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The best, worst health insurance exchanges for plan-shopping

Report from Clear Choices campaign recommends ways to improve federal and state websites

When it comes to the quality of consumer-friendly plan shopping tools, the Affordable Care Act health insurance exchanges are not all created equal, according to a new whitepaper from the Clear Choices campaign.

Clear Choices, which advocates for healthcare price transparency on behalf of the Council for Affordable Health Coverage (CAHC), shopped on 12 state-based exchanges and Healthcare.gov to grade them on a variety of factors, such as the quality and existence of an out-of-pocket cost calculator, language accessibility or the availability of an integrated provider directory.

The whitepaper also compiles the findings into weighted composite scores for each exchange, essentially ranking them from best to worst. Kentucky's exchange, Kynect, came out the winner with an 84 out of 100, while New York State of Health scored lowest. With a score of 63, Healthcare.gov joined most of the exchanges in the middle of the pack, while Vermont Health Connect, which does not have a window-shopping option, wasn't graded because it couldn't be accessed without signing in.

In general, exchange websites that scored well allow consumers to enter very specific information and the site sorts it in ways that allow them to make better choices about their health plans, CAHC President Joel White said on a call to discuss the findings.

"Details matter, and our individual circumstances matter a great deal" when it comes to healthcare, he said.

Curiously, two of the states that have "warmly embraced" the ACA--New York and Massachusetts--have exchanges that scored relatively low, while Kentucky, a "land of skeptics" about the law that could end up abolishing its exchange, was best in class, White said. "I don't know if this says something about the pressure to perform," he added.

Overall, Clear Choices found that while most of the websites' plan-shopping tools have dramatically improved since the exchanges debuted in 2014, "there's still substantial room for improvement," White said.

For example, many websites continue to display plans that don't make sense for consumers, as they don't always emphasize critical cost-sharing deductions, according to White. Some better-graded exchanges could offer lessons to other states, as well, he said, noting that Kynect and Washington HealthPlanFinder allow consumers to filter out plans that don't have their chosen providers in-network, while other exchanges do not.

Health plans, too, have a responsibility to help improve customers' ability to find the right plans on the exchanges, Andrew Schwab, senior legislative representative on the Federal Health & Family Team in AARP Government Affairs, said on the call. He suggested insurers improve the way they communicate with their customers and embrace technology and a consumer-centric mindset at a more rapid pace, noting that disruptive startups such as Oscar Health are helping to push the industry toward innovation.

Insurers also must ensure that the information they provide to the exchanges is accurate and up-to-date, White said, though he added "that's a two-way street," as providers also need to inform health plans whether they are accepting new patients or when they terminate a contract.

To address the shortfalls in the state and federal exchanges, the whitepaper makes a series of recommendations, calling for customized window-shopping tools, "smart, comparative" plan display pages, and access to detailed plan cost and benefit information, among other improvements.

The report also suggests the exchanges turn to private-sector innovations to improve users' experiences, echoing CAHC's previous call for private entities to created Expedia-inspired "consumer-friendly shopping interfaces" for health coverage.

To learn more:
- here's the whitepaper
- check out the exchange scorecard
- read an announcement about the report

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3 ways to improve consumer experience on health insurance exchanges
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