Consumer Reports Magazine publishes an annual ranking report on healthcare plans by state, making it easy for subscribers to do an apples-to-apples comparison. But it would be impossible to put every piece of information into a chart format. That’s why it never hurts to know what to look for in an insurance plan.
Private health coverage can be a whole lot more complicated than group plans, primarily because the rates can change dramatically for each member of the family. If you are self-insured, comparing Arizona health plans can be a daunting task. According to Consumer Reports (“How Does Your Plan Compare?” November 2012), a good insurance plan will steer you away from tests and treatments that waste time and money; preferring to steer you toward the care that gets you healthy.
For the third consecutive year the nonprofit health care accreditation group, the National Committee for Quality Assurance (NCQA), has ranked hundreds of private health plans, Medicare Advantage plans and Medicaid HMOs. These rankings are available online to subscribers of Consumer Reports.
Now that the Affordable Care Act has been fully implemented, the data collected by the NCQA will be even more crucial for informing the 25 million Americans expected to gain private health coverage.
What has changed in the most popular health plans?
In recent years, there has been some notable improvement in the quality of HMO and PPO plans. HMOs require patients to get their care from network providers, while PPOs allow treatment from out-of-network providers. Out of the 32 performance measures tracked by NCQA, private HMO plans have shown improvement in 23 of them. For example, more patients are receiving recommended tests, such as colorectal screenings and blood sugar tests.
Health insurance should do two things:
- Cover all kinds of medical care. That includes outpatient treatment, doctor visits, hospitalization, prescription drugs, emergency services, mental-health and substance-abuse treatment, laboratory and imaging tests, preventive care, maternity care, and rehabilitation services. You might not need everything now, but sickness and injury can strike at any time.
- Limit your out-of-pocket exposure. Good insurance should pick up 100 percent of your medical expenses when your out-of-pocket expenses from deductibles and co-insurance hit a certain level in a year—say, $5,000 or $10,000.
It is tempting to reduce your premiums by choosing a plan that omits major benefit categories, such as prescription drugs. But rather than doing that, it is better to reduce premiums by opting for a higher deductible and/or a higher out-of-pocket limit. This may mean that in years when you’re healthy you may get very little benefit from your health plan. However, it is vital protection against the financial catastrophe of high medical bills.
Understanding the plans details may take some time, but there is no need to figure it out on your own. It is important to learn how an HSA works, and the benefit of tax-free out-of-pocket costs. Similarly, you should make sure an HMO or PPO network includes your doctors and specialists. Work with an experienced Arizona health insurance broker and find out which health plan is right for you.