America's Best Health Plans
Deciding on health coverage isn't getting easier-or cheaper
Lower premiums were a big draw for Al Meginniss. When his employer, Lutheran Social Services in Elgin, Ill., switched from a standard PPO to a high-deductible HSA-compatible plan through UnitedHealthcare 18 months ago, the premium deducted from Meginniss's paycheck every two weeks for family coverage immediately dropped from $294 to $174. The nonprofit covers half of his $2,200 deductible, leaving him with $1,100 to handle on his own-only $100 more than before. Between Meginniss, who has diabetes, gastroesophageal reflux disease, and arthritis, and his son, an athlete with frequent chiropractor bills, their HSA has been getting a workout. Meginniss has been able to accumulate just $500 in his account. But he figures he's doing OK. The key, he says, is Lutheran Social Services' contribution of half of his deductible. "If my employer wasn't making a contribution," he says, "it would be a very hard thing to deal with, and the benefit might not be worth it."
Unwise skimping. Meginniss's use of his health plan and HSA may be the exception. A recent study published in the journal Health Affairs by researchers at Rand found that people in consumer-driven health plans tended to seek less care but did so indiscriminately, forgoing necessary as well as unnecessary medical services.
In hopes of at least reining in cost increases, health plans are cranking out consumer-friendly tools that give members information to help them make educated decisions about their care. Much of the focus is on price and provider quality, and sometimes the two are combined into an "efficiency" rating, with a ranking system that awards stars or dollar signs to providers that offer the best care for the money. Doctors and hospitals that are considered most efficient are increasingly grouped into "high-performance networks," which employers try to entice workers to use by offering incentives like lower copayments.
Many healthcare experts applaud the idea of high-performance networks and believe they could play an important role in bringing down medical costs in the long term. But at this point, most high-performance network measurements are pretty rudimentary-keeping blood sugar and blood pressure on target for someone with diabetes, for example. "We're years and years away from meaningful quality assessments of physicians," says Paul Ginsburg, president of the Center for Studying Health System Change, a health policy research organization. "We're a lot closer on hospitals."
Pricing is another area where health plans have put a lot of energy into making information available to plan members. Aetna, for example, now makes specialists' fees for the 30 most common services available to members in 15 markets. Experts agree, however, that unless prices are routinely combined with quality information, they're not very useful for consumers except for simple purchases like MRI services or diabetic supplies, where quality differences are minimal.
When Matt Podhradsky needed to schedule his 16-month-old son to have ear tubes inserted, he checked with his doctor and local hospitals to try to get an idea of how much he and his wife should expect to pay out of pocket to cover the 20 percent coinsurance they would owe. His doctor said he had no idea how much the procedure would cost, and hospitals in the area said they couldn't give him specifics either. So Podhradsky checked the HealthPartners website, which administers the PPO plan that he has through his employer, the city of Chaska, Minn. The website informed him that inserting ear tubes, including office visit, surgery, and hospital fees, typically costs between $1,400 and $3,240. Armed with that information, Matt and his wife set aside $400 for the operation. Their final bill: $420.
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