For the majority of people in the study, the Connector provided the only marketplace used; this suggests that the Massachusetts Exchange is an important mechanism for coverage for many, including those who were previously uninsured. We also found, however, that a subset of people struggled with selecting their health plan. More than 40 percent found it difficult to understand the information on plans during enrollment. Although approximately one-third of people had help selecting plans, most commonly from friends or family members, one-fifth wished they had had help narrowing plan choices. Not receiving needed help in selecting plans had important consequences. Respondents who wished they had help selecting a health plan were more likely to report negative experiences related to plan understanding, satisfaction with affordability and coverage, and unexpected costs.
What does this mean for the design of Exchanges across the country? This effort is just beginning. One question is the extent to which Exchanges draw on lessons from behavioral economics, which finds that consumer decisions are affected by how information and choices are presented, and take a more “active” role in structuring plan choices with the aim of helping consumers make better choices. However, even Exchanges that adopt a more “clearinghouse” style and offer all qualified plans still share the goal of creating a transparent and navigable marketplace. Exchanges need to provide additional resources and tools to help consumers make good health plan choices as they seek affordable coverage. Since the time of our survey, the Connector has made the selection process easier, including standardizing plan benefits across metallic tiers and adding a search function for providers in a plan’s network. In addition, the ACA requires Exchanges to include tools such as a cost calculator that can be used to estimate out-of-pocket costs in a plan and a Navigator program that provides access to experts who can help consumers understand and select plans. It will be important for states and the federal government to invest adequate resources into building this functionality if we hope to achieve the promise of Exchanges.
Sinaiko is a postdoctoral research fellow in the Department of Health Policy
and Management at the Harvard School of Public Health.