consumers about the quality and cost of service providers and how to select and deal with such providers. Checkbook publishes magazines and books and has websites to make its ratings and reports on service providers widely available to consumers. For example, at Checkbook.org, consumers will find ratings of individual surgeons and of hospitals throughout the U.S. based on how their patients fare in terms of death rates and complication rates. For 36 years, Checkbook has produced its Guide to Health Plans for Federal Employees and Retirees, subscribed to by individual consumers and by many federal agencies (HSS, Dept. of Labor, Federal Reserve, Social Security Administration, and many others) to help their employees make good plan choices. Among other honors, Checkbook in 2015 received the National Quality Forum's first-ever Consumers and Patients Quality Award.

Contact: Jamie Lettis
202-454-3006
[e-mail]

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SOURCE Consumers' CHECKBOOK