Health Plan Quality
V. Key Health Policy Issues >> M. Quality/Satisfaction>> Quality Improvement >> Health Plan Quality (last updated 8.31.15)
Topic Outline
Analysis
- See Medicare + Choice Conditions of Participation, Professional Rights, and Patient Protection under Health Insurance Regulation
- PPOs: New Accreditation Standards Released By URAC
- NCQA: External Appeals Debut in New Standards
- Quality Compass Web Site
- Breast Cancer: Detection Treatment Better in HMO’s?
- Audit of the Medicare HEDIS Data (provided by IPRO)
- New Quality Index from PacifiCare Health Systems
Health Plan Comparison Tools
- Affordable Care Act Exchanges.
- Healthcare.gov. Health Insurance Plans and Prices. This is the site for the federal Exchange used in more than 30 states. It allows users to enter Zip code and county of residence to obtain a listing of plans by net premium (after qualified tax credits based on household income), annual deductible and maximum out-of-pocket cost. Users can drill down for plan details regarding coverage, copayments etc.
- Marketplace Health Plan Comparison Tool 2015 – Illinois. This award-winning website, created as a free public service, was designed to help Illinois consumers choose health plans from the federal marketplace that best meet their needs and preferences. Unlike the Healthcare.gov site, it provides an estimate of predicted out-of-pocket costs based on family characteristics, which allows for more meaningful rank-ordering of plans by costs, as well as the same details regarding plan coverage.
- Federal Employees. The Guide to Health Plans for Federal Employees & Annuitants takes users through a few simple steps to find the best health plan for themselves and family. Find every plan available to you ranked by estimated out-of-pocket costs, quality metrics and more. The guide is available in print and on-line form.
- Medicare.gov Medicare Plan Finder. Medicare expert Walton Francis suggests using this site as follows: “Enter your data into that tool (best to use it unofficially to compare plans and experiment with it, saying you are already 65). You can skip entering your drugs, or not, as you choose, but if any of them are expensive I would go to that trouble because the tool will take your drugs into account in its comparisons). The tool will provide an actuarial comparison that compares both premium and out of pocket costs for all your options at your zip code. If you clicked the right options, you can see both Medicare Advantage (MA) and Medigap plans, all compared to each other and to original Medicare, including your Part D drug plan, listed cheapest total costs to you first.” He further adds the following insights:
- You will find that MA plans are the best buys. They all have good catastrophic protection for everything except drugs (you need a Part D plan for that, and should sign up for one). A few of them charge you no extra premium and even pay your Part D premium, but Affordable Care Act cuts to MA have all but eliminated those super buys. Almost all of them limit you to the plan network.
- The Medigap plans give you de facto catastrophic protection for everything except drugs, and give you coverage without regard to network, but are pretty costly since you have to pay their hefty premiums on top of the Parts B and D premiums.
- The actuarial part of the calculation is fairly primitive by the standards of the tools the Center for the Study of Services and I create for federal employees and on some of the ACA exchanges, but good enough to get you to the right ballpark.
Rankings
- Best Health Insurance Plans (U.S. News and World Report)
- Health Insurance Plan Rankings. NCQA’s annual Health Insurance Plan Rankings rates both Accredited and non-Accredited health plans by quality and performance metrics.