Consumer Health Insurance Shopping Behavior and Challenges: Lessons From Two State-Based Marketplaces

Abstract

Selecting a health plan in a health insurance exchange is a critical decision, yet consumers are known to face challenges with health plan choice. We surveyed new enrollees in two state-based exchanges in 2015 to investigate how a nonelderly, primarily low-income population chose their health plans and the implications of shopping behavior for early experiences in their plans. Financial considerations were most important to enrollees. Prior Medicaid enrollees and the uninsured were more likely to have multiple shopping challenges (e.g., difficulty identifying the best or most affordable plan, fair/poor experience, unmet need for help) than enrollees with prior employer coverage (42.9% vs. 32.5% vs. 16.4%, respectively, p < .01). Shopping challenges were associated with difficulty finding a doctor, understanding coverage, and getting questions answered. Assistance targeting enrollees who previously had Medicaid or lacked insurance could improve both shopping experiences and downstream outcomes in plans.

Decision-Making Experiences Of Consumers Choosing Individual-Market Health Insurance Plans

“…13 Consumers with shopping challenges are more likely than those without such challenges to have negative experiences in their plans. 14 Consumers seeking a health plan in the individual insurance market can also purchase one outside of the Marketplace (off Marketplace), and 3.6 million enrollees (approximately a quarter of the total enrollees in ACA-compliant individual plans) are estimated to have done so in 2017. 15 Most health plans offered on Marketplace can also be obtained off Marketplace by purchasing directly from the insurance carrier or through a broker.…”

“Pick a Plan and Roll the Dice”: A qualitative study of consumer experiences selecting a health plan in the non-group market

“…In addition to improving satisfaction and retention, optimizing health plan choice in the non-group market is important given the ramifications for downstream health care access, quality, and affordability. Misunderstanding insurance benefits or incorrectly estimating out-of-pocket costs or eligibility for subsidies when choosing a plan may lead to burdensome downstream costs, unmet need, greater Emergency Department use, and worse overall health [10] , [11] , [12] , [13] , [14] , [31] , [32] , [33] . The uncertainty expressed by participants about future health care needs and associated fear of unexpected downstream health care costs could drive consumers to over-insure and choose plans with higher premiums, even if healthy [34] .…”

“…Consumers in the non-group market, particularly those eligible for Marketplace subsidies, may be a more socioeconomically and clinically vulnerable population than other commercially insured groups [11] , [12] . While a goal of the ACA was to help consumers obtain affordable coverage that meets their needs, surveys demonstrate considerable challenges for consumers choosing non-group health insurance and negative experiences using their plan, including difficulty seeing a desired provider, unexpected high costs, and financial burden [8] , [13] , [14] , [15] .…”

Health Insurance Literacy Improvements Among Recently Diagnosed Adolescents and Young Adults With Cancer: Results From a Pilot Randomized Controlled Trial

“…10,11 Choosing a health insurance plan can be daunting, 12 especially for patients who have experienced unexpected health care costs. 13,14 Confusion about what services are covered by a plan can also lead to greater costs. 14 Multiple studies show cancer survivors and the general population with low HIL also report financial hardship and skipped care because of costs, including cancer-related care for survivors, more often than individuals with high HIL.…”