Coverage When it Counts

What Does Health Insurance in Massachusetts Cover And How Can Consumers Know?

How can people know when health insurance provides adequate coverage?

This report suggests a new method for developing benchmarks to illustrate some types and costs of medical care consumers might need under a variety of scenarios, and for evaluating health insurance protection using these benchmarks.

Using simulated claims scenarios for different types of patients—one diagnosed with early stage breast cancer, another who has a heart attack, and a third with diabetes—the authors analyzed the content of coverage provided by 10 health insurance plans sold in Massachusetts and estimated out-of-pocket costs for care that patients might face. They also reviewed the transparency and accessibility of information about policies that consumers would need to understand how coverage works. Massachusetts was chosen because of its precedent-setting reforms to achieve universal coverage that included the establishment of standards for minimum coverage for all residents.

The report concludes with a recommendation for the development of standardized health plan comparison tools—patterned on the FDA nutrition label, but for health insurance—that could help consumers appreciate the kinds of medical events for which health insurance may be needed and relative

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