Is a New Health Insurance Plan 4 Stars? NY Shoppers Can Judge

Ratings for now are provisional

Wednesday, November 13, 2013

John Batteiger, a freelance writer and editor, weighs the pros, cons and costs of different health exchange insurance plans. (Fred Mogul/WNYC)

Making a hotel reservation? Buying a smartphone? Deciding on a movie to watch?

One way to choose among the abundance of options is to look at the number of stars they get from reviewers.

Federal and state officials hope consumers will use the familiar format to help guide the choices they make when purchasing insurance coverage through new health exchanges as well.

"I don't think people will be looking at these ratings first, but when they've got it down to a couple of plans and are trying to make a decision, I could see it tipping the scales," said Pat Roohan, head of the New York State Health Department's Office of Quality and Patient Safety.

New York appears to be one of the few places that have such a system up and running. The federal government's exchange that covers roughly two-thirds of states is only partly functioning, and other states that are running their own exchanges — including California and Minnesota — don't yet have ratings data integrated with the other parts of the system.

But New York's star system still comes with caveats. It excludes three brand-new companies that have not been graded yet: Oscar, Health Republic and Northshore-LIJ Care Connect. And the 14 other companies around the state that do get stars get them based on data from previous years and from very different insurance products than what they sell on the exchange.

Those data sources provide a reasonable yardstick for now, Roohan said, though in the future he expects the scoring system to grow increasingly accurate and useful.

"It does take a little bit of time to get the wheels rolling," he said, "it will probably be almost two years before we'll have real data on the exchange plans."

Locally, the seven companies in the metropolitan area with established records all get either two or three stars — basically B's or C's. Healthcare advocate Elisabeth Benjamin, from the Community Service Society, says the real value for many people might come from clicking through those stars, getting the nitty-gritty scores underneath, and matching their needs to a plan's strengths.

"If you really value maternity care and you're going to be having a baby next year, you can really figure out which carrier is doing the best job," Benjamin said. "Or, if consumer satisfaction surveys is the thing that's most important to you, you can go on and see which plans have the best reported consumer satisfaction."

You cannot drill down yet, though. Making those star ratings a gateway to a rich trove of quality scores is a goal for the coming months, according to a state spokesman. In the meantime, quality-oriented shoppers who want more information can find it at the state Health Department's website.

Exchange shopper John Batteiger, 54, an uninsured freelance writer and editor, was not thinking about insurance company ratings when he went in to see Benjamin for help selecting an exchange plan. He was focused on the monthly cost and whether Lenox Hill Hospital, near his apartment, would be in-network.

He found an insurance plan from Emblem that had his hospital, saved $60 a month over Empire Blue Cross Blue Shield, the runner up—and had three stars to Empire's two.

"I wasn’t aware of these consumer ratings," Batteiger said, "and it looks like I’ve got a better star rating with Emblem – and so that’s good."



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Comments [2]

Seth from NYC

I commented rather negatively on this report back in November. Well I'm back nearly 4 months later and I stand by my criticism. According to the NY State of Health website, about a half million people have signed up for coverage. Yet I look at the plans, the ratings are as useless as they were back in November. There are still no ratings for the newer providers' plans and generic brand-wide ratings for the established providers' plans. There is nothing even remotely useful about the information currently available. This report was irresponsible at the time and should be apologized for.

Mar. 05 2014 02:30 PM
Seth from NY


I typically value your reporting but this piece is light on detail and, as a result, very misleading. The takeaway from the piece is essentially praise for the NY Exchange with respect to its star rating system. But my experience with the exchange (and, in fact, your reporting as well) would prove that the star ratings are useless.

First, my searches for plans revealed two providers based on my zip code. One has a rating and one does not. More than half the plans have no rating. Your reporting confirms this. You can't compare ratings based on this type of information.

Second, the rating is the same across all plans from a given provider. For example, every Oxford plan is rated the same. You confirm this with your reporting, yet you lead off with the analogy of ratings for purchases of smartphones or movie tickets? Would you buy a particular smartphone based on a rating for Samsung that included every product they sold like other smartphones, televisions and microwaves?

Third, you state that the ratings do not "drill down" yet you seem to give credit for some theoretical ability to find out which plan has the highest rating for maternity care. The current ratings don't come anywhere close to providing this level of information.

As of today, the NY Exchange is being treated with kid gloves by the press. It is reportedly one of the exchanges that is working well. Perhaps it works well compared to other states but by any objective standard it is a pretty bad place to shop (particularly when you consider the promises made for meaningful options, full information, transparent comparisons and low prices). If you spend time at the exchange site you will see this. If you go to the NY State of Health Facebook page you will see this as well. It is full of complaints. Some individual specific problems but most are rooted in glitches, errors and poor choices, information and pricing for the plans.

The actual experience (and the facts in your report) would support the following headline: "Star Ratings Provided for Some Plans are Not Particularly Useful." Anything more charitable than that is misleading.

Nov. 14 2013 08:40 AM

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