Shopping on the Public and Private Health Insurance Marketplaces: Consumer Decision Aids and Plan Presentation

Wong, Charlene A.; Kulhari, Sajal; McGeoch, Ellen; Jones, Arthur Taber; Weiner, Janet; Polsky, Daniel; Baker, Tom

doi:10.1007/s11606-018-4483-x

Cited by 10 publications

(11 citation statements)

References 17 publications

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“…Further research is needed to tailor decision aids to individuals who have low health insurance literacy. Additionally, identification of effective decision aid components (e.g., total cost estimators, quality ratings) can inform future development of decision aids 59 …”

Section: Discussionmentioning

confidence: 99%

Health insurance literacy among head and neck cancer patients and their caregivers: A cross‐sectional pilot study

Nguyen

McCormick

Patel

et al. 2022

Laryngoscope Investig Oto

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Objective Health insurance literacy interventions may reduce financial burden and its effects on cancer patients and their caregivers. However, little is known about the health insurance literacy levels of head and neck cancer (HNC) patients and their caregivers. We assessed the feasibility of screening for health insurance literacy in a pilot study and described the health insurance literacy levels of HNC patients and their caregivers. Methods We administered a survey that assessed demographics and subjective and objective health insurance literacy to HNC patients and their caregivers. Subjective health insurance literacy was measured through the Health Insurance Literacy Measure (score range: 0–84). Objective health insurance literacy was measured through correct answers to a previously developed 10‐question knowledge test. Due to a small sample size, inferential statistics were not used; we instead descriptively reported findings. Results The pilot included 48 HNC patients and 13 caregivers. About 44.4% of patients and 30.8% of caregivers demonstrated low health insurance literacy (HILM ≤60). On the 10‐item knowledge test, patients had an average of 6.8 (SD: 2.3) correct responses and caregivers had 7.8 (SD: 1.1) correct responses. Calculating out‐of‐pocket costs for out‐of‐network services was challenging; only 9.5% of patients and 0% of caregivers answered correctly. Conclusion Additional outreach strategies may be needed to supplement screening for health insurance literacy. Areas of focus for interventions include improving understanding of how to calculate financial responsibility for health care services and filing an appeal for health insurance claim denial. Level of Evidence IV

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Section: Discussionmentioning

confidence: 99%

Health insurance literacy among head and neck cancer patients and their caregivers: A cross‐sectional pilot study

Nguyen

McCormick

Patel

et al. 2022

Laryngoscope Investig Oto

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“…In addition, health insurance plans can be challenging to understand, especially if the decision-maker has limited financial or health insurance literacy [ 2 , 5 ]. Previous research has shown that the way information is presented in the decision aid can impact consumer choice [ 6 ]. Factors such as the order in which plans are presented, word choice and symbol use, and difficulty in finding information can significantly affect trust in the information and consumer choice [ 1 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…VBCs are designed to provide guided support by mimicking a one-on-one interaction with a human resources (HR) representative. Although there has been limited research on health insurance decision aids [ 6 , 9 , 10 ], VBCs are a relatively new product for supporting health insurance choices that combine access to tools, such as cost estimators, and further guidance and recommendations presented through a conversational interface. The effects of this more guided approach to decision-making are still not well understood, and little research has examined how guided systems affect consumer health insurance decision-making when compared with traditional self-directed methods such as websites.…”

Section: Introductionmentioning

confidence: 99%

User Interactions With Health Insurance Decision Aids: User Study With Retrospective Think-Aloud Interviews

Giang¹,

Bland²,

Chen³

et al. 2021

JMIR Hum Factors

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Background Two barriers to effective enrollment decisions are low health insurance literacy and lack of knowledge about how to choose a plan. To remedy these issues, digital decision aids have been used to increase the knowledge of plan options and to guide the decision process. Previous research has shown that the way information is presented in a decision aid can impact consumer choice, and existing health insurance decision aids vary in their design, content, and layout. Commercial virtual benefits counselors (VBCs) are digital decision aids that provide decision support by mimicking the guidance provided by an in-person human resources (HR) counselor, whereas more traditional HR websites provide information that requires self-directed navigation through the system. However, few studies have compared how decision processes are impacted by these different methods of providing information. Objective This study aims to examine how individuals interact with two different types of health insurance decision aids (guided VBCs that mimic conversations with a real HR counselor and self-directed HR websites that provide a broad range of detailed information) to make employer-provided health insurance decisions. Methods In total, 16 employees from a local state university completed a user study in which they made mock employer-provided health insurance decisions using 1 of 2 systems (VBC vs HR website). Participants took part in a retrospective think-aloud interview, cued using eye-tracking data to understand decision aid interactions. In addition, pre- and postexperiment measures of literacy and knowledge and decision conflict and usability of the system were also examined. Results Both the VBC and HR website had positive benefits for health insurance knowledge and literacy. Previous health insurance knowledge also impacted how individuals used decision aids. Individuals who scored lower on the pre-experiment knowledge test focused on different decision factors and were more conflicted about their final enrollment decisions than those with higher knowledge test scores. Although both decision aids resulted in similar changes in the Health Insurance Literacy Measure and knowledge test scores, perceived usability differed. Website navigation was not intuitive, and it took longer to locate information, although users appreciated that it had more details; the VBC website was easier to use but had limited information. Lower knowledge participants, in particular, found the website to be less useful and harder to use than those with higher health insurance knowledge. Finally, out-of-pocket cost estimation tools can lead to confusion when they do not highlight the factors that contribute to the cost estimate. Conclusions This study showed that health insurance decision aids help individuals improve their confidence in selecting and using health insurance plans. However, previous health insurance knowledge plays a significant role in how users interact with and benefit from decision aids, even when information is presented in different formats.

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“…In fact, Vardell [38] points out the need for consumers to seek various sources of information (2.8 sources, on average) to fully assess their options. As studies began to highlight the importance of decision aids [39][40][41], these tools became the standard for informed consumer choice when the information was accurate and understood by consumers. Later studies have also shown a greater adoption of some decision support tools by websites for private and public health insurance marketplaces [42,43], a trend that is likely to continue.…”

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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Shopping on the Public and Private Health Insurance Marketplaces: Consumer Decision Aids and Plan Presentation

Abstract: The ACA's public health insurance exchanges offered more tools in OEP4 to help consumers select a plan. While private health insurance exchanges presented notable features, the total cost estimates for a standardized consumer varied widely on public versus private exchanges.

Cited by 10 publications

References 17 publications

Health insurance literacy among head and neck cancer patients and their caregivers: A cross‐sectional pilot study

Health insurance literacy among head and neck cancer patients and their caregivers: A cross‐sectional pilot study

User Interactions With Health Insurance Decision Aids: User Study With Retrospective Think-Aloud Interviews

Informed Decision-making for Health Insurance Enrollment: Survey Study

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