As the second open enrollment period nears completion, a new study commissioned by the National Partnership for Women & Families finds that marketplace websites could be doing significantly more to help consumers make informed choices about their health plans. While the study found some marketplace websites are using highly effective tools to help consumers choose the plans that best meet their families’ health care needs and financial circumstances, those tools are not yet available to all consumers shopping for plans in the marketplace.

Supporting Informed Decision-Making in the Health Insurance Marketplace: A Progress Report is based, in part, on in-depth interviews with academics, foundation staff, consumer advocates and representatives of patient groups. These experts helped identify four features of marketplace websites that are key to helping consumers make informed decisions: enhanced anonymous browsing; direct access to key plan features; useful plan display and availability of consumer tools; and easy website navigation and links for assistance. Researchers then conducted a high-level review of all 15 marketplace websites (Healthcare.gov and those run by 14 states), as well as a more in-depth analysis of Healthcare.gov and the marketplaces run by California, Colorado, Connecticut, New York and Washington state, to assess their performance on those features.

Researchers found that 13 of the 15 marketplace websites now allow consumers to anonymously review available plans before they establish official marketplace accounts. As part of their anonymous browsing features, four marketplace websites allow consumers to use integrated directories to search for plans that include their providers and/or cover their prescription drugs. Additionally, while there are highly effective “smart tools” and interactive features in use on marketplace websites, they are still the exception rather than the rule. The new report includes a comprehensive set of recommendations for administrators to consider as marketplace websites continue to mature.

“Health care reform has given millions of people access to quality, affordable health plans — for many, for the first time,” said National Partnership President Debra L. Ness. “Certainly, it is the greatest advance for women’s health in a generation. But we must also make it as easy as possible for consumers to compare coverage options and identify the plan that best meets their families’ needs. We need to continuously improve the marketplace websites for that to happen. As the marketplace continues to evolve, it is essential to identify and build on promising practices. Marketplace administrators should continuously review and improve how they help consumers analyze and select plans.”

Among the exemplars identified in the new study are: the Colorado marketplace website’s integrated provider directory and integrated prescription drug directory, which allows consumers to quickly and easily see which plans cover their medications; Washington’s marketplace website’s “plan wizard,” which allows people to enter information on their plan preferences and then provide consumers who do so with customized plan options; Healthcare.gov’s feature that allows individuals the flexibility to decide how much personal information to enter when anonymously browsing for plans; the feature on the Connecticut and Washington marketplace websites that highlight Silver-level plan options for consumers who appear to be eligible for cost-sharing reductions; the California marketplace website’s use of tag lines to alert non-English-speaking consumers about how to get help in their own language; and the avatars used by Connecticut’s and Colorado’s marketplace websites to help consumers navigate their plan options.

The new report recommends that all marketplace websites should, as part of their anonymous browsing features:

• Facilitate consistent and direct consumer access to information on key plan features, including provider directories, prescription drug formularies, and deductibles as well as other cost-sharing information;
• Offer integrated provider and prescription drug directories;
• Display, as soon as possible, comprehensive information on quality ratings and enrollee satisfaction;
• Display plans in an order that takes into account multiple factors, including eligibility for cost-sharing reductions, total out-of-pocket costs, and provider preferences;
• Utilize “smart tools” that facilitate informed decision-making;
• Conduct regular usability analyses; and
• Support robust consumer feedback loops.

“We found many promising practices that enhance transparency in the marketplace and support informed decision-making by consumers,” said Lauren Birchfield Kennedy, director of health policy at the National Partnership. “Anonymous browsing has become standard practice. Marketplace websites are starting to allow consumers to tailor their searches to align with their circumstances and preferences. Healthcare.gov is among the websites that give consumers flexibility in terms of how much financial and health information to share when anonymously browsing. But for too many consumers, shopping online for a health plan is still daunting and confusing. We can, and must, do better.”

Manatt Health conducted the analysis, reviewing marketplace websites from November 15 to December 23, 2014. Their reviews looked only at plan data and plan choice tools available to the general public as part of a website’s anonymous browsing feature, and therefore did not assess the shopping experience of consumers after they have created accounts on a marketplace. The study also did not verify the data displayed by marketplace websites, such as the accuracy of plans’ provider directories.

The new report is available here.