John Martie, President of Anthem Blue Cross Blue Shield in Colorado, has written an article with pointers consumers can use when choosing a health insurance policy. His article focuses on group coverage, where employees have to choose among the options offered by their employers, and must do so during their plan’s open enrollment period (often this time of year, ahead of a policy renewal date in January). But I think his advice is just as pertinent for people searching for their own health insurance in the individual market. As an employee, you may only have one option for coverage from your employer, although many employers offer a handful of choices (usually an HMO, a PPO, and maybe an HSA, with varying out of pocket expenses and premiums). But when you’re looking for your own policy in the individual health insurance market, the choices can be overwhelming. You put your birthday and zipcode into an instant quote tool and within a few seconds you have hundreds of quotes on your screen. Now what? This is where a broker comes in handy, especially since you don’t pay any extra money to use a broker. We usually ask our Colorado clients to tell us in their own words what they’re looking for, and we use that as a starting point to narrow down the options. But if you go through the list of questions John has come up with, choosing a health insurance policy will seem much less like a shot in the dark. To John’s questions, I’ve added (in italics) my own thoughts regarding issues that are specific to individual health insurance, and links that I think will be helpful to consumers in Colorado.
Start by comparing plans and getting a ballpark idea of the prices to expect.
Choosing a Health Plan: What Should Consumers Look For?
By John Martie, President, Anthem Blue Cross and Blue Shield in Colorado
October and November is “open-enrollment” season, when employees are able to enroll in a health plan or make changes to their current coverage. And every year, consumers make decisions without thoroughly evaluating their choices.
Selecting a health plan is an important decision. Don’t be tempted to simply sign-up for the plan you had last year, or select the plan that your co-worker chose. Take the time to ask questions, compare plans, consider advantages and disadvantages and make an informed decision. Remember, you’re going to have to live with your decision for the next year, so make sure you choose the health care plan that best meets your total health needs and budget.
Based on a recent study released by the WellPoint Institute of Health Care Knowledge on what consumers want in a health plan, the following questions may be helpful during open enrollment when considering which health plan to choose:
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Am I satisfied with my current choice of networks and doctors?
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Are my current doctors covered by this health plan? You can use our provider directory to find doctors, specialists, and hospitals on the major health insurance networks in Colorado.
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What is my household’s current and anticipated health care service usage, what are the kinds of things we will need? If you’re switching from one individual health insurance policy to another, or making the choice to go from a group policy to an individual policy, keep in mind that medical underwriting will be part of the application process. If you currently have extensive health care usage, you may find that a new individual health insurance policy is more expensive (based on medical history), or excludes pre-existing conditions. It’s important to wait until you have a policy that you’re comfortable with before you cancel your existing policy.
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What are my out-of-pocket expenses and monthly premium costs? Does is it make sense for me to pay a higher premium for lower out-of-pockets, or vice versa? It’s helpful to do the math, and consider worst case scenarios (meeting your deductible and coinsurance maximums every year, in addition to premiums paid). You might find that a lower deductible is actually costing you more in additional premiums than you’d save with the lower deductible, even if you had to meet your deductible every year.
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Prescriptions are one of the most utilized benefits. What coverage is provided by the plans I’m evaluating? Are my current prescriptions covered and at what level? As the price of prescriptions has increased, some individual health insurance policies have removed prescription coverage all together. Even if you don’t take any medications now, it’s generally not a good idea to get a health insurance policy with no coverage for prescriptions. You never know what the future might bring, and a serious illness could leave you with a huge out of pocket expense for medications. A better tactic to save money on premiums and still have a good safety net in the event of a catastrophic health problem is to get a policy with a mid to high-range deductible, and make sure that prescriptions are covered once the deductible is met.
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How much will it cost me if an emergency situation occurs? A lot of people find the emergency room copay to be a confusing part of individual health insurance policies. Most policies have a copay for emergency room access ranging from $75 – $150. On the plan description forms it will say “waived if admitted.” It’s important to note that with the exception of Anthem’s Tonik policies, the emergency room copay is charged in addition to the normal deductible and coinsurance on the policy. If you’re admitted to the hospital, you just pay the deductible and coinsurance – if you’re not admitted, you also pay the additional emergency room copay. So for most individual health insurance policies in Colorado, you can assume that you’ll be paying at least your deductible (and coinsurance if applicable) for emergency care.
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What types of health or wellness programs could I (or my family) benefit from?
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Are these types of programs offered by the health plan I’m evaluating?
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Have I looked into health plan report cards provided by independent organizations? Complaint ratios compiled by the Colorado Division Of Insurance are a helpful tool.
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Do the health plans I’m evaluating provide tools for estimating the costs of health care services?
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What types of experiences are friends and family having with their health plans when they have questions?
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Are my customer service needs met quickly and efficiently?
John Martie is the president of Anthem Blue Cross and Blue Shield in Colorado. Anthem is the State’s largest insurer, providing health benefits to nearly 900,000 Coloradans.
Individual health insurance is generally a month-to-month contract, and since you choose and pay for your own policy, you have the option to shop around for new coverage whenever you like, as long as you remain relatively healthy. But since you never know when a serious illness could strike (leaving you “stuck” on your current policy), it’s a good idea to be thorough when describing your needs to your health insurance broker, and to really consider the options. Simply choosing the cheapest policy, or the policy with the lowest deductible might not be the best long-term strategy.
