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

Abstract

The health insurance Marketplaces established by the Affordable Care Act include features designed to simplify the process of choosing a health plan in the individual, or nongroup, insurance market. While most individual health insurance enrollees purchase plans through the federal and state-based Marketplaces, millions also purchase plans directly from an insurance carrier (off Marketplace). This study was a descriptive comparison of the decision-making processes and shopping experiences of consumers in two states who purchased a health insurance plan from the same large insurer in 2017, either through the federal Marketplaces or off Marketplace. In a survey, those who selected plans through the Marketplaces reported less difficulty finding the best or most affordable plan than did those enrolling off Marketplace. Respondents in families with chronic health conditions who enrolled through the Marketplaces reported better overall experiences than those who enrolled off Marketplace. Respondents with low health insurance literacy reported poor experiences in enrolling both through the Marketplaces and off Marketplace. Access to consumer assistance in the individual health insurance market should target off-Marketplace populations as well as all populations with low health insurance literacy.

Keywords: Affordable Care Act; Brokers; Chronic Conditions; Consumer Choice; Decision Support; Direct Enrollment; Health Insurance Literacy; Health insurance marketplace; Individual Market; Insurance Coverage; Marketplace; Navigators; Non-Group Market.

Exhibit 4

Percentages of respondents reporting types of experiences in choosing a health plan on and off the Marketplace in 2017, overall and by at-risk group SOURCE Authors’ analysis of data from their survey of enrollees in individual market health insurance plans offered by Harvard Pilgrim Health Care in New Hampshire and Maine in 2017. NOTES The percentages reflect model-adjusted predicted probabilities when sociodemographic and other population characteristics were controlled for, weighted using inverse probability weights to account for sampling design and subject-level nonresponse. Section 5 of the appendix includes regression tables (see note 16 in text). Comparisons of enrollees in families with chronic conditions (“Chronic condition”) and with low health insurance literacy in on- versus off-Marketplace plans were calculated from a model that interacted chronic condition with Marketplace participation and one that interacted health insurance literacy with Marketplace participation, respectively. Significance was determined by a Wald test. The error bars indicate 95% confidence intervals. **p < 0.05 ***p < 0.01