Editor's Note: As implementation of the Affordable Care Act (ACA) moves forward and the marketplace continues to evolve, the focus on consumer behavior and decision-making is growing. A key question for both advocates and policymakers is whether consumers have the tools required to support informed choices with regard to health plan selection in the marketplace. Recognizing that the selection of the right plan—one that meets a family's healthcare needs and preferences and aligns with its financial reality—is key to consumer satisfaction, there is increased interest in ensuring that consumers have easy access to reliable information about plan options and the tools that support informed decision-making.

For a new report by the National Partnership for Women and Families, Manatt Health evaluated how well the marketplace is providing consumers with key information about available health plans. Manatt Health reviewed marketplace websites—including the federally facilitated marketplace (HealthCare.gov) and all 13 state-based marketplace websites—in early 2016. Manatt Health's review was supplemented by focus groups conducted by the National Partnership for Women and Families in five states with consumers who had firsthand experiences with marketplace websites. Key findings are summarized below. Click here to download the full report free.


Summary of Key Findings

The report found that, overall, marketplace websites made significant strides during the third open enrollment period in offering more consumer-friendly shopping tools within window shopping. Most notably, HealthCare.gov added new tools to support informed consumer decision-making, including a customized cost estimator, an integrated provider directory and a simple, but useful, prescription drug directory. A number of state-based marketplace websites took similar steps, offering tools that allow consumers to provide information on their financial and/or health circumstances and receive tailored cost estimates and/or plan listings. However, the marketplace is still young and there is considerable room to improve its support for informed consumer decision-making.

The report addressed the tools available on marketplace websites across six "key elements of consumer-friendly marketplace design":

  1. Cost transparency: Marketplace websites increasingly offer tools to help consumers estimate their total out-of-pocket costs, but these tools are relatively new. A clear majority of marketplace websites—HealthCare.gov and 7 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 healthcare utilization. Although valuable in helping consumers look beyond premiums alone, these 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.
  2. Accessible providers and prescription drug information: Integrated provider and prescription drug directories are becoming more common and are offered by HealthCare.gov, but are not standard practice among state-based marketplace websites. Currently HealthCare.gov and 5 out of 13 state-based marketplace websites offer integrated provider directories, making it easier for consumers to identify plans that 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.
  3. Useful information about quality of plans: At present only four state-based marketplace websites provide information on the quality of plans; HealthCare.gov and nine state-based marketplace websites do not display quality information. However, more quality ratings will begin to appear on marketplace websites through a pilot program during the fourth open enrollment period for the 2017 coverage year, with all marketplaces scheduled to include quality ratings for the fifth open enrollment period. Quality ratings can help inform consumer decision-making, and marketplace websites can do more to display this information in prominent ways and explain the basis for the ratings.
  4. Effective smart choice architecture: Some marketplace websites are beginning to use "smart choice" architecture to help consumers take all costs into account when selecting a health plan. The order in which marketplace websites present plan options and other website architecture decisions can have a powerful impact on consumer choice. Several marketplace websites still default to sorting plans by premium, but five state-based marketplace websites instead sort based on estimated out-of-pocket costs. Of particular note, four state-based marketplace websites now help consumers eligible for cost-sharing reductions see savings by preferentially displaying Silver plans.
  5. Integrated assistance: Marketplace websites consistently offer assistance to customers in a variety of ways as they shop for plans online. Recognizing that some customers want in-person assistance or help over the phone, marketplace websites universally inform consumers about how they can contact a Navigator or other in-person assister. 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, a feature that may be particularly appealing to young customers or others who are more technologically savvy.
  6. Usability and reliability of information: Marketplace websites continue to improve on language accessibility and general usability, but may not always ensure the accuracy of the information they provide. HealthCare.gov and all but two state-based marketplace websites now offer their entire websites in Spanish at a click, and California and Massachusetts are among the state marketplaces that have gone well beyond, offering their websites and related materials in a wide array of languages. Although it was beyond the scope of this analysis to conduct a systematic review, the reviewers noted marked improvements in the look, feel and flow of the sites, including HealthCare.gov's design, which now makes it much easier for consumers to determine where they are in the window shopping process at any given time. However, problems remain with the accuracy of information: a review of 36 plans from 12 marketplaces that provided links to the Summary of Benefits and Coverage (SBC) uncovered 7 instances in which information on a plan's cost differed between the marketplace website and the plan's SBC.