Editor's Note: As marketplaces prepare for the third open enrollment period, consumers are increasingly invested in selecting plans that meet their healthcare needs and align with their financial realities. Therefore, there is a growing demand for information and tools to help consumers easily and accurately evaluate plan options. In a new report prepared for the National Partnership of Women and Families—based on interviews with Navigators (entities certified to help consumers choose and apply for coverage) and national experts—Manatt Health shares a frontline perspective on how to improve consumers' plan comparison and selection experience.
Building on our earlier analysis—"Supporting Informed Decision-Making in the Health Insurance Marketplace: A Progress Report"—our new paper assesses the tools consumers are using to compare and choose plans, identifies three pathways for supporting informed decision-making in the marketplace, and offers recommendations for improvement. Highlights are provided in the following summary. Click here to download a free PDF of the full report.
Roughly 16.4 million people have gained health coverage in the five years since passage of the Affordable Care Act (ACA), and more than 11 million people signed up for marketplace plans during the second open enrollment period alone.1,2 As consumers gain familiarity with their healthcare coverage, they are increasingly looking for plans that match both their healthcare needs and their economic circumstances. They recognize that their choice of plans can directly affect their access to providers, ability to afford prescription drugs and level of out-of-pocket spending. In response, policymakers and marketplace officials are seeking to enhance consumer access to information on health plan features, particularly concerning provider participation in plan networks, cost-sharing charges and prescription drug coverage.
In light of growing interest in how best to support consumer decision-making in the marketplace, Manatt Health interviewed national consumer assistance experts and Navigators in California, Colorado, Florida and Illinois. The insights they shared—based on their extensive experience helping consumers select health plans during the last two enrollment periods—provide a frontline view of ways to improve plan comparison and selection for consumers. Drawing on Navigators' experiences, we were able to identify three key pathways for supporting informed consumer decision-making in the marketplace:
- Improving consumer health literacy,
- Developing and applying tools that simplify and streamline plan comparison and selection, and
- Ensuring health plan information is accurate and reliable.
Summary of Key Findings and Recommendations
Consumers—particularly those who already have experience with marketplace plans—are eager for more help selecting health coverage. They want to be able to identify the plans that cover their preferred providers and prescription drugs and that protect them from excessive out-of-pocket costs. Interviews with Navigators and national experts suggest that the following will help consumers identify the marketplace plans that best meet their healthcare needs and align with their financial circumstances:
1. Support Consumer Healthcare Literacy.
- Continue to develop and share creative materials to improve consumer health literacy and integrate these tools into the plan comparison and selection process. Health literacy materials should include a list of factors to consider when selecting a plan, including definitions of key terms, guidance on how to use a provider directory and review a prescription drug formulary, differences among plan products and provider network models, and direction on how to use healthcare coverage. Policymakers and marketplace officials should work with advocacy organizations, Navigators and others to determine the best ways to deliver this information and integrate it into the plan selection process.
- Provide consumers with a checklist of information they should have on hand prior to shopping for a plan. This information should include income and citizenship information, names and addresses of current providers, and a list of healthcare services and prescription medications they need.
2. Develop and Apply Tools That Simplify and Streamline Plan Comparison and Selection.
- Continue to improve and develop tools that allow consumers to compare plans across key dimensions. These tools should be easily accessible and integrated into the plan shopping experience. The four fundamental tools for supporting informed consumer decision-making are:
- Summary of Benefits Coverage Template, enabling consumers to compare plans across standardized elements, such as benefit design and cost-sharing structuring.
- Integrated Provider Directory, enabling consumers to enter the names of their providers and see which plans include those preferred providers in network.
- Integrated Prescription Drug Directory, enabling consumers to enter the names and dosage levels of their prescription drugs and see which plans cover those medications.
- Out-of-Pocket Cost Calculator, enabling consumers to estimate their annual out-of-pocket costs under different plans, based on anticipated healthcare usage.
3. Ensure That Health Plan Information Is Accurate and Reliable.
- Take specific steps to ensure plan information is complete, correct and up to date. At minimum, marketplaces should conduct occasional spot checks to assess the accuracy of plan information and establish procedures that consumers and Navigators can use to flag any inaccuracies or issues with plan data. Marketplaces should notify consumers that plan information is updated continuously and provide guidance on how consumers can access updated information. Policymakers and marketplaces must hold Qualified Health Plan (QHP) issuers accountable for reporting requirements set forth in federal and state policy. - See more at: https://www.manatt.com/health-law/Lessons-From-the-Frontlines-Strategies-for-Supporting.aspx#sthash.ftt8yB3x.dpuf
As the third enrollment period approaches, marketplaces are well-positioned to strengthen and improve the tools and resources offered to consumers to support informed decision-making about plan selection. A key support system for consumers comparing and selecting marketplace plans, Navigators provide valuable insights into the tools consumers are currently using, how those tools could be improved and what additional tools are needed.
States, Healthcare.gov, Navigator organizations and public and private entities have taken important steps to synthesize information and provide tools that simplify and streamline plan comparison and selection. Even so, enrollment remains a time-consuming, complex and hugely challenging process for many consumers.
While great progress has been made over the first two open enrollment periods, advocates and policymakers must continue collaborating to develop and refine tools that will help consumers make informed decisions about health plans that best meet their healthcare needs and financial circumstances. Only then can the promise of the healthcare marketplace be fully realized.