By Michael McLafferty, CPA, MBA, FACHE, FHFMA, FACMPE
A number of insurers sell their plans under names like Select, Preferred, Premier, Exclusive, Enhanced, Essential, Essential Plus, Prime, Ultimate and Deluxe. Multiple offerings from one company may have the same benefits and cover the same share of a consumer’s costs, but go by different names.
Sometimes the names assigned to a plan can be misleading. For example, a plan named “exclusive” can be interpreted by the consumer to mean the plan has comprehensive coverage with major access to medical providers. However, on most exchanges a plan described as “exclusive” typically means the consumer has a “limited” choice of doctors or hospitals.
America’s Health Insurance Plans, a trade group, said that companies did not sell their plans based on one or two-word names. Insurers display online detailed information about their benefits, premiums, deductibles and copayments data that consumers need to make a decision.
Health care providers should provide counsel to their patients regarding their insurance coverage. This service can best be provided at the time of enrollment to avoid any misunderstandings of financial responsibility. Health insurance is complicated even for consumers who have had it for years. Many consumers seeking coverage under the Affordable Care Act (ACA) have not had insurance, and for them, the choices can be particularly challenging.
The ACA helps consumers compare health plans by classifying them in four categories, from least to most generous: bronze, silver, gold and platinum. In some markets, however, consumers have dozens of choices in the same category.