Buy in to your health

Choosing health insurance can be confusing, as consumers try to decipher terms like “non-preferred providers” and “out-of-network co-insurance.” Buying it on your own, as many have been forced to do in the past decade amid a harsh economy, can be intimidating.

Enter the Internet’s glut of information. Online shoppers for health coverage face potential dangers, including scams. But online tools introduced recently aim to ease the process.

Individual coverage – health insurance you buy directly from a company for yourself – is “not ever a better deal” than coverage through an employer, said Stephanie Marquis, a spokeswoman for the Office of the Insurance Commissioner.

But it’s often the only option for people without jobs or whose employers don’t offer the benefit, if they don’t qualify for government health care coverage. In 2011, nearly 4.3 percent of Washington residents were insured through the individual market, according to the Office of the Insurance Commissioner.

Individual enrollment statewide declined from 2010 to 2011 by about 5,000 people, but that was the first decline in the past decade. Since 2004, the earliest year the numbers are available, the individual market has grown 44 percent, compared with state population growth of 9 percent since 2004.

One element of federal health care reform, a statewide “health benefit exchange,” is expected to be up and running in Washington next October, with coverage starting Jan. 1, 2014. Idaho last week announced plans to pursue its own exchange.

The Washington Healthplanfinder will let users go online to compare plans side by side based on cost and specific benefits, according to the state Health Care Authority. Help will also be offered on the phone and in person.

Individuals will still be able to purchase health plans in the current market – the exchange and private market will offer plans under the same regulations.

Until then, individuals without insurance can work with an agent – or go it alone. While a licensed agent can navigate the options, there’s nothing wrong with shopping for health coverage at home via the Web, Marquis said.

“If you’re buying an individual plan and you’re Web-savvy, I think it’s perfectly fine to buy it online,” she said.

Some tips for online shoppers seeking health insurance:

• Check out HealthCare.gov. The federal site lets users search for insurance available where they live as well as what public programs they might qualify for, according to their age and other characteristics. For a 30-year-old pregnant veteran who lives in Washington who’s losing her employer-based insurance, for example, the site lists eight options, including COBRA coverage, participation in a pre-existing condition insurance plan (aka “high-risk pool”), and care through the Department of Veterans Affairs.

• Use the “summary of benefits and coverage” forms. As of this fall, under the Affordable Care Act, all companies are required to provide standardized forms outlining how much certain treatments would cost under each plan.

“It allows you to do an apples-to-apples comparison,” Marquis said.

Among the worst mistakes consumers make, she said: basing their choice solely on monthly premiums without considering their out-of-pocket costs for doctor’s visits, treatment and medical tests. The plan with the lowest premium is not necessarily the best plan.

“That’s where the summary of benefits form comes in, to help people see for (each plan they’re considering), this is how much you’ll pay for certain things that maybe you didn’t think about before,” Marquis said.

• Guard your data. If a company asks you to provide your Social Security, bank account or credit card number even before you’ve quoted a price or approved for insurance, that’s a bad sign, said Chelsea Dannen, of the Better Business Bureau’s regional office.

“Scams are usually trying to get information for identify theft or financial information,” Dannen said. “So if you are being pressured to give that information without already trusting this company or knowing they are going to offer the services you’re asking for – that shouldn’t happen. … You have the power and the right to not give that information unless you feel fully comfortable.”

• Use the Office of the Insurance Commissioner’s website, at www.insurance.wa.gov, to make sure the company is authorized to sell insurance in Washington – especially before entering your credit card or Social Security number or other personal information, Marquis advised. The site also lets consumers compare the number of complaints received by the state about various health carriers and search for information about the companies’ past requests for rate increases, which could suggest future rate increases, too, Marquis said.

• In Idaho, check with the Department of Insurance. The agency’s site directs consumers to a site run by the National Association of Insurance Commissioners. The site is at https://eapps.naic.org/cis/. The agency also lets online shoppers look up a company’s license status at www.doi.idaho.gov/ insurance/search.aspx.

• Be cautious around discount plans. If you’re looking for insurance, make sure that’s what you’re getting.

“There are a lot of companies that sound like insurance that aren’t insurance,” Dannen said.

Discount medical programs charge a monthly fee in return for discounts at urgent care or dental providers. While they’re allowed in Washington, some come with catches. They might not be accepted by a member’s provider – or by any providers where they live.

And some may not report clearly that they’re not insurance, Dannen said.

“They can sound really similar,” she said. “And with scams, that’s their whole goal – to sound extremely similar, to sound too good to be true, with extremely discounted rates. That’s where (shopping) online can get really messy.”

If you want a discount plan, make sure that it’s authorized to operate in the state and that your provider participates. If the company selling it lists no physical headquarters and you can’t reach its employees by phone to ask questions, “those are big red flags,” Dannen said.

• See a great deal? Exercise skepticism. The state regulates health insurance premiums. Consumers will pay the same premium for the same plan whether they buy it directly from the company, through a local agent or from an online marketplace like eHealthInsurance.com.

If a site promises a deal that sounds too good to be true, check it out with the Insurance Commissioner’s Office, she advised.

“It’s not like you can go to one site and get a better deal on a Regence plan,” Marquis said.