Choosing health coverage involves more than just evaluating premium costs. Learning about company business practices, plan quality, provider networks, member satisfaction, and added benefits allows identifying the optimal insurer for your needs. This guide provides a framework of factors to research, questions to ask, and resources to consult when reviewing insurance companies and plan choices.
Why Research and Compare Health Insurers?
Making an informed selection:
- Weighs features like deductibles, copays, and drug coverage against premium costs to identify plans providing the best value.
- Allows understanding insurers’ reputations for claims handling, medical management, and customer service.
- Identifies widely recommended plans based on independent patient feedback and ratings.
- Ensures choosing companies exhibiting favorable financial health and business conduct.
- Prevents unpleasant surprises from unforeseen restrictions, gaps, or gotchas in plan fine print.
Detailed upfront research protects against choosing plans that don’t meet coverage expectations and service needs.
Also, Check this as well Health Insurance Open Enrollment Guide
Assessing an Insurance Company’s Financial Health
Why financial standing matters:
- Insurers must maintain reserves and capital to continue paying claims.
- Financially fragile companies risk unexpectedly discontinuing plans or pulling out of markets.
- Provides peace of mind your insurer will remain stable and in business over the long term.
Metrics to Review
- Capital and surplus ratios – assess financial cushion.
- Risk-based capital (RBC) ratio – measures capital to risks like underwriting, expenses and investments.
- Financial strength ratings – independent analyses by firms like Moody’s, S&P, and Fitch.
- Quarterly and annual financial filings – available on company website.
Selecting insurers exhibiting solid financial footing reduces chances of disruption.
Researching Insurer Business and Sales Practices
What ethical conduct indicates about an insurer:
- Review ratings for business ethics from organizations like Better Business Bureau.
- Avoid companies with histories of misrepresenting plan terms when marketing, bait-and-switch sales tactics, or deceptive advertisements.
- Search for any regulatory orders issued against insurer for unlawful business activities.
- Check for lawsuits over denied claims or bad faith business practices.
- Ask about sales commission structure – are agents rewarded for volume over properly matching clients?
Reputable, honest operations suggest an insurer that will deal with you above board as a policyholder.
Checking Plan Quality and Patient Experience Ratings
Third party evaluations provide useful insight:
- Consult NCQA plan rankings based on clinical quality and service measures.
- View J.D. Power ratings demonstrating member satisfaction and experience.
- Compare Consumer Reports scores assessing plans based on multiple factors.
- Search online reviews citing first-hand experiences with the insurer.
Independent ratings help substantiate marketing claims of superior coverage and service.
Researching the Insurance Company Complaint Record
What complaints data reveals:
- States publish insurer complaint ratio statistics – consult department of insurance website.
- High complaint volumes could signal poor customer service or claims handling issues.
- Review if nature of complaints indicate systemic problems versus minor one-off gripes.
- Ask how company tracks, measures, and improves based on complaint feedback.
Complaint metrics provide real user experiences rather than just marketing content.
Verifying Plan Details Beyond Just Monthly Premiums
Aspects that influence out-of-pocket costs:
Deductibles – How much you pay directly before coverage kicks in.
Copays – Set flat fees per doctor visit, hospital day, or prescription.
Coinsurance – Percent of costs you pay yourself after deductible.
Maximum Out of Pocket – Total you would owe in a year before plan covers 100%.
Allowed Amounts – Plan’s allowed payment limit for procedures, hospital daily rates, etc. Amounts above require additional out-of-pocket payment.
Covered Services – Exact treatments, therapies, medications, devices, and specialty care included and exclusions.
Don’t assess affordability on premiums alone – understand the complete picture of potential expenses.
Making Apples to Apples Plan Comparisons
Like for like evaluation:
Compare premiums on same metal tier plans – Platinum vs Platinum for example.
Ensure each plan examined includes all members you want covered.
Use online plan finder tools to generate customized full-year cost estimates accounting for:
- Monthly premiums
- Likely doctors visits and prescription costs
Assume using in-network providers and average utilization patterns.
Modeling total yearly expenses for your situation facilitates accurate side-by-side comparisons.
Provider Network and Prescription Drug Coverage
Two key coverage components:
- Ensures sufficient doctor access without excessive delays for appointments or inconvenient locations.
- Look up specific preferred doctors and hospitals to confirm participating in-network.
- Generous formulary covering medications you take with affordable copays.
- Restrictions against medications requiring prior authorizations or higher cost tiers create headaches.
Provider access and drug coverage heavily influences day-to-day experience using benefits.
Added Benefits to Look for Beyond Basic Insurance
Potential bonus features:
- Gym membership reimbursements
- Discounts for weight management programs, alternative therapies, LASIK surgery.
- Child vision and dental coverage.
- Retail and service discounts using insurer ID card.
- Health and wellness content and tools.
- Nurse advice hotline providing free medical guidance 24/7.
Perks and ancillary benefits build added value on top of core insurance coverage.
Resources for Researching and Comparing Health Insurance Companies
Where to look for objective information:
State Department of Insurance Portal – Plan quality data, complaint ratios, and financial ratings.
Healthcare.gov Plan Finder – Customized cost estimates and plan details.
Independent Clearinghouses – Tools allowing side-by-side comparisons across insurers.
Trusted Insurance Agents – Experts familiar with local plan pros and cons.
Online Reviews – First-hand patient accounts of insurer experiences.
Leverage unbiased resources to make the optimal health plan selection for you.
Choosing a health plan extends well beyond comparing monthly premiums listed on a website. Do your homework investigating the insurer’s financial standing, company history, covered benefits, drug formularies, provider networks, and patient experiences using objective data and metrics. While requiring some diligence upfront, selecting the optimal health insurance company and plan saves money long term while protecting your wellbeing.