At the bottom: Practical tips
First, Eric Schultz, chief of Harvard Pilgrim Health Plan, the #1-ranked plan in the nation, told me with utter certainty: This is the wave of the future. Soon it will be as common as having a 401K plan.
That got my attention. Then Attorney General Martha Coakley put it at the top of her list of what should be done to cut Massachusetts health care costs. And the state’s Group Insurance Commissioner, Dolores Mitchell, declared at a hearing, “I think it’s an idea whose time has now finally come.”
What’s the idea? Please pay attention, because there will be a test on this topic — the next time you’re choosing health insurance.
The concept is called “tiered” health insurance. It is a major national and statewide trend. It has both major upsides and major downsides. And it goes roughly like this:
One way you can lower your painfully high health insurance premiums is to sign up for a plan that limits the doctors and hospitals you can use to cheaper ones. That’s called a “limited network.” But it can be scary to rule out any chance of going to a fancier, more expensive hospital or doctor.
So now, increasingly, you can opt for a cheaper-premium plan that lets you sign up for a lower-cost “tier,” or level of health care, but also gives you an out: If you ever want to get care that’s ranked by your health insurer in a more expensive tier, you can. You’ll just have to pay more out of pocket in a co-pay or deductible — maybe a lot more.
“What tiering does is it lets the consumer, the member, make a choice every time they have a medical need, and that makes people more comfortable,” said Jim Roosevelt, chief of Tufts Health Plan, which is ranked a close #2 in the nation and has about one-third of its members in tiered plans. Health insurance, after all, “is supposed to relieve the fear of the unknown,” he said.
Everybody’s Doing It
Blue Cross Blue Shield of Massachusetts made a big splash this winter when it introduced its “Hospital Choice Cost Share” plan, which would charge members up to $1,000 in co-pays if they choose (in non-emergency situations) to go to the 15 hospitals it ranks as high-cost.
It sparked some controversy when it was announced. To many — including me — it is daunting to contemplate giving up free access to prestigious but expensive hospitals like Massachusetts General and Brigham and Women’s. But Blue Cross chief Andrew Dreyfus now says it’s one of the fastest-growing products in the insurer’s history. Continue reading