America’s biggest health insurers want to get bigger, potentially leaving consumers with fewer choices and higher rates. But patients looking to steer clear of these giant corporations may find viable alternatives among an emerging group of health insurance companies that offer new ownership models, more personalized service and innovative ways to access care.
If Anthem acquires Cigna and Aetna merges with Humana, two deals that are in the works, America’s five biggest health insurers will become three, including United Healthcare. But just because they’re the biggest doesn’t mean they’re the best — or only — options.
Especially for people on the coasts, newer, smaller health insurers are popping up. Instead of covering millions of people, they cover thousands and often cater just to individuals purchasing insurance on their own or through a federal or state exchange.
They offer a few perks and quirks the big guys don’t. Some give free fitness trackers to their members to keep them moving, or free telehealth services in which members can have a phone chat with a doctor rather than a visit. Others are owned by the doctors themselves, giving the insurance company rare medical knowledge and eliminating authorizations and appeals.
Here’s a bit more about alternative insurers, and the features and philosophies that might make them right for you.
Co-Ops, Where Members Get a Say in Policies
Health insurance co-ops were created to be operated by consumers, giving members more say in the way their insurance companies are run. Even though they’re private companies, co-ops were started on government loans in 23 states in hopes of offering more low-cost choices with competitive provider networks. Members of co-ops get to vote on key changes in policies, and all surplus revenues go to reducing premiums or improving benefits.
Maine’s Consumer Health Operative, the most successful co-op thus far, was able to offer consumers an alternative to Anthem, previously the only choice for Mainers on the federal exchange. Recently, CHO expanded into New Hampshire, still offering members in-network access to all major hospitals and a large selection of doctors.
Co-ops are only available through insurance exchanges or small-business employers. By law, they’re not allowed to compete in the large employer marketplace, so if you get your insurance from a large employer, this option is not available to you.
A co-op might be right for you if:
? You purchase individual insurance on a marketplace or own a small business.
? You live in one of the 23 states where co-ops are available.
? You’d like a say in how your health insurance company is run.
? You like the idea of a non-profit insurer that returns savings to you.
Startup Insurers With Big Vision
Oscar, a startup out of New York, is getting a lot of buzz in the health insurance business lately. Sometimes referred to as “hipster” health insurance, Oscar doesn’t identify with that designation. Oscar is private health insurance, also offered on insurance exchanges, that is currently available only in New York and New Jersey, and plans to expand to California.
Oscar has about 40,000 members, according to its press officer, all of whom receive free fitness trackers and unlimited telemedicine visits or phone calls with doctors. The idea is that by staying fit and discussing minor questions with a doctor, members stay healthier, which results in lower health care usage and costs.
Oscar plans are all exclusive provider organizations, so services from non-network doctors and hospitals are not covered at all, except in some emergencies. However, even its lowest-coverage plans have low or no copays so long as members stay in-network. This is a little easier in New York and California, where laws protecting patients make it mandatory to notify patients when providers are out of the insurance network.
Oscar might be right for you if:
? You live in New York, New Jersey or California.
? You’re tech-savvy and like gadgets and mobile apps.
? You’ll diligently stay within your provider network to spend less on health care.
? You like the benefit of talking to a doctor without always visiting an office.
New Options for Employers
You’ll have the most say in your insurance if you pick it yourself, but about 56 percent people in America get their health insurance from an employer, according to ZaneBenefits. Different breeds of health insurers are popping up for employers, too.
For example, take Crystal Run Healthcare, owned and run by doctors. Executive Director Glenn Polansky says that because doctors know patients best, Crystal Run can save money for patients by eliminating wasteful procedures and increasing members’ health care literacy.
“If a patient wants an X-ray, we don’t just order it because they asked or deny it without explaining why. There’s always a dialogue between patients and doctors,” Polansky says.
When employers choose Crystal Run, they agree to let a representative educate their employees about insurance and health care usage. They also provide a personal concierge to each employee member who helps coordinate each family’s care, and helps members find the cheapest MRI or highest-value doctor in their area. Crystal Run makes sure doctors are available for patients, too, by only providing insurance for employers in areas where their doctor network is large.
Collective Health is another startup that wants to offer smaller employers, those with 5,000 employees or fewer, the option to customize health plans like bigger companies do. Self-insured employers take on risk themselves, so if claims are higher than predicted in any year, the employer pays for it. If they calculate risk well, they spend less than they would with a one-size-fits-all insurance plan.
Many large companies operate this way and save money, and now Collective Health wants to help smaller employers do the same. Employers with many young, healthy employees, like tech startups, stand to save the most because their employees are less likely to use health services and drive up costs.
Even though most of these alternative health insurers serve the coasts, they all have plans to grow and compete with bigger companies. So if one of these isn’t an option for you now, they may be available in the future.
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Should You Switch to an Alternative Health Insurer? originally appeared on usnews.com
