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CommonHealth: Tiered Health Insurance Trend Takes Hold In Mass.11:00

This article is more than 9 years old.

The ever-rising cost of health care in Massachusetts has many consumers looking for new solutions. The latest trend is called "tiered health insurance," and it's what Attorney General Martha Coakley has put at the top of her list for cutting Massachusetts health costs.

Here's how it works: Doctors and hospitals are assigned tiers based on quality of care and affordability. Consumers pay lower premiums to receive care in lower tiers. While they have the option of seeking care outside of their tier, consumers can expect to pay more in co-pays and deductibles.

The question is, how much more? And will this system actually help cut costs?

One thing is for sure - the triered insurance system requires extensive consumer education and awareness. Insurers may move doctors and hospitals from one tier to another, and tier assignments may differ from one insurance company to the next.

We ask CommonHealth's co-host Carey Goldberg what tiered health insurance means for your wallet.


Tips from Health Care For All for navigating the tiered health insurance system:

  1. Make sure you know the details of the plan you’re buying. For example, not all doctors’ visits cost the same amount under each plan. Ask your insurer how much it will cost each time you visit your doctor under the plan that you are considering.
  2. Be sure that you’re buying the best value plan for your household. Your monthly premium may cost less, but you may have to pay more out-of-pocket expenses than you are used to each time you visit a doctor, depending on what tier the doctor is in. Make sure your co-pays are affordable for you and your family.
  3. Do your homework. Remember that doctors within the same practice may be in different tiers. Always call your doctor’s office to verify their tier.
  4. Ask lots of specific questions about your tiered plan. For example, doctors can move up and down the tiers. Ask the insurance company how often they evaluate the doctors and decide on their tiers. This is important because you may form new relationships with doctors who are in the lower-cost tiers, only to have them move into a higher-cost tier that will increase your copays and even render their services unaffordable. If you are curious about how your doctors are evaluated and tiered, ask those questions as well.

This program aired on July 19, 2011.

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