Column: Shopping around for health insurance
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Louis Gutierrez is the executive director of the state's health insurance exchange, the Massachusetts Health Connector.
Faced with a monthly health insurance premium increase of $312 a month next year, a Massachusetts family knew they needed to consider all of their options for 2017 insurance coverage.
As soon as open enrollment started on Nov. 1, they went to see a local Navigator, an organization funded to help Massachusetts residents review their health insurance options. They found they qualified for premium assistance through the state’s subsidized ConnectorCare program, and therefore are able to receive state and federal help paying for their coverage. After reviewing their options, they walked out with a new plan with a no-cost premium for 2017, after paying a premium in 2016.
This story isn’t unusual this open enrollment season. Across Massachusetts, many people are seeing significant increases in their premiums for next year. That includes people buying insurance on their own through the Health Connector and even those who qualify for subsidies. Some carriers are dramatically increasing their rates and the state is no longer able to subsidize some high-cost plans.
Not everyone qualifies for a $0 premium plan, but by shopping around, many people will be able to lower their scheduled 2017 increase, or even save money.
Examining costs beyond premiums
Managing health care – and its costs – is an important family decision that should be reviewed every year. The monthly premium gets the attention, there are other factors.
There is no one-size-fits-all solution for an individual or family buying health insurance, but knowing all the details can help determine what the best fit is for the next year.
Premiums are the easiest factor to compare between plans, but not the only cost consideration to look at. The cost of a doctor’s visit, for example, can vary, and the amount paid out-of-pocket can be different.
How often a member visits the doctor, and how costly the services are, are important variables. Someone who goes to the doctor regularly or is receiving expensive care will be more likely to consider a plan with lower co-pays and deductibles, but higher premiums. The Health Connector uses metallic tiers – Bronze, Silver, Gold and Platinum – to group plans with similar benefits together. Bronze plans offer lower premiums but higher co-pays and deductibles, with Platinum plans offer higher premiums, but smaller co-pays and deductibles.
These details matter. For a 40-year-old in Worcester, the lowest-cost Bronze plan is $255 per month compared to $390 for the lowest-cost Platinum plan – a different of $1,620 annually. But, the Bronze plan includes co-pays of $500 for an emergency room visit and $1,000 for an MRI – after paying the $3,300 deductible. The Platinum plan co-pays for those services are $150, with no deductible.
Other considerations
When members talk about healthcare preferences, having access to a certain provider is a priority. Checking to see if a doctor or hospital accepts a particular plan is an important step. Once open enrollment closes, a member can’t change plans to get back into a network that includes a specific doctor.
Balancing cost with access to services and doctors can be challenging. For those who want a helping hand, there are trained experts ready to walk through the shopping process. In Worcester, the Health Connector walk-in center is at 146 Main St., and the Family Health Center of Worcester is a Navigator with staff able to handle shopping questions. A full list of assistance around the state can be found at MAhealthconnector.org.
Louis Gutierrez is executive director of Massachusetts Health Connector.
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