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Health Plan Reviews and Carriers

Carriers and Health Plan Comparisons

We strongly feel that in today’s world of Amazon and Yelp, to not use the resource of 1000’s of other consumers when comparing and reviewing health plans is just short of crazy.  That’s why we created  By definition, a health plan review is partially a review of the underlying health insurance carrier as well but we should take some time to look at the role of the carrier in comparing health plans as that drives a great deal of interaction we’ll have with the plan.  So, how should we consider health insurance carriers when reviewing plans.


Survival of the Strongest (health carrier)

You’ll notice on that the largest health insurance carriers with the longest track records dominate the health plan comparisons and for good reason.  You probably don’t want to have the newest health insurance carrier on the market.  It takes years if not decades to really prove that your reliable and sustainable in any insurance market but even more so for health insurance which is fraught with dangers as a carrier.  The model itself is nightmare.  Negotiate with 10’s of thousands of doctors and hospitals.  Manage millions of subscribers and 100’s of millions of claims all while trying to predict who will be riskier.  Do this all with a 2-3% margin of error.  It’s important to show that a carrier can do this successfully for many years.  As health reform brings about guaranteed issue coverage, it will likely complicate the business model further and we expect consolidation of the industry to just a few strong carriers.  Guess what, those are likely the carriers that pop up all over Hoodles.  Let’s take a look at the some of “national” players which are found in many States.


The biggest carriers get bigger still

The big “nationwide” carriers will continue to gain in market share while small carriers will find the new health reform regulatory environment stifling.  On this short list is Blue Cross Blue Shield (under a few different parent companies such as Anthem), United health insurance (sometimes marketed under Golden Rule), Aetna (dominant in Group market but will need to  transition to the individual family market aggressively), Cigna, and Cigna.   You’ll also find regional players which can be strong in individual markets such as a Kaiser or Health Net.  We don’t see these players going away as they are strong enough in their individual markets and most importantly in their local provider contract negotiations to remain viable.  Many smaller HMO’s and carriers will probably find it difficult to transition to the new health reform world.  The new paradigm is going to be costly for a carrier and the risks of guaranteed issue great especially if you don’t have enough members to smooth out some bad claims experience.  The nationwide carriers will likely continue to gain marketshare.


So what’s in a Carrier’s name?

How much does a carrier matter when comparing health plans.  Quite a bit, but automatically takes this into account.  Think about it.  The five review metrics are Pricing, Benefits, Doctor Networks, Customer Service, and Claims Processing.  All of these are direct results of a carrier’s functioning.  Pricing and benefits reflects two sides of the same coin which loosely translates to the common request we hear…”The best coverage for the lowest price”.  These two metrics in health reviews keep health insurance carriers honest.  Don’t be too expensive and make your benefits easy to understand.  Doctor networks is probably the most relevant to a carrier’s reputation.  How many doctors participate with the carrier speaks to the strength of the carrier (the doctors have to be with a dominant provider in a given area).  Customer Service and Claims processing also point directly to the day to day functioning of the carrier as a business entity and how they respect their customers.  It’s all baked right into health plan reviews.  Go with a big carrier and use Hoodle to confirm your choice!

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