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Advocates, providers: Look beyond price when choosing health plan

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Choosing insurance options under the Affordable Care Act based on lowest premiums could wind up costing consumers more in the end through out-of-pocket costs and not being able to see their preferred doctors, advocates and providers say.

“To some individuals, it could be like the cost of another mortgage payment, another car payment,” said Alicia Nunez, president of Chicanos Po La Causa Insurance Inc. “We try to explain (the plans) to them, but they mostly focus on the dollars.”

Consumers should also consider copays, prescription costs and specialist care, said Diane Brown, executive director of the Arizona Public Interest Resource Group.

“A lot of people are very focused on what they’re going to pay each month but should also be looking at other costs they may be incurring now or incurring in the immediate future, particularly for young adults and other Arizonans who will be receiving health insurance for the first time,” she said.

The federal government set the sign-up deadline as March 31 for health insurance exchange purchasers. Anyone who hasn’t purchased health insurance by that date will be charged a penalty of 1 percent of annual household income or a $95 flat rate, whichever is higher, according to healthcare.gov.

The U.S. Department of Health and Human Services announced Tuesday that the deadline would be extended for anyone who has started the process before the March 31 deadline, citing concerns about turning away those who are trying to get coverage. Through February, 4.2 million people had signed up for health insurance available under the Affordable Care Act, according to HHS.

“People want to pick a plan that protects them and their families and fits their budgets,” said Herb Schultz, HHS regional director. “All plans cover a core set of services such as prescription drugs and hospital care, and regardless of a person’s health he or she can’t be denied coverage.”

Phoenix Children’s Hospital is working to educate its patients on selecting the right plans for their needs, including making sure the hospital’s doctors are within the allowed network, said Bob Campbell, the hospital’s chief strategy officer.

“Last year, nearly 2,000 patients were transferred from other hospitals to PCH for a higher level of care,” Campbell said. “In some of those cases, they arrive here and find out they’re not within their plan.”

Patients can then choose to go to an in-network provider or pay for the medical services at PCH out of pocket, Campbell said.

“In most cases, there’s a description of the plan to understand who’s contracted in the exchange product that they’re looking at, a directory of physicians,” he said. “It’s important that they’re able to research that ahead of time.”

Arizona purchasers have more than 100 plan options for health care coverage through healthcare.gov. That keeps competition high and prices lower, according to Dr. Daniel Derksen, director of University of Arizona’s Center for Rural Health.

Derksen said he understands why people are just choosing the cheapest premiums.

“It’s a little bewildering the first time you go through,” he said. “That familiarity and getting used to it will happen over time. This is the first time, so it’s not surprising that people are having trouble. It’s more complicated, there’s more options … it adds a degree of difficulty for people to get used to.”

Health care navigators are stationed throughout the state to help consumers decide which plan is best for them, and they’re not allowed to sway purchasers toward any particular plans, said Joe Fu, director of health policy for Children’s Action Alliance.

“We would recommend against asking the providers themselves because most often they’re too busy to know which plans they’re on,” Fu said.

As for Chicanos Por La Causa, Nunez said her team sees the people who come through the doors just want to make sure they’re not going to be getting penalties or breaking the law.

“They want to be in good standing with the federal government, they know it’s the law,” she said. “I think a lot are just getting an insurance plan to follow the law and be in good standing.”

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Key terms

From healthcare.gov

Deductible

The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible.

Copay

A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.

Premium

The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

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