Private Insurance/Exchanges

The main source of health insurance in the US, primarily through employers. The Affordable Care Act established health insurance exchanges (marketplaces) for the individual and small group market.

A Tale of Two States: Do Consumers See Mental Health Insurance Parity When Shopping on State Exchanges?

Nov. 19, 2015

Kelsey Berry, Haiden Huskamp, Howard Goldman, Colleen Barry

In Psychiatric Services, Kelsey Berry and colleagues, including Colleen Barry, present an analysis of parity compliance in how behavioral health benefits are presented to consumers shopping on health insurance exchanges established by the Affordable Care Act.  All insurance plans sold on the exchanges are required to offer mental health and substance use disorder benefits in compliance with requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The researchers reviewed summaries of benefits documents available to...

“Sticker Shock” in Individual Insurance under Health Reform?

Nov. 9, 2015

Mark Pauly, Scott Harrington, Adam Leive

In 2013, before the ACA’s health insurance marketplaces opened, more than 10 million people purchased insurance in the individual market. In the American Journal of Health Economics, Mark Pauly, Scott Harrington, and Adam Leive estimate how the ACA affected the prices these buyers faced in 2014.  Before taking any federal subsidies into account, they find that the impact of the ACA on total average price was relatively modest.

They looked at the effects of the ACA on premiums, expected out-of-pocket payments, and total expected price paid by these former buyers. They...

Seeing Health Insurance and HealthCare.gov Through the Eyes of Young Adults

Oct. 15, 2015

Charlene Wong, David Asch, Cjloe Vinoya, Carol Ford, Tom Baker, Robert TownRaina Merchant

In the Journal of Adolescent Health, Charlene Wong and colleagues, including David Asch, Tom Baker, Robert Town, and Raina Merchant, describe young adults’ perspectives on health insurance and HealthCare.gov, including their attitudes toward health insurance, health insurance literacy, and benefit and plan preferences. Access to preventive or primary care and peace of mind were the most salient advantages of health insurance for young adults. The authors find that young adults perceive the financial strain of paying for health insurance as the most salient disadvantage. Deductible...

The Experience of Young Adults on HealthCare.gov: Suggestions for Improvement

Oct. 15, 2015

Charlene Wong, David Asch, Cjloe Vinoya, Carol Ford, Tom Baker, Robert Town, Raina Merchant

In the Annals of Internal Medicine, Charlene Wong and colleagues, including David Asch, Tom Baker, Robert Town, and Raina Merchant, survey young adults on ways to improve the HealthCare.gov insurance selection process. Participants explained their thinking in real time as they used the website and made decisions about health insurance. Challenges that they expressed included poor understanding of health insurance terms that were inadequately explained on the website. Although participants expressed their preferred plan benefits, they had difficulty matching plans with their...

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

Oct. 15, 2015

Charlene Wong, Gabbie Nirenburg, Daniel Polsky, Robert Town, Tom Baker

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...

The Price of Responsibility: The Impact of Health Reform on Non-Poor Uninsureds

Sep. 29, 2015

While the Affordable Care Act has achieved a second victory before the Supreme Court and produced significant coverage gains, it might also have produced a less positive outcome: in an NBER working paper, Penn LDI colleagues Mark Pauly, Adam Leive and Scott Harrington found that a large portion of non-poor (measured by income above 138% of the poverty level) who gained coverage now have a higher financial burden and lower welfare (well-being) than when they were uninsured.

State Variation in Narrow Networks on the ACA Marketplaces

Data Brief
Aug. 24, 2015

In June, we presented national data from one of the first attempts to measure the size of provider networks in plans sold on the health
insurance marketplaces. We used simple “T-shirt” sizes to categorize networks in a way that could help consumers quickly grasp the
choices they were making. In this Data Brief, we present network sizes summarized up to the level of the state and the rating area.
This analysis should help regulators and consumers assess and understand the trade-off between premiums and network size as we
enter the next open enrollment period.

How Wide Are Your Physician Networks?

Aug. 24, 2015

In June, we described the first attempt to measure, in a consumer-friendly way, the breadth of physician networks offered by all silver plans on the 2014 health insurance marketplaces. We estimated network size based on the fraction of office-based physicians participating in the network within relevant rating areas in the state. We categorized networks using "T-shirt" sizes:  x-small (less than 10%), small (10%-25%), medium (25%-40%), large (40%-60%), and x-large (more than 60%). We found that nationally, 41% of all networks were either “small” or “x-small”.

It's All in the Presentation

Aug. 17, 2015

In the beginning (Web Site 1.0), we measured the success of health insurance marketplace sites by whether they worked. Last year (Web Site 2.0), technical glitches were resolved, and we can start to measure success by whether the sites help people make the best decisions in choosing a health plan.

Mergers, Monopolies, and the Medical Loss Ratio

Aug. 1, 2015

cross-posted with US News

Health insurers are merging everywhere you turn in the newly reformed and more heavily regulated health insurance system. Anthem announced last week it will buy insurance giant Cigna for over $54 billion, acquiring more than 53 million new patients. And Aetna, earlier this month, announced its agreement to buy Humana, the nation’s fifth-largest health insurer.

Who Has The Most To Lose From Health Insurance Mergers?

Jul. 31, 2015

cross-posted with the Field Clinic

In recent weeks, two sets of already huge health insurers—Aetna and Humana, Cigna and Anthem—have announced plans to combine. And more mergers may be in the works.  Should the rest of us fear being trampled when these behemoths connect? The answer to that question, as with almost all questions in health economics, is “it all depends.”

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