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Tuesday, December 23, 2014

Best of 2014: Rate Review, Network Adequacy, and High-Deductible Health Plans

Lydia Mitts

Associate Director of Affordability Initiatives

We asked our policy experts to share their picks for 2014’s must-read—or, in some cases, must-see—articles, reports, videos, and more. See more “best of” lists from our teams working on health system transformation and enrollment.

The Private Insurance team at Families USA focuses on making sure that health plans are affordable and can meet enrollees’ needs. We advocate for reasonable insurance premiums and cost-sharing requirements, benefits that cover the care people need, adequate provider networks, and other consumer protections to ensure that the private health insurance market works for consumers. With that lens, these are our must-read picks for 2014. 

Cheryl’s picks: Promoting health insurance literacy and advocacy for fair health insurance premiums

The items that impressed me the most in 2014 also happened to be some of the most practical for health care advocates—and will be just as essential in the coming year as enrollment continues and debates  resume over premium rates.  The Kaiser Family Foundation is doing a great job producing health insurance literacy resources to improve consumers’ understanding of how health insurance works. Their series of Health Reform FAQs make it is easy for navigators, assisters, and consumers to find answers to common questions about enrolling in coverage and how premium tax credits work.

Every spring, when health insurers propose their premium rates for the coming year, advocates and consumers should weigh in. Public comment on whether proposed health insurance premium rates are reasonable and affordable can help to influence which rates regulators approve—and can save consumers a lot of money. Some states provide a rigorous review of proposed rates. Consumers Union provides excellent resources describing state review processes. Also worth reading is their plain English guide to rate review for non-actuaries

Claire’s picks: Great reporting documenting the need to improve health plan provider directories and networks

Throughout the year reporting highlighted the importance of consumer access to accurate information about the providers in an insurer’s network and also of timely access to appropriate care. Some of these stories—like this one from The New York Times—were mind-blowing. They showed what happens when consumers pick an in-network hospital, but face egregious medical bills because they unknowingly get care from out-of-network providers. 

Others, including this Los Angeles Times article about California and this report from the Mental Health Association of New Jersey, illustrate the urgent need to improve health plan provider directories. Fortunately, as we described in our November issue brief, there are steps that health plans, states, and the federal government can take to address these problems and make high-quality care available to health plan enrollees in a timely manner. 

Lydia’s picks: Personalizing the problems consumers face with high-deductible health plans 

In 2014, many reports shed light on consumers’ opinions about and experience with high-deductible plans. The Commonwealth Fund Survey, “Too-High a Price: Out-of-Pocket Health Care Costs in the U.S,” showed that, while millions more are gaining insurance, high deductibles are still coming between many consumers getting the care they need. The New York Times article, “Unable to Meet the Deductible or the Doctor,” gave life to this report’s findings—sharing real stories from consumers who have to make the hard decision to delay care due to the cost of their deductible. And this recent Time magazine article shows that even young adults are wary of high deductibles and would actually prefer more comprehensive coverage, dispelling the myth that this demographic is only interested in the cheapest monthly premium. The good news is that health plans and state and federal governments have the power to tackle this problem and make sure that, even in health plans with high deductibles, consumers face more affordable costs for basic care. 

Cheryl, Claire, and Lydia’s 2014 Picks

  1. Kaiser Family Foundation: Marketplace Health Insurance FAQs
  2. Consumers Union: Rate Review Resources
  3. The New York Times: “After Surgery, Surprise $117,000 Medical Bill from Doctor He Didn’t Know
  4. Los Angeles Times: “Top Insurers Overstated Doctor Networks, California Regulators Charge” 
  5. Mental Health Association of New Jersey: Managed Care Network Adequacy Report
  6. The Commonwealth Fund Survey: “Too-High a Price: Out-of-Pocket Health Care Costs in the U.S” 
  7. The New York Times article: “Unable to Meet the Deductible or the Doctor
  8. Time: “Why Millennials Hate Their Least Expensive Health Care Option
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