Concerns about Not Having Enough Health Coverage Drive Down Member Satisfaction

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WESTLAKE VILLAGE, Calif.: 10 March 2014 — While health insurance companies are introducing themselves to customers in new markets through new channels, 41 percent of existing health plan members feel they do not have enough coverage for routine visits, serious illness or injury, health and wellness programs, routine diagnostics and drug coverage. Concerns over not having enough health coverage negatively impacts overall satisfaction by 133 points, more than any other coverage-related issue, according to the J.D. Power 2014 Member Health Plan StudySM released today.

Now in its eighth year, the study measures satisfaction among members of 136 health plans in 18 regions throughout the United States by examining six key factors: coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service. In 2014, overall member satisfaction averages 669 (on a 1,000-point scale).

Key Findings

  • The study finds that 55% of members indicate having experienced an increase in costs in 2013, which negatively impacts cost satisfaction.
  • More than one-third (35%) of members say they received a notice of changes in their coverage, networks or rates from their health plan in the past 12 months.
  • In the 2013 plan year, 74% of health plan members maintained their preferred physician and 83% retained their same hospital network.
  • Seventy-five percent of members indicate having submitted a claim in the past 12 months.
  • The average monthly premium paid in 2013 is $285.
  • Nearly half (49%) of members indicate their plan does not offer the most common types of health and wellness discount/incentive programs.

"On average, members wait eight days for communication from their provider after a pre-approval request has been submitted," said Rick Johnson, senior director of the healthcare practice at J.D. Power. "Health plans must look for ways to promptly communicate both pre-approvals and cost in order to minimize member anxiety and mitigate concerns about access to care, ultimately increasing customer satisfaction."

Study Rankings

Satisfaction is highest among health plan members in the California and Michigan regions (in a tie); the Indiana-Illinois and Mid-Atlantic regions (in a tie); and the East South Central and South Atlantic regions (in a tie). Satisfaction is lowest in the New England, New York-New Jersey and Southwest regions.

West

  • Kaiser Foundation Health Plan ranks highest among health plan members in the California region for a seventh consecutive year, with a score of 756. No other plans in this region perform above the region average.
  • Kaiser Foundation Health Plan (703) ranks highest among health plan members in the Colorado region for a seventh consecutive year, followed by Anthem Blue Cross Blue Shield of Colorado (671).
  • SelectHealth (698) ranks highest among health plan members in the Mountain region (which includes Idaho, Montana, Utah and Wyoming) for a fifth consecutive year, followed by Regence Blue Cross Blue Shield of Utah (689) and BlueCross of Idaho (672).
  • Kaiser Foundation Health Plan (732) ranks highest among health plan members in the Northwest region (which includes Oregon and Washington), followed by Group Health Cooperative (GHC) (706).
  • Blue Cross Blue Shield of Arizona (675) ranks highest among health plan members in the Southwest region (which includes Arizona, New Mexico and Nevada), followed by Aetna (668) and Cigna (666).

Midwest

  • Wellmark Blue Cross Blue Shield of Iowa (680) ranks highest among health plan members in the Heartland region (which includes Arkansas, Iowa, Kansas, Missouri, Nebraska and Oklahoma), followed by Anthem Blue Cross Blue Shield of Missouri and Blue Cross Blue Shield of Kansas City (in a tie at 678 each).
  • Health Alliance Medical Plans (692) ranks highest among health plan members in the Indiana-Illinois region, followed by BlueCross BlueShield of Illinois (689).
  • Health Alliance Plan of Michigan (711) ranks highest among health plan members in the Michigan region for a seventh consecutive year, followed by Priority Health (685) and Blue Cross Blue Shield of Michigan (683).
  • Dean Health Plan (703) ranks highest among health plan members in the Minnesota-Wisconsin region, followed by HealthPartners (681) and Blue Cross Blue Shield of Minnesota (671).
  • Medical Mutual of Ohio (697) ranks highest among health plan members in the Ohio region, followed by UnitedHealthcare (676) and Aetna (673).

East

  • Kaiser Foundation Health Plan (732) ranks highest among health plan members in the Mid-Atlantic region (which includes Maryland, Virginia and Washington, D.C.) for a sixth consecutive year followed by CareFirst Blue Cross Blue Shield (696).
  • Tufts Associated Health Plans (681) ranks highest among health plan members in the New England region (which includes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont), followed by Anthem Blue Cross Blue Shield of Connecticut (674) and Blue Cross Blue Shield of Massachusetts (669).
  • Capital District Physicians Health Plan (727) ranks highest among health plan members in the New York-New Jersey region, followed by Independent Health Association (705) and Horizon Blue Cross Blue Shield (679).
  • Geisinger Health Plan (705) ranks highest among health plan members in the Pennsylvania region for a third consecutive year, followed by Highmark BlueShield (678) and Capital BlueCross and UPMC Health Plan (in a tie at 672 each).

South

  • Cigna (689) ranks highest among health plan members in the East South Central region (which includes Alabama, Kentucky, Louisiana, Mississippi and Tennessee), followed by BlueCross Blue Shield of Alabama (688) and Humana (677).
  • AvMed Health Plans and Humana (in a tie at 690 each) rank highest among health plan members in the Florida region, followed by Cigna (680) and Florida Blue (677). AvMed ranks highest in the Florida region for a third consecutive year.
  • Kaiser Foundation Health Plan (784) ranks highest among health plan members in the South Atlantic region (which includes Georgia, North Carolina and South Carolina) for a fifth consecutive year, followed by UnitedHealthcare (684) and Blue Cross Blue Shield of North Carolina (681).
  • Aetna (677) ranks highest among health plan members in the Texas region, followed by Cigna (672) and UnitedHealthcare (668).

J.D. Power plans to release a study focused on health plan members satisfaction with the Affordable Care Act (ACA) in April 2014.

The 2014 Member Health Plan Study is based on responses from more than 34,000 members of 136 commercial health plans across 18 regions in the United States. The study was fielded in December 2013 and January 2014. For more comprehensive health plan rankings for all 18 U.S. regions, please visit www.jdpower.com.

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