Target group mulling over decisions

December 1, 2013

A fraction of consumers who could be buying plans actually did

Less than 20% of individuals potentially eligible for coverage through healthcare exchanges visited the new state-run health insurance marketplaces or healthcare.gov in October, according to a survey from the Commonwealth Fund. One in five of those visitors reported enrolling in a plan.

The survey asked consumers who went to the marketplaces and did not enroll why they didn’t:

• 48% in the survey said they were not certain they could afford a plan;

• 46% said that they were still trying to decide which plan they wanted;

• 37% of those who did not enroll cited technical difficulties with the sites.

“Given that coverage does not begin until January 1, the fact that people are still trying to decide on a plan should not come as surprise,” says lead survey researcher and Commonwealth Fund Vice President for Health Care Coverage and Access Sara Collins. “And the website problems are likely preventing people from finding out if they are eligible for subsidies. This is likely to span the age distribution.”

The survey, conducted between October 9 and 27, tracked consumer experiences with the marketplaces. Of those individuals who sought out information through the exchanges, 21% were in the 19 to 29 age group-a key population to attract into the risk pool.

The vast majority of uninsured young adults (about 94%) are eligible for premium subsidies or Medicaid. Those eligible for private plan subsidies with incomes between 250% to 400% of federal poverty level (11%) might apply their tax credits to a Bronze plan instead of the benchmark Silver and thus get a lower premium, according to Collins.

Those with incomes between 133% to 250% of poverty level (more than one-fourth) are also eligible for cost-sharing tax credits that increase the actuarial value of their plans.

 “These [cost-sharing tax credits] do not apply to the Bronze plans,” Collins says. “Adults of all ages would be advised to choose the Silver plan in order to take advantage of the enhanced cost protection.”

Exchange shoppers reported that they were in good health, with 73% describing their health as excellent, very good or good, and only 25% in fair or poor health.

Poor experience

Reflecting the serious technical problems that have plagued the federal marketplace and some state marketplace websites, 70% of adults who visited the marketplaces ranked their experiences as fair or poor. 

• 56% said it was impossible, somewhat difficult, or very difficult to find a plan with the coverage they needed, while 38% said it was very easy or somewhat easy to do so. 

• 61% said it was impossible, somewhat difficult, or very difficult to find a plan they could afford, compared with 30% who said it was very easy or somewhat easy to find an affordable plan. 

• Majorities of those surveyed had a hard time comparing insurance plans, saying it was impossible, somewhat difficult, or very difficult to compare benefits offered (58%), premium costs (52%), and potential out-of-pocket costs (51%).

The survey also asked people who did not enroll or did not visit the marketplace, whether they intended to come back, 58% of the sample said they were somewhat or very likely to go to or go back to the marketplaces and enroll in plan or find out if they are eligible for financial help by March 31. There was no difference in this response by age.

Young adults can also choose the law’s catastrophic option for those under age 30, Collins says. 

“Premiums are expected to reflect the risk of that group,” she says.

Collins believes that it will be important, particularly for those eligible for cost-sharing subsidies with incomes under 250% of poverty level, to get help understanding what their potential out-of-pocket costs are under the Bronze and Silver plans.

“This is why the navigators, consumer assisters, and brokers are so critical to consumers making the right choices about their coverage,” she says. “The vast majority of Americans have coverage through an employer and get considerable assistance in choosing a plan. It is important that people buying on their own also get assistance in making a decision so critical to their health and financial security.”