Enrolling in the right health plan is vitally important for consumers and families. The coverage choices people make can affect their health and economic security for years to come. But for many, choosing the health plan that best aligns with their family’s financial circumstances and health care needs is an intimidating, complex, time-consuming and hugely challenging process. A new study commissioned by the National Partnership for Women & Families identifies key ways to help consumers make the best possible choices in the health insurance marketplace: improving health literacy; creating and utilizing high-tech tools that simplify and streamline plan comparison and selection; and ensuring that health plan information is accurate, reliable and up-to-date at all times.
Lessons from the Frontlines: Strategies for Supporting Informed Consumer Decision-Making in the Health Insurance Marketplace is based on in-depth interviews with national consumer assistance experts and Navigators who worked with consumers in California, Colorado, Florida and Illinois during an open enrollment period. It finds that consumers are eager to identify the plans that cover their preferred providers and prescription drugs and that protect them from high out-of-pocket costs. Among the report’s recommendations:
- Policymakers and marketplace officials should continue developing creative materials and tools, integrated directly into the plan selection process, that improve health literacy and help consumers understand what health insurance is, how it works, and what basic terms mean. The study found that hover mechanisms and avatars are showing promise here.
- Marketplace websites should provide consumers with a checklist of information to have on hand before they begin the comparison and selection process.
- Marketplaces should continue developing and improving four fundamental tools that can simplify plan comparison and selection: the Summary of Benefits and Coverage template; an integrated provider directory; an integrated prescription drug directory; and an out-of-pocket cost calculator.
- Marketplaces should conduct spot checks to ensure plan information is complete, accurate and up-to-date; establish procedures for Navigators and consumers to report inaccuracies; and provide disclaimers as needed.
“As we prepare for the third open enrollment period, it is essential that we understand how consumers are selecting plans, what obstacles they are facing, and how we can make their shopping experiences in the health insurance marketplace more successful,” said National Partnership President Debra L. Ness. “Clearly there are no one-size-fits-all solutions, but we have identified strategies that can help; they include going back to basics to improve consumers’ health literacy, making plan comparisons easier, and ensuring that information on plan features is current at all times.”
“The Affordable Care Act (ACA) is a tremendous and unmitigated success – the greatest advance for women’s health in a generation,” Ness continued. “But we will only realize its full promise if consumers can make smart, informed decisions about the health plans they choose for themselves and their families. This report provides a roadmap to do just that. We will share it broadly with policymakers, marketplace designers and consumer advocates.”
More than 11 million people signed up for plans in the marketplace during the second open enrollment period alone, and some 16.4 million have gained health coverage since the ACA became law.
“Consumers need simpler ways to compare plan features and costs, and to weigh the options that are best for them, based on their health needs and family finances,” said Lauren Birchfield Kennedy, director of health policy at the National Partnership. “This is especially important for consumers with extensive or specific health care needs and lower incomes. Strengthening plan comparison and selection tools and resources should be a high priority for marketplaces, as they are critical to informed consumer decision-making.”
Under the ACA, Navigators are entities that are certified to help consumers choose coverage and enroll in marketplace plans.
Manatt Health conducted the analysis for the National Partnership. It is based on interviews with national consumer assistance experts and with Navigators in California, Colorado, Florida and Illinois, conducted between March 17 and May 8, 2015. The analysis evaluates Navigator experience in states operating state-run marketplaces (California and Colorado) and states that rely on Healthcare.gov as their marketplace (Florida and Illinois). Interviewees were asked to provide insight into consumers’ priorities for and their approaches to plan selection; the availability and effectiveness of plan comparison and selection tools; and recommendations for how to improve consumers’ plan comparison and selection experiences.
Lessons from the Frontlines complements and builds on a National Partnership study released earlier this year, Supporting Informed Decision-Making in the Health Insurance Marketplace: A Progress Report. The new report is available here.