Prior to the Affordable Care Act (ACA), it was nearly impossible for consumers shopping for coverage on their own to see all of their health plan options in one place, let alone compare them on the basis of benefits, costs, and provider networks. A fundamental goal of the ACA’s marketplaces was to provide an online portal that would enable these comparisons. Recognizing that navigating the ins and outs of private health insurance remains difficult for most people, all marketplaces have taken steps over time to simplify the enrollment process, including by developing decision-support tools that make it easier for consumers to draw meaningful comparisons between plans.
Comparison Shopping Is About to Get Harder
Republican plans to repeal and replace the ACA had called for scaling back (or scrapping) the marketplaces and decreasing regulation of health plan designs. Among their many other effects, these proposals would have made it more difficult for Americans to shop for coverage, according to the Congressional Budget Office.
Though repeal efforts seem to have stalled, the health plan shopping experience is still likely to get more complicated. In April, the Department of Health and Human Services issued the first major ACA-related regulation of the Trump administration. Among other changes, the rule slashed the upcoming 2018 open enrollment period from three months to 45 days and weakened actuarial value standards, blurring the distinction between the different plan choices.
Consumer Support Tools Are Needed
To navigate this environment, consumers will continue to need a portal displaying their plan options and the comparison tools that have been developing over time in the ACA marketplaces. These should include, at a minimum:
- Total Cost Estimators — providing customized estimates of what consumers can expect to pay on a monthly basis (premium, minus subsidy, plus cost sharing)
- Provider Directories/Network Look-Ups — providing the ability to search for health care providers covered by a plan
- Formularies/Drug Look-Ups — providing the ability to search for prescription drugs covered by a plan, and
- Quality Ratings — allowing consumers to compare plans based on state/federally approved quality metrics such as measures of patient safety and clinical effectiveness.
Today, most marketplaces employ at least one, and sometimes all, of these tools, which serve as valuable resources that provide information about estimated plan costs and benefits and help consumers compare their options to find the plans best suited to their needs. Awareness of the value of such tools has grown since the ACA marketplaces’ rollout in 2014. In interviews with over 40 marketplace stakeholders, we found that total cost estimators are strongly supported as a means for providing consumers with a simple way to determine costs and distinguish among plans. Interviewees at all state-based marketplaces — even those that have yet to implement an estimator tool — have expressed support for the adoption of one, and many believe they play a critical role in advancing health literacy.
Implementing Decision-Support Tools Requires Commitment from Policymakers
Development and implementation of decision-support tools haven’t always been easy. Support tools can be complicated to build, requiring careful thinking about data sources, coordination with stakeholders, and a design — ideally informed by consumer testing — that conveys needed information while being easy to use. These design decisions have been made while marketplace operators are juggling competing demands, declining budgets, and restricted staff capacity. Once built, marketplaces have needed to continue to refine their designs and identify best practices for engaging their consumers.
The marketplaces have made important progress, working in a regulated environment where the disclosure and display of plan information is built into law. The ACA requires the provision of comparable information through summaries of benefits and coverage, uniform glossaries of terms, and the promotion of standard benefit designs. This emphasis on clear and consistent information set the stage for consumer tool comparisons, while still allowing health insurers the flexibility to design consumer-centric plans.
Looking Forward
Decision-support tools have received broad support in a market structured to become more standardized and consumer-friendly; yet, even under those circumstances, marketplaces have had to work diligently to improve the consumer shopping experience. The Trump administration is currently moving to reduce federal market regulation and oversight. Should it loosen rules to allow still greater variation in plan designs, it may become more challenging to develop support tools. And yet, investment in such efforts will be more critical than ever before, as consumers are left to make more complicated comparisons. Policymakers committed to fostering consumer choice should consider how best to ensure consumers have the tools they need to choose the plan that’s right for them, recognizing that they will need significant time and resources to do so.
