Health Policy$ense

Shopping On The New And Improved Some Observations

The federal government’s health insurance marketplace (re)opened for business on November 15th. Last year, LDI Fellow Charlene Wong, MD researched how to improve the site to respond to the needs of young adults. Here she reflects on what improvements have been made to and what issues remain.  

The ‘young healthies’ studied by Wong are a key target for insurance markets, because they balance the costs of older and sicker populations. They are 40% of the eligible population for the individual marketplaces and in the first enrollment period were 28% of enrollees. Has the 2014 version of addressed their recommendations?

We asked Wong to test the site’s ‘shop around’ feature and her responses are below.

What improvements do you see on the new

Clear statement that cost-sharing reductions are available on Silver plans
Previously, it was unclear that cost-sharing reduction discounts applied only to Silver plans. Now, if eligible, the shop around clearly states that cost-sharing reductions are available on Silver plans and that this program reduces the out-of-pocket expenses paid for deductibles, copayments, and coinsurance. There is also a link off to a separate page that gives further details about how to save on out-of-pocket health care costs.

Separate dental insurance marketplace easy to find
Previously, it was unclear while viewing health insurance plans that a separate dental insurance marketplace existed. Now there is a button at the top of the screen to toggle between the two.

Plans have more descriptive names to highlight differences
Many plan names now include descriptors to pull out unique characteristics. Examples include: Aetna Bronze $15 Copay HMO Savings Plus and Aetna Bronze Deductible Only HSA Eligible HMO.

What issues have not been adequately addressed on the new

An overwhelming amount of information with insufficient filters and comparison methods
With an increased number of plans available on the marketplace, and a great deal of information presented about each plan, there’s risk of information overload. It’s too difficult for users to absorb and process this amount of information.

Additionally, there are insufficient filters and sorts to narrow plan options by consumer preferences. The only coverage benefit filters available are for a few select medical management programs, e.g. heart disease, diabetes. None of the young adult participants in our study placed high value on this. They were instead interested in knowing if plans covered specific services, such as mental health services.

The young adults in our study also found that arranging plans using metallic categories, i.e. Bronze, Silver, Gold and Platinum, is helpful for a first pass to narrow down between plans. Although plans can be filtered by metallic category on, they cannot be seen alongside plans from the other categories for easy comparison. Actually the comparison tool does not allow for any side-by-side comparison of plans, making it more difficult to see sometimes subtle differences between them.

The mysterious missing mouseover
There are insufficient explanations of complicated insurance terms.  The 2013 version of (to purchase health insurance for 2014) had belatedly added narrative examples and mouseover definitions – a pop-up bubble that appears when the cursor hovers over a term. This was a key recommendation from our study. Now there are no mouseover definitions or even links out to definitions. 

The 2013 version of (to purchase health insurance for 2014) had belatedly added
narrative examples and mouseover definitions – a pop-up bubble that appears when the cursor hovers over a term. 

Complicated plan design
The lack of health insurance literacy support tools is particularly problematic for plans with more complicated design. Let’s take the example of a plan where emergency room care has a $250 copay before deductible and 30 percent coinsurance after deductible. These terms, and the differences between them, need to be explained.

Lack of decision support tools
Missing from and potentially very useful are tools such as an out-of-pocket cost estimator. The Idaho and California state-based marketplaces, for example, have out-of-pocket cost estimates for each plan based on the user’s estimated number of provider visits and prescription medications.

Out-of-pocket cost estimate tool on Covered California