Consumers want more choices but are confused by plan options

March 1, 2012

New benefit summaries sure to ad administrative costs

NATIONAL REPORTS-It's no surprise that survey data indicates selecting a health insurance plan can be a confusing process for consumers. Experts say consumer-oriented tools and provisions within the Patient Protection and Affordable Care Act (PPACA) set to roll out in 2012 could help minimize some of the confusion.

Aetna found that more than half of the insured adults it surveyed across the nation were unclear about aspects of selecting a health insurance plan. According to the survey of more than 1,000 adults, 32% reported being confused about the total cost of an insurance plan; 30% had trouble understanding the difference between plan types; 26% expressed confusion over which providers were considered in-network; and 24% weren't sure whether referrals were needed.

"Over the years because consumers have wanted more choice, things have become more complex, and I think this is just bearing that out because we don't just have one plan for everybody," says Wendy A. Richards, MD, a national medical director for Aetna.

Cheryl Fish-Parcham, deputy director of health policy at Families USA, says some consumer confusion can be attributed varying definitions of key terms within health plans.

"People don't really understand what cost they are going to face," she says. "If there are out of pocket limits, for example, some health plans will define a limit as being the most the plan has to pay and others will describe a limit as being the most the consumer has to pay."

Fish-Parcham also says that consumers are often confused about what benefits are covered under their health plans. While most consumers know what to look for in a plan while they are healthy, she says, they often don't know what possible benefits they may need if they are sick.

"They can be very unpleasantly surprised if they have a serious illness and their plan isn't covering things," she says.

She believes consumer confusion will lessen now as plan sponsors and insurers begin to provide a summary of benefits and coverage as part of provisions within PPACA. As part of the requirement, the summary of benefits will include uniform definitions for terms, as well as information about coverage including cost sharing information and possible exceptions.

At least for the essential benefit package and plan comparisons in the exchanges, consumers will be able to see exactly what the differences are and what plans cover, Fish-Parcham says. Making sure consumers actually receive the standardized benefit summary document for their plan coverage and review it is also important, she says.

"We're hoping that in every marketing opportunity there is a notice about this document," she says.

Another survey released in December by the ADP Research Institute, based in Roseland, N.J., indicates that among the 500 human-resource leaders polled, the majority believe decision support tools increase employee understanding of benefits. However, 51% of large companies and 72% of midsized companies don't provide them. Such tools typically include online applications, which give employees the ability to compare healthcare plans to determine which plans best meet their needs.

Dr. Richards, who is also a book author, says Aetna has tried to provide a variety of consumer tools such as mobile applications, interactive Web sites and a virtual online assistant to educate consumers about their health plans and the options available to them.

The company plans to continue to test, improve and add new tools as they move closer to 2014, when more consumers will likely be in the market for health insurance.