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What to Know About Health Options’ Tiered Provider Networks in Individual/Family Plans

Oct 05, 2021
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The year ahead comes with a few changes to Health Options’ health insurance plans – and it’s all good news. One change we are excited to announce is a new tiered provider network option available in select individual/family Health Maintenance Organization (HMO) plans. While tiered plans may be new to Health Options, they are not new to health insurance. In fact, they are a proven way to save money on medical expenses. Read on to learn what tiering means to insurance plans and what it means to you as a health insurance consumer.

Tiered provider networks are a way to better manage the costs of healthcare services. They also provide health insurance consumers a better way to consider the cost of care when choosing their care options. Plans featuring tiered provider networks generally combine quality and cost in developing a preferred tier. Providers with high-quality outcomes and lower contracted prices are typically placed in the most preferred tier rankings.

As a consumer, you may wonder how Health Options decides which providers are considered part of our preferred tier. It is important to note, that all providers meet our quality standards, which is why they are part of the Health Options network. For tiered providers, we review claims history to analyze the quality of provider outcomes combined with their contracted cost and efficiency. Providers and facilities that meet or exceed our standards for quality, cost, and efficiency are “preferred,” and others are “standard.” 

To take advantage of tiered providers, you will need to select an individual/family plan with a tiered network option, which is available in both bronze and silver metal level plans for 2022. It’s important to note, that on a tiered plan, you always have the option to visit standard providers with a standard co-pay. 

As we enter the Open Enrollment season for 2022, we are proud to offer the highest quality healthcare at the best possible value with all our plans, and our new tiered network offers additional savings. If you have questions about tiered network plans and want help finding the health insurance plan that best suits your needs, contact our Member Services team at (855) 624-6463.

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As you may have read in the news or in our recent blog, Maine’s small group and individual health insurance markets are merging.  With this merger, health insurance premiums are expected to decline in the first year or two, which may open the door for small group employers to consider offering health insurance for their employees.

This article explores what you need to know as you work with your broker to consider health insurance coverage for your employees.