Evaluating health insurance companies

How to evaluate insurance carriers for the best fit

When you’re debating over where to spend your money for the best possible individual or group health insurance coverage, there’s plenty to consider – and it’s not just the premiums and out-of-pocket costs. Before you start seeking health insurance quotes, it’s prudent to take a look at the health insurance companies and their potential service to you as a consumer.

As the ACA-created health insurance marketplaces (exchanges) open in October 2013, consumers will have access to one-stop shopping for individual and small-group health insurance. The plans that will be available for sale in each state’s marketplace will be ranked (Platinum, Gold, Silver and Bronze) based on the percentage of costs that they cover before the maximum out-of-pocket limits are reached.  This will make it easier to compare your options.  In addition, all of the plans will have have out-of-pocket limits of no more than $6,350 for an individual or $12,700 for a family (in 2014). These amounts will increase slightly each year.

The health insurance carriers whose plans will be for sale in the marketplaces will be private companies, many of whom will already be familiar to you from the pre-ACA health insurance market.  In many states, there will also be CO-OP plans available, and some new carriers that have joined the market following health care reform. Navigators and certified brokers will be available to help people who are shopping in the marketplaces.

Consumers who qualify for premium subsidies and cost-sharing subsidies will need to make sure that they purchase policies within their state’s marketplace, as that’s the only way the subsidies will be available. But people who don’t qualify for subsidies will also be able to shop for health insurance outside of the marketplace, the same way they have in the past (directly from health insurance carriers, or by using a broker).

Plans sold outside of the marketplace will also be guaranteed issue and will cover the essential health benefits, but buyers will not be eligible for premium or cost-sharing subsidies.

Although many aspects of health insurance will be changing in 2014, most consumers will still be purchasing private health insurance, whether they do so via their state’s marketplace or outside of it.  And although plans will be more regulated in terms of the benefits they’re required to offer, there will still be a lot of variation among plans and carriers.

In your evaluation of an insurance company, you should ask yourself questions that include the following:

  • Is your insurance company financially stable?
  • Will your company make it easy for you to switch physicians if necessary?
  • Does your company care about the reputation of the doctors in its network?
  • Will the company respond quickly to your concerns?

How to check out your prospective health insurance provider

Financial rating

An easy place to start is your prospective insurer’s financial rating. Free resources, such as A.M. Best’s Financial Strength Ratings provide online ratings of insurance companies and their ability to fulfill their financial obligations to the consumer.

Health insurance carriers raise their premiums annually in line with the rising cost of health care. The ACA provided funding for states to be better able to review the rates that carriers file and make sure that increases are justified.  The process is now more transparent and it’s easier than ever for consumers to check on a carrier’s rate increase history before applying for a policy.

Who provides your health care?

Take a look at a health plan’s network of physicians – and take a look at the physicians. The American Medical Association offers free basic information about every licensed physician in the United States. Healthgrades.com is another good resource for comparing providers.  Your local library also likely carries the Official ABMS Directory of Board Certified Medical Specialists.

Provider customer service

From the very start of your interaction with an insurance company, you can gauge their customer service by noting the way they respond to your questions (and hopefully, you’ll have many). Are they sympathetic to your individual needs? Are they trying to help solve your problems?  Talk to friends and co-workers to get their opinions of the customer service provided by the insurance companies they use.

Independent rankings

You can also get information about customer satisfaction through sites such as Consumer Reports – with membership – and through annual rankings by magazines such as U.S. News & World Report.

The National Committee for Quality Assurance also provides an online Report Card that allows you to compare plans based on criteria that includes member satisfaction.

You can also do a Google search of each company’s name for articles OR a search pairing the company name with the word “complaints” or “violations.” You can do the same with the name of your state plus “insurance commissioner” and “complaints” to see the number of complaints filed against a carrier.

Once you’ve done your homework on health insurance companies’ customer service, financial stability and policy quality, your research comparing health insurance quotes will be that much easier.

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Related terms

essential benefits

guaranteed issue

health insurance exchange