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

how is star health insurance

Nov 13, 2013 · by Fred Mogul

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."

Category: Insurance

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