How to pick a health insurance company?

October 15, 2020 10:18 AM

I recently got a new job, and with this new job of course comes new health insurance. By some miracle, this company gives me a choice between three different health insurance companies. Making things difficult: they all charge exactly the same premium, they all have the same deductible, and my doctor accepts all three. How on earth am I supposed to pick one?

(Possibly relevant: I have enormous out-of-network costs, and of course they all offer identical partial out-of network coverage. The only difference might be what each company considers "usual and customary" for those costs, or maybe those would be identical too? I have no idea.)

posted by Ampersand692 to Health & Fitness (11 answers total)

Hmm. You may indeed be on to something with the "usual and customary" thing.

I'm assuming the reason you have high out-of-network costs is because of a particular chronic condition. Maybe if there is a support group for this particular condition, you could ask the members which of your three options seems to be the most reasonable with rulings on what is "usual and customary"?
posted by EmpressCallipygos at 10:28 AM on October 15, 2020

Congrats on the new job! Unfortunately, this is the kind of thing where you might have to dig into each policy and look for your specific health issue and see how it's handled. I would start with folks in your company's HR office and see what insight they can share, and chat with your coworkers too, especially those who have started in the past few years, and ask which they chose and why.
posted by bluedaisy at 11:12 AM on October 15, 2020 [2 favorites]

You might also ask your main doctor's office if there's one they prefer to deal with over the other two, if all other factors continue to be mostly equal.
posted by ApathyGirl at 11:25 AM on October 15, 2020 [1 favorite]

Does any one of them have a broader network in general? You said that your particular doctor takes all three of them, but you don't know what you might need in the future. All else being equal, I'd want the policy with the largest number of "in-network" choices, particularly for specialists who treat my particular thing.

ALSO maybe ask the HR people if they know if any one of the companies has been more difficult to work with or has been raising rates or might be in more chance of being dropped?
posted by mccxxiii at 11:44 AM on October 15, 2020 [1 favorite]

Another couple of areas to look at are out-of-pocket maximums and what counts against your deductible.
posted by 4rtemis at 11:51 AM on October 15, 2020

If your main doctor is in anything larger than a solo practice, speak with their billing staff. They'll know which insurance is worst for them to deal with-- and worst for them likely means worst for any provider, and most likely to deny claims if at all possible. (You'll probably have an easier time getting a "worst" than a "best". I don't think "best" exists, there's just "least bad".)
posted by nat at 11:57 AM on October 15, 2020 [2 favorites]

Yet another place to check is the drug formulary - usually drugs are priced at tiers - generic, low cost name brand, high cost name brand and not covered/need special permission.
posted by metahawk at 11:58 AM on October 15, 2020 [4 favorites]

Oh, and depending on your health condition, you might see which local hospitals are in-network for each.
posted by nat at 11:58 AM on October 15, 2020 [1 favorite]

Seconding the drug formulary, as well as drug coverage; also mental health coverage can be a gotcha.
posted by chesty_a_arthur at 12:08 PM on October 15, 2020 [1 favorite]

Best answer: The document you are looking for is the Summary of Benefits and Coverage. This will spell out what is included in your policy. They will give you this if you hassle them, but it might not be this year's version.

HR should also be able to give you this if you ask, but generally nobody asks so they will likely not know where to get it-- you will likely need to be very assertive about getting a copy of this year's Summary of Benefits and Coverage. You can explain that you're trying to choose, but you want to make sure that you're picking the best one so you need to see the details. They don't need a reason beyond that. If you can't get a copy of the SBC, you should escalate the complaint through HR.

It also helps to know what the laws are in your area regarding your specific condition. Some companies have a generic Summary of Benefits and Coverage that they use in multiple localities, which may differ in how they handle your condition. The ACA has flattened this out a lot, but it's not 100%-- some localities require a higher level of coverage or have a different interpretation than the minimum required by the ACA.

You can also check with activists who advocate with people with your condition-- they will know the details of what is meant to be covered and how to make sure it's covered, which insurance is better, and so on. They will also know how to complain to the state's insurance commission if it comes down to that. (You can also check with the state's insurance commission to find out what company has the most complaints in regards to your specific condition, but it's often a matter of public records requests and takes an absolute age, so it's not your go-to.)
posted by blnkfrnk at 12:13 PM on October 15, 2020 [2 favorites]

Your employer likely is working with an insurance agent or agency in order to be offering this multi-carrier deal -- see if you can connect with the agent who sold these insurance plan(s) and they likely understand it better than your employer does.
posted by AzraelBrown at 2:33 PM on October 15, 2020