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Journal of General Internal Medicine

, Volume 33, Issue 8, pp 1400–1410 | Cite as

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

  • Charlene A. Wong
  • Sajal Kulhari
  • Ellen J. McGeoch
  • Arthur T. Jones
  • Janet Weiner
  • Daniel Polsky
  • Tom Baker
Health Policy

Abstract

Background

The design of the Affordable Care Act’s (ACA) health insurance marketplaces influences complex health plan choices.

Objective

To compare the choice environments of the public health insurance exchanges in the fourth (OEP4) versus third (OEP3) open enrollment period and to examine online marketplace run by private companies, including a total cost estimate comparison.

Design

In November–December 2016, we examined the public and private online health insurance exchanges. We navigated each site for “real-shopping” (personal information required) and “window-shopping” (no required personal information).

Participants

Public (n = 13; 12 state-based marketplaces and HealthCare.gov) and private (n = 23) online health insurance exchanges.

Main Measures

Features included consumer decision aids (e.g., total cost estimators, provider lookups) and plan display (e.g., order of plans). We examined private health insurance exchanges for notable features (i.e., those not found on public exchanges) and compared the total cost estimates on public versus private exchanges for a standardized consumer.

Results

Nearly all studied consumer decision aids saw increased deployment in the public marketplaces in OEP4 compared to OEP3. Over half of the public exchanges (n = 7 of 13) had total cost estimators (versus 5 of 14 in OEP3) in window-shopping and integrated provider lookups (window-shopping: 7; real-shopping: 8). The most common default plan orders were by premium or total cost estimate. Notable features on private health insurance exchanges were unique data presentation (e.g., infographics) and further personalized shopping (e.g., recommended plan flags). Health plan total cost estimates varied substantially between the public and private exchanges (average difference $1526).

Conclusions

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.

KEY WORDS

health insurance marketplace Affordable Care Act consumerism health insurance decision support 

Notes

Contributors

None

Funding Information

Funding for this project was provided by the Robert Wood Johnson Foundation.

Compliance with Ethical Standards

Conflict of Interest

Tom Baker is a co-founder of Picwell, Inc., a health information/technology company that leverages big data and predictive analytics to help consumers optimize health plan choice. All other authors declare no conflicts of interest.

Prior Presentations

Presented as a poster at the AcademyHealth Research Meeting, June 2017 in New Orleans, Louisiana.

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Charlene A. Wong
    • 1
    • 2
    • 3
  • Sajal Kulhari
    • 4
  • Ellen J. McGeoch
    • 4
  • Arthur T. Jones
    • 4
  • Janet Weiner
    • 4
  • Daniel Polsky
    • 4
  • Tom Baker
    • 4
    • 5
  1. 1.Department of Pediatrics, Margolis Center for Health Policy, Duke Clinical Research InstituteDuke UniversityDurhamUSA
  2. 2.Margolis Center for Health PolicyDuke UniversityDurhamUSA
  3. 3.Duke Clinical Research InstituteDuke UniversityDurhamUSA
  4. 4.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.University of Pennsylvania Law SchoolPhiladelphiaUSA

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