What Are Individuals Looking for in Their Healthcare Coverage?

Individuals and businesses are looking for guidance to help them assess several different variables when shopping for the right healthcare coverage.

Outdated Healthcare Assumptions

Historically, those in the healthcare brokerage industry have assumed that their customers value choice above all else when examining which healthcare coverage and network to choose. This might not be true, though, according to data released by Accenture in 2015.

Jean-Pierre Stephan, a managing director at Accenture, said that this belief among brokers started as a backlash against the overly-restrictive HMOs of the 1990s. Today, however, data suggests that people are comfortable limiting their range of choices as long as they have control over and access to their medical information, Stephan said.

“We found that patients actually prefer these coordinated-care networks,” said Stephan. “Consumers don’t want unlimited choice. What they want is a few good choices.”

Another inaccurate assumption that healthcare experts are now challenging is the belief that customers are loyal to their doctors, and that they choose to change networks or stay in their current network based on their physician’s affiliation. This too has been found to be only partially true, as only 26% of those polled in the Accenture study said they would leave their network if their doctor was no longer a participant.

So if consumers aren’t looking for unlimited choice and they aren’t looking for the perfect doctor, what are they looking for? At this point, most individuals rightfully expect to receive quality medical care no matter where or from whom they receive it. This shifts the primary differentiators among networks to more personal components such as transparency, customer service, and a large, coordinated network.

Or, as Stephan puts it, “It’s not about the doctor, it’s about the experience.” And a critical part of that experience is access to convenient, competent, and clear healthcare.

However, without a basic understanding of plan levels and fundamental terminology, that experience could be doomed from the beginning.

Informed Healthcare Consumers Make Informed Decisions

Saurabh Bhargava, an assistant professor of economics at Carnegie Mellon, conducted research with his colleagues and found that 71% of participants in a survey lacked an understanding of some basic insurance related terms, including “copay,” “deductible,” “coinsurance,” and “out-of-pocket maximum.”

Furthermore, Bhargava and his team discovered that this fundamental lack of understanding leads individuals to choose expensive plans that don’t align with their needs. For instance, one common misunderstanding among healthcare consumers is that higher-tier plans correlate with higher-quality care, more attractive medical facilities, and more prestigious physicians.

The truth, of course, is that the level of plan an individual chooses is strictly about how their costs will be split with their insurance provider of choice.

The Role of Health Insurance Brokers

Brokers have a responsibility to help explain to individuals and businesses alike the drawbacks and benefits of various health plans and healthcare networks. In doing so, they should conduct on-site visits to businesses and one-on-one consultations with employers and individuals to educate them regarding their options and help them determine the best fit for their needs.

For instance, a young, healthy individual should probably choose a low-cost, minimum-coverage option that allows them to visit physicians within their network with whom they are familiar and comfortable. On the other hand, an older person with chronic health problems will probably want to opt for more comprehensive coverage from an expansive network that provides convenient and consistent care across a larger service area.

According to the Huffington Post article “Everything You Need to Know About Choosing Health Insurance,” there are three primary questions that consumers should ask themselves when considering which level of insurance is right for them:

  1. What do I expect to pay? Consumers should add up their monthly premium and their expected out-of-pocket costs to determine this figure.
  2. What is my out-of-pocket maximum? This is the worst-case-scenario dollar amount you will have to pay through your coinsurance and deductible before your insurance plan kicks in at 100% coverage.
  3. How broad is my network? If you are comfortable with a certain physician, check to ensure that they participate in your network of choice.

Each of these three questions will be personal to your clients, and they should consider their answers thoughtfully before making their choice. As a broker, you’ll need to help them find accurate answers to these questions, and these answers need to take the client’s potential variables throughout the coming year into account.


Kutscher, B. (2015, June 5). Quality and control, not choice, is what insurance customers want. Modern Healthcare. Retrieved from http://www.modernhealthcare.com

Schumaker, E. (2015, November 16). Everything you need to know about health insurance. Huffington Post. Retrieved from http://www.huffingtonpost.com/entry/health-insurancevocabulary_us_563b8e20e4b0307f2cac5fe0

Wen LS, Tucker S. (2015, June 18). What do people want from their healthcare? A qualitative study. Journal of Participatory Medicine, 7:e10. Retrieved from http://www.jopm.org/evidence/research/2015/06/25/what-do-people-want-from-their-health-care-a-qualitative-study/