Wednesday, January 29, 2014

Covered California Rates Plans It Sells


 San Diego UT

For many people enrolling in Covered California this may be their first time in many years to enroll in any health  insurance plan.  For some it may be the first time they have qualified to be insured.

The array of plans is overwhelming at best and the enrollment program (contrary to  President Obama's statemtn) is not user friendly (such as buying on  In fact the process has been made more difficult by this attempt to make health care fit into a business model for shopping.

Health Insurance has been like no other, and labelling a web site to encourage enrollment as the "Market Place" demeans the process further.  It equates health along with such things as a meat packing plant, and a piece of steak.

Although statistics can be misleading and subject to interpretation , this attempt to rank plans is a starting point for 'newbies'.

Nevertheless in order to assuage critics of Obamacare by pretending to offer quality comparison Covered California has listed their 'ratings'.

Several articles have appeared, one in the San Diego Union Tribune,  which stated that the two plans in San Diego which  rated the highest were Kaiser Permanente, and  Sharp Health Plan. Sharp and Kaiser each got four stars, one better than Anthem Blue Cross and Blue Shield of California.  This applies specifically to the San Diego region.  This is a truly unique area in terms of Kaiser and Sharp Health Plan for which there is no equivalent plan in other regions of California.

There are several organizations that rate health insurers based upon selected criteria.

NerdWallet Health offers The Best Hospitals tool which includes the most recent hospital data available through Medicare. The data features the 100 most frequently performed inpatient procedures from over 3,200 hospitals across 50 states. This website offers a straight forward chart which ranks hospitals/plans

NerdWallet devised the Easy Index, which ranks each company as Easy!Decent, or Painful, based on our experience calling each company and health plan data from the National Committee for Quality Assurance (NCQA’s Private Health Insurance Plan Rankings 2012-2013 and NCQA’s Medicaid Health Insurance Plan Rankings 2012-2013).  NerdWallet Health's ranking differ significantly from what Covered California rated.

The other organizations that rank healthplans and/or hospitals are:

     NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA         accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care.

Hospital Consumer Assessment of  Health Care Providers and Systems (HCAHPS) is a national, standardized survey of hospital patients about their experiences during a recent inpatient hospital stay. These rankings appears at Data.Medicare.Gov

NerdWallet Health offers their criteria for ranking.
 This is a beginning for some. For many assessing co-pays, deductibles, and benefits will be more of a challenge, especially those on subsidized plans who were previously covered by Medi-caid.  It is unclear to me whether Medi-caid will upgrade their coverage, provider lists, or hospital eligibility.

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