Best health insurance
37,481 readers show you how to make the right choice
With health-care reform on center stage in Washington, one of the main questions in the debate is whether the health insurance that consumers currently have will suffer.
Guess what? Consumers might not love their insurance that much to begin with.
Only 64 percent of readers in our survey said they were very or completely satisfied with their plan, a lukewarm response that's a slight drop from the 67 percent in our 2007 report. In terms of services we rate, that puts satisfaction with health insurance above satisfaction with cable TV, a perennial whipping post, but below pharmacies and real-estate agents.
The findings from the Consumer Reports National Research Center were based on responses from 37,481 subscribers reporting on their experiences over the course of a year. The numbers do not represent the experience of the population as a whole, but they do provide a good benchmark for the two kinds of managed-care plans the respondents used, health maintenance organizations (HMOs) and preferred provider organizations (PPOs). In fact, 84 percent of our survey respondents were in an employer-based plan, which they could keep under most health-reform proposals now before Congress.
Our survey suggests that, reform or not, some of them might welcome a change. Eighteen percent of our respondents complained that they had trouble getting to see a plan doctor at some point during the year. And among users of some lower-rated plans, as many as 16 percent complained that it was either difficult or impossible to get needed care.
The real news this year is that choosing an HMO over a PPO seems like a smarter choice than in the past. HMOs have usually been better on costs in the past, and that was true in our survey. Those in HMOs paid less for premiums than people in PPOs ($1,466 compared with $2,003) and less out of pocket for medical bills. HMOs scored better than PPOs on billing and telephone customer service. In the past, HMO members who were seriously ill had more trouble getting access to care, but this time there was little difference between HMOs and PPOs, in part because the PPO experience got worse. Of HMO members who were ill, 15 percent had problems getting care, compared with 14 percent of PPO members.
Slightly more HMO members reported having to wait a long time to get appointments, but PPO members were a bit more likely to spend lots of time catching up on reading in their doctor's waiting room.
Health-care costs continued to shoot up for respondents in both plan types. They reported that their median annual out-of-pocket cost for premiums rose to $1,829, up about $500, or 38 percent, from two years earlier. That's just a fraction of the total cost of individual health-insurance coverage, with the rest usually paid by the employer.
The HMO price advantage was evident in other areas: Among PPO members who reported being seriously ill, 69 percent paid $1,000 or more of their medical bills; only 47 percent of seriously ill people spent that much if they were in an HMO.
People in PPOs had more trouble with their bills. Eleven percent said they were repeatedly sent statements they were not obligated to pay, compared with only 6 percent of HMO members. Sixteen percent complained that their plan took a month or more to reimburse them for bills they'd paid; only 5 percent of HMO members had to wait that long. Sixty-two percent had to call a plan rep to check up on a bill or claim, versus only 27 percent of HMO members.
Dealing with bills was the most problematic for people who needed their plan the most. Overall, 24 percent of people in PPOs had a billing problem, but that jumped to 33 percent among people who were ill. Only 11 percent of HMO members found dealing with bills a pain. But if they reported being seriously ill, that number rose to 14 percent.
