By Jane Sarasohn-Kahn

First Posted at Health Populi on 3/21/2013

Jane Sarasohn-Kahn, Host of Health Populi

Jane Sarasohn-Kahn, Host of Health Populi

As the Affordable Care Act, health reform, aka Obamacare, rolls out in 2013, American health insurance shoppers will look for sources of information they can trust on health plan quality and customer service satisfaction — as they do for automobiles, mobile phone plans, and washing machines. For many years, one of a handful of trusted sources for such insights has been J.D. Power and Associates. J.D. Power released its 2013 Member Health Plan Study (the seventh annual survey) and found that most consumers currently enrolled in a health plan have had a choice of only “one” at the time of enrollment.

Thus, in 2013, many consumers will be newly-exposed to the experience of having to “shop” for health plans as they do other consumer products. And this will require stretching new muscles for at least the 7 in 10 (73%) of U.S. health consumers who purchase insurance on the individual market (and not through their employers) believe they’ll look to the new health insurance exchanges in their state to buy a health plan.

JD Power best plans for 2012This sentiment is particularly true for people who are enrolled in a high-deductible health plan (59%) vs. a lower-deductible plan (45%). 60% of people who have experienced a problem with their health plan in the past year are keener to use a health insurance exchange than those who did not (45%). Still, this latter number shows that about one-half of people who seem satisfied with their health plan would still be interested in seeking insurance from the state health plan marketplace. The health insurance exchanges will also be attractive to more people who work in smaller companies versus those employed by larger firms, J.D. Power found.

The chart shows which health plans consumers favored in 2012. The highest-ranking plans by region were:

  • Anthem Health Plans of New Hampshire
  • AvMed Health Plans
  • Blue Cross and Blue Shield of Alabama
  • Blue Cross and Blue Shield of Illinois
  • Blue Cross and Blue Shield of Kansas City
  • Blue Cross and Blue Shield of Texas
  • Geisinger Health Plan
  • Health Alliance Plan (HAP) of Michigan
  • HealthPartners
  • Independent Health Association
  • Kaiser Foundation Health Plan (which ranks highest in the California, Colorado, South-Atlantic and Mid-Atlantic regions)
  • PacificSource Health Plans
  • SelectHealth
  • UnitedHealthcare.

J.D. Power assessed 136 plans based on seven consumer-focused criteria:

  • Coverage and benefits
  • Provider choice
  • Information and communication
  • Claims processing
  • Statements
  • Customer service, and
  • The approval process.

The survey was conducted among 33,000 U.S. health plan members in the 136 plans in December 2012 and January 2013.

Health Populi’s Hot Points:  The most likely people that will take advantage of the state health insurance exchanges. The phrase “health insurance exchange” was coined in the Affordable Care Act legislation. That moniker is morphing into the phrase “health insurance marketplace,” which is more accessible and meaningful to people shopping for health care in their local/regional health markets. The Centers for Medicare and Medicaid Services (CMS) has been wise to change the name of this mechanism to make it more user-friendly. More on this from the government’s standpoint can be found here on the Health.gov website. Watch this video to understand “the new world of health insurance shopping” as the video explains.

Health insurance shoppers — which will be every American accessing health plans in 2013 — will need to gather and understand more information than they have in the past to learn how to use the marketplace, and assess the various health plan options available to us. J.D. Power recommends consumers look at their options in four ways:

  • Look at your costs compared with the features of the health plan (what it covers) and how much choice you have on selecting providers (e.g., doctors, hospitals). More flexibility might mean spending more — or not. Lower cost could mean fewer choices, which could suit people depending on their needs.
  • In October 2013, the state insurance marketplaces will launch and consumers can begin to assess their options. J.D. Power notes that your income could be in a range that qualifies you for buying a health plan at a lower cost. This is also the case if you work for a small company.
  • States may include quality ratings for the health plans in the marketplaces based on the states’ own assessment of health plan quality. J.D. Power notes that their survey is based on consumers’ own voices, not government criteria. These ratings may differ from how the state looks at the plans, so spending time reviewing ratings from several sources could be useful. Angie’s List could be another useful source, for example, along with Consumer Reports and other trusted reviewers.
  • Know the financial arrangements of the different health plan choices, such as amount of annual deductible, co-payments due for physician visits, and prescription drug plan if it’s included. Managing these financial arrangements can be complex, in which case a simpler plan might be a better choice for the consumer who doesn’t want the hassle of managing the money aspects of health insurance for themselves and their family.

While it’s always been important to be health-plan literate, 2013 is bringing a new and more substantial need to get more engaged with being an effective health insurance plan shopper.