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

Hero, Joachim O.; Sinaiko, Anna D.; Kingsdale, Jon; Gruver, Rachel S.; Galbraith, Alison A.

doi:10.1377/hlthaff.2018.05036

Cited by 26 publications

(23 citation statements)

References 19 publications

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“…Overall, our results were consistent with those of a survey among individuals enrolled in a single health plan, 34 which showed that approximately 60% of participants considered inclusion of a specific doctor or hospital when choosing a plan, although the researchers did not examine whether participants considered network status of mental health practitioners. We found that individuals were no more likely to check the network status of mental health practitioners than other specialists.…”

Section: Discussionsupporting

confidence: 85%

Assessment of Perceptions of Mental Health vs Medical Health Plan Networks Among US Adults With Private Insurance

Busch

Kyanko

2021

JAMA Netw Open

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IMPORTANCE Ten years after the Mental Health Parity and Addiction Equity Act, patients continue to report insurance-related barriers to specialty mental health care.OBJECTIVES To assess privately insured patients' perceptions of the adequacy of their health plan's provider network (provider network includes physicians, clinicians, other health care professionals, and their institutions that constitute the network), whether practitioners frequently leave plans, and whether practitioner plan participation affected patients' plan choice. DESIGN, SETTING, AND PARTICIPANTSA nationally representative, population-based internet survey study of English-speaking US adults participating in KnowledgePanel, an online research panel, was conducted from August to September 2018. Data analysis was performed from November 12, 2020, to May 12, 2021. From a sample of 29 854 panelists aged 18 to 64 years, 19 602 initiated the screener (completion rate of 66%), and 728 met study criteria: adults with private insurance receiving both specialty mental health and medical care in the past year.EXPOSURE Health plan's provider network. MAIN OUTCOMES AND MEASURESSelf-report of plan inadequacy, whether a practitioner left the plan and the participant's responses (stopped treatment, switched practitioner, or continued treatment), and whether participation of a specific practitioner was considered when a health plan was chosen. Experiences with both mental health and medical provider networks were assessed.Analyses were weighted to match the sample to the US population. Weights provided by KnowledgePanel were also adjusted for panel recruitment, attrition, oversampling, and survey nonresponse. RESULTSOf a total of 728 study participants, 204 (39%) were aged 18 to 34 years, 504 (61%) were women, 82 (17%) were Hispanic, and 551 (66%) were non-Hispanic White individuals. Serious psychological distress was reported by 262 participants (36%), and 214 participants (29%) also received mental health treatment from a primary care practitioner. Participants rated their mental health provider network as inadequate more frequently than their medical provider network ( 163[21%] vs 70 [10%]; odds ratio [OR], 2.69; 95% CI, 1.64-4.40; P < .001). However, among the 193 participants also receiving mental health treatment from a primary care practitioner, there was no significant difference in the ratings of mental health and medical provider networks (44 [14%] vs 18[9%]; OR, 1.55; 95% CI, 0.65-3.67; P = .32). Sixty participants (8%) reported that a mental health practitioner had left their plan's insurance network in the past 3 years. Of the 523 participants with a choice of plan, 98 (20%) considered whether a specific mental health practitioner was in network before choosing a plan. (continued) Key Points Question How do patient perceptions of mental health networks differ from perceptions of medical networks? Findings In this survey study of 728 US adults with private insurance receiving both specialty mental health and medical care, participants were signif...

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Section: Discussionsupporting

confidence: 85%

Assessment of Perceptions of Mental Health vs Medical Health Plan Networks Among US Adults With Private Insurance

Busch

Kyanko

2021

JAMA Netw Open

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“…We first fielded a baseline survey after 2017 open enrollment that collected data about enrollee demographic and socioeconomic characteristics; additional description of methods and findings have been published previously (Hero et al, 2019). Twelve months later, we fielded a follow-up survey to baseline survey respondents to collect data about experiences in their 2017 plan, health experiences during 2017, and plan selection for 2018.…”

Section: Study Design and Datamentioning

confidence: 99%

“…Premium varies by number insured on a plan, so we controlled for family size, excluding families larger than five because of small numbers of these families in the sample. All analyses adjusted for poststratification weighting for sampling and nonresponse using methods published previously (Hero et al, 2019). In sensitivity analyses, we measured health status using self-reported health status instead of the presence of a chronic condition.…”

Section: Characteristics Associated With Plan Disenrollmentmentioning

confidence: 99%

Understanding Consumer Experiences and Insurance Outcomes Following Plan Disenrollment in the Nongroup Insurance Market

et al. 2021

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Disenrollment from health plans purchased on Affordable Care Act (ACA) Marketplaces is frequent; little is known whether disenrollment from off-Marketplace plans is as common or about the experiences and consequences of disenrollment. Using longitudinal administrative data on 2017-2018 nongroup plan enrollment linked with survey data, we analyze plan disenrollment in one regional insurance carrier servicing three states. Overall, 71% of enrollees disenrolled from their 2017 plan. Disenrollment was associated with purchasing through an ACA Marketplace, the carrier making significant changes to an enrollee’s plan benefit design, being healthier, being younger, and paying a higher premium for their 2017 plan in 2018. Experiencing financial burden or poor access to preferred providers was not associated with disenrollment. Most disenrollees (93.2%) enrolled in other coverage, often at a lower premium, but lacked confidence that they could afford needed care. These results can inform policy to support enrollees through coverage transitions and foster stability in the nongroup market.

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“…However, this is still a challenge for most people because only 4% of the US population understands basic health insurance terminology [3]. In fact, Hero et al [35] showed that among people with low health insurance literacy, at least 54% had difficulty finding the best or most affordable plan, and at least 48% had fair or poor overall experience when choosing their plan. These findings suggest that disparities in the ability to access and understand health insurance information may be a reason why different demographics may have differing plan selections [36].…”

Section: Introductionmentioning

confidence: 99%

Informed Decision-making for Health Insurance Enrollment: Survey Study

Colón-Morales¹,

Giang²,

Alvarado³

2021

JMIR Form Res

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Background Health insurance enrollment is a difficult financial decision with large health impacts. Challenges such as low health insurance literacy and lack of knowledge about choosing a plan further complicate this decision-making process. Therefore, to support consumers in their choice of a health insurance plan, it is essential to understand how individuals go about making this decision. Objective This study aims to understand the sources of information used by individuals to support their employer-provided health insurance enrollment decisions. It seeks to describe how individual descriptive factors lead to choosing a particular type of information source. Methods An introduction was presented on health insurance plan selection and the sources of information used to support these decisions from the 1980s to the present. Subsequently, an electronic survey of 151 full-time faculty and staff members was conducted. The survey consisted of four sections: demographics, sources of information, health insurance literacy, and technology acceptance. Descriptive statistics were used to show the demographic characteristics of the 126 eligible respondents and to study the response behaviors in the remaining survey sections. Proportion data analysis was performed using the Cochran-Armitage trend test to understand the strength of the association between our variables and the types of sources used by the respondents. Results In terms of demographics, most of the respondents were women (103/126, 81.7%), represented a small household (1-2 persons; 87/126, 69%), and used their insurance 3-12 times a year (52/126, 41.3%). They assessed themselves as having moderate to high health insurance literacy and high acceptance of technology. The most selected and top-ranked sources were Official employer or state websites and Official Human Resources Virtual Benefits Counselor Alex. From our data analysis, we found that the use of official primary sources was constant across age groups and health insurance use groups. Meanwhile, the use of friends or family as a primary source slightly decreased as age and use increased. Conclusions In this exploratory study, we identified the main sources of health insurance information among full-time employees from a large state university and found that most of the respondents needed 2-3 sources to gather all the information that they desired. We also studied and identified the relationships between individual factors (such as age, gender, and literacy) and 2 dependent variables on the types of primary sources of information. We encountered several limitations, which will be addressed in future studies.

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

Cited by 26 publications

References 19 publications

Assessment of Perceptions of Mental Health vs Medical Health Plan Networks Among US Adults With Private Insurance

Assessment of Perceptions of Mental Health vs Medical Health Plan Networks Among US Adults With Private Insurance

Understanding Consumer Experiences and Insurance Outcomes Following Plan Disenrollment in the Nongroup Insurance Market

Informed Decision-making for Health Insurance Enrollment: Survey Study

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