Health Insurance Puzzle

health insurancepuzzleHelping a person enroll in a health insurance plan is like solving a puzzle – a health insurance puzzle. It’s also a good brain exercise for a sixty-something like me.

I got a call this week from a 64-year old woman who is quitting her job and will lose her employer health insurance.  She has done some research and knows she will get a $290 premium subsidy when she enrolls through the Federal Marketplace (healthcare.gov).  My assignment is to help her find a heath insurance plan that fits her needs.

Nancy is healthy and she wants to keep her primary care physician, Kristen Lorenz.

Off the top of my head, I’m pretty sure her doctor is part of Arizona Community Physicians (ACP), a large doctor group in Tucson.  I go to the ACP website and confirm that Dr Lorenz is with this group.

Off the top of my head, I know that ACP doctors are not contracted with narrow-network HMO plans in Tucson. That means Nancy is going to need a PPO plan.

I know ACP doctors are in the Meritus PPO network because of research I recently did for another client.  ACP doctors don’t show up in the Meritus online provider search, but I got confirmation from someone at Meritus, which “rents” its PPO network from the Arizona Foundation.  Dr. Lorenz is in this network.

I should know the Health Net network off the top of my head, but there have been so many changes in the last year, so I need to check their online provider search.  I find Dr. Lorenz is in their PPO network.

Next, I check the UnitedOne network – and I do not find Dr. Lorenz.

I focus on Meritus and Health Net because of their pricing and plan designs.

Meritus has Silver and Bronze plans that have co-pays for many services. Health Net’s Gold plans have premiums that are often lower than other companies’ Silver plans.

I have sent Nancy summaries for Meritus Silver and Bronze PPO plans.  I did not send her the Meritus Gold PPO plan because it is significantly more expensive than the Health Net Gold PPO plan.

I did not send Nancy the Health Net Silver PPO plan because it has no co-pays for any services. The deductible is $1,500 and Nancy would pay the full bill for her medical care until she meets that deductible. If she’s going to go Silver, she should go with Meritus.

Now it’s up to Nancy to choose between the three plans I sent her.  With her $290 subsidy, she would pay $233 for a Meritus Bronze PPO plan; $278 for the Meritus Silver PPO plan; or $302 for the Health Net Gold PPO plan.

We will go over the plan summaries so Nancy fully understands all the details. She will then go to her account on Healthcare.gov and enroll in a plan.

The entire process is a health insurance puzzle and the pieces are the networks, plan benefits, and premiums.  Each client is a new puzzle and each one is an interesting challenge.

I recall that people (and politicians) who promoted Obamacare said signing up for health insurance would be easy – like going online to make travel reservations.   OMG! Finding the right health insurance plan is sooo much more complicated than that!

 

What Next?

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