Health insurance plans that help hold down costs

A good health care plan should provide high overall quality and help members avoid unnecessary medical care. That can help cut health care costs and reduce the risks that come with all medical tests and treatments. (Read more about the outrageous costs of health care in this country).

The PDF chart linked to here shows rankings for all private plans (those you buy on your own or get from your employer) in each state plus Puerto Rico and Washington, D.C, and also identifes plans that earned our check mark in Avoiding Overuse. The data come from the National Committee for Quality Assurance, a nonprofit quality measurement and accreditation organization. (See the full rankings of health insurance plans, including Medicare Advantage and Medicaid plans.)

To earn a check in Avoiding Overuse, plans must have sufficient data, score higher overall, and do better in at least three of these areas:

• Avoiding inappropriate use of antibiotics. Overuse of the drugs has undermined their effectiveness and has bred dangerous antibiotic-resistant strains of bacteria. Read more about the dangers of overusing antibiotics.
  
• Limiting imaging tests for lower-back pain. Getting an X-ray, CT scan, or MRI within the first month of back pain is rarely necessary because back pain almost always clears up on its own in that time. Read more about the best tests and treatments for back pain.
  
• Reducing hospital readmissions. Being readmitted to the hospital soon after discharge could mean, for example, that the hospital or doctor didn't properly coordinate discharge or provide appropriate care when the patient was there. Read more about hospital readmissions.
  
• Reducing overuse of invasive heart procedures. It can be more cost-effective and better for patients when heart disease can be controlled with lifestyle changes and drugs. Read more about the best ways to treat heart disease.
• Avoiding overuse of emergency rooms. Good plans help patients stay out of the ER, in part by controlling chronic diseases.  

Our analysis found that in general, preferred provider organizations (or PPOs, which allow you to see out-of-network providers, but at higher cost), did not perform as well in Avoiding Overuse as health maintenance organizations (HMOs, which only cover in-network providers and usually require you to get a referral from a primary-care doctor). We also looked at which health insurance companies had the most plans overall that did well in Avoiding Overuse, and where those plans tended to be situated in the U.S. (see below).

Which insurance companies are better at helping their members avoid unnecessary medical care?

We looked at large insurers that offer multiple health plans to see how they compare when it comes to avoiding overuse. The table shows the percentage of NCQA-ranked private plans for each insurer that earned a checkmark for Avoiding Overuse.

Where are the plans that do better in Avoiding Overuse?

We looked at private health insurance plans across the country. In nearly half of the states, not a single plan received our checkmark for Avoiding Overuse, while in some states—notably Minnesota and  Massachusetts—at least half earned that designation. Overall, plans in the Northeast outperformed those in the rest of the country.

What else is in the health insurance rankings?

Overall score. Each plan gets a score from 1 to 100, based on how well it provides preventive services, including cancer screenings and immunizations; how well it manages chronic diseases, such as heart disease; consumer satisfaction; and accreditation. The overall score is also used to determine a plan's national rank, shown in the far left column of the chart.

Consumer satisfaction. This indicates how well a plan performed in a survey of members about such factors as getting timely doctors' appointments, getting the care they need, and their overall assessment of their doctors and specialists.

Prevention. This measures the proportion of eligible members who received preventive services, such as prenatal and postpartum care, cancer screenings and immunizations. It also looks at access to primary- and preventive-care visits for children and adolescents.

Treatment. This measures the proportion of eligible members who received the recommended care for people with conditions such as asthma, diabetes, heart disease, alcohol and drug dependence, and mental illness.

Accreditation. Most plans in the rankings are accredited by the NCQA, which requires plans to consistently show high-quality care, strategies for improvement, and public disclosure. Plans pay fees to any organization that evaluates them, including NCQA.

Read more about how health insurance plans are ranked.