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When Comparing Health Insurance, Look at Total Costs

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"It's counterintuitive," he says.

Insurers anticipate that people with high medical costs will gravitate toward platinum and, to a lesser extent, gold plans, and they're pricing those plans accordingly, say experts.

If only one member of a family has high medical expenses, families may want to consider splitting coverage between different plans.

"Many insurers are expecting that savvy families will enroll a sick family member in a platinum plan and the rest in lower level plans," says Tolbert.

Depending on where people live, that strategy could run into snags. Although splitting family coverage is allowed on the individual market, state and federal officials say the Department of Health and Human Services is considering whether to limit the practice on the exchanges it will run in 34 states next year, as are some states setting up their own exchanges.

In addition, platinum plans may not be available in every state. For example, none of the seven insurers that have been approved to sell plans on the Washington State Health Benefit Exchange will offer platinum plans next year, says spokeswoman Bethany Frey.

A platinum plan may not be the best option in any case, even for people with expensive medical conditions. Although premium tax credits are available for any type of plan, cost-sharing subsidies that can substantially reduce deductibles, copayments and coinsurance are only available on silver plans.

"If you qualify for cost-sharing reductions, you'll have lower out-of-pocket costs for doctor visits," among other things, says Carrie McLean, director of customer care at ehealthinsurance.com, an online vendor. "Add those things up and see what would happen if you were to forgo that [subsidy] and get the platinum plan."

In addition to how much the plan costs overall, people with serious medical conditions need to carefully review whether the drugs they take are on the plan formulary, and the specialists and facilities they visit regularly are in the plan's network, say experts, as well as their out-of-pocket costs to go out of the network.

"People need to do an honest assessment of their needs, and determine what's on their 'must have' list," says Kirsten Sloan, senior director of policy at the American Cancer Society’s Cancer Action Network.

Please send comments or ideas for future topics for the Insuring Your Health column to .

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Mon, Dec 19 2011

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