Comparison shopping for a health plan

Introduction

During the last few weeks of this year, most of us will need to make a decision about our health insurance coverage for 2015, regardless of whether we get it through an employer or buy it on our own. But unless you live in California, chances are you won’t find much information about how satisfied people are with their existing health plans or how many complaints are filed against them.

Now that the law requires us to have health insurance — and buy it from a private insurer unless we’re eligible for a government program like Medicare or Medicaid — you’d think it would be easy to discover which health plans rank the best and which ones bring up the rear.

There are some online resources to find out how much various plans would cost in monthly premiums and out-of-pocket expenses. If you can’t get coverage at work and want to compare costs among competing health plans, you can go to healthcare.gov, maintained by the U.S. Department of Health and Human Services, or a private online source like healthinsurance.org, which has been around since 1994.

But finding customer satisfaction and clinical performance information and complaint ratios is a lot more difficult.

California is the only state I know of where you can find data on both, but it’s not likely that even many Golden Staters understand how to discover it or go to the trouble of seeking it out.

Back in 2000 when Democrat Gray Davis was governor, California began operating an agency called the Office of The Patient Advocate (OPA). According to its website, OPA was created “to help health plan members get the care they deserve and to promote transparency and quality health care” by publishing an annual “Quality of Care Report Card.” The most recent report card was released last Wednesday.

If you’re a Californian and care as much about good customer service as you do about how much you’ll have to pay for coverage, you’ll choose one of the nonprofit health plans, regardless of where you live in the state, after spending a few minutes on the OPA site.

One consistent theme over the years has been that nonprofit plans have ranked better than their for-profit competitors in both customer satisfaction and complaint ratio ratings. That comes as no surprise to me. During the nearly 20 years I worked for big for-profit health insurers, we always trailed the nonprofits. One reason: nonprofits have made it a priority to assure that their customers are satisfied and get the care they need. The top priority of the for-profits, I know from experience, is to enhance shareholder value, a euphemism for making sure Wall Street is satisfied.

In last week’s OPA report, Kaiser Permanente of Northern California and Kaiser Permanente of Southern California, both nonprofits, were the only plans to score four stars (an “excellent” rating) in both clinical performance and patient experience. They were followed by Blue Shield of California, Sharp Health Plan (in greater San Diego), and Western Health Advantage (in the Sacramento area). All of those plans are also nonprofits.

The plans with the fewest stars were Aetna, Anthem Blue Cross, Cigna, Health Net and UnitedHealthcare of California, all for-profit companies.

Conversely, the HMOs with the highest ratio of complaints and inquiries were the for-profits and the ones with the lowest were the nonprofits. Cigna, where I used to work, had the highest ratio. It had more than three times as many complaints and inquiries as the Kaiser HMOs and nearly four times as many as Sharp.

Not only have these results been consistent over the years in California, they are also consistent with the national health plan rankings compiled by Consumer Reports and the National Committee for Quality Assurance.

Regardless of where you live, you should check out those rankings before selecting your insurance carrier for 2015. You’ll find that, just as in California, the nonprofits lead the pack and the for-profits are eating their dust.

In fact, there are no for-profits among the NCQA’s top 25 health plans. And it has been this way for as long as the NCQA has been publishing its annual ranking.

Open enrollment for health plans offered on the state and federal exchanges for 2015 will start in just four weeks, on November 15. Most employer-sponsored health plans will also have open enrollment at approximately the same time. It would be well worth your time to see how the health plans available to you stack up to competitors in quality and customer satisfaction — as well as cost.