As open enrollment winds down, consumers must educate themselves to make health plan choices

Clock is ticking on 2010 health care plan choices

NEW YORK — The holidays may be starting to crowd your to-do list, but one thing you shouldn’t let get buried under the tinsel is your health insurance coverage.

Open enrollment period, the annual window when people get to update their health insurance choices, is winding down. The opportunity to change coverage under some employer- and union-sponsored plans has already passed, but many will continue to accept updates for a few more weeks. Medicare participants have until the end of the year to choose or make changes to their Medicare Advantage plans and prescription drug coverage.

Picking from the options available can be confusing. There’s an alphabet soup of HMOs, PPOs, HSAs, FSAs and other choices to decipher, so learning the terms is an important first step. Knowing what sort of care you’ve used in the past year is also key, because that should play a part in your choices for 2010.

Another factor is the doctors and hospitals you’ll have access to. Doctors accept payment from different insurance plans, so if you are considering switching plans, make sure you know if you’ll also have to switch doctors, or pay out-of-pocket for care that’s not covered.

Learning the terms

Most insurance programs offer two kinds of managed care plans, health maintenance organizations, or HMOs, and preferred provider organizations, or PPOs. Premiums tend to be lower for HMOs, while PPOs typically offer a wider choice of participating doctors.

In addition, a growing number of companies are trying to contain costs by offering a type of plan that can chop premium payments by nearly 20 percent. But the plans, called consumer-directed health plans, or CDHPs, come with a big tradeoff in the form of high deductibles — up to $10,000 a year for family coverage.

Also growing fast are options like health savings accounts (HSA) and flexible savings accounts (FSA), both of which allow a person, and sometimes an employer, to set aside money before taxes to cover health-related expenses. These accounts are usually offered alongside a high deductible plan to help people pay out-of-pocket costs, and may also be available with more traditional plans.

Each plan has pros and cons, many of which depend upon the way you and your family use health care. High deductible plans, for instance, may not be the best choice for those with tight budgets and little savings to tap if there is a medical emergency, or for large families making frequent visits to the pediatrician.

Once you understand your choices, you should take a look at what sort of medical care you’ve used in the past year. Adding up your spending on co-payments, over-the-counter medications and treatments that are not covered by your current plan can give you a target for funding an HSA or FSA. If you have a chronic condition and have grown to trust a certain doctor, you’ll want to make sure that doctor participates in any plan you’re considering.

And if you think you might switch plans, doing some research about the doctors and hospitals in the available plans can help you decide.

Checking up on doctors

There are a number of Web sites that rate health care providers, and it’s clear people are hungry for more information. The busiest eight sites focusing on doctor ratings saw usage spike 20 percent in the past year, to more than 8.6 million individual visitors, according to Compete Inc., which tracks online behavior.

User demand drove the 2008 decision to add health care provider reviews to Angie’s List, a site better known for its customer opinions about household contractors and services. “It was one of the most requested additions to the list in our 14 years,” said founder Angie Hicks, estimating that about a quarter of all reviews collected each month are now health care related.

Unlike many free sites, users who post to Angie’s List cannot do so anonymously, and the number of times they can report on a particular provider is limited.

But just like sites that don’t require membership, the information available is inconsistent. With most consumer-based ratings sites, you’ll find some that some doctors have dozens of reports, while others have a handful. Fewer patient reviews can skew the ratings. And often, the people posting comments have had very positive or very negative experiences, making it hard to assess overall care.

Sites that rely on commercial databases for background information may also have incorrect details, like whether a doctor is board certified, said Dr. John Santa, director of the Consumer Reports Health Ratings Center. Consumer Reports offers hospital and health plan ratings on its site, but does not yet rate doctors. Santa said that’s because details about the nation’s 800,000 physicians in the country is scattered, sometimes unreliable and sometimes hard to compare because definitions of certain terms can vary by state.

Santa recommended checking state Web sites to make sure doctors are licensed and see if they have been disciplined. For specialists, check the American Board of Medical Specialties site, www.abms.org, to see if they are board certified in their specialty.

Another source for information for people in 14 states is a project sponsored by the Robert Wood Johnson Foundation that brings together information provided by doctors, insurance companies and employers to measure performance.

The project uses scientific standards measuring good care, explained Anne Weiss, director of the foundation’s Quality/Equality health care team. Their approach takes into account more than just personal experience and looks at issues like cost and health results, in some cases for specific illnesses like diabetes or breast cancer.

Several of the foundation’s sites, particularly the ones for Wisconsin and Maine, see spikes in usage during open enrollment season. In some communities, employers are using the information to chose health care plans to offer to workers, Weiss said. The Aligning Forces for Quality project sites can be accessed through the foundation’s Web site, www.rwjf.org.

“What’s the most exciting thing about this developing online information is that people understand that in every community and in every doctor’s office, good care and bad care is provided,” said Weiss.

(This version CORRECTS Corrects name of org in graf 20 — Specialties)