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No excuse for poor consumer guidance on health insurance exchanges


The message from my relative caught me by surprise. It read: "Your article today hit a resounding tone for me. I didn't take advantage of my CSR plan last year, but I did for this year's plan and I'm glad I did."

She was referring to cost-sharing reductions, a type of subsidy that helps millions of people afford health plans they purchase through the Affordable Care Act (ACA) exchanges. Like 2.2 million other Americans--according to a recent Avalere analysis--she qualifies for a CSR, but didn't receive it during her first year with an ACA plan because she chose a plan that wasn't in the silver category.

But it's not as though she didn't do her homework: She meticulously researched her health plan options once the ACA took effect. But, like many others, she was stymied by the near-constant glitches on Healthcare.gov.

It's worth noting, though, that with help from a knowledgable Healthcare.gov customer service representative, plus the experience of already having used the exchange, she chose a plan that qualifies her for a CSR this year. 

In fact, ACA "assister" programs helped nearly 5.9 million consumers choose health plans this year, according to a recent issue brief from the Kaiser Family Foundation, though only 27 percent of the programs indicated there will be adequate funding to support them next year. Even worse, 31 percent of assister programs this year said consumers had health plan questions that weren't answered by information provided on an exchange's website.

This is all in spite of the fact that consumer outreach has always been a major component of the ACA, from the initial focus on enrollment to the subsequent shift to help consumers understand how to use their plans.

A recent study from University of Pennsylvania researchers seems to highlight some good news, indicating that online exchanges have improved their decision-support tools from the first open enrollment period to the second.

Yet out of 12 state-based exchanges plus the federal exchange that Penn researchers studied, only three provide a feature that allows consumers to calculate their out-of-pocket expenses. Price transparency, it seems, is as elusive goal a as ever.

The Penn study also noted that exchanges' default sorting of health plans by premium amount may lead consumers to focus too much on that particular dollar amount rather than their actual out-of-pocket expense. And wouldn't you know that the above-mentioned Avalere analysis highlighted the same issue--saying preoccupation with premiums is probably the culprit behind consumers picking plans that cost them potential subsidies.

That couldn't be worse news for my own generation--those darn millennials--as a June study found we struggle to define many health insurance terms, a fact that's none too helpful when we enroll in health plans. 

For all generations and sociodemographic groups, the research matches up with what you'll hear from just about anyone you ask: Shopping for and using health insurance is a complicated, confusing chore. Attempts to simplify the process are surely well-intended, but often fall short and fail to be applied universally.

This isn't just a loss for consumers, for whom getting adequate, affordable health coverage is pretty important. It also means insurance companies likely miss out on business, as many of the individuals who choose to forgo health insurance altogether cite cost as the reason. And specifically among exchange customers, only 30 percent they were satisfied with their current plan, a recent report from Deloitte found.

The bottom line is, the government, the exchanges and insurance companies have to do better. The ACA's legacy--and everyone's health--depends on it. - Leslie @HealthPayer

Related Articles:
2.2M who qualify for health insurance subsidies don't access them
Health insurance marketplaces improve consumer-friendly tools
Health insurance exchange customers more engaged, cost-conscious
Focus shifts from health plan enrollment to healthcare outreach
Health exchange assisters continue to enroll consumers amid funding uncertainty