Health Plan Selection Research Articles

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

BackgroundFor consumers without access to employer-sponsored or public insurance, health plan choices in the non-group (individual) insurance market that do not meet consumer needs have the potential for negative downstream implications for health and financial well-being. ObjectiveThis qualitative interview study sought to understand consumers’ experiences and challenges with choosing a non-group health plan, among those who later had negative experiences with the plan they chose. MethodsWe conducted semi-structured telephone interviews with a purposive sample of 36 participants from a large regional health insurance carrier in three states who enrolled in non-group plans in 2017 (21 in Affordable Care Act (ACA) Marketplace plans and 15 enrolled off-Marketplace). Participants were included if they reported negative experiences using their plan after enrollment, such as higher-than-expected medical costs. Interviews explored challenges choosing a plan; information needed for choosing; usefulness of available tools; and preferred format for interventions to improve plan choice experiences. We analyzed interview transcripts using thematic content analysis. ResultsStudy participants reported experiencing substantial challenges to choosing an insurance plan. Key barriers included understanding insurance terms, finding relevant information, and making comparisons across plans. Participants valued the ability to make comparisons across carriers when using the Marketplace websites but were less satisfied with customer service. Suggestions for improvement included greater standardization of plans and language and availability of customized one-on-one assistance. ConclusionFindings from this study suggest that health plan selection in the non-group market presents challenges to consumers that may be addressed through enrollment assistance and improved presentation of information. Personalized assistance to find and choose coverage may lead to plan choices that better meet consumer needs and increase confidence choosing a plan in subsequent enrollment periods.

States' racial resentment correlates with administrative distancing and lower rates of health plan selection in affordable care act marketplaces: a cross sectional analysis.

In the United States, the Affordable Care Act (ACA) pursued equity in healthcare access and treatment, but ACA implementation varied, especially limiting African Americans' gains. Marketplaces for subsidized purchase of coverage were sometimes implemented with limited outreach and enrollment assistance efforts. Reflecting state's ACA receptivity or reluctance, state's implementation may rest on sociopolitical stances and racial sentiments. Some states were unwilling to provide publicly supported healthcare to nonelderly, non-disabled adults- "the undeserving poor" -who evoke anti-black stereotypes. The present study assessed whether some states shunned Affordable Care Act (ACA) marketplaces and implemented them less vigorously than other states, leading to fewer eligible persons selecting insurance plans. It assessed if states' actions were motivated by racial resentment, because states connote marketplaces to be government assistance for unworthy African Americans. Using marketplace and plan selection data from 2015, we rated states' marketplace structures along a four-level continuum indicating greater acceptance of marketplaces, ranging from states assuming sole responsibility to minimal responsibility. Using national data from a four-question modern racism scale, state-wide racial resentment estimates were estimated at the state level. Analysis assessed associations between state levels of racial resentment with states' marketplace structure. Further analysis assessed relationships between both state levels of racial resentment and states' marketplace structure with states' consumer plan selection rates-representing the proportion of persons eligible to enroll in insurance plans who selected a plan. Racial resentment was greater in states with less responsibility for the administration of the marketplaces than actively participating states. States higher in racial resentment also showed lower rates of plan selection, pointing to less commitment to implementing marketplace provisions and fulfilling the ACA's coverage-improvement mission. Differences persisted after controlling for differences in conservatism, uninsurance, poor health, and rejection of Medicaid expansion. Resentment of African Americans' purported irresponsibility and entitlement to government assistance may interfere with states structuring and operating marketplaces to maximize health insurance opportunities for everyone available under the ACA. N/A.

Moving to Personalized Medicine Requires Personalized Health Plans.

When individuals, families, and employers select health plans in the United States, they are typically only shown the financial structure of the plans and their provider networks. This variation in financial structure can lead patients to have health plans aligned with their financial needs, but not with their underlying nonfinancial preferences. Compounding the challenge is the fact that managed care organizations have historically used a combination of population-level budget impact models, cost-effectiveness analyses, medical necessity criteria, and current medical consensus to make coverage decisions. This approach to creating and presenting health plan options does not consider heterogeneity in patient and family preferences and values, as it treats populations as uniform. Similarly, it does not consider that there are some situations in which patients are price-insensitive. We seek to highlight the challenges posed by presenting health plans to patients in strictly financial terms, and to call for more consideration of nonfinancial patient preferences in the health plan design and selection process.

Rationalizations and Mistakes: Optimal Policy with Normative Ambiguity

Behavior that appears to violate neoclassical assumptions can often be rationalized by incorporating an optimization cost into decision-makers' utility functions. Depending on the setting, these costs may reflect either an actual welfare loss for the decision-maker who incurs them or a convenient (but welfare irrelevant) modeling device. We consider how the resolution of this normative ambiguity shapes optimal policy in a number of contexts, including default options, inertia in health plan selection, take-up of social programs, programs that encourage moving to a new neighborhood, and tax salience.

Community Characteristics and Qualified Health Plan Selection during the First Open Enrollment Period.

To examine state and community factors that contributed to geographic variation in qualified health plan selection during the first open enrollment period. Administrative data on qualified health plan selections at the ZIP code area merged with survey estimates from the American Community Survey. Descriptive and regression analyses. Data were generated by healthcare.gov and from a household survey. Thirty-one percent of the variation in qualified health plan selection ratios resulted from between-state differences, and the rest was driven by local area differences. Education, language, age, gender, and the ethnic composition of communities contributed to disparate levels of plan selection. Medicaid expansion states had a qualified health plan selection ratio that was 4.4 points lower than non-Medicaid expansion states, controlling for covariates. Our results suggest community-level differences in the intensity or receptiveness to outreach and enrollment activities during the first open enrollment period.

Health plan selection and out-of-pocket costs for cancer patients in the health insurance exchange.

6504Background: Little is known about variation in out-of-pocket costs for cancer patients in exchange-based health insurance plans. Despite annual maximums, it is unclear to what extent the Afford...

Consumer determinants of the use of health plan information in plan selection

One of the major issues in achieving optimum levels of performance in health-care markets is to enhance consumer understanding of their health plan choices in order to facilitate the expansion of 'high-value' health plans at the expense of 'low-value' health plans. The Federal government offers employees many choices of health plans and provides large amounts of information on all of these options through (1) comparative written health plan information, (2) information from the health plans themselves, and (3) comparative health plan information on the Internet. The present study examines the degree to which 1722 Federal employees in the Department of Health and Human Services utilized health plan information from the above three sources in making their annual health plan selection. Results indicate that most employees (64%) used at least one information source, with written information from health plans the most common (53%), followed by comparative written information in The Guide (32%) and the Internet (16%). Those employees who regularly search for information prior to making an important purchase, those with a short time in their current plan, those with family coverage, Whites, African-Americans, and men were all more likely to use health plan information to make their annual choice. The Internet was accessed more often by younger and higher paid employees. Implications for policy and future research are discussed.

Determinants of the Use of Health Plan Information in Formulating Health Plan Selection Decisions

This study seeks to identify the impact of information on employees' health plan selection decision-making. Surveys were administered to 1,722 Federal employees working in the Department of Health and Human Services (DHHS) enrolled in the Federal Employees Health Benefits Program (FEHBP). This study focuses on the enrollees' access to and use of three types of health plan information: print information issued by the Federal government (in particular, The Guide to Federal Employees Health Benefit Plans), print information issued by the health plans, and web-based information. Literature from health plans was utilized to a greater degree than The Guide. Web-based information was the least accessed and used. Major positive predictors of the use of health plan information from any source were: race, time in Federal employment, whether the employee was considering a plan change, employees with less time in current plan, employees who search for information to make decisions, and spouses' health status. Younger and more-educated employees were more likely to access web-based information. Implications for management, policy, and future research are discussed.

Health plan selection criteria by people with impaired mobility.

Many decision-support tools for consumers selecting a health plan include a module measuring peer-group satisfaction with service and quality of care. The most widely used tools are sufficient for most people, but fail to report measures that are important to many individuals with disabilities. To elicit health plan selection and assessment criteria by groups of people with one type of functional impairment arising from different origins. Observational study and qualitative analysis of structured focus groups. Content analysis of CAHPS survey instruments. Each participant had a mobility impairment arising from spinal cord injury, cerebral palsy, rheumatoid arthritis, or multiple sclerosis. Each participant had a choice of health plans. Focus groups were conducted in Phoenix, Philadelphia, and Washington DC. People with mobility impairments arising from the studied conditions desire comparative health plan information on the reliability of transportation to medical appointments, the ability to use an experienced and knowledgeable specialist as a primary provider, and accessible buildings and examination equipment. This study population also seeks information about the experience of their peers in each health plan, especially about benefits administration. People with mobility impairments arising from spinal cord injury, cerebral palsy, multiple sclerosis, or rheumatoid arthritis currently have little information and little bona fide choice of health plans and physicians. This group of people seeks specific information within the areas of benefit coverage, benefits interpretation and administration, provider panels, accessibility to clinics and equipment, and how to navigate the health plan's grievance and appeals process.

Similarities and differences in choosing health plans.

Increasingly, consumers have multiple health insurance options. New information is being developed to help consumers with these choices. To study similarities and differences in how the publicly and privately insured choose health plans. To explore the effect of traditional enrollment materials and reports developed by the Consumer Assessment of Health Plans Study (CAHPS) on consumers' perceptions and decision-making. Using data from eight CAHPS demonstrations, we tested for significant differences across consumers with employer-sponsored insurance, Medicaid, and Medicare. Approximately 10,000 consumers with employer-sponsored, Medicaid, and Medicare health plans. Perceptions of the health plan selection process, use of information sources, and reactions to and use of traditional enrollment materials and CAHPS reports. Most consumers with all types of insurance thought that choosing a health plan was important and obtained information from multiple sources. Choosing a plan was more difficult for Medicare and Medicaid recipients than for the privately insured. When choosing a plan, Medicaid recipients cared most about convenience and access, whereas the privately insured emphasized providers and costs. The percentage of consumers who looked at and remembered the CAHPS report varied widely from 24% to 77%. In all but one of the demonstration sites, most consumers spent less than 30 minutes looking at the CAHPS report. Group sponsors and the developers of information interventions such as CAHPS may need to invest in developing and testing different reporting approaches for Medicare, Medicaid, and privately insured consumers.

Perceptions of Young Adults as to the Future of Health Care in the 21st Century

This study assessed the perceptions of the need for and quality of future health care programs of those who will be major users of medical services in the 21st century. Findings indicated that most recognize the importance of having medical coverage. While copayment costs were most important in health plan selection, less personal factors (e.g., ease of obtaining appointments) were more important than the plan's quality reputations and its physicians. Finally, few respondents thought the quality of physicians and hospitals would improve. Even fewer believed the range of services covered would be better, access to care would be easier to obtain, or that service would be more personalized. They also expect the costs of health care to escalate, and costs to have more impact on the availability of medical services.

Workers' Preferences among Company-Provided Health Insurance Plans

Data from four plants of a single company are used to examine differences in health plan selection in 1989 among employees offered a choice of plans. A 10% increase in the traditional fee-for-service (FFS) plan premium reduced the fraction choosing that plan by 4–9 percentage points, and a doubling of the deductible reduced the plan's market share by 3–4 percentage points. Most workers rejecting such a plan chose the high-premium prepaid plans, which offer the lowest cost-sharing provisions. On the other hand, attaching a modest deductible to prepaid plans reduced their market share by 3–4 percentage points and increased participation in the traditional FFS plan, which requires a relatively high premium but low cost-sharing. The authors also find that increases in real salaries and in the age of the work force boosted employee choice of the traditional FFS plan.

Risk selection of families electing HMO membership.

This study analyzes the health plan selection history of approximately 30,000 employees of a large aerospace corporation. The data show that families selecting HMOs were younger, had lower income, and had less time on the job. HMOs attracted families with lower annual claimed expenditures, and these families' claimed expenses were lower still in the year immediately prior to switching into the HMO. Lower costs among families switching into the HMOs are partly explained by the composition of these families compared with families who stayed in the FFS plan. However, the selection pattern persisted even after adjusting for the size of the family, the age and sex of family members, and other family characteristics, such as race and income. Families switching out of HMOs had higher total annual claims during their first year back in the FFS sector compared with families about to switch into HMOs. However, recent HMO exiters did not always differ from families who never left the FFS plan.

Health plan selection in the Federal Employees Health Benefits Program.

A survey of over 8,500 employees of the U.S. Department of Health and Human Services (DHHS) during the May 1982 open season, supplemented by enrollment data for all DHHS employees enrolled in the Federal Employees Health Benefits Program (FEHBP), was used to study insurance plan selection when multiple fee-for-service options as well as HMOs are available. There is evidence of biased selection of health risks in the FEHBP, yet historically the program has exhibited considerable stability. The stability may be attributable partly to control over entry and over changes in benefits and premiums and partly to inertia on the part of enrollees. In spite of large changes in relative premiums and benefits, only 21 percent of all enrollees in the DHHS switched plans during the May 1982 open season. Those employees who did switch plans astutely identified bargains; on average they lowered their annual contribution to premium by almost 40 percent while maintaining the level of benefits. Insurance plans offering relatively generous coverage of a particular service attract a disproportionately high share of enrollees who expect substantial use of that service. The extent of adverse or beneficial selection into HMOs depends on the price and the comprehensiveness of benefits of each available fee-for-service option.