Making decisions about health insurance is among the least interesting, most confusing, and most frustrating experiences any consumer faces. This has become even more evident with the launch of exchanges through the Affordable Care Act (ACA).
Whether the consumer is shopping for an individual or family plan, or is an entrepreneur looking for a small group plan, these decisions have important implications for the people involved as well as for the marketplace. From a researcher’s perspective, understanding their needs and experiences is essential to providing improvements that will help as many marketplace users as possible obtain coverage in an appropriately priced and configured plan.
Deciding to shop: Is buying insurance optional or a necessity? For owners of cars or homes, it is required; in the US, health insurance is also moving into the necessity category, as mandated by ACA. However, not everyone is on board with this yet, as evidenced by a recent survey 1 showing that about a third of adults between 19 and 64 are unlikely to shop for coverage via the ACA exchanges before March 31. Given the hype about courting the “invincibles” to make ACA viable, one might think that this “missing third” consists mainly of young, healthy adults. In fact, levels of disinterest are similar across age groups. (Note—these results are affected by adults ages 19 to 25, who are now eligible to remain on a parent’s plan. Also, a majority of respondents who completed the survey did report that they are likely to shop for coverage.)
Advocates for coverage are trying a variety of tactics to encourage ACA participation, particularly among young adults. This begs the question of whether the chosen tactics are the most effective. Messaging, delivery strategy, and execution can all be measured to ensure that, whatever the approach—fear, information, humor—it is having the desired effect. Such an assessment seems sorely needed.
Making the purchase: Having decided to enroll in a health insurance plan, consumers next need to obtain information about their options, make a selection, and complete the transaction. For purchases conducted via the exchanges, their first barrier would have been overcoming the early ACA website glitches, which continue to this day in many cases. However, as the bugs get worked out, the next challenge will relate to the quality of the information available on the sites. This challenge is not unique to the ACA marketplace; people shopping on the individual market or choosing from among employer-sponsored options have long bemoaned the confusing nature of health insurance purchasing.
The implications of this are not trivial; research has shown that many consumers do not make the most cost effective choice for their situation, and, as a result, spend more on their health coverage than they would need to without necessarily obtaining the coverage that best fits their needs. 2 This can be addressed, in part, by providing better information to understand their options and guide their choices.
Details count. Which information is included on the site? Which items receive priority in terms of layout? How much information is on a page, and how complex is the navigation? Making the right decisions in terms of design and user experience fundamentally affects the outcomes. Again, this is an area where careful investigation by user experience experts and others can help achieve a better approach and accomplish the desired outcome for the program and the individual.
Health insurance is complex, with no simplification in sight. To make sure that people stay engaged and ultimately obtain coverage, no less the right coverage to meet their needs, insurers and public agencies need to understand the consumer decision process and provide tools and information to support it.
1 Americans’ Experiences in the Health Insurance Marketplaces: Results from the First Three Months, Lead author: Sara R. Collins, 2014, The Commonwealth Fund
2 Can Consumers Make Affordable Care Affordable? The Value of Choice Architecture
Lead author: Eric J. Johnson, July 9, 2013, University of Pennsylvania Law School, Institute for Law and Economics