During the third open enrollment period, the health insurance marketplace created by the Affordable Care Act (ACA) added tools to help consumers make informed decisions about which health plans to choose, according to Supporting Informed Decision-Making in the Health Insurance Marketplace: A Progress Report for 2016. Released today by the National Partnership for Women & Families, the study finds that it is becoming easier for consumers to evaluate the cost of health insurance plans. More marketplace websites are providing integrated provider and prescription drug directories that help consumers identify the plans that best meet their specific health care needs. Most websites now offer their entire window shopping experience in Spanish at a click.

“We are pleased with the significant strides we found in this analysis,” said National Partnership President Debra L. Ness. “The ACA is largely responsible for reducing the uninsurance rate in this country to a historic low, and more people with coverage means more people getting the health care they need. But the law can only be successful if we create a high-functioning marketplace that helps consumers find the right plans for themselves and their families. HealthCare.gov’s customized cost estimator, integrated provider directory and prescription drug directory are important advances, and a number of state-based marketplace websites now provide similar tools that allow consumers to receive tailored cost estimates or lists of plans that include their providers and/or prescription drugs. We see better labeling, design and speed. All that is good. We must help consumers make decisions informed by both cost and quality.”

The new study looks at the tools that were available during the third open enrollment period to consumers who were window shopping on HealthCare.gov, which is used in 38 states, and on the 13 state-based marketplace websites. It was conducted in January and supplemented by six focus groups in five states with consumers who had shopped on marketplace websites. It builds on a 2015 analysis of the features available on marketplace websites during the second open enrollment period.

Among the key findings from the new analysis of marketplace websites:

• HealthCare.gov and seven out of 13 state-based marketplace websites now offer tools that allow consumers to see how much they are likely to spend in total, through premiums and cost-sharing, given their expected health care utilization. But the new customized cost estimators offer only very rough estimates of total out-of-pocket costs, failing to take into account specific medications or treatments that consumers know they will need.
• HealthCare.gov and five out of 13 state-based marketplace websites offer directories that make it easier for consumers to identify which plans include their providers. HealthCare.gov and only two state-based marketplace websites offer integrated prescription drug directories that show which plans cover various medications. The new directories are relatively simple, generally identifying only whether a provider is in-network or a medication is covered, and not the level of cost-sharing consumers will face if they use the provider or medication.
• Only four state-based marketplace websites provide information on the quality of plans; HealthCare.gov and nine state-based marketplace websites do not yet display quality information.
• HealthCare.gov and 10 out of 13 state-based marketplace websites utilize “hover” technology to define terms and assist consumers as they shop. The Colorado, California and Washington marketplace websites also offer assistance via live chat.
• HealthCare.gov and all but two state-based marketplace websites offer their entire websites in Spanish at a click, and California and Massachusetts are among the state marketplaces that offer their websites and related materials in a wide array of languages.

In the focus groups, consumers generally gave high marks to the marketplace websites. Many said they had low expectations because of the complications inherent in purchasing health insurance. Still, a majority reported being able to purchase health insurance, in most cases in less than one hour, and most felt they had made the best possible choice.

By a wide margin, consumers identified cost as their top consideration when purchasing health insurance. Maintaining access to their physicians and specialists, to hospitals they trusted, and to coverage for their prescriptions also mattered to them.

Many shoppers, particularly young adults, found the terminology on marketplace websites confusing.

Across states, consumers reported struggling to afford health insurance. Even some who purchased plans on the marketplace websites were unsure if they would be able to afford them in the future, and expressed a wish for lower-priced plans.

“Even as we work to make health insurance more affordable, we must continue working to make costs more transparent for those shopping for health insurance plans in the marketplace,” Ness added. “Website administrators can improve the sophistication of customized cost estimator tools; strengthen the availability, reliability and sophistication of integrated directories and formularies; develop and highlight quality ratings; and enhance the design of their websites. Consumers would benefit from an even more transparent and user-friendly window shopping experience.”

The new report includes recommendations to further enhance the marketplace websites, including:

• Make eligibility for premium tax credits and cost-sharing reductions easy to discover within window shopping, and integrate results into the plan costs that are shown.
• Continue to refine cost estimator tools by incorporating information on consumers’ expected use of health care – such as prescription drugs – and assessing how well such tools work for consumers.
• Adopt designs that preferentially display Silver plans for consumers potentially eligible for cost-sharing reductions, to help them take advantage of these savings.
• Ensure that consumers have easy access to plan-level network and prescription drug information via direct links.To maximize the effectiveness of provider and facility directories, allow consumers to create a “profile” with multiple providers and medications.
• To maximize the effectiveness of prescription drug directories, offer suggestions via auto-fill for the names of medications, recognize both generic and brand-name drugs and incorporate tier placement and cost-sharing into results.
• As HealthCare.gov and state-based marketplace websites work on developing quality rating systems, place quality information in a prominent location on the website; use simple, straightforward language to explain the ratings; and partner with consumers to test and evaluate how they understand and use the quality ratings.
• Keep plan information as updated as possible. Identify for consumers when information was last updated.
• Integrate definitions, explanations and other forms of support into the shopping experience.
• Provide additional features to help people who are limited English proficient become aware of how to access non-English resources.

Manatt Health conducted the analysis, reviewing each marketplace website in detail between January 5 and January 31 of 2016. The third open enrollment period ran from November of 2015 through January of 2016.

The new report is available here.