By Katie Kerwin McCrimmon
Chronically ill and disabled patients who need a lot of medications and care from doctors should be careful about which health plans they pick.
Insurance that appears more affordable on the surface may in fact force patients who need a great deal of care to pay costly out-of-pocket expenses.
“Plan selection matters dramatically to people with complex, chronic conditions,” said Marc Boutin, executive vice president and chief operating officer for the National Health Council, the lobbying group for patient advocacy organizations.
The council’s members also include PhRMA, the drug industry’s lobbying group, and various pharmaceutical and medical device companies that will benefit if patients spend more on drugs and health care.
Unlike some other cost calculators, this one allows patients to feed in detailed information about medications they take and how many times they visit various providers each year. Then the cost calculator can help them determine which plans could be most affordable for them.
The creators of the calculator say it has state-by-state information and therefore should be useful to patients across the country. They hope to hand off the calculators to state exchanges like Connect for Health Colorado so they can further customize them.
Connect for Health also has a calculator on its website, but it focuses primarily on whether customers can qualify for federal tax subsidies. (Click here to see the Connect for Health calculator.)
Boutin said his group’s calculator can help people make complex decisions about which plans are right for them.
“It’s not perfect, but it shows how your use is going to have a very big impact on your costs,” Boutin told a group of patient advocates, health policy experts and insurance industry representatives during a panel discussion on Monday in Denver. “In some cases, the gold plan (which might have higher premiums) is going to have cost savings.
“It also gives you prompts on providers and services,” Boutin said.
Eileen Hunt is a certified health coverage guide for the advocacy group, Boomers Leading Change in Health.
She has been working with clients to help them sign up for health insurance and said the complexity of health insurance has been a real challenge.
“This is an awesome tool,” Hunt said during Monday’s gathering.
She said many clients have been overwhelmed by the number of choices they have and don’t know how to pick the best plan.
“We have all this information available. Most clients qualify for up to 75 plans, but no human being is going to look at all these plans,” she said.
She tries to ask meaningful questions about how much care they will need, but it’s difficult to help clients understand details about premiums up front versus costs they’ll have to pay later.
Said Hunt: “There will be assistors and navigators who will use this tool with them.”