Cutting through the rhetoric of empowerment, free competition and the rest of the distractions being presented to consumers has made consumers powerless in the health services industry as we hold our breath during benefits season and hope we choose a plan that will cover us. Truthfully, there's not as much "choice" as we think though making bad choices is a real possibility as plans that are affordable become affordable through reduction of services, coverages, and providers.
The myth of the free market
The free market myth is one of those things that has been used to really mess with consumers. The three biggest US health insurers are Aetna, United Health Group, and WellPoint. The BC/BS companies are separate (around 40 separate companies)that are BC/BS affiliated but don't make the list because they are separate companies. Further, HUMANA, a company that supplies employer sponsored health insurance also offers HUMANA ONE, so that it can get in on the "empowerment" bandwagon. Cigna, which boasts insureds "worldwide" also offers plans.
Medicare and Medicaid are separate issues, not addressed here as they are public health insurance plans.
Okay, so skip through all the emails and narrow down your list to these five "CHOICES" the "FREE" market place provides. Now try to do a little research by investigating complaints on websites ranging from the Better Business Bureau to your state insurance department. A general search might reveal a red flag for you in terms of number of providers, access (how long you wait to see someone), reimbursement issues. You can also call around to your own doctors and see whether they currently accept health insurance from these companies. Remember, provider contracts do NOT coincide with the duration of your insurance coverage so that your yearly election is not during the same period of time as a provider agreement. This means your provider may not accept your insurance for the duration of your elections period.
Narrow your search of the five big choices by examining which ones are dominant in your state. Search your state name and biggest health insurer and you'll find a short list of which of these five companies is biggest in your state. For instance in Colorado, among your choices you'll find a BC/BS, and you'll also see PacifiCare which is actually a United Health Care company.
What you need Things you don't control:
First, you do not control what HAS to be covered. Legislative mandates for your state exist, these are things that health insurance plans must cover. If you are choosing one of the novel ideas such as a medical discount card or some of the other "price" driven "choices" MAKE SURE that they are covered by legislative mandates for health insurers. You can also print out a list of what is mandated by your state or contact your state insurance department to make sure your choice is covered by mandates.
Second, if you think you've discovered a bargain, remember, the market isn't as free as you think so get a reasonable explanation for your bargain: Promotion to try to expand business (which means it will probably be a one year bargain), less coverage (likely), your own good health (also likely). Remember, these are annual choices and next year if you have been sick your choices will change because your needs will change.
Third, yup, you have to calculate your own risk. What do you want health insurance for? Emergency room? (We just got a $6500 bill for assessment of a stomach ache that we really only wanted to make sure was not from the appendix). Check ups? (These are cheap throw ins that distract you from paying attention for coverage of needed medical services. They are also the largest number of mandates, the annual exam and screening stuff). If you have specialized needs such as mental health or dental, there is a big likelihood you will be dealing with some sub-contractor of the big insurer or that the service is not provided. If you are interested in health, mental health and dental, see whether this is offered UP FRONT.
Okay, you've got your list of needs. Price for what you need will not vary that much, that's just the way it is. If the cost of a premium is too high you are in the position of gambling on what you can do without. Can you do without coverage after a $2500 deductible, meaning can you raise your deductible to $5000 or some other number?
Are there coverages you can do without? Personally, I'd like to toss all the preventive stuff, but as mentioned, that is the stuff covered by many legislative mandates. Chances are this will be a deductible based compromise. Make sure you ask about co-pays the kissing cousin of deductibles because they are also out of pocket.
Most often people choose health insurance and opt out of dental or vision. Funny how those don't make the cut into screenings!
Once you've narrowed down your choice by a)determining which health insurers are big in your state b) what you need c) considering cost of what you need d) determining what you can do without to lower your cost then and only then do you enter the world of specific plans. Do NOT be bamboozled. You have your list of what you require, make sure whomever writes your policy validates that what you are being sold covers your list. This is a legal thing. Do not take someone's word for it. There are two choices: Write out what you believe you have and assume that they have offered you a product with that provision...if you don't get an email confirmation, go further.
Insurance policies like most written agreements explain that the document is all that is agreed to, things that were said don't count. HOWEVER, if you have a document that confirms and memorializes your communications with company rep and then you find out that your coverage isn't what you bargained for, you will have some legal recourse. Insurance policies are too complex for us to see what companies can maneuver.
Communicate. Write about your health insurance experience if you have time. Let others know, including consumer organizations, representatives, and state insurance departments. This is the ONLY way that consumers will be able to consolidate the power of their collective dollars to influence the direction of our health services industry...because, next year's benefits season is coming.
