Kaiser Foundation Health Plan ranks highest in member satisfaction with health plans in California for a fifth consecutive year, according to the J.D. Power and Associates 2012 U.S. Member Health Plan Study.
Now in its sixth year, the study measures member satisfaction among 141 health plans in 17 regions throughout the United States by examining seven key factors: coverage and benefits; provider choice; information and communication; claims processing; statements; customer service; and approval processes.
Kaiser Foundation Health Plan achieves a score of 769 on a 1,000-point scale and performs particularly well in California in all seven factors.
In 2012, overall member satisfaction averages 702, compared with 696 in 2011. There are notable gains in the information and communication, statements and claims processing factors. The average satisfaction index score in California is 705 -- three points higher than the 17-region average. Member satisfaction in California has improved by 11 points in 2012, compared with 2011.
Health plans in California and nationwide are preparing for changes as a result of the Affordable Care Act, such as the establishment of state health insurance exchanges. The study finds that a majority of health plan members who purchase insurance on their own indicate they would likely use one of the exchanges (55 percent), which are conceived, in part, to address their needs. However, a sizable percentage of health plan members who are covered under an employer-sponsored program -- 39 percent -- also indicate they would shop for insurance on an exchange if it were available.
In addition, the study finds increased levels of interest in state-sponsored health insurance exchanges, compared with the previous year. In 2012, only 37 percent of health plan members say they would not be likely to use an exchange, compared with 50 percent in 2011 who expected to continue obtaining coverage at work.
"Health insurance exchanges are meant to appeal to individuals who must buy coverage on their own, yet the level of interest among those who obtain health insurance at work could have important implications for the future of employer-sponsored coverage," said Rick Millard, senior director of the healthcare practice at J.D. Power and Associates. "Satisfaction among some health plan members may be low enough that an alternative, direct retail model could become more attractive than traditional wholesale purchasing by employers."
The study also finds substantial interest among health plan members in private health insurance exchanges, in which an employer might provide employees with vouchers for purchasing health insurance independently.
Approximately 42 percent of employer-insured health plan members indicate they would use this approach if it were available.
"The private exchange model could further erode reliance on obtaining health insurance at work," said Millard. "Creating new channels for purchasing insurance could trigger more changes. It could mean more attention will be paid to direct purchasers, and also make achieving high levels of satisfaction critically important for health plans that strive to acquire and retain members."
J.D. Power offers the following tips to health plan members and consumers who are shopping for health insurance coverage:
* Understand your coverage. Health insurance plans are sometimes difficult to understand, with complex rules for deductibles, co-payments and other kinds of expenses. If you don’t have a clear understanding of the coverage and you have a choice of plans, opt for the simpler approach. For example, you may be more satisfied with fewer options for doctors in order to have coverage with less complicated costs.
* Before enrolling in a health plan, familiarize yourself with online tools that may be offered by your
insurance company. Some health plans are set up to offer online services to track your medical condition, receive prescriptions, make appointments, or even email your doctor.
* If you obtain health insurance coverage through your employer, be prepared for fewer choices. More than one-half of health plan members who receive health insurance at work are given only one option.
* If you purchase coverage on your own, understand how your state will offer a health insurance exchange (such as the Massachusetts Connector). This is a new feature based on the Affordable Care Act, which is intended to make it easier for individuals to find affordable coverage.
The 2012 U.S. Member Health Insurance Plan Study is based on responses from more than 32,000 members of
commercial health plans. There were 2,445 members in California. The study was fielded in November 2011 and January 2012. For more comprehensive health plan rankings for all 17 U.S. regions, please visit www.jdpower.com.