Selecting the health plan best for you is not going to be that easy

2013

Should I take a high deductible health plan? What if I have higher than expected health care expenses next year? What is the difference between a PPO, an HMO and a HDHP? Can I go to any doctor I like? Exactly what health care services does my plan cover? How do I know that my premiums will not go up next year? Does my doctor participate in the plan I may choose?

These and many other questions face individuals trying to decide the best health plan each year. This decision making will become more complex when there are multiple options within health insurance exchanges, both public under the Affordable Care Act and private exchanges. Each of the insurers in the exchanges will be offering an array of plan options so individuals may face a dozen or more alternative choices.

Having managed health benefits for nearly five decades, I know first hand how confusing choice can be. I also know that many people rather not have that choice for fear of making the wrong one to the detriment of their families. Generally, making the wrong choice means wasting money. People tend to overestimate their future health care costs and often over insure. In some cases, unexpected out of pocket costs can cause a financial burden.

To see how confusing the choice can be look at the health plan finder now on healthcare.gov This webpage was available long before Obamacare, but it provides a good indication of the type of information that will be provided and how complex the decision process may be.

Consumers will need help which may come from employers, the government, the exchanges and the insurance companies. Most important, consumers will need to kick it up when it comes to devoting the time and effort necessary to make an informed choice.

Health Affairs, January 2013

The Experience Of Massachusetts Shows That Consumers Will Need Help In Navigating Insurance Exchanges
Anna D. Sinaiko1,*, Dennis Ross-Degnan2, Stephen B. Soumerai3, Tracy Lieu4 and Alison Galbraith5

In 2022 twenty-five million people are expected to purchase health insurance through exchanges to be established under the Affordable Care Act. Understanding how people seek information and make decisions about the insurance plans that are available to them may improve their ability to select a plan and their satisfaction with it. We conducted a survey in 2010 of enrollees in one plan offered through Massachusetts’s unsubsidized health insurance exchange to analyze how a sample of consumers selected their plans. More than 40 percent found plan information difficult to understand. Approximately one-third of respondents had help selecting plans—most commonly from friends or family members. However, one-fifth of respondents wished they had had help narrowing plan choices; these enrollees were more likely to report negative experiences related to plan understanding, satisfaction with affordability and coverage, and unexpected costs. Some may have been eligible for subsidized plans. Exchanges may need to provide more resources and decision-support tools to improve consumers’ experiences in selecting a health plan.