Consumers Spend Little Time Choosing Health Plans

With open enrollment for 2016 underway, 59% of consumers say they will spend less than 30 minutes selecting a plan, according to an October HealthMine survey. “Consumers are treating an increasingly complex and costly purchase with inertia. With rising out-of-pocket costs, narrowing networks, and growing prevalence of chronic disease, not doing your due diligence on healthcare coverage could be hazardous to your health—and to your pocketbook,” said Bryce Williams, CEO and president of HealthMine.

The most important factors in selecting a health plan are monthly premiums and out-of-pocket costs. However, 76% of consumers don’t know what they spent in total out-of-pocket on drugs in the past year. And 67% don’t know what they spent out-of-pocket for doctor visits and labs. In addition, 42% don’t understand their total spend on monthly premiums.

Even though 85% of respondents say they have a good idea of needed services in the coming year, 36% find their plan somewhat or very confusing. Of those, 58% are most perplexed about which services are covered by their plan. Another 46% are confused about costs. Twenty-eight percent don’t know how to get the most from their wellness program. Sixty-six percent of consumers don’t plan to make any changes to their health plan in this enrollment period. Forty percent say that there has been no recent change to their plan’s quality and value. Another 35% say their plan is getting better.

What Doctors Want You to Consider Before Choosing a Health Plan

As open enrollment for 2015 exchange plans gets underway, the American Medical Association (AMA) urges patients to review the plans they are considering in order to prevent interruptions in care and higher out-of-pocket costs. Whether it’s a new plan or a renewal, patients should consider deductibles, co-pays, drug costs, which physicians and facilities are covered, and the cost of out-of-network treatment. Patients should ask whether their physicians are participating in plans they are considering. AMA President Robert Wah, MD said, “It is very important that patients look beyond the big print, color-coded plan designations and price of insurance plans and check the small print details before making their selection.” AMA asks patients to consider the following:

1) Are your family’s doctors in the plan? If not, what will you have to pay out-of-pocket for office visits or other services your doctor prescribes? Is the plan’s directory of participating physicians up-to-date and accurate? Are there physicians on the list who are still accepting new patients?

2) What does the plan cover? What percentage of your health care costs will you have to cover? If so, how much and can you afford it? How much will you have to pay out of pocket for the medicines your family needs? Will you be able to use hospitals, labs and other facilities that are convenient to where you live or work? Does the plan provide access to a sufficient number of specialists that you need?

3) Does your primary care physician have to get permission from the insurance company to refer you to a specialist? Does that rule include specialists you see regularly for a chronic condition? Does the insurer use penalties or incentives to induce physicians in the plan to limit referrals in any way?

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Many Americans Don’t Ask Basic Questions Before Choosing a Plan

Three out of four Americans say they understand health insurance. But 42% say they are somewhat likely or not at all likely to review plan details before signing up for coverage, according to a survey by the American Institutes for Research (AIR).  “Because many people believe they know more than they actually do about health insurance,…they may face the shock of high out-of-pocket expenses they didn’t expect,” said Kathryn A. Paez, Ph.D., R.N., an AIR principal researcher, and coauthor of the study. The survey reveals the following:

  • About half can identify general characteristics of an HMO, and 23% can identify the characteristics of a PPO.
  • While most can identify common insurance terms, such as “appeal” (80%) and “premium” (81%), far fewer can identify more complicated concepts, such as “step therapy” (37%) or “medically necessary” (60%).
  • Only 20% can calculate how much they would owe for a routine doctor’s visit.
  • Seventy-nine percent are at least moderately likely to check which hospitals and physicians are covered by various plans.
  • Those aged 22 to 34 answered 55% of the knowledge and skills items on the survey correctly, compared to 63% of 55- to 64-year olds.
  • People who have not seen a doctor in the past year answered 49% of the knowledge and skills questions correctly compared to 64% of those who see a doctor several times a year.

Workers Spend Less Than 15 Minutes Choosing Health Benefits

Forty-one percent of employees spent 15 minutes or less analyzing their health benefit options during the 2013 open enrollment season; and 24% spent five minutes or less, according to a recent Aflac open enrollment survey. Forty-two percent waste up to $750 a year on mistakes with their insurance benefits. The survey also found the following about workers:
• 90% auto-enroll or keep the same benefits year after year.
• 73% sometimes, rarely, or never understand everything their policy covers.
• 64% sometimes, rarely, or never understand changes in their coverage.
• 64% disagree or only somewhat agree that they are more prepared for open enrollment this year compared to last year.
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Last Updated 12/01/2021

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