Tiers are a growing trend in health insurance plans. It’s different from making hospitals “in network” or “out of network” — it’s when insurers put hospitals into tiers with varying cost for each level.
But the system is adding a layer of complexity for individuals shopping around for a plan on the health insurance marketplace.
Insurers see tiers as a way to hold down premiums and costs, said Robert Field, a health policy professor at Drexel University. The idea is that people will pay less for their care if they stick to providers in those lower tiers.
“You get what you pay for under a tier system,” he said. “If you want to go to a more expensive hospital then you pay more — higher co-pays and deductibles. And if you want to go with the cheaper ones … then it’s less out-of-pocket costs to you.”
Tiers are more common in all sorts of insurance plans. In Philadelphia, several of the plans offered through the healthcare.gov marketplace incorporate them.
Patrick Keenan, with the Pennsylvania Health Access Network, said tiers can actually be a good deal for people, but it depends. Geography can play a role.
“Some of the tier one options may be in Center City, and so if someone’s in another part of the city. they really need to think about whether or not they can get to a different part of the city to get care,” he said.
Keenan said that can become a bigger issue with unplanned hospital care.
The tier details may also be buried in the insurance plan summaries. Keenan said that’s why it’s important to look beyond the monthly premiums when comparison shopping for coverage.
Hospitals, however, are not always on board. Last week, several hospitals in New Jersey challenged the approval of a Horizon Blue Cross’ tiered system in one of their plans.
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