How do you choose which health plan to enroll in?

July 19, 2012 11:11 AM

My partner's application for Family Health Plus (New York) was approved. Now he needs to choose a 'health plan' to enroll in. We have no idea how to choose one. Please help!

Today we got a letter for the Department of Social Services letting us know that my partner's application for Family Health Plus (New York) was accepted.

The letter states the following:

"Under Family Health Plus, you must enroll in a health plan for your medical services. Your health plan will be CALL 1-800-XXX-XXX."

My partner called the number and they offered him four health plans to choose from. They are:

-Affinity Health Plan
-Fidelis/NYS Catholic Health Plan
-HIP
-Hudson Health Plan

My partner is a 29 year old male in good health. The plan will only be covering him as we are not married and I am currently insured.

How do we choose which plan is best for him? We're both totally new to this and want to make the best choice.

posted by 3T to health & fitness (10 answers total)

I liked HIP when I had it in Florida. YMMV, lots of people HATE HMOs. But I had a good experience.
posted by Ruthless Bunny at 11:17 AM on July 19, 2012

How do we choose which plan is best for him?

We can't really give you advice on this if we don't know the plan details. If we do know the plan details, we can only give really general advice that might be completely wrong based on a detail or two that you leave out.

That being said, stay the hell away from HIP.
posted by griphus at 11:18 AM on July 19, 2012

Usually when deciding between different plans, you put them side by side and compare coverages.

How much are co-pays?
How much is the cap?
Is your doctor in the insurance's network?
How much do you have to pay out of pocket for the insurance?
If you take prescription medication, is the one you take on the insurance's Prescription Formulary (this is the hugest impact for me. I used to pay $130 every quarter out of pocket for a medication I now get for $7.)

Then you pick the one you can live with.
posted by Ruthless Bunny at 11:23 AM on July 19, 2012 [1 favorite]

I just got full health coverage for the first time recently, and it's really daunting. But doable! The best way to choose a plan is to READ EVERYTHING each plan has to offer. They will lay out in minute detail how each plan works, but it is up to you (or your partner, really) to familiarize himself with what's on the table. Each of these providers also have phone numbers you can call to speak with someone who can explain the benefits and costs associate with that plan. It might help to call each of them and take notes on how much stuff will cost, what will be provided for, etc. They probably won't be able to help you compare plans, except to provide information about each one. That is, they won't evaluate your choices for you, only inform you about each one.

Affinity Health Plan Member Handbook (PDF)
Fidelis/NYS Catholic Health Plan Member Handbook (PDF)
HIP/Emblem
Hudson Health Plan

I think because each of these is providing services for a basic State-funded program those services are all going to be very similar in scope and cost. What will vary between them is stuff like locations (where your partner has to go to see a doctor) and hours of operation.
posted by carsonb at 11:24 AM on July 19, 2012 [1 favorite]

There is usually a 2 or 3 page chart that maps out the co-pays, limits, basic coverages, etc. Find them so you can compare. Given that this is a state plan, I would think those are all very similar, so it might come down mostly to which plans your current doctors participate in.
posted by COD at 11:27 AM on July 19, 2012

This thread had some great advice and explanations about the details.
posted by griphus at 11:31 AM on July 19, 2012

(It's for LA, but I went into some detail about how NY works.)
posted by griphus at 11:32 AM on July 19, 2012

The first thing I would do if I were trying to figure this out and I lived in New York would be to jump on the New York Health Department site and compare ratings for quality of care and consumer satisfaction for those plans. I think carsonb is probably exactly right that the actual benefits won't vary too much, but then again this isn't Medicaid where the benefit packages are very standardized so you might find one plan has better benefits--it's at least worth checking into.

The consumer guides for different regions in New York are here. There is also a much more in-depth and detailed report on HMO quality here. He should be looking under "Medicaid" plans, since the Family Health Plus program is grouped in there with all the other state-run health programs.

You can see in the consumer health guide that HIP and Hudson have slightly higher overall ratings than Affinity and Fidelis (73% versus 67%), but there's probably certain parts of that score that are more relevant to him than others. Hudson is three-stars (meaning significantly better than the statewide average) across all of the patient satisfaction measures, which I tend to think are the most important for people who are relatively healthy males with no chronic conditions. HIP on the other hand does better on most of the quality-of-care measures that are relevant to people with chronic illnesses (asthma, diabetes, cardiovascular problems) but only one-star (significantly worse than average) on overall patient satisfaction with the plan. Affinity and Fidelis are both two-stars across the board for patient satisfaction (meaning no different from average).

I am not your partner but if it were me, and there wasn't much of a difference between the benefits offered by each plan, I'd probably start with Hudson and see whether they had doctors accepting new patients in my area. If so, that's probably what I'd sign up for. Keep in mind that he should have 90 days after enrolling to change his mind and switch plans, in case he finds that he actually can't find a doctor in his area or hates the ones that are accepting new patients.
posted by iminurmefi at 1:03 PM on July 19, 2012 [1 favorite]

iminurmefi totally has it, assuming your partner does not already have doctors/specialists he likes. If he does, see which plans they accept, or which plans are accepted by he medical center where you're likely to go. After that you should definitely think about what your priorities are in terms of his specific conditions. I have heard, for example, that Fidelis's mental health care is not very good, but that may just mean that they don't have a lot of providers in the specific area where I work.

Hudson sounds appealing but I'm a primary care doc who sees mostly Medicaid patients and I have never heard of that plan, which may mean it has a limited set of places that take it.
posted by The Elusive Architeuthis at 1:46 PM on July 19, 2012 [1 favorite]

The accessibility and modernness of the plan was most important to me. I chose based on the excellence of the website and its online doctor search, supporting materials, whether the handbook was easily available as a PDF, etc. Several years ago, the clear winner in those terms was HIP -- by today, that may have changed. I was very happy with HIP.
posted by sparrows at 2:09 PM on July 19, 2012