Patients Need More Transparency When Choosing ACA Plans

The Affordable Care Act's insurance exchanges leave much to be desired with regard to transparency when patients are shopping for health coverage, according to a survey from the National Health Council.

The Affordable Care Act (ACA)’s insurance exchanges leave much to be desired with regard to transparency when patients are shopping for health coverage, according to a survey from the National Health Council (NHC).

Patients on the exchanges reported difficulty accessing information they need to make informed decisions about their health insurance and one-third of patients with chronic conditions had a hard time finding information about covered providers and medications. Overall, only 37% of patients enrolled in silver plans felt they had all the information needed to choose their coverage.

A third of enrollees said they chose their plan without fully knowing if their prescription drugs were covered and a quarter either did not know if their doctor was covered or thought their doctor was covered only to find out he or she was not. Younger enrollees and those with bronze plans were the most likely to be confused or not know.

“The study finds that patients want to pick a plan that meets their needs. But we need to ensure exchanges provide them the tools to make it possible,” Marc Boutin, NHC chief executive officer, said in a statement. “In particular, transparency standards and easy-to-use decision support can help patients make an informed decision about their insurance.”

According to the survey results, enrollees would like to see more tools to help them choose a plan. However, only 7 of the state exchanges analyzed had additional resources and tools beyond the federal minimum requirements.

A standardized list of covered providers is the type of resource that 88% of respondents said would be helpful when choosing coverage. They would also like a standardized list of covered drugs (85%) and a calculator to help them estimate their out-of-pocket costs (83%).

Despite the difficulties consumers had when choosing plans, 70% still said they were very or somewhat favorable toward the insurance purchased through the ACA.

The NHC has developed 5 principles for a more patient-focused insurance market:

  • Ensure cost-sharing structures and other plan design elements do not discriminate against people with chronic conditions or impede access to care
  • Create transparency standards to ensure patients have access to complete details about the coverage and cost of health insurance exchange plans
  • Make insurance exchange plan materials easier for patients to understand by creating uniformity of content and design
  • Establish continuity of care requirements that protect patients transitioning into new coverage
  • Ensure that all health insurance exchange plans meet federal requirements