Why more health plans are good for consumers
A new report from the U.S. Department of Health and Human Services was released last month announcing that there will be 25% more health plans participating in the federal and state based insurance marketplaces. That's 77 more health insurance options for consumers across different markets. There were over 250 health plans last year, with some markets like New York and California almost saturated with health plans, while some markets like Alabama and New Hampshire had little competition within the state.
Before the Affordable Care Act was enacted, health insurance premiums increased each year by an average of 10 percent or more, while a recent analysis by the Kaiser Family Foundation finds that 2015 premiums will decrease by an average of 0.8 percent across 16 populous cities. This is competition at work.
When consumers visit the health insurance Exchanges, they will see some big name insurance companies, familiar hospital/provider systems and new insurance companies all offering coverage options. How does one sort out who's who?
Sally Poblete, entrepreneur and the founder and CEO of Wellthie, a healthcare technology company offering the only comprehensive software and analytics platform of its kind to help people understand their health insurance options in a simple way, offers advice as to why health care plan competition is good for consumers and what people need to watch out for this open enrollment season:
New players – Provider-owned organizations account for a number of new entrants to the health insurance market. These health care providers turned accountable care organizations offer a unique value proposition for consumers. As provider-owned health plans, a consumer will have access to the main hospital(s) in the system and the doctors who are affiliated with these hospitals. They promise closer coordination, shared patient records and a trusted brand the consumers know within the community. On the other hand, because they are new insurance companies, consumers need to be aware that they may be starting or scaling up their insurance and administrative infrastructure. Enrollment, billing and claims systems and customer service systems may take some time to work out the kinks.
Existing health plans – Some health plans decided not to enter the market last year. But after witnessing the robust enrollment, these companies are selling insurance through the Exchange.
CO-Ops or Consumer-Oriented and Operated Plans- Were created through startup loans made available by the Affordable Care Act to give consumers more non-profit options in the health insurance market. CO-OPs are member-governed and have a non-profit mission, so they must use profits to either lower premiums or improve benefits. CO-OPs are also new entrants to the marketplace and consumers may find them to be an attractive coverage option. As with any health plan, be sure to check the formulary and provider network to ensure any regular medications and visits to your physicians are covered.
More competition among the players forces them to distinguish themselves through discounted pricing, or offering better products with a wider provider network or richer benefits.
The additional choices makes it harder for a consumer to choose the better plan for their needs. A consumer should not just look at prices on the Exchange and choose the cheapest one. A consumer needs to take the time to research various health plans' websites to have a deeper understanding of their offerings and options.
1. Carefully consider the insurance company's provider network – if you have an existing relationship with the doctor or a hospital, check that your doctor is in the network. Remember too that a product sold on the Exchange may have a different network. Thus it is important to search the health plan's provider directory for their Exchange products to confirm that your doctor is covered.
2. Increased competition also means that consumers will have a wide variety of access to products – like HMOs, PPOs, etc. Thus, it is helpful to understand how these products functionally and financially differ. Preferred Provider Organizations (PPO) have the broadest set of doctors to choose from, but will likely be more expensive than a product with a Health Maintenance Organization (HMO) network or Exclusive Provider Organization (EPO) network, which does not typically cover non-emergency out-of-network services.
3. Do the plans or providers offer any other value-added services like wellness programs and financial rewards for healthy behaviors? Some health plans even offer access to doctors online or reimburse for gym memberships.
4. Is the plan or provider's website easy to understand and can you quickly get assistance if needed?
5. Research the quality of the health plan from independent organizations such as NCQA., a national group that issues yearly reports on health plan quality and consumer satisfaction measures.
As the second open enrollment for Exchanges begins, consumers with coverage have the opportunity to update their information through their state's Exchange to ensure they receive the appropriate benefits and coverage options. Those consumers that are currently uninsured can take advantage of this time to learn about their eligibility for tax credits or public programs available to make insurance coverage more affordable for their families. With more health insurance companies offering coverage in nearly every state, consumers should take advantage of the competition to explore their coverage options and find the best plan for their needs and budget. Don't delay – open enrollment begins on November 15 and will end on February 15!
Sally has been a leader and innovator in the health care industry for 18 years. She founded Wellthie in 2013 out of a deep passion for making health insurance more simple and approachable for consumers. She had a successful career leading product development at WellPoint, one of the nation's largest health insurance companies. An entrepreneur at heart, she also ran a long-term health care business and worked at several health care start-ups like HealthMarket and Medscape. Sally received her B.S. in Management, magna cum laude from New York University and received her MBA from the Wharton School at the University of Pennsylvania, specializing in Health Care Management.
Wellthie offers the only software platform that helps people understand their health insurance options, confidently choose the right plan from their insurer and make the most of their benefits. Installed on a health care organization's site and matched to their brand, our easy-to-use software offers a welcoming front door that's designed to educate, enroll and retain consumers looking for health insurance. For more information, visit, http://www.wellthie.com.
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