• Lesson Plan
  • Lesson 1: Introduction to Health Insurance
  • Lesson 2: The Costs of Your Policy
  • Lesson 3: Choosing the Right Health Plan
  • Lesson 4: Things to Watch Out For
  • Lesson 5: Balancing Cost and Coverage
  • Lesson 6: All About Health Savings Accounts
  • Lesson 7: Start Comparing Plans
  • Lesson 8: How to Evaluate Insurers
  • Lesson 9: Get the Best Care Possible
  • Lesson 10: Final Summary

Lesson 8: How to Evaluate Insurers

If not, take a few minutes now to get some quotes online. It will take literally 5 minutes, and you'll be so much further along in the game. Alright!

Today we turn our attention to the simple but vital task of evaluating your quotes from the all-important consumer's perspective.

Health insurance is different from most other types of coverage or financial products in that who you deal with is of the utmost importance. (Sure, you want your mortgage broker to be a nice guy, but it's not the end of the world if you don't care for his phone manner.)

Not so with health insurance.

The relationship you have with a health care provider is probably one of the closest and most personal you have, and in these days of managed care, that relationship is becoming increasingly defined by your insurer.

So you need to take the time to evaluate any health plan in terms of how the insurer will control your access to and quality of care. Here's how:

Step one - get policyholder testimonials

This information speaks to the quality of coverage no matter what type of policy you're considering, from pure indemnity to pure HMO. Check out the reputations of any and every potential insurer. Ask family, friends, co-workers, neighbors and your pizza delivery guy both who they use and how they would assess the quality of their care.

There is literally no measure of quality as telling and reliable as the opinion of an experienced customer.

But your work doesn't stop there . . .

Step two - research plan accreditation

There are several national organizations that specialize in evaluating the health care industry in the US for the benefit of consumers. These organization all use some form of "accreditation" to measure consumer satisfaction with the level of service provided by a health insurer. Take a look at what these organizations have to say about any policy you're considering buying.

On thing we want you to know before you take a look at any reports: helpful as they may be, please keep in mind that these organizations are not completely independent of the very health insurers they are evaluating. Many people who sit on the boards of these organizations sit on the boards of insurance conglomerates as well. Furthermore, much of the information used in accreditation is not evaluating by an outside impartial source, but is actually taking the insurer's "word for it".

Still, any yardstick is better than none, and there are definite "absolutes" you can take away from their reports. Definitely steer clear of any insurer that has been denied accreditation by any of these organizations.

(Notice that we said "denied". Some insurers, especially small ones, simply may not have undergone the accreditation process, so the lack of accreditation is not necessarily a black mark).

These three services are a good place to start:

NCQA, the National Committee for Quality Assurance
JCAHO, the Joint Commission for the Accreditation of Healthcare Organizations
AAHC, the American Association of Healthcare Consultants

Step three - find insurer financial ratings

Inspect the financial well-being of any insurer from whom you're considering buying a policy. Fortunately for you, that's easily done with eHealthInsurance, because they give you the A.M. Best rating of every insurer right next to policy they offer!

If you're looking at policies from a different source, you'll need to find this financial information for yourself, from a respected source such as AM Best or Standard & Poor's. But why bother when eHealthInsurance does it for you?


Whew! That's a lot to look into. But guess what: if you're considering an HMO or PPO, your work is not over yet. You also need to look into the network of doctors and hospitals used by the plan.

Here you're pretty much on your own. You may already have a trusted family physician you'd like to keep, and if this is the case you certainly want to take it into consideration. And, once again, ask family and friends about their experiences with specific doctors hospitals and other care facilities.

Okay, that's it for today. You probably have a lot of research to do. Tomorrow we'll wrap things up and concentrate on cutting costs over the long term. Easy last day.


Next: Lesson 9: Getting the best care for your premium