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Monday, November 3, 2014

Asking the Right Questions Helps Consumers Choose the Right Plan

Jessica Kendall

Director of State Partnerships

We all know that if you ask the wrong questions, you’ll get the wrong answers. And nowhere is this more important than in the health insurance marketplace, as consumers make decisions about which health plan to buy or renew.

As the second open enrollment period in the health insurance marketplace approaches, navigators and assisters can encourage consumers to follow the advice of our popular infographic: Stop, shop, and enroll. And in order to help consumers do this well, there are critical questions that navigators and assisters can ask to help consumers make an informed choice that reflects their unique priorities when choosing a health plan. Today’s blog covers the most important questions that navigators need to ask consumers in order to help them choose the plan that’s right for them. (See our related infographic “7 Questions to Ask When Buying or Renewing Health Insurance in the Marketplace.")

Here are the top questions assisters can ask uninsured consumers and those renewing their health coverage.

The top 5 questions assisters should ask consumers who are renewing their coverage

In this open enrollment period, consumers currently enrolled in marketplace plans will be auto-renewed in most states (their current marketplace plan and their 2014 tax credit amount will be automatically continued for 2015). However, it is important that consumers understand that their current plan may change significantly in 2015—it may have a different monthly premium, different providers in network, or different deductibles or copayment amounts for some services. 

Moreover, there may be different plans available in the marketplace than there were last year. In many states, consumers will have more choices. While automatically renewing is the easier option, consumers may find that the plan they chose last year may not be the best one for them in 2015. Consumers might be able to save money when choosing a new health plan that offers similar health care benefits and coverage. 

Assisters can help consumers by encouraging them to research plan options to compare price, network, etc. As consumers do this, they should bear in mind what health care services they used in 2014 and how much they spent on those services. 

When engaging consumers already enrolled in marketplace plans, navigators should ask consumers:

  1. Which providers are in the plan’s network? If the consumer currently has a primary care provider, or needs to see a particular specialist, is that provider still in-network?
  2. Does the cost-sharing still fit the consumer’s budget? 
  3. Have the premiums changed? 
  4. Are consumers able to get a plan that’s better for them, and get more financial help paying for it?
  5. Has the deductible changed?
    • Will the plan start paying claims for each family member once the consumer reaches the individual deductible?
    • Or does the entire family need to meet a family deductible?

We’ve created a checklist of questions for enrollment assisters to use to make sure to ask the right questions of the consumers they are helping to enroll. Here are the top questions assisters can ask uninsured consumers and those renewing their health coverage. 

The 7 most important questions navigators and assisters need to ask uninsured consumers to help them choose the right health plan 

Concerns about the affordability of health insurance loom large for the consumers who remain uninsured. Naturally, questions about cost will be important to helping these consumers sign up. However, it’s important to help them think through which aspect of cost is most important: out-of-pocket costs, monthly premiums, or medication coverage, to name a few. The questions below should help you focus your conversations with consumers. 

  1. What matters most to the consumer?
    Is it affordability; being able to see a certain provider; having access a nearby pharmacy, hospital, or urgent care center; or prescription coverage?
  2. How important is monthly cost?
    Navigators should assess the premiums and how much financial assistance a consumer would receive for the plan. The plan that offers the best price may have changed from last year. Also, don’t stop at the premiums; consider the other costs consumers will face when getting care. 
  3. What costs may consumers face in deductibles, copayments, and co-insurance when getting care?
    The metal levels (gold, silver, bronze), refer to the percentage of costs the plan will cover for the average consumer, and give a rough idea of how much of the cost consumers should expect to bear for their annual healthcare costs. But there can still be significant differences between plan costs within each metal level and it’s important for consumers to consider how much they are willing to spend out of pocket every year, in addition to their monthly premium. Consumers want to be sure, for example, that they can pay for doctor visits until they’ve met the plan’s deductible. 

    Tip: For more details on the services covered, look at the summary of benefits and coverage for examples. Ask consumers how much they spent on health care in 2014.
  4. Does the plan cover the consumer’s medications and if so, what are the copays? 
  5. How many times per year will the plan pay for specific services a consumer needs?
    Some plans limit the number of physical therapy or speech therapy visits that they cover per year, for example. Likewise, if there are certain services that a consumer uses, check to see whether there are any limits to the plan’s coverage of those services.
  6. What level of out of pocket expenses must a consumer pay before the plan begins paying for health care services? 
  7. Are consumers getting the care they need? Look at the plan’s provider network to make sure
    • If there are particular providers the consumer would like to visit, are they in-network?
    • What type of plan is it? Is it an HMO, PPO, EPO, or POS plan? 
    • Will the consumer need to get a referral from a primary care provider to see specialists?
    • Will the plan pay anything if out-of-network services are used?

For more details on questions to ask consumers while they are selecting a health plan, read our fact sheet. When working with consumers who have disabilities, this guide from the National Disability Navigator Resource Collaborative can help. AHIP has also written a guide that helps consumers learn more about health plan networks

Consumers and enrollment assisters in federally facilitated marketplaces can find information about the plans sold in the marketplace by simply clicking on the name of the plan. All health plans must provide an easy-to-read summary of their benefits and coverage that looks like this. It shows what a consumer would pay and what the plan would cover, for various services. Consumers and enrollment assisters can find links to these plan summaries on the marketplace for each state.

Remember, in order for consumers to get the plan that meets their needs, they need to stop, shop, and enroll into the plan that’s right for them this open enrollment. For a reminder of this, check out our new infographic, “7 Questions to Ask When Buying or Renewing Health Insurance in the Marketplace.”

Families USA Private Insurance Program Director Cheryl Fish-Parcham contributed to this blog. 

Asking the Right Questions Helps Consumers Choose the Right Plan | Families USA


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