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Survey: As health plans prepare for increasing enrollments, many members consider using HIXes

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WESTLAKE VILLAGE, Calif.: 11 March 2013 — The introduction of health insurance exchanges is generating interest among health plan members who purchase insurance directly, as well as those who have high deductibles and/or lower levels of overall satisfaction, according to the J.D. Power and Associates 2013 Member Health Plan StudySM released today.

Now in its seventh year, the study measures satisfaction among members of 136 health plans in 17 regions throughout the United States by examining seven key factors: coverage and benefits; provider choice; information and communication; claims Key Findings

• A majority (59%) of health plan members say that they had only one health plan available to select at the time of enrollment.

• Slightly more than one-half (51%) of all members say that their premium cost has increased during the past year.

• Interest in exchanges is highest among health plan members in small companies (53%), followed by those in medium (48%) and large (43%) companies. processing; statements; customer service; and approval process. In 2013, overall member satisfaction averages 701 (on a 1,000-point scale), compared with 702 in 2012.

Nearly three-fourths (73%) of members who purchase insurance on their own instead of through their employer say they “definitely will” or “probably will” shop for coverage using a state exchange, if available. The new insurance purchasing method intends to make it easier for members to access insurance and, ideally, at more competitive rates. The desire to reduce costs may also attract all types of members to the concept of exchange purchasing. A higher percentage of members in high-deductible health plans indicate they are interested in using exchanges, compared with those in low-deductible plans (59% vs. 45%, respectively). Service quality may also play a role in shaping demand, as members with the highest levels of interest in using exchanges are those who have contacted their health plan regarding a problem during the past year (60%), compared with those who have not had a problem with their health plan (45%).

“As healthcare costs continue to increase and members pay a higher percentage of the premium, health plan members are increasingly aware of exactly what they are getting for their premium,” said Rick Millard, senior director of the healthcare practice at J.D. Power and Associates. “If a member has experienced problems and perceives the possibility of having more control over costs through exchanges, this new purchasing method may become more appealing.”

Overall, 48 percent of health plan members (combining both group and individual markets) indicate they are interested in using a state exchange, if it were available to them. Among members with group coverage, interest in state exchanges is more prevalent when their employer has not offered a choice of health plans. Members who have a choice of health insurance brands are less interested in exchanges (36%) than do those who have no choice (50%).

“Income-eligible members with high out-of-pocket costs and less tenure with a health plan are most likely to try exchanges,” said Millard. “The exchange also appeals to those working at small companies who want to take more direct control over their healthcare expenses.”

Satisfaction is highest among health plan members in the Michigan, Texas and East South Central regions, and is lowest among those in the Mountain and Colorado regions.

Health plans ranking highest in their respective regions (in alphabetical order) are Anthem Health Plans of New Hampshire; AvMed Health Plans; Blue Cross and Blue Shield of Alabama; Blue Cross and Blue Shield of Illinois; Blue Cross and Blue Shield of Kansas City; Blue Cross and Blue Shield of Texas; Geisinger Health Plan; Health Alliance Plan (HAP) of Michigan; HealthPartners; Independent Health Association; Kaiser Foundation Health Plan (which ranks highest in the California, Colorado, South-Atlantic and Mid-Atlantic regions); PacificSource Health Plans; SelectHealth; and UnitedHealthcare.

J.D. Power offers the following tips to health plan members and consumers who are shopping for health insurance coverage:

When shopping for a health insurance plan, consider the cost-to-benefit ratio. Generally speaking, the higher the cost, the higher the number of plan features and healthcare provider flexibility. Conversely, while lower-cost plans may provide lower premiums, they may also provide fewer choices of plan features or healthcare providers.

If you purchase coverage on your own, research state-sponsored health insurance exchanges to learn how they work, and particularly how your state’s exchange will be offered. Beginning later this year, you may qualify for state exchanges if your income is within a certain range or if you work for a small company, which may mean the possibility of more choices of coverage at a lower cost.

While some states are implementing exchange ratings programs based on health plan quality (e.g., did the doctor order the right tests), be sure to review J.D. Power and Associates health plan rankings, which are based on member satisfaction, to see how your plan compares in the rankings.

Understand your coverage. Health insurance plans are sometimes difficult to understand, with complex rules for deductibles, co-payments and other expenses. If you don’t have a clear understanding of the coverage and you have a choice of plans, opt for the simpler approach. For example, you may be more satisfied with fewer choices of healthcare providers in order to have coverage with less complicated costs.

The 2013 Member Health Plan Study is based on responses from more than 33,000 members of 136 commercial health plans across 17 regions in the United States. The study was fielded in December 2012 and January 2013. For more comprehensive health plan rankings for all 17 U.S. regions, visit www.jdpower.com.


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