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Best Value in U.S. Health Insurance Is in Massachusetts

Posted by John McDonough  October 10, 2012 10:08 PM

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"Value" is a dicey word because we each value different things. This is especially true in relation to health insurance. Some people value insurance based on the price of premiums, and some people want to consider the required level of cost sharing in the form of copays, deductible, and coinsurance; some care mostly about choice of provider and others care more about the scope of services covered.

A new report from U.S. News and World Report takes a crack at answering this thorny question by closely evaluating near 6,000 health insurance plans across the U.S. that sell "non-group" coverage to individuals and families. Click here for the summary of the report and click here for access to the full report.

Bless USNWR, they also evaluated the value of plans state by state. We already know that Massachusetts has among the highest health insurance premiums in the nation. Surprise, surprise, though, U.S. News and World Reports concludes that Massachusetts health insurance plans "consistently offered broad coverage and protection against a potential flood of medical bills..."

Here are some more details, including their state by state map:

insurance_heat_map.jpg


"A first-ever U.S. News analysis of nearly 6,000 health insurance plans marketed to individuals and families reveals that many of the consumers who enroll in these plans may confront budget-wrecking out-of-pocket costs that deplete their savings. Large numbers of plans severely limit coverage for such services as prescription drugs, maternity coverage, mental health treatment, and rehabilitation therapy. To help consumers make more informed choices, U.S. News today launched Best Health Insurance Plans, an interactive consumer tool, to help those who are not covered by an employer or a government plan find a health plan that best meets their individual or family needs. ..."

"Massachusetts plans consistently offered broad coverage and protection against a potential flood of medical bills. All 67 plans available to individuals received four or five stars. New York (94 percent) was next on the list, followed by Washington, D.C. (85 percent), Maryland (76 percent), and Virginia (75 percent). The states with the smallest proportion of four or five-star plans were Washington (4 percent), Alaska (10 percent), Wisconsin (15 percent), and South Carolina (19 percent), though several states including Alaska had few plans available for analysis. ..."

"Cost and coverage across states show major variation in the U.S. News analysis. Two states that stand out are Massachusetts, a crucible of health care reform with its Health Connector program, the acknowledged template for the Affordable Care Act, and Minnesota, which has a more traditional insurance marketplace.

"Judged by premiums alone, the 67 plans displayed in Massachusetts are among the most expensive in the nation, with a median premium of $528 per month, more than two-and-a-half times higher than the $196 median for the 285 plans listed in Minnesota. (Massachusetts helps defray health insurance costs by providing subsidies to any individual whose household income is less than $33,516 a year and to any family of four whose income falls below $69,156.)


"Yet in Massachusetts, after the deductible is paid, about 45 percent of health plans fully cover hospitalization, hospital-based physicians' services, and imaging, compared with 19 percent in Minnesota. Why? A board established to create the Massachusetts Health Connector decided that benefits should be "fairly comprehensive," says Robert Mechanic, executive director of the Health Industry Forum, a market-based health policy center at Brandeis University in Waltham, Mass. As a result, coverage in Massachusetts is broader than in Minnesota, with health plans required to cover emergency care, hospitalization, maternity and newborn care, medical and surgical care, mental health and substance abuse, prescription drugs, cancer therapy and outpatient services, including surgery."

Some insurance industry sources in Massachusetts tell me they are under growing pressure these days from national insurers whose entire game plan is based on low premiums with increasingly high cost sharing. We know many consumers and businesses are inclined to purchase low premium/high cost sharing plans -- though Massachusetts consumers who make that choice at least are protected with a guaranteed minimum of coverage.

The U.S. News and World Reports release helps to make clear what's at stake.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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