‘One-stop shop’ for health insurance

Oct. 31--A new consumer portal should allow health insurance shoppers in New Mexico to better compare plans that meet their specific needs, even steering them toward companies that favor a specific doctor or provider.

The site OSICompareHealthPlans.org is being provided by the New Mexico Office of the Superintendent of Insurance just as the open enrollment period for health plans is set to begin Nov. 1.

The insurance website does not replace the federal portal where consumers go to enroll for health plans -- healthcare.gov -- or the state site that can provide health insurance information and free counseling, bewellnm.com.

But OSI's search engine can provide more specific information in an easy-to-search format to compare all plans certified in New Mexico, even if they are not available on the healthcare.gov exchange. Many plans that do not offer federal subsidies, for instance, are not available on healthcare.gov but can be purchased directly through the company or a broker.

Once a consumer finds a suitable plan on the insurance site, they should record the plan identification number and can go onto healthcare.gov or contact the company or a broker to enroll.

"It's a never-before-offered one-stop shop," said Heather Widler, a spokeswoman for state Superintendent of Insurance John Franchini. "All your doctors are in the plan, the medicines that are covered. It takes five minutes to answer all your questions."

Widler added that the search engine has a drop-down box with all the physicians who are part of a plan network. So a consumer who wants to keep their doctor can be sure to find a plan where that individual or practice offers in-network billing.

"We see a lot of people confused with the provider they thought was in the plan but is not -- this takes the guesswork out of it," she added.

The portal was developed by the nonprofit Consumers' Checkbook organization and has been customized to specific states with plans and insurance companies. The site is running in Pennsylvania, Minnesota and Vermont. Eric Ellsworth, the director of health data strategy at Consumer's Checkbook, said the group has created similar search engines for employees of the federal government who often have a range of insurance plan options.

The Office of the Superintendent of Insurance is paying a $190,000 licensing fee to customize the site to New Mexico plans and providers.

One advantage is that just four companies sell plans through the Affordable Care Act's healthcare.gov portal, but more options are available for middle- and upper-income individuals who would not receive any federal assistance to pay monthly premiums. The OSI site includes all those plans as well.

For instance, a 40-year-old Santa Fe resident with an income of $40,000 has more than two dozen plan choices, ranging from $4,090 a year for a bronze plan from Molina Health of New Mexico to an individual HMO plan from Presbyterian Health Plan for $7,400, which is not sold on the healthcare.gov platform.

The search engine also calculates the average out-of-pocket costs in a plan year for each option as well as a worst-case scenario for what medical costs might be in a year of bad health.

For a 60-year-old earning $60,000 annually in a Santa Fe ZIP code, the choices range from a low of $9,283 for an annual premium to a high of $15,477. Both scenarios were calculated for nonsmoking individuals in excellent health who do not have a regular dose of prescription medicine.

But the selector also can steer users to plans that cover their specific prescription needs.

The tool also estimates the amount of federal assistance available to those earning less than about $45,000 a year without having to go into the federal portal and create an account with personal information.

Of the 50,000 or so customers who purchased insurance in the state through the exchange in 2017, more than half qualified for some federal cost-sharing assistance or for advanced tax credits to offset monthly premium payments.

"Most people who do shop on the exchange do qualify for financial assistance," said Ellsworth of Consumer's Checkbook. "You can find out about assistance without having to go into healthcare.gov. We know not all people are comfortable doing that."

Contact Bruce Krasnow at [email protected].

On the web

Office of the Superintendent of Insurance: OSICompareHealthPlans.org

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