Mass. health plans for individuals, families among the most comprehensive in the country, analysts say

By Chelsea Conaboy, Globe Staff

Health insurance plans offered in Massachusetts and analyzed by U.S. News & World Report were found to be among the most comprehensive in the country. The analysis included 67 plans from four Massachusetts insurers that are sold to individuals or families. Each earned at least four of five stars based on scope of coverage and cost to consumers.

In other states, the portion of plans with the higher rankings ranged from 4 percent in Washington to 94 percent in New York.

The organization used federal data to rate nearly 6,000 plans that are sold to people without access to employer insurance or public programs, covering about 14 million people in the United States. The ratings and descriptions of the plans are available in a searchable database.

The database does not include plans from several insurers that sell individual plans in Massachusetts, including Harvard Pilgrim Health Care and Fallon Community Health Plan.

Deputy Health Rankings Editor Steve Sternberg said the organization worked off of federal filings and tried to fill in gaps by contacting insurers directly.

“The information is not perfect,” he said. “This was a huge challenge on the data side and on the programming side.”

It’s no surprise that Sternberg and colleague Chris I. Young, in their analysis of the data, found that premiums are high in Massachusetts. By other cost measures, the state did better. The median deductible for the Massachusetts plans was about one-fifth that of plans in Minnesota, where most products also lack coverage of labor and delivery or mental health services, they wrote.

They wrote:

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.

The authors cite another (sad) difference between Massachusetts and Minnesota.

“People who have cancer can buy insurance in Massachusetts,” Karen Pollitz, a Kaiser Family Foundation senior fellow, told them. “In Minnesota they can’t.” In 2014, the practice of insurance companies denying customers based on their health status will become illegal under the Affordable Care Act.