© 2010, Consumers Union of United States Inc.
The healthcare overhaul law will trigger a seismic shift in health insurance.
Early rumblings can be heard 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.
Those initial changes donít address consumer satisfaction with their coverage or plans' success at treatment and disease prevention.
To help fill this data 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 reports its findings publicly.
The top three plans, each of which scored about 90 on a 100-point scale, operate in New England.
The best performer in the Washington area was Cigna HealthCare Mid-Atlantic, with 86 points, ranked 39th among the 227 plans evaluated.
Trends this year include:
How to pick a good plan
- 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.
These big firms have more resources than smaller insurers do for quality improvements, often ones that target specific NCQA measures.
Still, plans owned by big insurers appear at the bottom of the rankings.
- Smaller plans compete.
Most of the 25 top-ranked individual HMOs are fairly large, but some, such as ConnectiCare in Massachusetts and Connecticut and Grand Valley Health Plan in Michigan, have fewer than 40,000 enrollees.
- You can't rely on brand alone.
Plans with the same brand name can vary in quality and be owned by different companies.
Some of the 39 Blue Cross/Blue Shield plans are among the top-ranked; a few are at the bottom of the list or not ranked at all.
- Quality doesn't ensure satisfaction.
The fact that a plan scores highly overall or produces greater 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 total measure of consumer satisfaction but much higher scores on preventive care and disease treatment.
- In 2014, the major provisions of the new healthcare law kick in; insurers will be required to offer comprehensive plans and accept all customers regardless of 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, insurers can operate by many old rules.
You'll want to avoid plans thin on coverage, exclude certain services, or refuse to report publicly on consumer satisfaction and healthcare outcomes.
Here are ways to evaluate a health insurance plan:
- Insurance should cover hospitalization, doctor visits, emergency services, diagnostic tests, and prescription drugs.
Verify there are no major exclusions listed.
- Ask your employer.
Your human resources department may be able to help you choose an appropriate plan.
- Consult www.HealthCare.gov, 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.
- Run the numbers.
With the employee share of group insurance still rising, 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.
- Check detailed rankings.
At www.consumerreportshealth.org, subscribers can compare up to five plans and get more detailed data about plans.