Best, and worst, N.J. healthcare plans

Monday, 10 October 2011 13:47
healthcarecosts101011_optBY WARREN BOROSON

The best New Jersey health-care plans are far better than the worst ones, Consumer Reports states in its November 2011 issue.

The ratings were compiled by the nonprofit National Committee for Quality Assurance

One brand name that acquitted itself with honor: Kaiser Permanente. (Not available in New Jersey.) One that didn’t acquit itself with honor: the nation’s largest insurer, UnitedHealthCare. Consumer Reports also claims that Preferred Provider Organizations from Cigna “scrape the bottom of the barrel,” although some of Cigna’s Health Maintenance Organizations are excellent.

Among private plans (where people obtain coverage through their employer or on their own), among the better HMOs is Cigna HealthCare of New Jersey, which received above-average (4) ratings for consumer satisfaction, prevention, and treatment. Its overall score: 85 out of 100.

The lowest score went to Horizon Blue Cross Blue Shield of New Jersey. Despite its above-average ratings for consumer satisfaction and treatment, its overall score was 68. But the plan is not accredited by the NCQA, which — according to Consumer Reports — could add 15 points to the score. So perhaps its score, if accredited, would have been 83 – in the same ballpark as other New Jersey HMOs.

The other state HMOs rated: Aetna Health (New Jersey)-Southern New Jersey (84), AmeriHealth HMO (New Jersey) (83), Aetna Health (New Jersey)-Northern New Jersey, Oxford Health Plans (NJ) (82), UnitedHealthCare Insurance (New Jersey) (81), and Horizon HealthCare of New Jersey (81).

Also among private plans, among the better PPOs are Aetna Life Insurance Company (New Jersey) (82), UnitedHealthCare Insurance(New Jersey) (81), and Oxford Health Insurance-New Jersey (81).

The worst scores went to Cigna (NJ) (68) and to Horizon Blue Cross Blue Shield of New Jersey (66). But these two plans are not accredited, so they might have added 15 points to their scores — bringing them to 82 and 81, in line with the other plans.

Moving on to Medicare plans, among the better HMOs are AmeriHealth HMO (83), Aetna Health (New Jersey)-Southern New Jersey (83), Aetna Health (New Jersey)-Northern New Jersey (83), Oxford Health Plans New Jersey (79), Horizon HealthCare of New Jersey (79, but not accredited), Healthfirst Health Plan of New Jersey (62, but not accredited), and WellCare of New Jersey (60, but not accredited).

Healthfirst received “lowest” ratings for consumer satisfaction and prevention.

WellCare received “lowest” ratings for those two areas, plus a “below average” for treatment.

Among Medicare PPOs, the highest rated was Aetna Life Insurance Company (New Jersey) (84). The lowest: Pyramid Life Insurance (63, but not accredited). Pyramid received “below average” ratings in all three categories.

Moving on to Medicaid plans, only one New Jersey plan was rated: Horizon NJ Health, which received a 67 (not accredited).

No New Jersey plan received a “highest” rating in any of the three categories.

The highest total score in the three performance categories for any New Jersey health plan: 12. Cigna HealthCare of New Jersey and Aetna Health (New Jersey)-Southern New Jersey received “above average” in all three categories. The two are private health plans.

With regard to the three performance categories, “treatment” reflects how well a plan cares for common conditions, such as heart disease. “Prevention” covers services like cancer care. “Consumer satisfaction” considers satisfaction with a plan’s doctors and services.

The rankings were of 830 private, Medicare, and Medicaid plans.

In an HMO, you must consult a provider in the HMO’s network. A primary-care physician will refer you to specialists and coordinate your care. You may have to pay full cost for care outside the network.

With a PPO, you can use any in-network specialist without a referral. You can also consult someone outside the network, but you’ll pay more.