Consumer Reports analyzed the recently released rankings of 830 private, Medicare and Medicaid health insurance plans, revealing wide variations in quality and mixed results for some of the nation’s largest health insurers. Many employers, as well as Medicare, schedule their annual open enrollment periods for the fall, so for consumers who have the option of switching plans, now is the time to do the research.
The rankings are from the nonprofit National Committee for Quality Assurance (NCQA), a respected nonprofit quality-measurement and accreditation group. The rankings are based on voluntary disclosure by 912 participating health-insurance plans that measure their quality using rigorous, standardized techniques.
Insurance plans in all 50 states and Washington, D.C., were ranked, including 540 HMOs, 285 PPOs, and five HMOs and PPOs whose owners operate them separately but combine their results. They include plans for Medicare and Medicaid beneficiaries as well as private plans serving employers and individuals. Together, these plans enroll an estimated 127 million Americans.
Some highlights from CR’s analysis:
— Kaiser plans excel. Almost all of Kaiser Permanente’s private and Medicare HMOs scored better than average for treatment and prevention and were among the highest ranked nationally.
— Biggest doesn’t equal best. The largest insurers —Aetna, Cigna, Humana, Kaiser Permanente and UnitedHealthcare — together with the 60 mostly state-based Blue Cross Blue Shield plans, account for 75 percent of the 390 ranked private plans, but only 36 percent of the top 50.
— Small can be good. Some of the top-ranked insurers are smaller, community-based and mostly nonprofit. Capital Health Plan, a Blue Cross Blue Shield HMO in Tallahassee, Fla., that has just 113,300 enrollees, ranks third in the nation among private plans. The magazine cites several other examples including Tufts Associated HMO and Tufts Health Plan (a PPO), which have enrollees in Massachusetts, New Hampshire and Rhode Island, and Group Health Cooperative of South Central Wisconsin.
— New England shines. Eighteen of the 50 top-ranked private plans are in this compact six-state region. And Aetna and the “Blues” had New England plans ranked in the top 100, while many of the same insurers’ plans in the southern and western states ranked near the bottom of the list.
The type of health insurance one has can affect out-of-pocket costs, provider choice and potentially the quality of care. Consumers should pick their plans carefully, using CR’s Rankings as a guide and bearing in mind that, while some general difference between plan types exist, employers and insurers have the flexibility to set up plans any way they choose. Consumers should look carefully at the actual terms of any given plan they’re considering.
CR suggests the following tips for choosing among an HMO, PPO or high-deductible plan:
— Health maintenance organization. In an HMO, a consumer usually must get care from providers in the plan’s network, often restricted to a certain geographical area, and must get a referral from a primary-care doctor to consult a specialist. Consumers will generally face less paperwork with an HMO than a PPO.
— Preferred provider organization. PPOs also have provider networks, but an individual can see in-network specialists without a referral. It is also possible to get care outside the network, though consumers will pay a higher proportion of the bill. While PPOs generally have larger networks of doctors, the report notes that HMO doctors are more likely than PPO doctors to be held accountable for quality of care. Out-of-pocket costs are generally higher for PPOs, too.
— Point of service. POS plans are a hybrid of an HMO and PPO. A consumer chooses a primary care doctor and needs a referral to see a specialist. But as with a PPO, there’s coverage for out-of-network providers.
— High-deductible plans. To lower premiums, consumers can choose plans with high deductibles, usually designed to be paired with a health savings account (HSA) or health reimbursement arrangement (HRA).
Filed Under: Consumer Reports