The open enrollment period for purchasing health insurance under the Affordable Care Act began on Nov. 15, 2014, and consumers have until Feb. 1 to enroll. For those who are already covered, there are new prices and plan options. For those who aren't, this is an opportunity to sign on.
Massachusetts, the first state to mandate universal coverage, is a bellwether once again in requiring insurers to provide information on the cost of specific procedures at hospitals, imaging centers, and doctors' offices. The rest of the country can turn to web-based comparison tools designed to help find the best prices for health insurance, hospitals, doctors, and prescription drugs. Take note, however -- many of these tools are still barebones and none are polished and complete.
People who are not covered through their workplace must buy health insurance independently. Finding a path through the information thicket is full of twists and turns. Eight states operate their own marketplaces for insurance and residents in the remaining 42 must rely on the federally run marketplace. (All states set their own Medicaid eligibility guidelines.) Participating insurance companies design their plans and fee structures, which require state approval. The U.S. Department of Health and Human Services reports a 25 percent jump in the number of marketplace insurers nationwide, which should help tamp down prices.
For anyone hunting around for health insurance, a good starting point is HealthInsurance.org. Here you can see what is available in your state: for instance, eligibility for Medicaid or CHIP, the Child Health Insurance Program; insurers that operate locally; and the presence of a healthcare CO-OP, or consumer-operated and -oriented plan, which is a nonprofit health insurance plan run by the people who are insured. Before making a final decision, it's always wise to check all the details with the insurance carrier.
HealthPocket shows out-of-pocket costs for various types of insurance. It provides a fairly complete list of insurers and plans targeted to different needs, e.g., Affordable Care Act, Medicare, Medigap (supplemental Medicare coverage), dental, and small business. Personal health insurance comes in a dizzying array: plans for children only, plans with and without dental, plans for adults with a dependent, plans for various deductible amounts and maximum out-of-pocket expenses. For the most part, the plans highlighted in HealthPocket are HMOs that feature low-cost premiums and hefty deductibles. The cost for a single adult, for example, usually runs between $150 and $500 per month, with a deductible ranging from $100 to $6,000; the older you are, the higher the costs. This health insurance comparison tool matches consumers with licensed agents and insurance companies. If you have a doctor or dentist you would like to continue using, search for the doctor's name to find the plans he or she accepts.
EHealth compares insurance plans for individuals and families, seniors, and small businesses. Input your ZIP code, birth date, gender, and recent use of tobacco products, and do the same for other members of your family, and a list of health insurers and plans pops up. Plans that surface on eHealth cost between $300 and $500 per month for a single adult, again with base costs rising with age. Some plans allow two to three doctor visits a year, covered in full, and then impose a low co-pay after a high deductible is met. EHealth offers 24/7 chat and a customer assistance contact number for help understanding the plans. Online applications are accepted.
States also maintain their own health insurance comparison tools. Illinois residents, for example, can use Consumers' Checkbook to find local carriers and rates based on factors such as age, income, and the number of people in the household. Search results indicate whether residents qualify for financial assistance through Medicaid.
Some employers offer multiple health insurance plans, which certainly complicates the choice but gives consumers more control. Most carriers who participate in employer-sponsored plans post some kind of comparison tool on their websites. Insurer Health Partners of Minnesota, for example, provides an interactive worksheet that facilitates side-by-side comparisons.
Costs for medical procedures vary from hospital to hospital, as does the amount covered by insurance. Those costs used to be completely opaque unless you knew the code that hospitals send to insurance companies. While there is greater transparency these days, there is no place where consumers can obtain the complete pricing schedule for every procedure at every hospital. The data used by the following healthcare comparison sites usually are gathered from Medicare billing information.
OpsCost lists the price of hospital stays for common conditions such as pneumonia and hip fractures. It shows an average cost billed to Medicare and the amount that Medicare reimbursed hospitals for each procedure. For example, in Franconia, N.H., in-patient treatment for pneumonia with no complications costs between $9,000 and $19,000, depending on the hospital; $4,000 to $7,000 is the Medicare-covered portion. Information about charges by and payments to hospitals for various procedures and services is available by state.
Additional state-level details may be available from other sources. The Washington State Hospital Association website is one; it tells you the median length of stay and the fees at in-state hospitals.
There is no good way to ferret out the cost of a doctor visit in advance. Different charges apply based on the insurance you have; contact your health insurance carrier to learn about your co-pay. If you have a high deductible and/or the visit is not covered, you'll be in a fog until the bill arrives. Ballpark estimates, though, are available for some services.
Fair Health uses a database of billed medical and dental services to estimate expenses. A drop-down menu lists billing codes for procedures and services, and entering the codes reveals estimated charges, as well as reimbursed and out-of-pocket costs.
Healthcare Bluebook maintains a limited list of procedures, such as a flu vaccine or an office visit for bronchitis, and provides what its research shows to be the "fair" price in your area. This tool also lists "fair" prices for commonly prescribed medications, lab tests, imaging, surgical procedures, and dental work. Your actual costs depend on insurance coverage.
Prescription drugs can run into the hundreds of dollars for a single month's dose. And some insurance plans don't cover medications. As with all other facets of the healthcare universe, pharmacy prices vary considerably.
GoodRx is a drug-price search tool. Enter the name of the medication you need and, as long as it's FDA-approved, GoodRx finds the pharmacies in your neighborhood and lists the cost of the medication at each.
PharmacyChecker goes a step further by comparing prices for medications in Canada and at mail-order houses, as well as local pharmacies. The site spits out addresses to which you can send prescriptions, as well as phone and fax numbers.