Abstract
ObjectiveThe Affordable Care Act’s marketplaces present an important opportunity for expanding coverage but consumers face enormous challenges in navigating through enrollment and re-enrollment. We tested the effectiveness of a behaviorally informed policy tool—plan recommendations—in improving marketplace decisions.Study SettingData were gathered from a community sample of 656 lower-income, minority, rural residents of Virginia.Study DesignWe conducted an incentive-compatible, computer-based experiment using a hypothetical marketplace like the one consumers face in the federally-facilitated marketplaces, and examined their decision quality. Participants were randomly assigned to a control condition or three types of plan recommendations: social normative, physician, and government. For participants randomized to a plan recommendation condition, the plan that maximized expected earnings, and minimized total expected annual health care costs, was recommended.Data CollectionPrimary data were gathered using an online choice experiment and questionnaire.Principal FindingsPlan recommendations resulted in a 21 percentage point increase in the probability of choosing the earnings maximizing plan, after controlling for participant characteristics. Two conditions, government or providers recommending the lowest cost plan, resulted in plan choices that lowered annual costs compared to marketplaces where no recommendations were made.ConclusionsAs millions of adults grapple with choosing plans in marketplaces and whether to switch plans during open enrollment, it is time to consider marketplace redesigns and leverage insights from the behavioral sciences to facilitate consumers’ decisions.
Highlights
The Affordable Care Act (ACA) represents the most sweeping and significant change to the United States health care system since the establishment of Medicare in the 1960’s
690 participants were recruited during the summer of 2014 for a between subjects design where the four plan recommendation conditions varied between
The sample was predominantly African American (78.0%) and the majority had completed at least some college (53.4%)
Summary
The Affordable Care Act (ACA) represents the most sweeping and significant change to the United States health care system since the establishment of Medicare in the 1960’s. The ACA mandates health care coverage for millions of Americans, many purchasing private insurance for the first time, and in the newly developed health insurance marketplaces. During the 2015 open enrollment period, 11.7 million Americans selected a marketplace plan or were automatically re-enrolled, the vast majority of whom received federal premium subsidies.[1] While subsidized insurance with coverage for essential health benefits presents an important opportunity, consumers face enormous challenges in navigating the enrollment and re-enrollment processes. As demonstrated during the first open enrollment period, signing up for coverage can be daunting.[2] Evidence on how well people are choosing health insurance in the new marketplaces environment is just emerging
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