Insurance Plan Presentation and Decision Support on HealthCare.gov and State-Based Web Sites Created for the Affordable Care Act

In the Annals of Internal Medicine, Charlene Wong and colleagues, including Daniel Polsky, Robert Town, and Tom Baker, assess the presentation of insurance plans as well as the availability of consumer decision aids on Healthcare.gov and state-based health insurance marketplaces. The authors examined HealthCare.gov and all state-based marketplaces during the first and second open enrollment periods. They collected information on what consumers would see while they were “window shopping” (before creating an account) and “real shopping” (after creating an account). The authors find that most state marketplaces present plans with the cheapest premium first and the most expensive last. This increases the premium’s influence on consumer choice despite that the plan with the lowest premium is not necessarily the most cost-efficient. The authors find that the decisions tools most likely to be helpful to consumers, such as total cost estimators, quality ratings, and integrated provider lookups, are not commonly available. They suggest that by including more of these tools during both real and window shopping, marketplaces can design their choice environments in a way that better support consumers in making informed health plan decisions.