When the Medicare Part D program began in 2006, I was the “go-to” person for my mother and all of her friends as they enrolled in plans through Medicare.gov, the website that helps people to shop for coverage. At the time, shopping online was fairly new to that demographic group, but the tool allowed you to sort plans by premiums and whether they cover certain prescriptions. It was much easier than sorting through Medigap options, which I had done with my mother a few years earlier.
Today, many people in my mother’s generation are confident online shoppers, getting good deals by comparing product features and prices. That’s true for several of their services, as many get online to book their flights and order books.
When health insurance exchanges (HIX) were still being discussed as a notion, supporters of the idea painted a picture of a new generation of shoppers. This new generation would find good health insurance coverage just as easily as they find affordable and convenient airfare. In direct opposition to “the old days” of individual insurance, where in most markets people would have to go to a broker or to each company’s site to find out what was available, a key to delivering on this promise was functional websites that allowed for online comparison and reasonably knowledgeable consumers who would figure out how to shop and what to shop for. Of course many helpers – formal ones (navigators and brokers) and informal ones (like me for my mom and her friends) – stood ready to help.
To gain ground in driving the competitive virtual marketplaces that many hoped for, key stakeholders, such as health plans, regulators, and advocates, identified three important ingredients:
- Consumers needed to be cost-conscious and searching for a good deal
- Consumers needed to understand the differences between options – what benefits are covered and the total cost (premium and cost sharing) of the products being offered
- Consumers needed to trust (and be able to use) the websites
So has it turned out like we thought it would?
Findings from Deloitte’s 2015 Survey of US Health Care Consumers reveal that the HIXs are beginning to deliver on the promise of transforming the individual insurance market. Many HIX customers are actively engaging in the buying process, using both “high-tech” and “high-touch” purchasing channels and putting health plans on notice that they will switch if they are dissatisfied. The exchanges already rank among consumers’ most trusted sources for information, suggesting they are quickly becoming an accepted way to purchase health insurance.
HIX consumers are more price conscious than consumers with employer coverage. To some extent, this is probably because they have lower incomes and are exposed to more of their premium than those with employer coverage. But many people with employer coverage do not have much choice among plans and options, so often are not in the position to shop for coverage to begin with. Even though the last figure on shopping tools indicates that tools like one finds on HIX websites are more important to HIX enrollees than people with employer coverage, the number being in the low 40 percent range shows, I think, that there is room for improvement in the tools.
HIX enrollees are relatively confident in their knowledge of the benefits included and cost of their coverage. Fifty-one percent of HIX enrollees said they had a good understanding of their benefits at the time they enrolled, compared with 47 percent of people in employer plans and 45 percent of people in Medicaid. When it comes to the total costs of their coverage, 55 percent of HIX enrollees said they understand this, compared with 47 percent of people with employer or Medicaid plans. Again, I think this is a good signal that people getting coverage through the HIXs feel they understand what their coverage is.
HIX enrollees expressed relatively high levels of trust with the information they find on HIX websites. Thirty-five percent of HIX enrollees report they trust the information they were provided. On its face, this might not sound very high, but it is just behind their trust in friends and family (38 percent) and health care providers (36 percent).
I find these results encouraging, but the work is not over. Price is the most commonly reported driver of dissatisfaction and switching among HIX enrollees. Satisfaction varies by age, subsidy eligibility, and prior insurance status, which could be a reflection of differences in expectations, needs, and preferences within the HIX population.
What is needed to equip this new generation of health care consumers? The survey findings suggest that multiple purchasing channels, more reliable information sources, better decision support, and further development of online resources and digital technologies could help health plans and exchanges fulfill the promise of these new marketplaces for health insurance coverage. Exchanges and health plans will likely need to give thoughtful consideration to strategies for accommodating differences within their HIX populations as they strive to retain customers and prepare for subsequent waves of enrollees.