How I found a surprisingly good health plan

20 minutes ago

I've written four posts on health insurance recently, and there are more to come. I have been trying to get a sense of what I am buying, of how many options I have to consider, of how much it will cost and of how I can explain my choices to my workers. This has been extraordinarily complex.

I wrote the first two posts in this series a couple of weeks ago, and since then I have turned up a lot more useful information. This installment will be about how I found out how many plans I can choose among. The next one will be about what they will cost.

You would think that it would be a simple question: How many plans do I, a small-business owner, actually have to choose from? Are we talking tens? Hundreds? Thousands? The answer, I found, was about a hundred. If you don't want the details, skip to the bottom of the post and you will find my recommendations as to what to look for. But the saga is kind of interesting, and it says something about how difficult it is to understand the insurance market.

The question of how many plans are available to me popped into my head after I got my initial quote from my agent, Maggie, on Oct. 30. That quote showed three plan options: a gold level H.M.O. that provided coverage and co-pays roughly equivalent to my existing plan but came with a big price hike and two silver level plans that came with a smaller premium increase but had higher co-pays and deductibles. All of the plans came from Independence Blue Cross, my current insurer.

Maggie also told me that, for 2014, I would need to choose one plan to cover all of my people. That requirement is expected to disappear in 2015, but for now I needed to identify a single plan that would be best for myself and my workers. Because I wasn't ready to make a decision based on what I had seen so far, Maggie offered to get quotes from United Healthcare and Aetna. I told her to go ahead.

While I was waiting, I went onto the HealthCare.gov exchange to see what it offered and was shown a monthly premium cost for 24 plans from all metal levels. Hmmm. That's a lot of choices compared with the first quote. The problem was that I could see pricing for all of these plans but no details on what the plans covered - just its type and metal level.

I finished my first session on the exchange on Nov. 5, and sent off a request for help through the SHOP exchange the next day. (As of Monday morning, I still had not heard a peep from them, and it now seems the government has given up on the idea of getting it working this year.)

On Nov. 6, I also got a package in the mail from Independence Blue Cross, which basically duplicated what Maggie had given me: pricing on three plans and not much more. The (not so) funny thing was that the cover letter stated: 'The enclosed package has everything you need to help you choose the benefit plan that's right for your business.' I would soon learn that that was not quite accurate.

On the morning of Nov. 11, Maggie got back to me with quotes for six plans from Aetna (three gold and three silver) and six from United Healthcare (two with health savings accounts and four that I found were too cryptically named to classify). The prices for all of these were considerably higher than the Blue Cross quote, so I didn't pursue any of them.

My post on my experience with the exchange was published on the 11th. Late the next day, I got a phone call from Brett Mayfield, vice president of sales at Independence Blue Cross. He had seen my post mentioning his company and offered to answer any questions I might have. And boy, did I have questions. We ended up talking for more than an hour in that first call, mainly about how hard it was for me to determine pricing on his company's website.

Over the next weekend, I spent some time thinking about what I had learned so far, and I realized that I really didn't know the magnitude of my options. How could I make a decision without knowing how many plans I had not seen yet? So I sent Mr. Mayfield an email asking how many plans his company was offering small businesses. His surprising answer: 36. And on the following Monday a package arrived. It was a bunch of brochures full of information about the new, post-Affordable Care Act market. Most of them weren't all that useful, but there was a 16-page booklet - labeled simply 'Health Plans 1/1/2014' - that showed all 36 plans. Bingo!

The plans come in amazing varieties: P.P.O.'s, P.O.S.'s, H.M.O.'s, some with H.S.A.'s and H.R.A.'s and F.S.A.'s, platinum to bronze. They were nicely arranged, grouped by metal level, so that one could flip back and forth and see the details (there are 36 points of comparison). The amount of information was considerable, but the booklet had one big advantage - it was all in one place - and one critical disadvantage - it offered no pricing information. The metal levels gave some indication of which plans were likely to be more expensive, but I couldn't actually tell how much each one cost.

Struck by how much easier it was for me to get a sense of my options in this brochure, I tried to find comparable information on the Independence Blue Cross website. Maybe it's just my age showing, but I found it very difficult to compare the details of several plans on a screen. I couldn't switch easily from one plan to another to see how the details compared. And there was no single place to see all of the plans at once.

There were a number of tools designed to help an individual choose a plan, and they worked by asking questions that narrowed the set of choices to several plans that could be shown in detail. But that's not what a boss trying to make a decision for a group of workers needs to see. At this point in my process, I wanted scope, not focus. I realized that this is one of the very few instances where the 20th century way, ink on paper, was clearly superior.

Just out of curiosity, I spent some time on the United Healthcare and Aetna sites trying to find a high level view of what they offered, with no success. Nothing I looked at on the web made clear what their universe of offerings looked like. I decided to continue to focus on Independence Blue Cross.

I spoke to Mr. Mayfield again on Monday afternoon, and asked him how I could see pricing on all of those options. I wanted complete grids with the premium for every age. I'd have to request a quote from my agent, he said, and I would get the numbers for my employees and dependents only. That seemed like a very clunky way to go about things: Why aren't the prices simply posted on the site? We had a long discussion about this, but I never heard an answer that made sense to me.

In my second discussion with Mr. Mayfield, he directed my attention to another brochure in the packet, one for a plan called Blue Solutions that I hadn't really noticed. This one was different: it would allow me to offer up to 10 of the 36 Independence Blue Cross small-business plans to my people. It was designed to get around the problem that Maggie had flagged for me - that I was required to choose a single plan for everyone this year.

This option removed one of my main concerns, that for my crew - some of whom are single and some of whom are married with children - a single plan isn't a good fit. The high deductible plans would come with high out-of-pocket costs for those with young children, but the lower deductible plans would lock in premium costs for more health care than the young and healthy workers need.

Blue Solutions is designed to be boss-friendly. The brochure said it was a defined-contribution plan, where I set a dollar amount of spending per employee, but later, speaking to Mr. Mayfield, I learned that it can also be set up as defined-percentage employer/employee split, like I have now. The brochure for Blue Solutions showed a custom web interface (with screen shots) designed to act as a private exchange for employees. They would submit answers to questions about their health needs and be guided to their best choices. This really seemed to be a nice option.

The next day I sent a list of 10 plans to Maggie, asking for quotes. And I asked her whether this type of plan, with multiple choices, was available from United Healthcare and Aetna. She said yes, they both had a version. Clearly, it's a lot of work for an agent to quote these plans. Maybe that's why she hadn't brought them up in the first place.

My search for options was long and involved, but ultimately turned up an excellent choice. I'm giving you the details because I know that prolonged series of discussions with a vice president of a local health insurance company is not a normal part of the buying process. Had I stuck with what my agent told me, I would have considered only a small subset of what was available, and I would have missed out entirely on a choice that I was actually quite happy about. Based on my research, here are my recommendations:

1) Choose a company you want to do business with.

2) Get a paper brochure or brochures for ALL of its plan choices. It's very difficult to comprehend details on a screen. Keep asking until you get something that has a lot of choices - two or three just doesn't cut it. I eventually received a brochure from Independence Blue Cross with 36 choices and confirmation that I was seeing everything.

3) The best plans are structured to contain multiple plan options, i.e., instead of choosing one to cover everyone, the owner's choice is to offer several plans and let employees choose one that fits their needs. All three insurers I was getting quotes from offered a plan like this, but it wasn't obvious initially that the plans existed and my agent didn't recommend this choice.

4) The most difficult detail to obtain is pricing that will let you see how the choices that employees make will affect your monthly premiums, both now and in the future as they age. I was looking for a complete pricing grid, with the correct premium at each age. This was very hard to get, but once I received a few, I found something surprising about every plan being offered.

I'll tell you a lot more about that, including a way to predict your company's costs from the quote for a single person, in the next post.

Paul Downs founded Paul Downs Cabinetmakers in 1986. It is based outside Philadelphia. This story, 'How I Found a Surprisingly Good Health Plan,' originally appeared in The New York Times. Related content from The New York Times

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