Topics:Buying health insurance health care Open Enrollment health insurance guides Health and wellness Medicare research
Last week, a special enrollment period for health insurance was announced for states that use HealthCare.gov as their health insurance marketplace. Some states that do not use HealthCare.gov have decided to open their own marketplaces, too. HealthCare.gov will be open for enrollment February 15, 2021 through August 15, 2021. (The enrollment period was recently extended.) Plans purchased during this period will likely be effective starting the month after you make a selection. During this enrollment period, you can enroll in a Marketplace health plan or change to a different Marketplace health plan. (States opening their own enrollment periods may have different dates and possible actions.) You can enroll or make changes three ways: Online through HealthCare.gov Over the phone with the Marketplace call center Through direct enrollment channels (e.g. working with a licensed insurance agent certified by the Marketplace) Louise Norris Health Insurance Expert Expert Tip People should seek out help if they feel unsure of the process. It's important to find a navigator, enrollment counselor, or broker who is certified by the exchange. In HealthCare.gov states, people can use this tool to find local help; the state-run exchanges have similar tools. Typically, you can only enroll in health insurance during the annual open enrollment period (November 1 through December 15). To enroll at any other time, you have to qualify for a Special Enrollment Period by experiencing a Qualifying Life Event. This recently announced special enrollment period offers a valuable opportunity to ensure that you have the health coverage you need. Tips for navigating the special enrollment period If you missed open enrollment, here's your chance to enroll in the coverage you need. Having health insurance can bring peace of mind at any time. However, the peace of mind a health plan offers is only heightened during a pandemic. As you evaluate health plans, pay attention to cost and coverage. Cost Health plan costs include the monthly premiums and out-of-pocket expenses. First, let's talk about premiums. These expenses need to fit your monthly budget so you can maintain your coverage. Subsidies on premiums are available with Marketplace plans. These subsidies are based on your income. When you apply for coverage through the Marketplace, you'll be able to check your eligibility for subsidies. Using these subsidies can make buying a health plan more affordable. With the economic uncertainty and significant changes people are experiencing, anticipated income can be harder to estimate as you determine whether or not you'll qualify for a subsidy. Norris notes how job loss and stimulus checks have posed some difficulty when estimating income: "It's important to understand that unemployment benefits, including the extra federal benefits that were provided last year and again in the bill that was enacted in December, are counted as income when subsidy eligibility is determined." In addition to ensuring that the monthly premium fits your regular budget, consider the plan's out-of-pocket costs. Health plans have an annual deductible that must be met before the insurer begins taking more responsibility for costs. Health plans also have an annual out-of-pocket maximum. This maximum is usually higher than the annual deductible. If you reach your out-of-pocket maximum, the health insurer will take responsibility for covered health care services. As you consider the deductible and out-of-pocket limits, look at the amounts for copays and percentages for coinsurance. These costs are usually paid at the time of service, so they're important to keep in mind. Depending on your health needs, it can make sense to pay a higher premium for better cost-sharing and lower out-of-pocket costs. Coverage Most health plans available offer coverage per Affordable Care Act requirements. Coverage includes mental health services, hospitalizations, preventive care, maternal care, newborn care, prescriptions, and more. However, short-term and indemnity health insurance plans do not offer the same level of coverage. These plans often cover significantly fewer health services and don't cover pre-existing conditions. As you navigate this enrollment period, make sure you're looking at health plans offering full coverage. "It's also important to avoid scammy websites and sales entities that might try to piggyback on this special enrollment period in order to sell short-term plans, fixed indemnity plans, etc. People should start at HealthCare.gov, on the "get coverage" page. When they select their state, it will either keep them on HealthCare.gov or direct them to their state's marketplace, whichever is applicable. That way they'll know for sure that they're shopping in the official marketplace for their state," recommends Norris. As you consider health plans, understand the coverage offered and pay attention to costs to help you find a plan that meets your needs. Implications of the special enrollment period The special enrollment period will affect health insurers and uninsured or underinsured Americans. Health insurance industry Lesa Votovich, GBA Health and Benefits Vice President for Cowden Associates, Inc. observes that health insurers have responded positively to the special enrollment period: "I would say it is welcomed mostly due to the fact that leaving individuals uncovered in general is not good for our society as a whole. It is important for individuals to have access to coverage and to obtain the care that they need. The delay in care often leads to more adverse, higher cost medical events for individuals." Better health insurance coverage within a population can result in better health outcomes, reduce the necessity for expensive care, and protect people financially. During this special enrollment period, many Americans will be able to enroll in a health plan, which also helps insurers manage risk. "From a business perspective in insurance the law of large numbers applies, i.e., the more people you have insured, the more revenue you have to offset the expense and to level premiums against thus keeping insurance premiums in check," continues Votovich. In other words, more people enrolling in health insurance helps to keep premium rates reasonable. Of course, the number of people insured isn't the only thing that affects premium rates, but it does play a role. How much this special enrollment period will affect health insurers depends on how people respond: "Overall, I think the true impact on the health insurance industry will be determined based on how the numbers increase and the actual level of risk that exists within those that do enroll," says Votovich. Uninsured and underinsured Americans According to Kaiser Family Foundation research, having health insurance plays a key role in health care access in the United States. This special enrollment period can help many Americans overcome a major health care access barrier by getting needed coverage. Yet, simply having health insurance may not always translate to health care access for everyone. While acknowledging the importance of having health insurance, Nicole Rochester, MD and founder of Your GPS Doc, LLC also underscores how problems with the health care system affect health care access: "There are many structural barriers that prevent marginalized communities (even those with insurance) from accessing appropriate health care and those barriers will also need to be addressed. Getting health insurance is a first and necessary step, and I’m hopeful that we will see additional improvements moving forward." Taking advantage of this special enrollment period? Here are helpful resources to help you assess health plans and health insurance carriers: 4 Things to Look For in a Health Plan [Video] Aetna vs. Cigna vs. Kaiser Permanente 2021 Review 66% of BlueCross BlueShield Reviews Are 4 or 5 Stars Best Health Insurance Companies: What 2020's Customer Reviews Reveal [Video] Top Health Insurers According to Customer Reviews
2020 brought the importance of health insurance and health care access into sharp relief as we followed implications of the COVID-19 pandemic. It also heightened the importance of the customer experience in client retention as companies adjusted operations along COVID-19 guidelines. Regardless of industry, customer reviews play an important role in understanding what clients want. We analyzed health insurance customer reviews received in 2020 to understand more about what matters to health insurance plan members. Key Takeaway: Health insurers can improve the customer experience in 2021 by focusing on the areas listed below. Customer service Coverage options Provider networks Claims processing Affordability 2020 Customer Review Breakdown Best Company received 905 total reviews for the health insurance industry in 2020, slightly below 2019's 1066 total reviews. (Read the full 2019 report.) Here's how 2020's review star ratings came out: 44 percent 5-star (compared to 28 percent in 2019) 21 percent 4-star (compared to 18 percent in 2019) 6 percent 3-star (compared to 8 percent in 2019) 5 percent 2-star (compared to 5 percent in 2019) 24 percent 1-star (compared to 41 percent in 2019) The biggest difference between 2019 and 2020 reviews is the increase in 5-star reviews and the decrease in 1-star reviews. This change in review data makes the health insurance industry more hopeful than last year: 65 percent 4-star and 5-star reviews in 2020 versus 46 percent 4-star and 5-star reviews in 2019. These differences in review percentages may indicate that health insurers are doing a better job when providing services. However, we only have two years of similar analyses. Until we have more data, whether health insurers responded to 2019's complaints is uncertain. It's also unlikely considering the more pressing issues of responding to COVID-19. 5-star review analysis Since the largest proportion of 2020's reviews are 5 stars, we dug deeper to understand what plan members value about their experience: 47 percent mentioned good customer service 28 percent discussed coverage satisfaction 20 percent talked about provider networks positively 15 percent mentioned positive user experience with the insurer's platforms 14 percent of reviewers were happy with claims 14 percent of reviewers discussed cost satisfaction 7 percent of reviewers mentioned affordable out-of-pocket costs (counted separately from general cost satisfaction) Interestingly, 9 percent of 5-star reviewers mentioned being on a health plan through an employer. Customer service When you have a question or need to resolve something with a company, good customer service makes a big difference. Our data analysis found that praise for customer service included short wait times, quick response times, and knowledgeable representatives. Health insurers can continue to deliver high quality customer service by focusing on these aspects. Coverage You buy health insurance for the coverage, so good coverage is important. With health insurance, it's key to balance cost and coverage. Health insurers can make it easier to find good coverage that fits your price point by offering a variety of health plans. In customer reviews, reviewers liked having a variety of coverage options. Adjectives describing coverage also included "excellent" and "great." Customer Review: Nathan from Broomfield, Colorado "I have always been impressed with the quality and quantity of coverage I have gotten from Blue Cross Blue Shield. They have helped me get through some very trying times and pay for my medication!" Provider network The third most frequent praise was about provider networks. Reviewers mentioned either their plan's wide acceptance or praised the quality of their care providers and facilities. Finding a doctor you trust that provides good care matters. Large provider networks make it easier to find a good in-network, which helps you keep your out-of-pocket costs down. Platforms Reviewers also appreciated how easy their insurer's platforms were to use. These included the company's website, online member portal for tracking claims, tools for finding providers, and the mobile app. Customer Review: Rahim Sabadia from Yorba Linda, California "Excellent overall care. Very responsive and their online platform and tools make it very easy to keep track of appointments, lab results and communications with health care providers." Telemedicine is also included in this category because it can be accessed through platforms connected with an insurer. Platform interfaces and ease-of-use mattered even more in 2020 as we did more things remotely. Cost The cost satisfaction category included general statements about cost and affordability. In some reviews, it seems like these references were about monthly premiums. However, some reviewers may combine premiums and out-of-pocket costs when commenting on cost generally. Seven percent of reviewers specifically mentioned satisfaction with out-of-pocket costs. These were counted separately. Claims Claims satisfaction was just as common as cost satisfaction in 2020 5-star reviews. Reviewers mention never experiencing a denial or timely processing and payouts. Customer Review: Patti Miller "I had BC&BS for 27 years through my work place. Never had a claim denied. Not alot of time past before payments were made. Customer service was always available to answer questions." 2019's complaints and 2020's praises It's not hard to imagine that 1-star reviewers and 5-star reviewers have very different experiences with a company and an industry. Considering 2019's high number of complaints alongside 2020's high number of praises reveals a helpful parallel. 2019 Complaints Poor customer service (42 percent) Coverage difficulty or denial (32 percent) Claims process or payment difficulty (23 percent) Provider network concerns (22 percent) Cost vs value of plan (21 percent) 2020 Praises Good customer service (47 percent) Satisfaction with coverage levels and options (28 percent) Happy with provider networks (20 percent) Smooth claims processing (14 percent) Affordable cost (14 percent) Top complaints in 2019 strike similar notes as 2020's top praises. This congruity highlights the importance of each of these factors to the overall customer experience. Health insurers should pay attention to these areas as they train employees and serve plan members. Methodology These results are based on a total of 905 health insurance reviews left on Best Company in 2020. Of those reviews, 401 had 5-star ratings. A random sample of 163 5-star reviews is the basis for the praise analysis. Results of the 5-star review analysis have a 90 percent confidence level with a 5 percent margin of error.
2020 has affected our daily lives in profound ways. Job loss affected access to health insurance and health care in the middle of a pandemic. Health insurance changes may also be on the horizon because the Supreme Court starts hearing a case on the Affordable Care Act in November. A decision is anticipated in 2021. COVID-19 and potential changes to health insurance laws make this year's Open Enrollment period more important than ever. Employers are also feeling pressure from COVID-19's fallout, which may affect the health insurance options they offer employees. Whether you're buying health insurance on your own or through your employer, shopping for and enrolling in health insurance for 2021 has more significance than past years. A recent study from Unum found that 64 percent of workers plan to pay more attention and spend more time reviewing their benefits and 36 percent plan to enroll in different benefits. While there is no data on these questions to compare with previous years, these numbers do show that workers are making adjustments and planning to increase time understanding their workplace benefits. As we enter the Open Enrollment period, here's what you should know as you select health insurance plans. COVID-19 pandemic We're all too familiar with stories of COVID-19 patients needing care in the ICU, and that level of medical care can add up quickly. The U.S. legislative responses to COVID-19 provided resources to cover COVID-19 care for uninsured individuals. Although those resources make a difference, buying health insurance can offer valuable financial protection, peace of mind, and help you access medical care when you need it. Fortunately, there's good news if you're buying your own insurance. "Because the marketplaces are strong and healthy, we’ve seen an increase in the number of insurers participating and an increase in the number of options being offered. Regardless of the pandemic, high-quality, affordable and comprehensive coverage remains available," says Joshua Peck, cofounder of Get America Covered. The risks of going without health insurance are starker this year than they were last year. Insurance premiums aren't cheap, but it's worth making adjustments to your budget and exploring subsidies available to fit it in. Peck continues, "It’s always risky to be without coverage. No one knows when they’ll have an emergency or develop a serious health problem. Last Open Enrollment, no one deciding whether to get covered or not could’ve anticipated this pandemic. It’s abundantly clear that this pandemic is not temporary. It’s not going away any time soon, and no one understands the long-term health implications of even mild cases of COVID-19. Everyone deserves to enjoy the peace of mind offered by health coverage — especially amidst this potentially devastating illness." If you receive insurance through an employer group plan, you may see some changes. These will vary by employer, so it's difficult to make generalizations at this point. Peter Nieves, Chief Commercial Officer and benefits management expert with WINFertility, provides wise insight for employees who want to maximize their benefits: "Employers may shift costs to employees through higher deductibles and coinsurance or only offer a high deductible plan. Employees should consider optimal use of FSA, HSA or HRA accounts and, if not enrolled in an HDHP, consider the lower monthly cost of the offer. If an Employee will have a greater cost share burden in 2021 for care, then be sure to not delay treatment, surgery or testing and take thoughtful action in 2020." Although changes are possible, Lesa Votovich, Vice President of Health and Benefits at Cowden Associates, Inc., notes that employers are working to avoid making changes: "In the group marketplace, it has been my experience thus far that employers are trying to make as few changes as necessary, recognizing the impact that the pandemic has had on their employees this year. They definitely are not looking to add more insult to injury wherever possible." Supreme Court case The Supreme Court will start hearing arguments for California vs. Texas in November. This case calls the Affordable Care Act's (ACA) "individual mandate," requiring everyone to purchase health insurance, into question. The Court's ruling could upend the health insurance landscape we've become accustomed to if the ACA is overturned. The ACA protected people with pre-existing conditions from being denied coverage or charged higher premiums on policies. It allowed children to stay on their parents' health plan until age 26. It expanded Medicaid and instituted income-based subsidies on Marketplace monthly premiums that made buying a good health insurance plan more affordable. Insurers used to have annual and lifetime benefit maximums that shifted excess costs on policyholders and limited the benefits available to people with chronic conditions. "It’s difficult to predict how the Supreme Court will rule and thus hard to predict how it will impact people enrolled in health plans. But no decision is likely until June of 2021, so anyone who needs coverage now should check out their options, enroll, and know that their coverage is secure," advises Peck. Although there is uncertainty, it's important to consider the potential fallout if the ACA is overturned by the Supreme Court. Votovich paints a bleak picture of the effects that ruling could have: "Should the Supreme Court decide to strike down the ACA, more than 20 million people will lose their health care coverage. These are individuals who obtain their health care policy through a federal marketplace plan. Those covered by employer-sponsored health care coverage will likely still remain covered by that plan. Currently, as we are in the midst of the pandemic, continued racial disparities in coverage and the heightened likelihood of a potential financial crisis, the impact of individuals losing coverage would be devastating." Anticipate how the Supreme Court ruling to uphold or overturn the ACA would affect you. Make sure you get the coverage you need for 2021 during Open Enrollment. Votovich shares this advice: "Understand the coverage that you are purchasing. If you are uncertain and have questions about the options available to you, seek out an agent who can assist you in navigating the plans. Assess the typical services that you receive in a year and disclose them to the agent you may work with so that they can provide you with options that may best meet your needs. Most importantly, don’t let your coverage lapse. If the Supreme Court does strike down the ACA, you want to make sure that you have continuous health coverage so that you may avoid being limited by pre-existing condition policy limitations in the future. If history holds true, if one does have coverage for a continuous period without a 60-day lapse, then pre-existing conditions will not likely apply." We have time before the Supreme Court issues a ruling. If the Court overturns the ACA, some of the changes will be immediate. Others will take more time. "Once the ruling is made there will likely be a noted transition period. For example, if the Court rules next June there may be a period of six months to a year for insurers to decide how they will react to the ruling and formulate what their individual market will look like on a go forward basis," says Votovich. Managing through uncertainty One of the challenges of 2020 has been confronting uncertainty and dealing with the unexpected. We've confronted realities in new ways and adapted to new circumstances. Enrolling in a health plan during Open Enrollment can help you be prepared for uncertainty in 2021, whether it's unexpected medical expenses or transitioning to an unfamiliar health insurance landscape. Use the checklist below to help you navigate this year's Open Enrollment period.
Updated October 26, 2020 2020 Open Enrollment is just around the corner. With health care concerns from the pandemic and increased health care access concerns resulting from shutdown layoffs, health insurance's role in removing barriers to health care access is much clearer. Since health insurance companies can change their offerings and even your current plan, you should shop around each year to make sure that you have health insurance that fits your budget and meets your needs. For helpful information on choosing a health plan, read "4 Things to Look For in a Health Plan [Video]". In addition to finding a good health plan, it's important to choose a trusted and reliable insurer. To help you identify the best health insurance companies to work with, we'll review what this year's customer reviews say about nine companies. While Best Company lists more than nine health insurance companies, only these had a worthwhile number of reviews to analyze. These nine are listed from most 2020 reviews to fewest 2020 reviews. (In other words, we're the most confident about our findings for BlueCross BlueShield because there were more reviews. We're the least confident about our findings for Molina Healthcare because there were fewer reviews to analyze.) BlueCross BlueShield UnitedHealthcare Oscar Kaiser Permanente SelectHealth Ambetter Cigna Aetna Molina Healthcare 1. BlueCross BlueShield Best Company Rank: #12020 Best Company User Rating: 4.10/52020 Review Breakdown: 54% 5-Star 24% 4-Star 7% 3-Star 7% 2-Star 8% 1-Star 2020 Reviews by State: 12% from Utah 8% from Texas 7% from Mississippi 6% from California 6% from Florida 2020 Most Common Complaint: Cost (10%)2020 Most Common Praise: Customer Service (30%) Coverage dissatisfaction (8%) and concerns with red tape (6%) both followed cost dissatisfaction. Praise was much more common in BlueCross BlueSheild's 2020 reviews than complaints were. Other common praise included coverage satisfaction (22%), cost satisfaction (21%), general satisfaction (17%), network satisfaction (17%), and claims satisfaction (15%). Note: Qualitative analysis based on a random sample of 114 out of 194 reviews left on Best Company for BlueCross BlueShield as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 reviews by state, 2020 geography breakdown) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Vantresa Scott from Annapolis, Maryland "I've been with BCBS for most of my life. They have been great. I started when I was 26 years old and I am now 57. Their physician network is terrific and plans are great and I have never had a problem with them covering my expenses. NEVER EVER. I started my own company 5 years ago and we only offer BCBS plans because of the exceptional quality. Their national and international coverage is top notch." Our Advice With 78 percent of this year's reviews hitting 4 or 5 stars, BlueCross BlueShield is a great company to work with. Before enrolling in a plan, be sure you understand what's covered and what requires prior authorization. Having this understanding will help you be prepared for prior authorization and can prevent coverage concerns. While the most common concern was cost (10%), 21 percent of reviews were happy with the cost. As you look at plans consider whether the monthly premiums fit into your budget and do your best to estimate what your out-of-pocket costs may be next year. After evaluating BlueCross BlueShield plans, you can be confident in your insurance company choice since reviewers had more positive comments regarding customer service, provider network, coverage, and claims than negative ones. Keep in mind that BlueCross BlueShield is a national company and works through many subsidiaries. For more specific information on the BlueCross BlueShield subsidiary in your area, look for reviews for it by name. Subsidiaries include Regence, Anthem, Florida Blue, Independence BlueCross, and others. BlueCross BlueShield Health Insurance Learn more about BlueCross BlueShield by reading customer reviews and our expert analysis. Learn More Back to Company List 2. UnitedHealthcare Best Company Rank: #62020 Best Company User Rating: 3.61/52020 Review Breakdown: 51% 5-Star 16% 4-Star 2% 3-Star 7% 2-Star 25% 1-Star 2020 Reviews by State: 15% from Utah 10% from Florida 7% from California 7% from Texas 5% from Arizona 4% from New York 2020 Most Common Complaint: Customer Service (21%)2020 Most Common Praise: Customer Service (25%) The two other most common complaints were about claims (14%) and coverage (14%). Network satisfaction (14%) and general satisfaction (12%) followed praise for customer serivce. Note: Qualitative analysis based on a random sample of 85 out of 122 reviews left on Best Company for UnitedHealthcare as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Dorothy from Omaha, Nebraska "I have been a UnitedHealthcare customer for 2 years and highly recommend this reputable company. I was enrolled in their student health insurance plan and the plan's details were easy to understand, the plan was accepted at all of my providers, and customer service was always helpful!" Our Advice Based on this year's customer reviews, it's harder to give a clear recommendation of UnitedHealthcare. It's promising that a majority of its reviews (67%) are 4 or 5 stars. However, 25 percent of this year's reviews are 1 star. It's also concerning that reviewers offered more specific complaints than praise. As with most health insurance companies, your coverage, network, and cost vary depending on the plan you choose. Health plan offerings can also vary by location. Because of this variation, you need to review any health plan you consider carefully to ensure it covers the medical services you need. You also need to ensure that the monthly premiums fit your budget and that the health plan will help you control your out-of-pocket expenses. Since a majority of UnitedHealthcare members reported a good experience this year, UnitedHealthcare is worth considering. However, carefully review the coverage offered in each plan you consider before you enroll. You'll want to avoid issues with claims and coverage. Double-checking that the services you need are covered will increase the odds that you'll have a good experience with UnitedHealthcare. UnitedHealthcare Health Insurance Learn more about UnitedHealthcare by reading customer reviews and our expert analysis. Learn More Back to Company List 3. Oscar Best Company Rank: #32020 Best Company User Rating: 3.54/52020 Review Breakdown: 42% 5-Star 22% 4-Star 7% 3-Star 6% 2-Star 23% 1-Star 2020 Reviews by State: 33% from Texas 22% from California 12% from Florida 12% from New York 2020 Most Common Complaint: Provider Network (21%)2020 Most Common Praise: Customer Service (41%) Poor customer service was the next most common complaint at 16 percent. Praise was more common in Oscar reviews and included satisfaction with the app (20%), satisfaction with perks and incentives (18%), general satisfaction (14%), network satisfaction (14%), and cost satisfaction (14%). Note: Qualitative analysis based on a random sample of 56 out of 69 reviews left on Best Company for Oscar as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Brock Williams from Los Angeles, California "Oscar has been the best health insurance company I've ever had. I've been self-employed my entire adult life, so I've paid for my own health insurance and I've had a lot of different policies with different companies, in multiple states. Oscar has been the most affordable, easiest to navigate and best coverage I've ever had." Our Advice While 64 percent of Oscar's reviews are 4 or 5 stars, 23 percent are 1 star. As you consider Oscar health plans, pay attention to the provider network in your area. Make sure that the doctors you need are reasonably close. Fortunately, Oscar reviewers had more positive things to say than negative ones. If you're looking for a good app, nice perks and incentives, and good cost, Oscar is worth investigating further. Again, be sure to review each plan's network, coverage, and cost to ensure that you find an affordable health plan that meets your needs. Oscar Health Insurance Learn more about Oscar by reading customer reviews and our expert analysis. Learn More Back to Company List 4. Kaiser Permanente Best Company Rank: #42020 Best Company User Rating: 3.97/52020 Review Breakdown: 57% 5-Star 15% 4-Star 10% 3-Star 3% 2-Star 15% 1-Star 2020 Reviews by State: 41% from California 15% from Utah 7% from Colorado 7% from Georgia 5% from Oregon 2020 Most Common Complaint: Doctors and Staff (17%)2020 Most Common Praise: Doctors and Staff (42%) Other complaints included issues with member services or red tape (13%) and concerns that Kaiser Permanente was expensive (10%). Other common praise included general satisfaction (17%) and convenience (12%). Note: Qualitative analysis based on a random sample of 52 out of 61 reviews left on Best Company for Kaiser Permanente as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Luna from Rockville, Maryland "The doctors and nurses there are very nice. They have clean and high technology equipment. I think it worth the money." Our Advice A majority of Kaiser Permanete's reviews this year were 4 or 5 stars (72%), it still received a fair number of 1-star reviews (15%). Considering other years, Kthe proportion of 5-star and 1-star reviews are similar. It's tricky to make a clear recommendation. Kaiser Permanente stands out from other health insures because it employes doctors and runs hospitals instead of negotiating and contracting with doctors and hospitals to build a provider network. When you enroll in a Kaiser Permanente plan, you'll be limited to its doctors, clinics, and hospitals. Since both the most common complaint and most common praise this year were about Kaiser Permanete's doctors, you'll want to know how many Kaiser Permanente facilities and doctors are in your area and how good they are to gauge how well a Kaiser Permanente plan might work for you. You'll also want to pay attention to how your plan's coverage works and whether any services require prior authorization. Doing so will help you use your health plan better and be prepared for the prior authorization process. Kaiser Permanente Health Insurance Learn more about Kaiser Permanente by reading customer reviews and our expert analysis. Learn More Back to Company List 5. SelectHealth Best Company Rank: #22020 Best Company User Rating: 4.41/52020 Review Breakdown: 57% 5-Star 33% 4-Star 6% 3-Star 2% 2-Star 2% 1-Star 2020 Reviews by State: 78% from Utah 8% from Minnesota 4% from California 2020 Most Common Complaint: Cost (8%)2020 Most Common Praise: Customer Service and General Satisfaction (tied at 35%) Praise was far more frequent in SelectHealth reviews than complaints. Other common praise included provider network satisfaction (29%), coverage satisfaction (27%), and clarity regarding coverage (12%). Note: Qualitative and quantitative analysis based on 51 reviews left on Bes tCompany for SelectHealth as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Aidan Keogh from Ogden, Utah "We have like Select Health Insurance. The coverage is great and the number of available facilities and providers is large. They are quick to pay out benefits and to inform us what they plan on paying." Our Advice SelectHealth offers health plans in Utah and Idaho. With 90 percent of this year's reviews earning 4 or 5 stars, SelectHealth is a recommended health insurer. Even though SelectHealth received only 51 customer reviews on Best Company this year, it has consistently received a high proportion of 4 and 5 star reviews. Based on this year's reviews, you're likely to find good customer service, good provider networks, coverage, and be generally satisfied. While 2020 SelectHealth's reviews were full of general satisfaction and praise, cost was the most common complaint. You'll want to review your health plan's costs before enrolling. Your costs include monthly premiums and out-of-pocket expenses. Review the copays or coinsurance for the health services you think you'll need next year. Since most of this year's reviews come from Utah, it's difficult to say whether SelectHealth is as good in Idaho as it is in Utah. If you're in Idaho, review SelectHealth plans for the provider network, coverage, and cost. Compare these three aspects to plans offered by other insurers in your area to see which best meet your coverage and financial needs. SelectHealth Health Insurance Learn more about SelectHealth by reading customer reviews and our expert analysis. Learn More Back to Company List 6. Ambetter Best Company Rank: #72020 Best Company User Rating: 1.98/52020 Review Breakdown: 18% 5-Star 7% 4-Star 2% 3-Star 2% 2-Star 71% 1-Star 2020 Reviews by State: 31% from Texas 14% from Georgia 11% from Arizona 11% from Florida 2020 Most Common Complaint: Coverage (36%)2020 Most Common Praise: Customer Service (13%) Complaints were quite common in Ambetter's reviews. Other common complaints included network dissatisfaction (27%), claims issues (24%), and poor customer service (24%). Note: Qualitative and quantitative analysis based on 45 reviews left on Best Company for Ambetter as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Our Advice Even though Ambetter received only 45 reviews this year, 71 percent of them are 1 star. Ambetter has also consistently earned a high proportion of 1-star reviews on Best Company, which means that Ambetter is not a recommended insurance company. If you don't have another option in your area, ask questions about the provider network, the claims process, and be sure to throughoughly understand what coverage your plan offers. Learn more about Ambetter by reading customer reviews and our expert analysis. Back to Company List 7. Cigna Best Company Rank: #52020 Best Company User Rating: 3.33/52020 Review Breakdown: 36% 5-Star 15% 4-Star 18% 3-Star 8% 2-Star 23% 1-Star 2020 Reviews by State: 27% from Utah 13% from Texas 2020 Most Common Complaint: Coverage (18%)2020 Most Common Praise: Customer Service (21%) Other complaints included network dissatisfaction (15%), cost dissatisfaction (10%), and claims dissatisfaction (10%). Praise also included coverage satisfaction (15%) and claims satisfaction (13%). Note: Qualitative and quantitative analysis based on 39 reviews left on Best Company for Cigna as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Kevin Liu from Sandy, Utah "Cigna has good coverage options for my primary care doctors. Their web ports is very transparent and easy to use to find physicians and see what I’ve paid towards my deductible." Our Advice A clear recommendation is also difficult to make for Cigna. The insurer only received 39 reviews this year. While 51 percent of these reviews are 4-stars or 5-stars, a good chunk (23%) were 1 star. Considering all of the reviews left on Best Company regardless of year, Cigna has received a majority of 1-star reviews (40%). 4-star and 5-star reviews account for 43 percent of Cigna's overall reviews, 20 percent and 23 percent respectively. While it's promising that Cigna received a lower proportion of negative reviews in 2020, be careful as you look at plans from this company. Pay attention to the coverage offered, provider network, and cost to be sure you find a plan that meets your needs. Learn more about Cigna by reading customer reviews and our expert analysis. Back to Company List 8. Aetna Best Company Rank: #82020 Best Company User Rating: 3.53/52020 Review Breakdown: 41% 5-Star 22% 4-Star 6% 3-Star 6% 2-Star 24% 1-Star 2020 Reviews by State: 15% from Florida 15% from Utah 12% from California 2020 Most Common Complaint: Claims and Customer Service (tied at 18%)2020 Most Common Praise: Coverage (35%) Complaints were less common. Other complaints included network dissatisfaction (6%) and general dissatisfaction (6%). Praise also included good customer service (21%), cost satisfaction (18%), network satisfaction (18%), and plan choice (18%). Note: Qualitative and quantitative analysis based on 34 reviews left on Best Company for Aetna as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Phil Carriere from Cambridge, Iowa "Looked at several other plans from various other companies , but felt like the Aetna plan was best for my wife and I. Low cost,covered everything we needed covered, and includes a dental rebate program. When i needed an answer to a question they have always been there for me and are always concerned about improving my well being." Our Advice Although Aetna received 63 percent 4-star and 5-star reviews this year, it also received a good chunck of 1-star reviews (24%). If you opt for Aetna, be prepared for potential issues with claims and customer service. Keep in mind that Aetna doesn't offer individual and family plans. It offers Medicare and Medicaid. If you qualify for those plans and find one that meets your needs, Aetna can be a good option. Learn more about Aetna by reading customer reviews and our expert analysis. For specific information about Medicare, read Aetna's Medicare profile. Back to Company List 9. Molina Healthcare Best Company Rank: #152020 Best Company User Rating: 3.56/52020 Review Breakdown: 4% 5-star 13% 4-star 8% 3 star 0% 2-star 75% 1-star 2020 Reviews by State: 17% from Utah 17% from Washington 13% from South Carolina 13% from Texas 8% from Wisconsin 2020 Most Common Complaint: Coverage (38%)2020 Most Common Praise: General Satisfaction (8%) Other common complaints included poor customer service (33%), dissatisfaction with network (33%), issues with red tape (25%), and premium or billing difficulties (21%). Note: Qualitative and quantitative analysis based on 24 reviews left on Best Company for Molina Healthcare as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Our Advice Since the number of reviews is so small and this year's reviews are almost half of the reviews on Best Company for Molina Healthcare, it's hard to make a certain recommendation. It's concerning that 75 percent of this year's Molina Healthcare's reviews were 1 star while only 17 percent were 4 or 5 stars. If you're considering Molina Healthcare, call your current doctors — and even doctors you may need to visit — to ask if they accept Molina Healthcare insurance plans. You'll also want to carefully review the coverage Molina's plans offer so that you know how to use your plan and how to approach prior authorization when needed. You should also review your plan's costs, including the premium, deductible, copays, coinsurance, and out-of-pocket maximum. Keep an eye out for billing issues as well. Learn more about Molina Healthcare by reading customer reviews and our expert analysis. Back to Company List
BlueCross BlueShield has earned the top spot in health insurance on Best Company. It has earned a 3.6 user star rating, and 66 percent of its reviews are 4 or 5 stars. If these numbers seem just average or a little low, consider that 41 percent of health insurance reviews were 1-star in 2019. Since complaints are common for the health insurance industry, what look like average ratings are actually quite good. BlueCross BlueShield has also earned a 5.35 out of 10 net promoter score. This score indicates how likely reviewers are to recommend the company to a friend. A score of 5.35 may seem low, but the average for the health insurance industry is 4.14 out of 10. BlueCross BlueShield's net promoter score is above average. So, what is BlueCross BlueShield doing right? I looked at 4- and 5- star reviews to find out. The most significant areas of success were customer service, coverage, and reliability and quality. Customer service The most commonly mentioned positive experience with BlueCross BlueShield was customer service. Roughly 44 percent of reviews had praise for BlueCross BlueShield's customer service. Customer Review: Linda Hill "The best part of Blue Cross is their customer service. They are very patient and willing to take the time to explain your benefits." Customers appreciate BlueCross BlueShield's commitment to clarity and making sure they understand their benefits and claims. Customer Review: Thomas Hullinger from Pleasant Grove, Utah "BlueCross BlueShield has made it easy for me to take care of my health and the health of my family. They give you the information up front to make an informed decision and help you every step of the way. Top notch care from top notch doctors and nurses." Clarity isn't the only thing that BlueCross BlueShield customer service gets right. Members also appreciate how responsive BlueCross BlueShield is when they have questions or concerns. Customer Review: AJ and Maria Ferguson from Riverton, Utah "We have had BlueCross Blue Shield for many years. They have always been great in paying claims quickly. Their customer service has always been quick to respond and find the answers to my questions or help empower me with knowledge that I have needed when there has been a discrepancy with a provider." Another satisfied BlueCross BlueShield member was impressed by the care shown by company representatives. Customer Review: Brandy Rudy from West Jordan, Utah "I have had BlueCross BlueShield insurance coverage off and on since I was in college. The coverage and customer service remain impeccable and I highly recommend them. They send monthly updates on my coverage along with my usage and any concerns. They are truly concerned with me and my family receiving the best medical available." If you purchase a health plan from BlueCross BlueShield, these reviews show that you can expect clarity, caring, and quick responses from customer service. These traits of BlueCross BlueShield customer service are especially important because health insurance is where your health and finances meet. Coverage Positive reviews also frequently mentioned satisfaction with coverage offered by the plans. You're buying health insurance for coverage, so knowing that BlueCross BlueShield members are happy with coverage is reassuring. Roughly 36 percent of 4- and 5-star reviews mentioned satisfaction with coverage. Coverage and provider network satisfaction were often mentioned together. Roughly 19 percent of reviewers were satisfied with the network coverage. Customer Review: Jake from American Fork, Utah "Our favorite insurance we have had is Blue Cross Blue Shield. Their coverage of different things was very good. We also really liked their network of doctors and hospitals and urgent care facilities. It was very nice to know that they had such a wide range of coverage that was covered in network." Covered services and network size are both important because you don't want to buy a health plan from an insurer that doesn't have a good selection of providers in your area. If your area has many providers that accept your plan, it's easier to save money on care. Reliability and quality BlueCross BlueShield's general reliability and quality were mentioned by about 33 percent of reviews. Customer Review: Jerry and Janette Jack "Overall, they are excellent. I have had them on/off since the 1980's and they have improved vastly in that time." Improvement over the years shows that BlueCross BlueShield is committed to offering its plan members top notch services and plans. General reliability Health challenges are stressful enough without the added stress of an unreliable health plan or difficulties with insurance. Customer Review: Teagan Hickman from Salt Lake City, Utah "We have always had reliable insurance with bcbs they process their claims quickly" Knowing that reliability is one of BlueCross BlueShield's strengths offers peace of mind. General quality Quality is challenging to pin down because it encompasses many aspects of a health insurance company. Quality shows up in coverage, customer service, and more, but it can be articulated in vague terms. While these statements of how much people like having BlueCross BlueShield don't offer much in terms of specifics, they are indicators of general satisfaction. Other positive traits Customer service, coverage, and reliability and quality aren't the only things BlueCross BlueShield is getting right. These other aspects were not as commonly mentioned in reviews, but are still worth highlighting. Reviewers on Best Company were happy with the cost (17 percent), claims and paperwork (15 percent), value (9 percent), plan options (3 percent), and plan perks, meaning health incentive programs like Blue365®, (1 percent). Cost and value Generally, 4- and 5-star reviewers thought the rates were fair and were happy with the service and coverage they received in exchange. It's challenging to find an affordable health plan that offers the coverage you need. When customers mention reasonable rates and are happy with out-of-pocket costs, that's good news. Steven Davis also recognized the value offered by BlueCross BlueShield, even if the rates were a little higher. Customer Review: Steven Davis from Maineville, Ohio "Retired federal employee this is the best I have ever delt with and have delt with many. You get what you pay for, excemptional customer service and year-end tax info returns. Hospitals and Doctors love this insurance because of the service they provide (just ask, I did), no questions. Have never had a collections issue or billing. Customer oriented company. I will pay more for better service and thatâ€™s what I get." If you can afford to pay a little higher costs, the value and service offered by BlueCross BlueShield is worth it. Claims and paperwork Claims processing and getting the paperwork right are important for you and your doctors. Doctors need to be paid for their work, and you need to understand how your plan covered those costs and what you owe your provider. Plan options and perks If you're looking for an insurer, it's essential that it offers a health plan that meets your coverage and financial needs. You're more likely to find a plan that works for you when your health insurance provider offers a wide selection of options. Many health insurance companies are offering perks and incentives programs to encourage wellness among their members. While these certainly aren't a dealbreaker when choosing an insurance company, these programs are a nice feature and add value. Customer Review: Kristie Pierocich from Long Beach, Mississippi "Weâ€™ve had BCBS federal for many many years and the coverage and incentives are the best around." If you're looking for a health plan with a robust provider network and good value from an insurer that manages its claims and paperwork well and offers clarity, BlueCross BlueShield is an excellent insurance company to work with. Negative experiences Unfortunately, roughly a quarter of customers (26 percent) rating BlueCross BlueShield so highly also mentioned negative aspects and experiences. The most common concerns related to cost, coverage, claims, customer service, and network difficulties. It's important to understand that despite these concerns, these reviewers still gave BlueCross BlueShield high ratings and had good things to say about the company. In other words, even with the occasional difficulty, reviewers were still largely satisfied with their insurance. Cost The most common concern (32 percent) expressed by these customers had to do with cost. Some expressed regret for needing to switch companies because plans became too expensive to keep. Another reviewer felt that it was worth paying higher costs: Customer Review: Richard "Blue Cross has been the best provider I have had for 30+ years. We had switched providers many times, but have always returned Blue Cross. The extra monthly payments have been worth the coverage and services." It's hard to find a good health plan that fits your budget. However, if a BlueCross BlueShield plan does fit into your budget, you can know that you're buying a quality plan. Coverage The second most common concern was coverage (18 percent). Customer Review: Karen Nelson from Alpine, Utah "They occasionally are a hassle for us and don't cover things that we think they should. We have had to write a few letter to them to try to get them to cover different medicines and treatment, but other than that they have been pretty good at taking care of us." Be sure to understand how a plan works and check the Summary of Benefits before enrolling, so you have a better idea what to expect and know what's covered. Claims and customer service Issues with claims and customer service tied for third (16 percent of reviews with negative experiences). No one wants to deal with claims difficulties, but they do happen from time to time. Customers who rated BlueCross BlueShield highly were no exception. Be aware that issues with claims can arise, and be prepared to handle them whether you choose BlueCross BlueShield or another company. Customer service complaints tended to focus on trouble getting ahold of representatives. Provider network Concerns with provider networks were mentioned by 13 percent of reviewers who mentioned negative experiences. If doctors in your area don't accept your plan, it offers limited value, especially if it only covers in-network care. Some reviewers had trouble finding network doctors in their area. Before enrolling in a health plan, check the provider network online to see how big it is and if your current doctor accepts your plan. The most hopeful part of these reviews is that they mention positive responses from the company and the comparative ease of resolving issues and concerns. Methodology Data based on a random sample of 149 out of 241 BlueCross BlueShield's 4- and 5-star reviews from October 2017 to April 2020 on BlueCross BlueShield's profile. Roughly 37 percent of these reviews were from Utah, 11 percent from Arizona, and 22 percent did not have a location. Reviews from other states were between 0 and 5 percent. The confidence level is 95 percent with a 5 percent margin of error. The net promoter score data is based on review data from November 2017 to May 2020. BlueCross BlueShield has many subsidiaries that operate in specific states and regions. Many of these subsidiaries have their own profile on Best Company, like Anthem and Regence. Subsidiary profiles were not part of this analysis. BlueCross BlueShield Frequently Asked Questions How much is BlueCross BlueShield per month? It is difficult to give a good, blanket estimate on health insurance premiums because several factors affect the cost. Premiums for Affordable Care Act (ACA) plans are based on your age, location, and tobacco use. The kind of plan you choose and the number of people enrolled on the plan with you (e.g., spouse, children) also affect your rate. If you want to learn more about BlueCross BlueShield's monthly costs, you'll want to work directly with BlueCross BlueShield to compare coverage, out-of-pocket costs, and monthly premiums on different plans. What does BlueCross BlueSheild cover for dental? BlueCross BlueShield dental insurance coverage varies by dental plan. Some of BlueCross BlueShield's subsidiaries may not offer dental insurance. You'll need to work with the insurer directly to get more information. Learn more by reading BlueCross BlueShield dental insurance reviews. What vaccines are covered by BlueCross BlueShield? You'll need to check specific plans for vaccine coverage information. Many vaccines are considered preventive care, so plans that meet the Affordable Care Act guidelines should cover them. Call a BlueCross BlueShield representative or review your plan's Summary of Benefits and Coverage or the more detailed coverage agreement to understand vaccine coverage specifics. What does BlueCross BlueShield cover? Again, you'll need to check your plan documents or talk to a company representative to learn about what your plan covers. If you're buying an Affordable Care Act (ACA) plan, it will cover the Essential Health Benefits. These include outpatient and emergency care, prescriptions, preventive care, mental health services, and pediatrics. What type of insurance is BlueCross BlueShield? BlueCross BlueShield offers several types of insurance. It offers health insurance (including Medicare Advantage, Medigap, and Prescription Drug Plans), dental insurance, and vision insurance. Availability of specific kinds of insurance, plans, and network structures vary by BlueCross BlueShield subsidiary. How to read a BlueCross BlueShield insurance card? Your insurance card will have information on the kind of plan you have, its network structure, identifying numbers, and helpful phone numbers. The types of phone numbers may vary by plan and region, but possible phone numbers include customer service, pharmacy, and precertification. Your card will have all the information you and your providers need to access information on your health plan including the plan holder's name, member identity number, and its effective date. All the information is clearly labeled, but if you have trouble understanding the information on your card, you can reach out to customer service or check out this guide from BlueCross BlueShield Texas. How do I submit my insurance reimbursement to BlueCross BlueShield? In most cases, your health care provider or pharmacy will submit a claim on your behalf. However, you may need to file a claim yourself. Each BlueCross BlueShield subsidiary may have some variation in their processes. However, you'll have to complete a claims form and submit it within the deadlines. For more information on the process, reach out to customer service or do a quick Google search. How can you manage your Blue Cross coverage online? You can use your BlueCross BlueShield subsidiary's member portal to file a claim, estimate costs, request a member ID card, view Explanations of Benefits for care received, and check your deductible's balance.
Guest Post by Shobin Uralil No employee or employer could have predicted the wide-reaching impact of the COVID-19 pandemic when preparing for open enrollment last fall. Now, to help alleviate benefits costs in 2020, the IRS has taken an unprecedented step with IRS Notice 2020-29 to allow qualifying employees to make mid-year health plan election changes. This opportunity creates much-needed flexibility in a time of uncertainty. But health care needs are unfortunately even more unpredictable than a normal plan year. We will walk you through what your options are and how to think about health plan selection for the rest of this year. What happened? Specifically, the mid-year changes apply to employer-sponsored health coverage and spending accounts (Health Savings Accounts and Flexible Spending Accounts). This applies to all plans that are regulated by a 125 cafeteria plan. Section 125 is part of the IRS Code that allows employees to convert a taxable cash benefit (i.e., salary) into non-taxable benefits. Under a Section 125 Cafeteria Plan, you can elect to pay for qualified benefit premiums before any taxes are deducted from your paychecks for health care premiums, FSAs, and HSAs. Under the new IRS regulations, in 2020, employees are allowed to: Make a new health plan election. Cancel or change an existing health plan election. Continue using previously allocated FSA funds for qualified expenses until December 31, 2020, even if changes are made. This is only relevant if your employer selected the grace period option as part of their FSA plan design. Check with your HR or benefits administrator to confirm. What can you expect? Many of you get a chance to re-evaluate your health care needs and, most importantly, your out-of-pocket costs for the rest of this year. If you or a family member have had a change in your employment type, income, health expenses, or want to review your health care benefits, keep reading. Mid-year plan changes don’t mean that you can expect new health plan offerings at your current company. Instead, it’s an opportunity to change to another plan or pre-tax saving options that you previously did not select during open enrollment. There is one important caveat: employers are allowed to ‘determine the extent to which such election changes are permitted and applied, provided that any permitted election changes are applied on a prospective basis only, and the changes to the plan’s election requirements do not result in failure to comply with the nondiscrimination rules applicable to § 125 cafeteria plans.’ Essentially, these changes are not mandatory. This means that your employer can decide the extent to which plan changes are available. Check with your HR or benefits administrator to determine what changes are eligible at your company and when this special period takes place at your company. What should you do now? Even though this is a ‘mid-year’ open enrollment, it still follows the same key open enrollment parameters. You should select the most cost-effective and personalized health plan option that meets your and your family’s needs. Review your current health plan offering and your ongoing monthly costs. This includes the following: Monthly premiums Out-of-network care Out-of-pocket maximums Deductible amounts (before insurance kicks in) Co-pays and co-insurance Note: All of these costs (or cost scenarios) have one thing in common, they are paid directly by you, not your insurance provider. What is that monthly amount? Did COVID-19 impact your expected monthly costs or your ability to pay for those costs? Compare your current health plan elections to the full offering of your employer’s health care options. Here is a Health Plan Comparison Calculator to help you get started. Take a hard look at the costs outlined above, review receipts if you have any, and do your best to forecast your health care expenses and financial situation for the rest of the year. Change or keep your current health plan elections based on your findings. Select the best health, at the best cost, based on the coverage you need. Don’t overpay for coverage you don’t need! It might be time to consider what your health costs are going toward. If you haven’t considered adding a tax-advantaged savings account, like an FSA or HSA, you are overpaying for health care costs. Use this new review period to reconsider your health care and savings strategy. Take some time to think about what you missed. Health insurance is a direct intersection of your well-being and your personal finance. Many employees unintentionally overpay for bells and whistle coverage they don’t end up using. The right plan is the one that provides the most personalized and affordable health care coverage for you and your family. You get a do-over this year; make the most of it. The catch As with all good things, there is always a catch. In this case, it's related to the 2020 FSA and HSA contribution limits. Normally this would not be a concern unless you change jobs or had a qualifying life event. But with this mid-year change, there are some nuances to consider. If you previously contributed to an FSA in 2020 but decide to now switch to an HSA-eligible health plan, like a High Deductible Health Plan (HDHP), you would expect to be eligible to also contribute to an HSA. However, since you already contributed to an FSA, this disqualifies you from contributing to an HSA in 2020. It will be tough to find guidance around this and other nuanced rules, so check with a financial or tax professional to ensure you remain IRS-compliant. Looking ahead Without knowing what ‘next’ looks like, it is hard to prepare for the future. But with health care, what we do now know is that saving for the long-term, and the unexpected, is more critical than ever. Health care plans expire every year, but marrying an eligible high-deductible health care plan with a pre-tax savings account creates the only long-term health savings and planning option available today. Whether you are looking for short-term savings with an FSA or planning for a long-term safety net with an HSA, you can have savings ready for every ‘just in case’ scenario, at least for health care costs. Shobin Uralil is the co-founder and COO of Lively, a top-rated health savings account provider.
A special enrollment period is running from February 15, 2021 to August 15, 2021 in many states. If you don't have coverage, you can enroll in a health plan. Learn more about this special enrollment period. 54 percent. That's the percentage of Americans who don't know their health insurance options if they were to lose their coverage according to a recent study by HealthInsurance.com. If you're in that 54 percent, read on to learn more about your options for getting the coverage you need to defray health care costs. If you didn't have health insurance through your job and want to have coverage just in case, you'll also learn about health insurance options that may be available to you. In addition to reviewing your health insurance options if you lost employer-sponsored coverage or didn't have any health coverage, I'll also summarize how legislation in response to COVID-19 has affected health care coverage: I had insurance through my former employer. I did not have insurance through my employer. I want to learn about legislation responding to COVID-19 and its effect on medical expenses. I had insurance through my former employer. Normally, you can only enroll in a health coverage during open enrollment. However, a qualifying life event triggers a special enrollment period. Because you lost your health coverage when you lost your job, you qualify for a special enrollment period. This allows you to enroll in a health insurance plan even though it may not be open enrollment. Special enrollment periods end 60 days after the qualifying event. If your spouse has health insurance through their employer, you can work with their human resources department to be added to be added to your spouse's insurance plan during your special enrollment period. You can also choose to extend your former employer's coverage through COBRA, buy private health insurance, or buy an Affordable Care Act plan through the health insurance marketplace. If these plans aren't a good fit, you can explore alternatives. These options include short term health insurance, health care sharing ministries, and government-funded plans. To learn more about these, jump ahead to "I did not have health insurance through my former employer." For more on Special Enrollment Periods, read "[Infographic] 5 Questions to Ask About Special Enrollment Periods". COBRA COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It allows you to continue your employer coverage for 18–36 months. To be eligible for COBRA the following must apply: Your former employer must have had at least 20 employees for more than half of its business days last year. You were terminated, but not for gross misconduct. Or, your hours were reduced. If you're a dependent of someone who lost their job or now has reduced hours, you also qualify for COBRA coverage. Dependents are also eligible for COBRA if the employee becomes eligible for Medicare, in situations of divorce or legal separation, and if the employee passes away. If you choose to enroll in COBRA continuation coverage, you'll take full financial responsibility for participating in the health plan. The employer contributions will become your responsibility. "If someone loses their job because of COVID-19, they should first figure out when their health insurance will run out and what COBRA will cost them. COBRA is typically prohibitively expensive, but may be worthwhile if you have special or extensive health care needs or existing health care relationships you need flexibility to maintain," Deborah Gordon, The Health Care Consumer’s Manifesto author. Your former employer is legally obligated to provide you information on COBRA and enrollment. You typically have 60 days from when you receive the election notice or lose coverage, whichever is later to decide whether to enroll in COBRA. COBRA can also be retroactive, so if you do not enroll and need medical care within the 60-day election period, you can enroll, pay past premiums, and have coverage. You can enroll yourself or your dependents separately in COBRA. Each eligible person must make an election to be covered through COBRA. For more information on COBRA, read the Department of Labor's helpful FAQ. Private insurance Insurers can offer plans that do not meet the Affordable Care Act guidelines. Because these plans don't have to cover everything Affordable Care Act plans do, you may be able to find a plan that offers the insurance coverage you need at a lower price. These plans can have a lot of variability, so you need to carefully review what's covered and what isn't along with the premiums and out-of-pocket costs. Private insurers also offer off-exchange plans that do meet Affordable Care Act guidelines. These plans are not listed on your state's health insurance marketplace and are not eligible for premium-subsidies. However, they still offer comprehensive coverage. Working with an independent insurance agent can help ensure that you find a plan that meets your needs. Affordable Care Act plans If you visit HealthCare.gov, you can view the Affordable Care Act plans (also called Marketplace plans) available in your area. Depending on your financial circumstances, you may be able to qualify for a subsidy on monthly premiums. Marketplace subsidies make the monthly premium more affordable by giving you an advance tax credit. If you took too much or too low of a subsidy, the balance is adjusted when you file your tax return. Affordable Care Act plans do not have exclusions for pre-existing conditions and provide comprehensive coverage for health care services. If you're in good health and are under 30, you may be able to opt for a catastrophic insurance plan. These plans have low premiums and high deductibles. These plans are designed for people who don't have medical concerns and mainly need coverage for emergency situations. Compare Health Insurance Companies Learn more about health insurers and their offerings by looking at the top-rated companies and their customer reviews. Learn More Back to Contents I did not have insurance through my former employer. If you did not have health insurance through your former employer, you'll have to wait for the next open enrollment period to enroll in a typical health plan. However, some states have opened statewide special enrollment periods because of COVID-19 concerns. Do a quick Google search or check this helpful HealthInsurance.org article to see what your state has done. If your state has opened a special enrollment period, review the options in the "I had insurance through my former employer." If not, the options below are still available to you. Short-term health insurance Short-term plans can be bought year-round. These plans offer coverage for doctor visits and emergency room services. In some cases, they may even offer some coverage for prescriptions. These plans are very limited because they do not cover pre-existing conditions. Once your current short-term plan ends, any medical issue that occurred within that time frame is a pre-existing condition when you renew or buy another plan. Some states do not allow short-term plans If you just need some coverage to get you through, a short-term plan can be a great health insurance option. Just be sure to pick the longest term length you need in case any medical issues arise. For expert advice on short-term health insurance, read Short-term Health Insurance: 5 Questions You Should Ask Before You Buy Short-term Health Insurance: What Top Companies Offer Indemnity health plans You can also buy indemnity health plans without needing an enrollment period. These plans offer set benefits for specified health care services. You'll be responsible for paying your health care provider and making claims with the insurance company. "An indemnity plan may pay a maximum of $3,000 per day for a day in the hospital or maybe $5,000 a day, some only pay $300–$400 per day. So you have to really understand how they work. It can be a great value, but education is crucial," says Eric Wilson, Principal of Wilson & Associates. Understand what the fixed payments are for claims and check what services are covered. You'll also want to pay attention to coverage exclusions. Like short term health insurance, indemnity plans typically do not cover pre-existing conditions. Health care sharing ministries Another alternative to health insurance are health insurance ministries. Health care sharing ministries are usually connected to religious groups and expect members to live religious, low-risk lifestyles and be healthy. These are attractive, especially to people in good health, because the monthly premiums are usually lower than health insurance. Laura Handrick, Choosing Therapy contributing HR professional, shares her experience with a health care sharing ministry: "After extensive research, we chose a health share instead of insurance. The costs of these programs run 50–75 percent less than traditional healthcare. For just over $400 per month, we have access to low-cost medications, free telehealth, and affordable medical visits. Catastrophic health issues are covered, often at higher rates than traditional insurance." While these ministries can offer valuable coverage, realize that health care sharing ministries aren't technically insurance. They do not have the same legal obligations as insurers. Do thorough research because covered services vary. For more information on health care sharing ministries, read HealthInsurance.org's health care sharing ministry overview. Government-funded plans The government funds several programs to help specific demographics access health care. Most people become eligible for Medicare when they turn 65. However, there are other eligibility criteria that allow people to qualify sooner with certain diagnoses like End-Stage Renal Disease. Medicaid eligibility is primarily determined by income. In some cases, you may qualify because of disability or significant medical needs. Check your state's Medicaid policies even if you think you won't qualify. Some states have expanded Medicaid to increase access. "Some people may qualify for Medicaid, the public insurance program for lower-income people. In some areas, not as many doctors or health care providers accept Medicaid, but, to cover you in a gap, it may be worth signing up. It is usually free or very low cost if you qualify, and the benefits are mandated and comprehensive," says Gordon. The Children's Health Insurance Plan (CHIP) provides health insurance for children who do not qualify for Medicaid, Medicare, or have other insurance options. If you don't qualify for Medicaid coverage, you may be able to get coverage for your children through this program. Telemedicine subscription services Telemedicine services are not health insurance. However, if an insurance plan isn't an option for you, buying a telemedicine subscription can make it easier and more affordable to receive non-emergency medical diagnoses and medical advice. Telemedicine apps work differently. Some are subscription-based and allow a certain number of virtual visits per month. Others are fee-based and charge a set fee for each virtual visit. As you compare telemedicine services and costs, be sure to check that the application's security is HIPPA-compliant. Telemedicine is especially helpful right now as clinics and hospitals have instituted protocols and restrictions to prevent the spread of COVID-19. Having access to medical professionals through telemedicine can help offer you peace of mind. For more on telemedicine, review: Telemedicine: What You Need to Know What to Expect from Telemedicine Yes, You Can Get Health Care While Social Distancing Compare Health Insurance Companies Learn more about health insurers and their offerings by looking at the top-rated companies and their customer reviews. Learn More Back to Contents I want to learn about legislation responding to COVID-19 and its effect on medical expenses. Several pieces of legislation have been passed in response to COVID-19 including the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Families First Coronavirus Response Act. "A key focus of the CARES Act is the adoption of a variety of measures designed to expedite the approval and availability of drugs and devices needed to fight the pandemic, to shore up the financial positions of hospitals and other healthcare providers facing unprecedented demands, and to temporarily relax restrictions that may make it more difficult for patients to obtain access to needed testing and care," says Roger Milliner, MetroPlus Health Plan Chief Growth Officer. Federal legislation has responded to the many different types of needs created by the current crisis throughout the United States. States have also taken independent action to respond. We'll focus on federal changes specifically related to health care and health insurance. These governmental changes have made accessing telemedicine easier. "The CARES Act expands telemedicine so that healthcare providers and consumers can speak over the telephone, Skype, or Facetime to conduct a medical appointment. Telemedicine allows for diagnosis and a treatment plan to be developed over the phone, and the doctor can order labs or prescriptions as needed. This ease and efficient use of technology is typically a much more cost-effective solution that can help people who are uninsured receive reasonably priced treatment.” says Jan Dubauskas, healthinsurance.com Vice President. The CARES Act also expanded how Health Savings Accounts (HSAs) can be used to include telemedicine, over the counter drugs, and menstrual products. Some insurers also made adjustments to cover telemedicine visits the same way they cover in-person visits on plans that did not include coverage for telemedicine. As far as handling COVID-19 health expenses, the Families First Coronavirus Response Act and the CARES Act have made managing those costs easier for people with and without health insurance. If you do not have health coverage, the Provider Relief Fund will be used to pay eligible hospitals at Medicare rates for treating uninsured COVID-19 patients if they do not do balance billing for all COVID-19 treatment. If you have health insurance, your insurer is required to cover your cost-sharing payment for COVID-19 testing. The Trump administration has also negotiated with well-known health insurers like Cigna and United Health Group to have cost-sharing payments waived for all COVID-19 treatment costs. The CARES Act also incentivizes providers to bill all COVID-19 treatments at in-network rates with payments. "The CARES Act will make payments to certain providers if they agree to treat all COVID-19 patients with a preferred payment schedule as in-network patients, keeping costs down for patients whose coverage is out of network," says Dubauskas. Even with these legislative measures in place, your hospital may not qualify for or seek these incentives. If you get an unexpected bill, ask questions about the CARES Act and what payment options exist. In some cases, it may be helpful to seek a lawyer's advice. "In the worst case, if you don’t qualify for lower-cost insurance and you can’t afford to buy private coverage, you can wind up with a hefty medical bill if you get sick with COVID-19 or otherwise. In that case, negotiate! Ask for a payment plan. Seek forgiveness for the medical debt. No matter what, though, get care if you need it, and sort out the finances when you can," recommends Gordon.
Updated October 27, 2020 Maybe you just finished college and are navigating health insurance for the first time. Maybe you're buying your own coverage as a student. Maybe you just lost your employer-provided health insurance. Whether you just need a health insurance refresher or you are just getting your feet wet, I've collected the best resources the internet has to offer on the following topics: Health insurance and COVID-19 Understanding health insurance Terms to know How health insurance works Medical bills Types of health plans Marketplace (ACA, on-exchange) plans Private insurance (off-exchange) plans HSAs, FSAs, HRAs COBRA Medicaid and CHIP Medicare Student health insurance Catastrophic plans Short term plans Enrolling in health insurance Open enrollment Special enrollment Finding affordable health care FAQs Small businesses owners I'll continue to update and add new resources to this page. If you think there's a resource missing, let me know. Health insurance and COVID-19 updates COVID-19 has changed the everyday life of most Americans. Local, state, and federal governments have made changes to address this crisis. These changes have affected health insurance and health care. How to Get Health Insurance If You're Worried About Coronavirus or Have Lost Your Job — New York Times State and Federal Efforts to Improve Access to COVID-19 Testing, Treatment (notes states with special enrollment periods) — HealthInsurance.org What Will Health Insurance Cover for COVID-19? — eHealth Yes, You Can Get Health Care While Social Distancing — Best Company Telemedicine: What You Need to Know — Best Company Coronavirus Disease (COVID-19) Resources for Older Adults, Family Caregivers and Health Care Providers — The John A. Hartford Foundation CDC Updates and Guidance — Centers for Disease Control and Prevention Back to Menu Understanding health insurance Health insurance has its own language, terms, and definitions. The jargon can make choosing a plan and understanding medical bills difficult. Luckily, many websites have put together resources to explain terms and how insurance works. Terms to know 24 Health Insurance Terms Explained in Plain English — Vice Health Insurance Glossary: Your Guide to Terminology — UPMC Health Beat Cracking the Code: 14 Health Insurance Terms You Should Know — Bedside.org Acronym Exasperation: An Explanation of Common Health Insurance Acronyms — Best Company How health insurance works Health Insurance Explained: The YouToons Have It Covered (video) — Kaiser Family Foundation Health Insurance 101 — The Paper Gown Understanding Health Insurance — MedicalBillingandCoding.org Copay vs Deductible: How Does Insurance Work? — Aeroflow Healthcare Medical bills Understanding Healthcare Reimbursement — Verywell Health Understanding Medical Bills — MedicalBillingandCoding.org Understanding Your Medical Bills — FamilyDoctor.org Paying for Medical Care — USA.gov How to Negotiate a Surprise Medical Bill — AARP How to Appeal a Rejected Claim — WebMD Back to Menu Types of health plans Another reason it's easy to be overwhelmed by health insurance is the many types of plans available. Below are the top resources on health plans created for specific demographics. Plans within the categories listed below can also vary by type of network and cost-sharing structure. Marketplace (ACA, on-exchange) plans Private insurance (off-exchange) plans HSAs, FSAs, HRAs Medicaid and CHIP Medicare Student health insurance Catastrophic plans COBRA Short term plans Back to Menu Marketplace (ACA, on-exchange) plans What You Should Know About the Affordable Care Act — Verywell Health 11 Things to Know About Affordable Care Act Open Enrollment — AARP Back to Types of Health Plans Private insurance (off-exchange) plans Private Plans Outside the Marketplace Outside Open Enrollment — HealthCare.gov How to Find Private Health Insurance — Medical News Today Back to Types of Health Plans HSAs, FSAs, HRAs HSAs (Health Savings Accounts) What Is a Health Savings Account (HSA)? — Dave Ramsey Blog 7 Tips to Choosing the Best HSA Account — Bankrate HSA Basics — Benefit Resource, Inc. 6 Answers to Common HSA Questions — PeopleKeep HSAs: The Secret IRA Nobody Is Talking About — The College Investor Take Advantage of the HSA Loophole — Forbes The Truth About HSAs and Retirement — Betterment 4 HSA Mistakes to Avoid in 2020 — The Motley Fool The Best Ways to Use an HSA — The White Coat Investor FSAs (Flexible Spending Accounts) If You Have Access to an FSA or HSA, Here’s Why You Should Sign Up for One This Year — CNBC What Is a Flexible Spending Account? — Clark.com History of Flexible Spending Accounts (FSAs) — PeopleKeep HRAs (Health Reimbursement Arrangements) Health Reimbursement Arrangements: How an HRA Works — ConnectYourCare Health Reimbursement Arrangements (HRAs) — IRS.gov The Difference Between HRAs and HSAs — PeopleKeep What’s the Difference Between an HSA, FSA, and HRA? — Self.com Back to Types of Health Plans Medicaid and CHIP Medicaid and CHIP Coverage — HealthCare.gov What Everyone Needs to Know About Medicaid — Bankrate How to Apply for Medicaid and CHIP — USA.gov Children's Health Insurance Program (CHIP) — Medicaid.gov CHIP Program Name and Type — Kaiser Family Foundation A Guide to Medicaid: Eligibility, Enrollment and What It Covers — HelpAdvisor Back to Types of Health Plans Medicare What Are the Parts of Medicare? [Infographic] — Best Company Basic Differences Between Medicaid and Medicare — Bankrate Medicare.gov Medicare Benefits — Social Security Administration Medicare Terms and Definitions — The Healthy Most Popular Medigap Plans Won’t Be Available to Some New Enrollees in 2020 — AARP 5 Questions to Ask About Medigap — Best Company Understanding Your Health Care Needs — MedicareMadeClear.com 3 Expensive Misunderstandings of Medicare — Forbes Understanding Medicare's Hospice Benefit — Elder Law Answers Medicare and Mental Health: 4 Key Things to Know — Best Company Back to Types of Health Plans Student health insurance In School? Student Health Plans and Other Options — HealthCare.gov The Student's Guide to Health Insurance — BestColleges.com College Student Guide to Choosing Health Insurance Plans — AffordableCollegesOnline.org Student Health Insurance: Required Reading — HealthInsurance.org An FAQ About Health Insurance for Students — Vice Should I Buy the Health Plan My College Offers? Or Buy Through an ACA Exchange? — HealthInsurance.org Back to Types of Health Plans Catastrophic plans How to Pick a Health Insurance Plan: Catastrophic Health Plans — HealthCare.gov What Is Catastrophic Health Insurance, and Is It Worth It? — The Motley Fool What Is the ACA's Catastrophic Plan and Who Is Eligible? — HealthInsurance.org Back to Types of Health Plans COBRA Continuation of Health Coverage (COBRA) — Department of Labor What Is COBRA Insurance? — Dave Ramsey Do You Still Need COBRA Health Insurance? — HealthInsurance.org Is COBRA Insurance the Best Option for People Between Jobs? — HealthSherpa How to Get COBRA Health Insurance If You Lose Your Job or Retire Early — Business Insider Back to Types of Health Plans Short term plans ACA Open Enrollment: For Consumers Considering Short-Term Policies — Kaiser Family Foundation Is Short-Term Health Insurance Right for You? — HealthInsurance.org What to Know Before You Buy Short-Term Health Insurance — New York Times Warning: Short-Term Health Plans = Higher Premiums for Older Adults — AARP Short Term Health Insurance: 5 Questions You Should Ask Before You Buy — Best Company Short Term Health Insurance: What Top Companies Offer — Best Company Back to Types of Health Plans Back to Menu Enrolling in health insurance To enroll in health insurance, you need to pick a health plan. If you want a health plan that offers comprehensive coverage, you'll also need to understand enrollment periods. Outside of enrollment periods, you cannot buy comprehensive health plans. Health plan evaluation 5 Questions to Ask Before Signing Up for Health Insurance — Best Company 3 Things to Know Before You Pick a Health Insurance Plan — HealthCare.gov 4 Things to Think About When Choosing Your Health Plan — PhRMA Tips for Choosing a Plan — ConnectforHealthCO 10 Helpful Hints for Choosing a Health Insurance Plan — Cancer.net 4 Things to Look For in a Health Plan [Video] — Best Company Open enrollment 4 Ways to Prepare for Open Enrollment — Best Company Open Enrollment for Families — HealthMarkets ACA Open Enrollment If You Shop on Private Websites Instead of HealthCare.gov — Kaiser Family Foundation ACA Open Enrollment If You Are Low Income — Kaiser Family Foundation How to Save Money During Open Enrollment — Bankrate What to Do If You Miss Open Enrollment — Best Company Special enrollment periods Enroll in or Change 2020 Plans — Only with a Special Enrollment Period — HealthCare.gov FAQ of the Week: Who Qualifies for a Special Enrollment Period? — CHIRblog Understanding Special Enrollment Periods — CMS Health Insurance Marketplace [Infographic] 5 Questions to Ask About Special Enrollment Periods — Best Company Back to Menu Finding affordable health care Finding Health Insurance — USA.gov These 6 Resources Will Help the Self-employed Find Affordable Health Care — The Penny Hoarder If I Can't Buy a Short Term Plan and I Don't Have a Qualifying Event, What Are My Coverage Options? — HealthInsurance.org Best Health Insurance Companies (customer reviews) — Best Company Back to Menu FAQs FAQs: Health Insurance Marketplace and the ACA — Kaiser Family Foundation Frequently Asked Questions About Health Insurance — HealthInsurance.org Get Fast Answers to Your Health Insurance Questions — HealthCare.gov COBRA and State Continuation — Frequently Asked Questions — DataPath Back to Menu Small businesses owners Exploring Coverage Options for Small Businesses: Health Insurance for Businesses — HealthCare.gov Unpacking Health Insurance Basics for Small Businesses — Workest 5 Steps for Choosing the Best Health Insurance Plan for Your Small Business — TheSelfEmployed.com The Top 5 Small Business Health Insurance Options in 2020 — PeopleKeep Health Insurance Reimbursements: What Are the Options? — PeopleKeep Small Business Health Care Tax Credit: Questions and Answers — IRS.gov Open Enrollment Guide and Resources: How to Communicate with and Help Employees to Choose Workplace Benefits — SHRM Surviving Open Enrollment: A Four-Step Health Insurance Guide for Small Businesses — business.com
You and many others across the United States are self-isolating or under quarantine due to COVID-19. While inconvenient, these measures will help prevent the spread of COVID-19 to keep our hospitals and ICUs from being overwhelmed. Practically speaking, what do you do if you get a UTI, feel unwell, need to follow-up with a doctor, or just need a prescription? If you already have a physician, you may be able to get your needs taken care of by simply making a call to their office. If you have health insurance, you may have other options for receiving non-emergency care. Many health insurers offer a 24-hour nurse hotline with their plans. Some plans also include access to telemedicine, so you can schedule remote appointments with doctors, receive a diagnosis, and be prescribed treatment from your home. Even without health insurance, you can buy subscriptions to telemedicine services. GoHealth, for example, offers subscriptions to telemedicine services. Rates vary based on the kind of subscription you choose. Here's what you need to know as you evaluate telemedicine services: Telemedicine advantages Telemedicine apps Telemedicine costs Telemedicine and COVID-19 For more background on what telemedicine is, read: "What to Expect from Telemedicine" Telemedicine advantages Convenience is one of the biggest advantages of telemedicine. You don't have to take time to drive to the doctor's office and sit in the waiting room. "Telemedicine is a great option for people who value their health, yet may face barriers reaching an office appointment — childcare, time and cost of traveling to the office, taking time off of work, etc. It’s also a wonderful option for patients who would rather get cozy, grab their cup of coffee, and have their appointments in the comfort of their own home," says Ballehr. Efficiency is another advantage that goes hand-in-hand with convenience. "Telemedicine appointments are altogether more time-efficient. During a telemedicine appointment, more time is spent with the actual physician compared to an in-office visit. This means no time is wasted!" says Lisa Ballehr, DO. Telemedicine also helps overcome barriers like access to specialists and makes it easier to access medical professionals for those in rural areas. And, telemedicine also lowers risk of exposure for medical professionals and patients, which is particularly important during epidemics. For example, hospitals are using telemedicine technology to screen patients before they walk through the doors. Some apps offer screening to help people understand what risk group they're in for COVID-19. Others are working on developing at-home test kits for COVID-19. Even with these advantages, telemedicine does have limitations that in-person visits do not. Back to Menu Telemedicine apps Telemedicine companies have downloadable apps that you can use from your phone. Check to see if your insurer works with a specific app. Depending on your plan, it may be to your advantage to use the app preferred by your insurance company. You should also check with your doctor to see if they use an app as part of their practice. Some doctors and health care systems will use telemedicine companies to follow-up with patients after they are discharged from the hospital. To maintain a cohesive care process, check with your provider to see if they use a telemedicine app or system. This can help you maintain consistency with your care and keep your primary care doctor up to date on your health. Your preferences for maximizing your insurance coverage and receiving care from your primary care physician will affect what you look for in an app. "Some apps are intended to connect patients with the app's own providers, which can be a great option for patients who don't have a 'regular' doctor, but others are simply communication mechanisms intended to connect those with existing patient-provider relationships," says Erin Jackson, managing partner of the national health law firm Jackson LLP. As you're looking at telemedicine apps, make sure that the app you choose is HIPPA-compliant to keep your medical information secure. "Make sure it is 100 percent HIPAA compliant. Anything sent via the internet has to be encrypted in a unique way. Make sure that the one your doctor chooses is HIPAA compliant and that your photos, video, and voice are safe," says Yuna Rapoport, MD MPH, Manhattan Eye director and assistant clinical professor of ophthalmology at Icahn School of Medicine at Mount Sinai. Doing thorough research will help you find a good app. If you already have a health care provider, you can ask them for information on the app they use. "If patients have any concerns about their online therapy not being secure or HIPAA compliant, they should ask their therapist directly about how they are storing their records and whether their communication methods are HIPAA compliant," Haley Neidich, LCSW says. Video calls and communication are commonly used in non-medical settings. Ballehr recommends avoiding these services for medical appointments: "If patients are concerned about patient confidentiality, avoid any appointments over Skype, FaceTime, or any similar programs." In addition to security, Jackson identifies other questions to ask when choosing a telemedicine app: "Is it owned by investors or doctors? Are they aggregating the data they receive about patient encounters and monetizing it in some way? Are they HIPAA-compliant? It's a surprise to many consumers that not all apps are legally compliant, meaning they don't protect your data and facilitate connections to providers in a way that's legally permitted. Find an app that is legit and focused specifically on offering solid, secure patient care," she says. Back to Menu Telemedicine costs You can usually download an app for free. However, you'll be charged for the services you receive. Your telemedicine costs will vary based on how you approach it. Some telemedicine services are available through a subscription. Some subscriptions include a certain amount of visits or charge per visit. Other telemedicine apps do not have a patient subscription fee. However, you'll still pay what your doctor or therapist charges for a visit. If you have health insurance, you may have some coverage for telemedicine services. Check with your insurer to learn more about how telemedicine is covered under your plan. "Patients can reach out to their insurance companies directly to ask about coverage for teletherapy services, and whether coverage is possible under their plan or in their state. They should be sure to ask the frequency and number of total sessions that they are covered for, and clarify which mental health providers are covered," says Neidich. If you're concerned about coverage, it's best to reach out to your insurance company before you receive care. "Patients should definitely check with their insurance company before incurring the charge, as some insurance companies will deny a claim for services that are not covered and not pre-approved," advises Kay Van Wey, board certifed personal injury trial lawyer. Back to Menu Telemedicine and COVID-19 COVID-19 has resulted in increased interest and use of telemedicine. As you explore telemedicine during this time, here are a few things to keep in mind. Telemedicine is feeling a lot of growing pains. Before COVID-19, telemedicine was becoming more and more common. It helped make accessing care in rural areas easier, especially for seeing specialists. It also made it easier to see a doctor for homebound individuals. However, due to the COVID-19 pandemic and moves to lower exposure risk, telemedicine companies are experiencing unprecedented demand and moving quickly to meet it. More people are looking for telemedicine services to avoid being exposed to whatever germs are at the doctor's office. Medical professionals are also using telemedicine services to screen for COVID-19 patients before they come into the hospital. To accomodate for the rapidly increasing demand, telemedicine app companies are hiring more doctors. However, one tricky aspect of meeting this demand is that doctors are required be licensed in the states where they practice medicine or where their patients live. Rules around telemedicine are changing because of COVID-19. Some new, temporary rules are requiring expanded coverage for telemedicine services by insurers. Federal rules have changed to permit telemedicine coverage by Medicare. This shift is an important protection for elderly, who are at a higher risk for this virus. However, even this positive step doesn't benefit all equally. For example, community health centers are exempt from this change. This omission affects 81,000 seniors in Pennsylvania. Whether or not Medicaid covers telemedicine is being decided by each state. Check your state laws to see if your state has additional changes to require insurers to cover telemedicine during the COVID-19 pandemic. Your insurer should also have this information. However, as the situation with COVID-19 changes daily, your insurer's representatives may not always be aware of the most recent changes. "Many insurance companies are now offering telehealth parity — this means that if a service would've been covered for an in-office visit, it's required to be covered at the same rate for occurring via telehealth. If your doctor's office is asking you to pay upfront in full for a telehealth visit and won't file it with your insurance like they would a normal in-office visit, that should raise a red flag that your doctor isn't up on recent changes that the government and insurers have enacted with the COVID-19 pandemic," says Jackson. Since insurer choices and state laws can vary, check with your insurer to see how it's covering telemedicine services during this crisis. You should also be aware of any legal changes that have been made to accomodate self-isolation practices. "If you get a denial from your health insurance company for a telemedicine visit during this COVID-19 public health emergency, you should report them to your state Board of Insurance. During this public health crisis, 'we’re all in this together' must mean that health insurers and HMOs make it easy and affordable for patients to see their healthcare providers virtually and not have to break social distancing rules in order to receive routine medical care," says Van Wey. As you navigate telemedicine during the crisis, don't overlook security and privacy protections. "It's also crucial to mention that providers should be careful to comply with their privacy and security obligations. HIPAA has been loosened in some respects, but there's really no reason for a typical provider to offer care via a medium that falls below HIPAA's standards. Aside from creating potential liability for your practice, it puts your patients' privacy at risk," reminds Jackson.
How you use telemedicine and the kind of doctor you're seeing will affect what you should expect from an appointment. For example, there may not be much difference between a telemedicine therapy session and an in-person one. However, there are more differences between an in-person visit with a primary care physician and a telemedicine one. "Depending on where you get seen, you may still interact with a nurse at the beginning of the appointment before getting transferred to the physician. However, in some private practices, you will go straight to the physician so there is no waiting room time or time spent answering questions from a nurse. This allows the patient more time with the actual provider. If any additional work-ups are needed, at-home test kits could be provided, or the patient could be sent to a local lab if any of the tests can’t be done at home," says Lisa Ballehr, DO. Here's what you can expect from telemedicine: You can get simple diagnoses and medical advice. You can use telemedicine for therapy. You should prepare for appointments. Telemedicine does not replace the emergency room. You can get simple diagnoses and medical advice. Telemedicine is used by a surprising number of medical specialties including oncologists, OBGYNs, opthamologists, and dermatologists. Through telemedicine services, you can receive simple diagnoses and get medical advice. One concern many have regarding telemedicine is its care quality. A 2020 study by healthinsurance.com found that 64.65 percent of people did not think telemedicine was as good as an in-person visit. While telemedicine does have limitations, you can be confident in the care you receive from it. "The standard of care for doctors seeing patients virtually is the same as if they were seen in person, so for example, if a doctor made an erroneous diagnosis or prescribed a medication that was contraindicated, they could be held legally responsible," says Kay Van Wey, board certifed personal injury trial lawyer. While doctors still deliver a high standard of care and are liable for mistakes, keep in mind that the nature of telemedicine includes some limitations. Amy Baxter, MD, PainCareLabs founder and CEO, offers a few examples: "The biggest difficulty with telemedicine diagnoses in physical therapy is assessing strength. When you find out what's weak, you can extrapolate how someone is moving that results in pain. In general, therapy telemedicine makes more sense than diagnostic telemedicine. There are some telemedicine diagnoses that result in an overprescription of antibiotics or pain medications. When people pay for a diagnosis, they expect something in return. When a practitioner has laid hands on you, you feel as if you've received something and believe them. When you've paid for them to look at you, you expect something in return — a prescription. In medical school, we were taught never to go on visual examination of an ear infection, but always to puff air and see if in fact the eardrum moved (red but fine) or didn't (fluid behind it). Telemedicine will never insufflate an ear." Keep these limitations in mind, though the doctor you speak with should let you know if an in-person visit is necessary. "Sometimes a doctor can reach a diagnosis without a physical examination. Certainly for established patients physicians can refill most routine prescriptions for chronic medical conditions, seasonal allergies, etc. However, in the case of a new onset, acute condition, it will be incumbent upon the physician to explain the limits of the exam and either require you to come to the office or go to the ER depending upon the circumstances," says Van Wey. Back to List You can use telemedicine for therapy. Mental health doctors and physical therapists use telemedicine. Therapists and psychiatric doctors hold appointments over video chat or through telemedicine services. If you see a therapist regularly, ask what options they offer for remote appointments. Check with your insurer to see if they have their own telemedicine services to see if they have a preferred telemedicine resource. You can also look at telemedicine subscriptions. "While some states and insurers will provide some coverage for teletherapy sessions, a large portion of individuals are paying out of pocket. Many therapists in private practice have their own fee, and online therapy apps like BetterHelp and TalkSpace provide access to a mental health professional at a lower rate. Payments are typically made weekly and are either per session or monthly for a prescription package with one of the apps," says Haley Neidich, LCSW. If you're using telemedicine for physical therapy, you may get additional technology that will improve your experience. "Some of the new PT platforms using virtual reality and accelerometers for sensors will be able to make sure that a patient is doing the exercises correctly," says Baxter. You'll also want to talk to your physical therapist about exercises to do before and after your appointment. "Before a tele-physical therapy event patients need to warm up stiff muscles. Afterwards, they may need to reduce pain with mechanical or electrical stimulation, ice, or both," advises Baxter. You'll need equipment like a high-frequency vibration unit for mechanical stimulation or a TENS unit for electrical stimulation. Back to List You should prepare for appointments. Even though telemedicine is highly convenient, you should still prepare for appointments. "Don't treat it like a casual phone call or meeting — treat it like a true doctors appointment. Show up on time (hopefully your doctor will too), bring a list of questions, and come prepared," advises Yuna Rapoport, MD MPH, Manhattan Eye director and assistant clinical professor of ophthalmology at Icahn School of Medicine at Mount Sinai. Being prepared will help you get the most out of your telemedicine visit and have answers to your questions. Another aspect of preparing for a telemedicine visit is making sure your tech is working well. "Try to find a place that is quiet and that is well lit so your provider can hear and see you clearly. Be sure that your device is plugged in or charged fully before your appointment to avoid any technical issues," recommends Ballehr. Back to List Telemedicine doesn't replace the emergency room. While telemedicine is a great option for non-emergency care, it won't help you in an emergency situation. If you have a medical question or don't feel well, then scheduling an appointment via telemedicine is great. In fact, many people make unnecessary visits to the ER. UnitedHealth Group found that two thirds of ER visits by privately insured people were avoidable. So, if your typical point of contact with doctors is in the ER, you can re-evaluate how you reach out to medical professionals. Using telemedicine or calling your doctor's office for non-emergency situations can also save you from expensive ER bills. However, if you need immediate medical attention, don't spend time on telemedicine — get yourself to the ER or call 911. If you think you have COVID-19, mention it in your call so that first responders and hospitals can follow their protocols for receiving COVID-19 patients. Telemedicine is a convenient way to receive medical advice, simple diagnoses, and therapy. As you explore telemedicine, be sure to understand the costs and carefully consider apps to ensure that they are HIPPA-compliant. For more information on these topics, read "Telemedicine: What You Need to Know."