How much time should you devote to choosing a health insurance plan? A survey by Aflac found that about a quarter of Americans spend five minutes or less on this important decision. That may be because 90% of employees simply stick with what they've got, choosing the same plan as they had last year. That can be a mistake, as your employer’s offerings may have changed, as could the plans themselves. There might be a better choice for you in the offing.
Here we use Aetna and Cigna PPO plans offered by employers as examples. The details even for these companies will vary among employers. But the tips for comparing the plans will help you make your own decisions, whether it's among plans offered by your company or among policies offered on the individual market through healthcare.gov's Affordable Care Act's Health Insurance Marketplace/Exchange.
Survey Your Options
The first step is to take a look at your choices. You’re likely to have a number of plans to choose among. For example, employees of the federal government who live in New York have a mind-bending 25 plans to choose from. And in many areas of the country, the choices are plentiful at healthcare.gov. In either case, it pays to check every year to see if there’s a newly available or expanded plan available to you.
Consider the Company
Aetna and Cigna, which we are comparing here, both insure a very large number of people and rank among the top 10 for sheer size. While a large health insurance company is not necessarily better, it’s likely that a large one will have a good number of doctors to choose from in your provider network, and that you will also be able to find people you know who have had local experience with the plans you’re being offered.
One distinction is that Aetna is a U.S.-focused company, offering medical insurance through employers and on the individual market. Cigna is a global provider of health insurance for employers in 29 countries. If you work abroad or travel a lot, you'll find that Cigna has a number of international medical Insurance policies.
Check How Plans Rank in Your State
Rankings of health insurance plans according to consumer satisfaction and other factors have become easy to access and use. The nonprofit National Committee for Quality Assurance (NCQA) creates detailed quality rankings each year of PPOs and HMOs available in every state.
If your choice is between Aetna and Cigna PPOs, the rankings for 2018-2019 reveal that both insurance companies are well regarded by consumers overall. Their scores on a scale of one to five are identical in Pennsylvania, at 3.5. But in Vermont, the Cigna plan gets a 3.5 in consumer satisfaction while Aetna gets only a 3.0. You can dig deeper on each, using the compare tool to focus in on plans you’re considering and see how consumers rate them on such matters as getting care quickly and quality of primary-care doctors. In Vermont, Aetna rates highly on getting care quickly but falls short on quality of primary-care doctors. Cigna also rates highly on getting care quickly and rates a bit better on quality of primary-care doctors.
Consider What's Important to Your Family
The details in the rankings may be important. If you're planning on adding to your family, check the ratings for the company's prenatal and postpartum care. If someone in your family has asthma, check the plan's rating for asthma control and asthma drug management.
If you have doctors you like, you’ll want to check with their offices before switching insurance plans. Many doctors and hospitals take multiple plans, so this may not be a problem. If you’re looking for a new doctor, don’t just pick at random from the insurer’s book of practitioners. Ask around. Colleagues, neighbors and healthcare professionals can give you useful reviews of doctors in your area. It may take some time to gather a list of doctors and winnow it down, but once you do you can call their practices to ask about the insurance plans they accept.
Asking around is a good idea when considering a plan, too. Ask others about their experience with physicians who accept the plan, how out-of-pocket costs mount up and whether they’ve had problems filing claims or having services denied. These factors can vary by locale, so a colleague who lives in your area will be best informed.
One more tip: If your routine care involves tests or consultations with specialists, make sure that everyone involved in your care takes your insurance plan. Using in-network doctors and services will keep your costs down.
The Bottom Line
Both objective sources such as insurance plan rankings and subjective ones like the first-hand experience of colleagues are useful for choosing a plan. Rankings tell you how a plan rates with large numbers of its customers, but valuable information also can be found among your colleagues, friends and health professionals who have had experience with a particular plan that’s among your choices.