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Last updated on April 18, 2014 at 10:39 EDT

As Affordable Care Act Marketplaces (Exchanges) Prepare to Go Live Oct. 1, CHECKBOOK Experts Share Advice to Help Consumers Make Best Health Plan Choices for Themselves, Their Families

September 4, 2013

Making a Smart Plan Decision Could Save Consumers Thousands, Improve Their Access to Quality Health Care

WASHINGTON, Sept. 4, 2013 /PRNewswire-USNewswire/ — Millions of consumers will for the first time be able to choose among multiple health insurance plans beginning Oct. 1, 2013 (with coverage to begin Jan. 1, 2014), in the health insurance marketplaces (exchanges) set up under the Patient Protection and Affordable Care Act (“Obamacare”). Making the right choice can save many of these consumers thousands of dollars and help them get much better health care than if they make other choices. To assist them, Consumers’ Checkbook, a nonprofit consumer organization that has been helping consumers choose health plans for more than 34 years, has put together the following tips.

To Keep Costs Down

    --  Check what you'll have to pay in premiums--but don't go by premium alone
        because the plans with the lowest premiums will often cost you much more
        than other plans when you take into account out-of-pocket costs
        including deductibles, coinsurance, and out-of-pocket limits.
    --  Compare what you might have to pay out-of-pocket. See if the marketplace
        website gives you a single dollar-amount average total cost for people
        like you--same age, family size, etc. Because comparing out-of-pocket
        costs can be very difficult and confusing, some marketplace websites
        (such as Massachusetts' and Colorado's) will be giving such total-cost
        estimates and others may have this capability soon (unfortunately, the
        federal government's website, which will be used by many states, will
        not initially have this feature).
    --  Don't choose based on deductible alone. Plans with low deductibles often
        prove to be very expensive--especially if they have high coinsurance or
        don't have a low limit on the most you could ever have to pay if you
        have an unexpected disease of accident.
    --  Try to find an estimate of your risk--what your total cost would be in a
        year if you have very high health-care usage. Some plans are good on
        average but leave you with very high costs in a bad year. A few
        marketplaces are set up to give you such bad-year estimates for each
        plan; others may offer this help soon.

To Have a Good Choice of Doctors and Other Providers

    --  See if the marketplace lets you enter the names of doctors you know you
        would like to be able to see and then automatically tells you which
        plans have those doctors. If not, you will have to go to each plan's
        website to look at the plan's doctor directory (the federal government's
        website, will not initially have such an all-plan provider directory).
    --  If there are doctors you care a lot about and a plan lists them as
        available, follow up with a call to these doctors' offices to be sure
        the doctors intend to continue accepting insurance coverage from
        patients in the plan.
    --  If you don't have doctors you care about, this would be a good time to
        try to identify a preferred doctor or doctors--at least a good primary
        care doctor and maybe specialists of types you know you will want--and
        check whether any such doctor participates in plans you might consider.

To Get Good Care and Customer Service in a Plan

    --  Check what surveyed members have said about the plan. Many marketplaces
        will post the results of official, standardized surveys where the
        members rate, for example, the availability of good doctors when they
        need them, the helpfulness of plan websites and customer service staff,
        speed and fairness of claims handling, etc.
    --  Check whether the plan provides services you might want to help you stay
        healthy or deal with medical problems. Some plans offer free weight-loss
        and fitness programs, stop-smoking programs, nurses to help sick
        patients manage care and coordinate care from multiple providers, etc.
        Look for evidence that a plan's programs really have a track record of
        success.

Words of Caution

    --  Be wary if a marketplace tries to give you a total estimate of
        out-of-pocket cost based on how many doctor visits, prescriptions, etc.
        you say you expect to have. That type of total cost estimate ignores
        possible very high expenses for accidents, diseases, etc. that you can't
        predict.
    --  The best plan for you or your family might not be the same plan as is
        best for other people with different ages, family makeup, health
        conditions, or other characteristics.
    --  Don't assume that the bronze, silver, gold, or platinum labels on plans
        tell you which plan will be cheaper for you. The lowest-cost silver plan
        might be $2,000 less expensive than the lowest-cost bronze plan for one
        family with certain age and health-care needs, and the opposite might be
        true for another family when considering premium and what you have to
        pay out-of-pocket.
    --  Be aware that you might have to pay back part or all of the tax credit
        the marketplace (exchange) tells you you'll get to help pay your
        premium. The tax credit is based on your family income in a prior year
        and you might have to pay some or all back on a future tax return if
        your income turns out to higher than what was used to figure the credit.
        If you are worried about that, you can choose to take a smaller credit.
    --  Even when looking at specific benefits, look at the details and
        exceptions. For example, when you see a figure for the maximum amount
        you will have to pay out-of-pocket in a year, check whether that limit
        applies to drugs.
    --  Don't narrow the list of plans you will consider without checking what
        you will be giving up. Some exchanges might ask you up front if you want
        to rule out joining an HMO or joining a plan that does not have your
        doctor. If you do such narrowing up front, you might never see plans
        that would cost you thousands of dollars less or that have great doctors
        and customer service.
    --  Don't rely too much on examples plans give of the costs for specific
        procedures or conditions. All plans are required to tell consumers how
        much the out-of-pocket costs will be for a normal childbirth and for a
        typical person with controlled diabetes. Check that information. But be
        aware that, for example, a plan might require members to pay a low
        portion of costs for childbirth but a relatively high portion for most
        other types of service.

For Additional Assistance

    --  Visit Healthcare.gov or call 1-800-318-2596 for more information; both
        the website and call center are operated by the U.S. Centers for
        Medicare and Medicaid services and are designed to provide information
        and put consumers in touch with resources related to the exchanges.

These tips are based on Consumers’ Checkbook’s research, consumer-testing, and experience helping consumers choose insurance plans. The organization has provided Checkbook’s Guide to Health Plans in annual books and online since 1979, focused on helping 8 million Federal employees and retirees who get to choose plans in an insurance program that includes more than 200 plans. Based on this work, Checkbook has developed a website that stands out in the Consumer Reports Choice Architecture report comparing the major health plan comparison tools. Checkbook is working with various states helping them set up their marketplaces with easy ways to compare health plan costs, quality, and access to high-quality doctors. And Checkbook has created a model health plan comparison tool (at www.checkbook.org/plancompare) to guide states and the federal government in creating online tools that will make it easy for consumers to choose the right plan for their needs and preferences.

About Consumers’ Checkbook/Center for the Study of Services

Consumers’ Checkbook/Center for the Study of Services (www.checkbook.org) is a nonprofit organization whose mission is to inform the public about the quality and cost of available service providers, educate members of the public on how to select and deal with such providers, and disseminate information that can guide and motivate service providers to deliver higher quality, more efficient services.

Checkbook/CSS also has extensive experience collecting and processing health care quality measurement information under contract with government and other organizations that produce the information for public reporting on quality and cost of health plans and of health care providers.

CONTACT: Jamie Lettis

202.454.3006 jlettis@checkbook.org

SOURCE Consumers’ CHECKBOOK/Center for the Study of Services


Source: PR Newswire