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Shopping for Health Insurance: the Essential Features

Soon it may be a thing of the past, but currently, the stiff competition between health insurance companies results in millions of dollars spent on advertising by these companies. We were curious about what features tend to attract the most members to a particular plan. Some companies advertise their wellness programs; others advertise their physician providers' medical education and specialty boards, while others appeal to potential members' desire to choose their own physicians. We asked patient advocates, marketing and sales specialists, health insurance company representatives, hospital administration reps, and health care industry researchers, what they've seen attract clients and here's what they had to say:

I am a Certified Financial Planner™, licensed health insurance agent, owner of a 50+ agent health insurance agency, and the founder of the website InsuranceProviders.com. Here are a few brief things to note:

People tend to fall into one of two different categories when shopping for a health insurance plan: there are those who don't care so much about the monthly premium cost but they just want to know that if anything happens, major or minor, then their out-of- pocket costs will be very low- these types of people are attracted to co-pay type plans- then, there is another group of people who primarily are concerned with having a very low monthly premium. These types of people are attracted to high deductible type plans, especially HSA plans.

Joel J. Ohman, CFP®
CERTIFIED FINANCIAL PLANNER



For most people shopping for insurance online, the answer is cost, cost, cost! Depending on the person, this might mean a low deductible, small co-insurance, or simply a cheap monthly premium. Beyond that, people look for higher out of pocket limits (which will be obsolete soon). People who research more might look to see if their family doctor is covered or they have to stick to a certain network.

Adam Andrews
navixmarketplace.com



The features that tend to attract the most members to a particular plan are member needs, pricing of product offering, product features (e.g.: lower copayments for prescriptions for members who have a chronic condition, incentives awards for activities).

Additional interests to members are the provider network, primary care physicians, OBGYN, pediatric care and hospital distance from member home. People are also very concerned about prescription availability (mail order, retail), member outreach by customer service or care management, website ease of use, enrollment process, and customer call centers to help on enrollment.

Dave Hom
Chief Solutions and Business Development Officer SCIO Health Analytics



I'm a patient advocate and spend half my time working on such issues. Something that attracted me to the insurance company I currently use is that they have a staff of dietitians and nurses and such who can be reached with a phone call to get advice. I don't have to pay for an office visit with a doctor, who then often would refer me to someone like a dietitian (another office visit to pay for) to get answers to simple questions about health problems and preventative medicine. I was suspicious at first that it only was a way to keep track of how high to raise my insurance rates according to what they found out about my health by talking to me, but it has turned out to be helpful advice about how to prevent becoming someone who has to use more health care. It didn't cost me anything to find it out, saved me wasting all that time going to appointments with care givers (since all that was replaced with phone calls) and it probably saves the insurance company money in the long run. Win, win.

For instance, success rates for treatments, facilities and care givers would be good to know. Right now no one can give you accurate information on that. They are not all equally good at everything. It would be cheaper to insure patients who are able to determine which facilities, treatments and caregivers are good and which are just plain dangerous for specific things. All of the things I described about liking about my current insurance company have to do with how they made me smarter and healthier through their knowledge about how to respond to health issues I have. What I want to see added to that is my being able to become smarter about whether or not to get care in the first place, and who to get it from, according to how other patients with the same issues fared.

Joel Selmeier
www.patient-safety.com



I have been in the insurance industry for over 20 years, and previously worked for two insurance companies. Currently, I own a medical billing/credentialing business and a medical claim advocacy company. Also, in 2008, I received the Insurance Professional of the Year Award in my county.

With the January 2014 health insurance requirements due to Obamacare and the

Affordable Health Care Act rulings, younger people will need health insurance otherwise they will be fined.

When someone is searching for health insurance, they look for "a bang for their buck"- in other words, the best health insurance at the most reasonable fee. Other people think about the status of their health and how much coverage they really need. Many younger people who are healthy are searching for catastrophic health insurance only so they will save money on their premiums. There are also healthy individuals that do not even want coverage since they feel they are healthy, and therefore, even with the financial penalty of not having health insurance, they will be saving money. The bottom line is the healthier the individual, the less chance of them agreeing to have health insurance unless offered by an employee at a reasonable, affordable fee.

Adria Goldman Gross
MedWise Insurance Advocacy, Division of MedWise Billing, Inc.