Key differences between Engaged and Disengaged consumers

Engaged consumers have more favorable attitudes and behaviors
Compared to Disengaged consumers, Engaged consumers are…

  • More confident filling out medical forms (87% vs. 40%).
  • Much more likely to feel prepared to select health insurance coverage for themselves (78% vs. 17%).
  • Much more likely to know what they will pay out of pocket when visiting a doctor (97% vs. 35%).
  • Much more likely to carefully research what their doctor says before acting on his or her instructions (81% vs. 34%).
  • In much better health overall (62% excellent or very good health vs. 16%).
  • Much more likely to have a normal Body Mass Index or BMI (60% vs. 16%).
  • More likely to have visited a dentist in the past year (96% vs. 37%).
  • More likely to have a personal doctor (96% vs. 60%).
  • More likely to have visited a doctor in the past year (97% vs. 64%), but fewer total visits on average compared to Disengaged consumers (2.4 visits vs. 3.2 visits).
  • Less likely to have visited an ER in the past year (18% vs. 29%).
  • Less likely to have visited a hospital in the past year (7% vs. 14%).
  • Exercising at least three times per week (77% vs. 21%).
  • Receiving annual physical exams (96% vs. 49%).
  • Concentrating on eating healthier (90% vs. 46%).
  • Much more likely to have had their cholesterol checked in past year (72% vs. 37%).
  • Receiving flu shots each year (68% vs. 25%).

Engaged consumers more satisfied with and more loyal to their health plans
Engaged consumers are much more likely to have private health insurance coverage that they pay for out of their own pocket (46% Engaged vs. 20% Disengaged) and less likely to have government coverage such as Medicaid or state-based plans (8% Engaged vs. 20% Disengaged) or be uninsured (3% Engaged vs. 25% Disengaged).  Having a larger financial stake generally leads consumers to be less satisfied with their health insurance coverage, yet Engaged consumers are significantly more satisfied with their coverage and more loyal to their plan.

  • 43% of Engaged consumers rate their health plan a 9 or 10 on a 0 to 10-point scale compared to 22% of Disengaged.
  • 65% of Engaged consumers rate their health plan a, 8, 9 or 10 on a 0 to 10-point scale compared to 34% of Disengaged
  • When considering overall value for the price paid, 41% of Engaged consumers rate their health plan a 9 or 10 compared to 19% of Disengaged.
  • 61% of Engaged consumers rate their health plan’s overall value a, 8, 9 or 10 compared to 31% of Disengaged.
  • When faced with a 20% premium increase, 59% of Engaged consumers say they would pay the higher price to remain with their current plan compared to 36% of Disengaged consumers.
  • Under the assumption of a 20% premium increase, only 34% of Engaged consumers would change plans and 7% drop coverage while 46% of Disengaged expect to change plans and 18% say they might drop coverage in this situation.
  • Between 2014 and 2015, 16% of Engaged consumers changed plans within the same health insurer (8% for Disengaged), but only 13% actually changed carriers compared to 15% for Disengaged.

When asked to review several statements related to their health plan, more Engaged consumers were much more likely to make positive associations with their plan.

  • 77% of Engaged consumers said “my plan is perfect for people like me” (40% Disengaged).
  • 75% of Engaged consumers think of their insurer as “my health insurance company” (40% Disengaged).
  • 67% of Engaged consumers agree with the statement “the people who work at my plan understand me” (27% Disengaged).
  • 59% of Engaged consumers say the people at their insurer are “sympathetic to my problems” (32% Disengaged).
  • 50% of Engaged consumers believe “my health plan has benefits no other plan has” (19% Disengaged).

Engaged consumers are not…
Engaged consumers are not older on average than their Disengaged counterparts.  Contrary to some expectations, Engaged consumers are slightly less likely to be female (54% Engaged vs. 60% Disengaged) and can be found amongst all ethnic groups and all household sizes.  Engaged and Disengaged consumers are equally likely to choose leading health insurance companies such as Blue Cross Blue Shield, Aetna, Cigna, Humana, Kaiser or United HealthCare.

Despite reporting to be in much better health, Engaged consumers are only slightly less likely to have one or more of the most common chronic conditions like diabetes, high cholesterol, hypertension or mental health issues.  Fewer Engaged consumers smoke cigarettes today, but they are just as likely as Disengaged consumers to have smoked at some point in their life.

Posted in Health Care Engagement, Health insurance - general, Health risk, Satisfaction | Leave a comment

Health Insurance Attitudes Vary By Age and Level of Engagement

Consumer attitudes regarding the importance of health insurance in their lives does not vary dramatically across most consumer groupings, but is significantly more meaningful to the oldest and most engaged consumers.

Engaged consumers value health insurance from every perspective
The most engaged consumers are much more likely to see health insurance as a means of keep their families healthy and protecting them financially.  Engaged consumers are also more likely to feel at ease with insurance, but have worries of potential bankruptcy without it.  Twenty percent of Engaged consumers say their family and friends turn to them when they have questions regarding health insurance and health care providers compared to only 4% of Disengaged consumers.

Engaged consumers are more committed to having health insurance from every perspective considered.

Engaged consumers are more committed to having health insurance from every perspective considered.

Older consumers are also concerned about financial risks without health insurance
The oldest consumers (65 to 79 years of age) are much more likely than the youngest (18 to 30 years of age) to be worried about bankruptcy without adequate health insurance and to feel at ease when properly covered.  The oldest consumers also consider it their duty to provide health insurance for their families, but they are only slightly more likely to have a passion for keeping themselves healthy, to expect health plans to reward healthy members or to be a resource for family and friends who have questions about health insurance and health care.

Older consumers value the financial protections of health insurance more so than younger ones.

Older consumers value the financial protections of health insurance more so than younger ones.

Posted in Health Care Engagement, Health insurance - general, Statistics | Leave a comment

Opportunities to improve doctor satisfaction

Almost 80% of US consumers have a physician they consider to be their personal doctor and many of them are very satisfied with the care they receive or they would look elsewhere for a new doctor.  However, the latest DSS Health Care Engagement Index (HCEI™) survey shows there is still room for improvement.

Uninsured and new HIX members need doctors.  It is not surprising that with more limited access to medical care, only 37% of uninsured consumers have a personal doctor.  Something harder to explain is why only 76% of consumers with an individual health insurance plan have a personal doctor despite paying for coverage out of their own pocket and having free access to checkups.  New health plan enrollees in general and public exchange enrollees specifically are less likely to have a personal doctor.

Half are extremely satisfied, but half are not.  On a scale of 0 to 10 where 10 means the best possible personal doctor, 45% of consumers rate their doctor a 9 (20%) or 10 (25%).  Consumers heavily Engaged in their health care, those 65 to 79 years of age and those with Medicare coverage are significantly more likely to have a personal doctor and to rate their doctor a 9 or 10.  That still leaves 50% of consumers less than delighted with their current physician.

Infographic on doctor preferences from the DSS Health Care Engagement Index (HCEI) survey.

Infographic on doctor preferences from the DSS Health Care Engagement Index (HCEI) survey.

Not enough consumers saying their doctor is the best ever.  When given a choice of describing their doctor as the “best ever“, “good enough for the moment“, “the only doctor I have ever had” or choosing from a list of complaints, only 34% said their doctor is the “best ever.”  Another 11% said they have “never had another doctor” to compare against, so they are uncertain how good their doctor really is.   One-quarter of all consumers say their doctor is “good enough for the moment“, which implies they will look elsewhere at some point in the future.  Half of those who said their doctor is “good enough for the moment” also selected one or more complaints such as taking too long to get an appointment, long waits at the doctor’s office, a dismissive attitude when asking questions, language issues, etc.  One-third of consumers who said their current doctor is the “only one they have ever had” also mentioned one or more complaints, indicating that they already recognize opportunities for improvement despite their limited experience.

60% of doctor relationships could be upgraded.  In a separate question, 27% of consumers said they “would drive across town and pay more” to continue seeing their current physician – a clear sign of loyalty for their physician.  However, 30% said they stay with their doctor out of convenience more than anything else, 14% said they would change doctors if they could easily find a better one and 17% stay with their doctor out of fear that they might end up with an even worse doctor.  That means about one-third of consumers are ready to change doctors if the process is easy and there is enough information to insure a good decision.  Another 30% of consumers might switch if circumstances change.

Utilization is skewed.  The typical US adult visited a physician 2.3 times during the past year, but utilization varies across many respondent groups.  Almost every Engaged consumer said they visited a doctor at least once in the past year while only 64% of Disengaged consumers did so.  When Disengaged consumers visited a doctor, the often did so multiple times, averaging 3.2 visits per year compared to only 2.4 visits for the typical Engaged consumer.  Despite a lack of insurance, 50% of uninsured consumers visited a doctor at least once while 89% of those with an individual plan and 97% of those with Medicare had a doctor visit in the past year.  Those with 1 chronic condition are not much different from consumers with no chronic conditions, but both groups have significantly fewer visits than those with 2+ chronic conditions (3.4 visits per year versus 1.5 visits per year for those with no conditions).  Grouping consumers by BMI produces results similar to those based on number of chronic conditions with overweight individuals having slightly more utilization than those with a normal range BMI, but significant less visits than consumers classified as obese (1.8 visits per year for normal BMI verses 2.7 visits per year for obese BMI).

Posted in Health Care Engagement, Health insurance - general, Health insurance exchanges, Physicians, Satisfaction, Uncategorized, Uninsured | Leave a comment

2015 Federal Exchange Summary

The infographic below summarizes statistics from the Department of Health and Human Resources regarding enrollment on the Federal health insurance exchange for 2015.

2015 Federal Exchange Enrollment Infographic

Over two-thirds of the 8.8 million consumers (69%) chose a Silver plan, but given that 87% of the Federal exchange enrollees are receiving a subsidy, the proportion of Silver plans should be even higher.

For those not choosing a Silver plan, Bronze is the metal tier of choice.  The Bronze plans should minimize monthly premium (with or without Federal subsidies), but out-of-pocket costs will be significantly higher if medical services other than preventive care are received during the year.  This is particularly true for anyone who chooses a Bronze plan when eligible for one of the cost sharing Silver plan designs (note: cost sharing plans reduce out-of-pocket costs such as deductibles and copayments for consumers with incomes below 250% of the Federal Poverty Level).

Just over half of those who enrolled on the Federal exchange did so for the first time in 2015 (or during the opening enrollment period at the end of 2014 – for 2015 coverage).  Among the 47% who re-enrolled on the exchange for 2015, slightly more than half actively selected their 2015 plan (even if it ended up being the same plan they had in 2014) while the remaining consumers auto-enrolled in their previous plan for 2015.

The age distribution of Federal exchange purchasers relative to the US population (those under age 65), is heavily skewed towards older consumers.  Only 8% of enrollees are under 18 years of age compared to 27% of the US population.  Almost 50% of Federal exchange enrollees are between 45 and 64 years of age while only 31% of the US population falls within this age range.

Some additional factors not shown on the infographic are:

  • Only 2% of all 2015 Federal exchange purchasers have incomes over 400% of the Federal Poverty Level (FPL) compared to 43% who have incomes below 150% FPL.
  • 65% of enrollees are White, compared to 14% Black / African American, 11% Latino and 8% Asian.  Despite special plan designs for native Americans, very few have enrolled via the Federal exchange.


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Engaged consumers participate in wide range of activities

Not surprisingly, Engaged consumers are significantly more likely than the Disengaged to participate in most types of health care activities. Over 80% of Engaged consumers have done one or more of the 12 health-related activities compared to only 49% of Disengaged consumers.

Almost one-quarter visited insurer’s websites

24% of consumers said they visited a health insurer’s website in the past 12 months. One-third of Engaged consumers said they have visited an insurance website while only 16% of Disengaged consumers have done so.

Engaged consumers also reading insurer newsletters

One-quarter of Engaged consumers said they have read a newsletter from a health insurance company in the past year, which is more than three times the percentage of Disengaged consumers doing so (7%).

Participation in Health-related Activities

Participation in Health-related Activities

Calling customer service is not related to engagement

About 15% of consumers indicated that they called their health plan’s customer service, while only 14% of Engaged consumers have called and slightly fewer (10%) Disengaged consumers have called, leaving the middle engagement levels (Involved and Reactive categories) as being more likely to call than either extreme. Engaged consumers are expected to respond to any problems and address them rather than ignore them like a typical Disengaged consumers, so we might assume that Engaged consumers are experiencing fewer customer service issues due to their knowledge and involvement.

Engaged consumers are not more likely to check prices

Although we would expect the most Engaged consumers to be much more likely to check prices for medical tests and procedures, only 15% of them reported doing so in the last year compared with 11% of Disengaged consumers and 13% of consumers overall. Past studies have shown that Engaged consumers are willing to pay more than other groups to retain their personal provider and to receive services they deem necessary, so price considerations may be less of a concern for these consumers – making this an opportunity for further costs savings from these customers.

Blogs are not very popular

Only 7% of consumers said they have read a health-related blog in the past year and less than half that many (3%) have posted such a blog. Amongst Engaged consumers, 14% have read a health-related blog and 7% have posted one. By comparison, only 1% of Disengaged consumers have read a health-related blog and none reported posting such a blog.

Electronic Health Records (EHR) underutilized by all

Only 9% of consumers said they use EHRs today. Even among Engaged consumers, EHR usage is a minority while Disengaged consumers are almost as likely as the typical consumer to use an EHR.

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Very few uninsured enrolled for 2014

As of February 7, 2014, only 10% of uninsured consumers age 18 – 64 said they have selected health insurance coverage for 2014. With only seven weeks until the end of open enrollment under ObamaCare for 2014, it appears that a small proportion of uninsured will have coverage this year. Only 37% have visited a state or Federal marketplace and only 53% of those who have not yet visited the insurance marketplace expect to do so before March 31st.

Most group and direct pay consumers have renewed for 2014

In contrast, 82% of consumers with employer group coverage have selected coverage for 2014 and 76% of those with a direct pay plan have enrolled in coverage for the rest of 2014. Overall, 63% of all consumers surveyed have coverage for the remainder of 2014.

Age is not as critical a factor as income

Older consumers (45 – 64) are only slightly more likely to have selected coverage than 31 – 44 year olds or 18 – 30 year olds, however, college graduates are much more likely to have selected coverage compared to those with a High School education or less.

Engaged consumers made their choice

Engaged consumers are much more likely to have already selected coverage. Almost 80% of Engaged consumers have selected coverage compared to 45% of the Disengaged.

Percentage of consumers who selected coverage for 2014

Percentage of consumer groups who selected coverage for 2014

Posted in Health Care Engagement, Health insurance - general, Health insurance exchanges, Uninsured | Leave a comment

Attitudes towards exchange are split

A few consumers still have not heard of ObamaCare

Despite launching the Federal and state health insurance exchanges on October 1, 2013, the percentage of consumers who said they know at least something about the Affordable Care Act (ACA or “ObamaCare”) was only slightly higher in December of 2013 than it was in December of 2012 (68% vs. 61% in Q4 2012). Five percent of consumers surveyed in Q4 2013 still said they have not heard of ACA or ObamaCare (9% had not heard of it in 2012).

Overall image of ACA is neutral

Virtually unchanged for the past 12 months, the overall perception of ACA remains neutral with 46% saying it will have a very positive (13%) or somewhat positive (33%) impact, 44% saying it will have a somewhat negative (21%) or very negative (23%) impact and 10% saying it will have no impact. However, perceptions of health care exchanges remain more positive with 40% saying exchanges will positively impact the way they personally buy health insurance, 41% saying exchanges will have no impact and only 19% saying exchanges will have a negative impact on their personal insurance purchases.

Most consumers just “kicked the tires” of exchanges

Through February 7, 2014, 35% of consumers age 18 to 64 said they tried accessing the Federal ( or state health insurance exchange or spoke with a broker or navigator about the exchange. More than one-quarter (26%) tried accessing the state or Federal website themselves. Of those who remembered when they first access the website, 28% were not able to create an account or do anything. 61% were able to create an account and 46% made it so far as to verifying their identity. Just under 4% (3.7%) of consumers surveyed between 18 and 64 said they selected a health insurance plan on the state or Federal exchange and 1% of them had actually paid their first month’s premium by February 7th.

Exchange Activity through February 2014

Health insurance exchange / marketplace activity between October 1, 2013 and February 7, 2014

Initial experience was split

One-third of consumers who visited a Federal or state health insurance marketplace rated their experience an 8, 9 or 10 while 34% rated it a 0, 1, 2, 3 or 4 on a 10-pt scale where “10” means the “best possible experience” and “1” means “the worst possible experience.” In addition, 19% said the variety of plans was much better than expected and 12% said they were somewhat better than expected, while 26% said they were somewhat worse and 16% said they were much worse than expected.

Some agreement about prices being higher

Only 22% of consumers who visited a state or Federal marketplace indicated plan premiums were much less expensive (9%) or somewhat less expensive (13%) than they previously paid for health insurance. Almost one-quarter (24%) said plan prices in the marketplaces were much more expensive than what they previously paid and 27% said they were somewhat more expensive, leaving just 27% who said prices were about the same.

Navigators were not as successful as agents in enrolling consumers

Navigators did not have a major impact on plan selection. Only 5% of eligible consumers spoke with a navigator and less than half those who did speak to a navigator found health insurance coverage. In comparison, brokers were more successful. Of the 6% of consumers who talked with a broker or agent, 77% said they were able to successfully select insurance coverage.

Additional exchange activity expected to be modest

Of those 18 to 64 year olds who have not yet visited the state or Federal marketplace, only 17% said they intend to do so before the March 31st deadline. Another 23% are unsure whether they will do so.

Posted in Health Care Engagement, Health insurance exchanges, Health insurance reform | Leave a comment

2014 Medicare Star Ratings show modest improvement

The CMS databases showing Medicare Star ratings for Medicare Advantage (MA) and Medicare Prescription Drug Plans (PDP) are out. Analysis shows that CMS is keeping a tight reign on the number of 5-star plans, while allowing slightly more 4.5-star plans and significantly more 4-star plans in 2014.

Number of plans receiving each rating level

More MA plans, but fewer rated in 2014

There are 677 MA plans (664 MA-PD plans that include prescription coverage and 13 MA-only plans that do not include prescription coverage) listed in the 2014 report card, but only 437 of those plans received a star rating from CMS. In 2013, there were 578 total MA plans (563 MA-PD and 15 MA-only), with 454 of those plans being rated by CMS. The difference appears to be a large influx of new plans that have not been in existence long enough for CMS to measure member experiences and plan performance. There were 52 plans in the 2013 rating year that were designated as “too new to be rated” while there are 176 plans in the 2014 rating year with this designation.

A few changes at the top of the MA plan rankings

Four MA-PD plans and one MA-only plan slipped from 5-stars in 2013 to 4.5-stars for 2014. Conversely, four MA-PD plans managed to raise their scores from 4.5-stars to 5-stars over the same time period. No plan jumped a full star rating to attain the ranks of the 5-star plans and no former 5-star plan fell more than one-half star compared to 2013. In fact, four plans (HealthPartners, Humana, Kaiser of OH and Medical Associates of WI) have been straddling the fine line between a 4.5 and a 5.0 star rating for several years with each plan receiving 4.5-stars in 2012, then 5-stars in 2013 and 4.5-stars for 2014.

The five plans that lost their 5-star rating in 2014 are:

  • Humana WisconsinHealth Organization Insurance Corp
  • Health New England (HNE) Medicare Advantage Plans
  • HealthPartners (Group Health Plan of MN)
  • Kaiser Permanente of Ohio
  • Medical Associates Clinic Health Plan of Wisconsin (MA-only plan)

The MA plans that attained a 5-star rating for 2014 are:

  • Cigna-HealthSpring (FL) – new for 2014
  • Group Health Cooperative (WA)
  • Gundersen Health Plan, Inc. (WI)
  • Kaiser Foundation Health Plan, Inc. (CA)
  • Kaiser Foundation Health Plan, Inc. (CO)
  • Kaiser Foundation Health Plan, Inc. (GA) – new for 2014
  • Kaiser Foundation Health Plan, Inc. (HI)
  • Kaiser Foundation Health Plan of the Mid-Atlantic States (MD/VA)
  • Kaiser Foundation Health Plan of the Northwest (WA)
  • KelseyCare Advantage (TX) – new for 2014
  • Providence Health Plans (OR) – new for 2014
  • Dean Health Plan, Inc. (WI)
  • Kaiser Foundation Health Plan, Inc. (CA)
  • Medical Associates Health Plan, Inc. (IA & IL)

More volatility in PDP rankings

The number of Medicare prescription plans (PDPs) that received a 5-star rating increased from four to five and the number of PDPs receiving 4.5-stars increased from four to six from 2013 to 2014. The total number of PDPs also increased slightly from 79 in 2013 to 85 in 2014. While the overall counts for PDPs did not change significantly, the roster of 5-star plans did change dramatically with three new plans attaining the 5-star rating in 2014, two plans lost their 5-star rating (Excellus and Wellmark) and two other retained their 5-star rating from 2013. Two of the additions for 2014 are Employer/Union organizations (Missouri DOT and national Rural Electric Coop). PDPs either gained a full star rating to climb into the 5-star category or lost a full star rating to lose the coveted 5-star ranking from 2013.

  • Catamaran Insurance Of Delaware, Inc. (DE)
  • Hawaii Medical Service Association (HI)
  • Missouri Department of Transportation (MO) – new for 2014
  • National Rural Electric Cooperative Association (most of US) – new for 2014
  • Tufts Health Plan (MA) – new for 2014
Posted in MCAHPS, Medicare | Comments Off on 2014 Medicare Star Ratings show modest improvement

The Federal marketplace experience

Many articles and comments have been written about the trials and tribulations of the trying to access the Federal Marketplace (formerly known as an “exchange”) beginning on October 1. Like many consumers, consultants and researchers, I wanted to see what the Federal Marketplace looked like and get a sense of how well (or poorly) complex health insurance information was being presented to many first-time buyers.

Wide range of issues encountered

It was not surprising that problems were encountered. The secrecy during the development process (i.e. no public review of the website was made available before October 1) and concerns from politicians and industry insiders clearly offered many warning signs, if not, bona fide red flags. However, the extent of the problems was probably greater than many anticipated. Some of the specific issues I personally encountered were:

  • Site was down or inaccessible. I received this message at 6:20am Central on October 1 and numerous times throughout the first day and week the marketplace was “open” for business.
    The common, system is down message

    The common, system is down message

  • Site is busy. The most common response to attempted access to the Federal Marketplace, but I have received this message at 2am on a weekday, at 6am on a Saturday, at 10pm on a Sunday and many times in-between. So I am certain this issue goes beyond unusually high demand at popular times of day, revealing instead a systemic problem that the site is unable to handle even a moderate number of users.
    Website is busy

    Website is busy message

  • Page not found. Every website occasionally experiences a page not found (also known as 404 errors in HTML-speak), but this is uncommon for a brand new website. These message usually occur when old pages are decommissioned or edited and moved to a new location as part of a restructuring. A newly built website should not experience these kinds of messages on day 1 unless something has been overlooked or was left incomplete.
    Some pages can't be found on the site

    Some pages can't be found on the site

  • Unexpected errors. I frequently received this message the first few days trying to access the exchange and still see it occasionally even 12 days later. It usually appears as a red box somewhere on the screen, saying “Unexpected Error” and the text “Error ID”, but never lists a more detailed message or ID that might be useful in tracking the problem down. With such a cryptic message, the user doesn’t know whether to quit, close the message box or try something else.
    An example of the common red error box and it's lack of meaningful information

    An example of the common red error box and its lack of meaningful information

  • Access denied. I received this and similar messages on a few occasions. This particular example occurred when trying to access a menu for “places to contact for local help” – very helpful indeed!
    Access denied message received when trying to access list of contacts for local help.

    Access denied message received when trying to access list of contacts for local help.

  • Failure messages. The most common failure I received was regarding the creation of a Marketplace account. You can’t do anything meaningful in the Federal Marketplace until you have a valid user account and the site repeatedly failed at creating the account. It often crashed or generated an error before completing the initial application process. Other times, I made it to the point of generating the account, before seeing a message like this one.
    One of several attempts to create a valid login that failed for some unknown reason which was not disclosed

    One of several attempts to create a valid login that failed for some unknown reason which was not disclosed

  • Non-functioning pages. This one is already well known by many people, the case of being asked to fill out security questions during the initial account creation process, but being unable to do so because the dropdown list of security questions was blank. Trying to continue without answering the questions is met with a message to fill-in the security questions. The same message is received if you type random answers into the three answer boxes. Refreshing the page numerous times did not seem to work, but risked putting you at the back of the line where you might have to wait 20 to 30 minutes for another chance to re-enter all your account information again (and hope this time the security questions are filled in). I received this message at 6:45am on October 1 and I was still receiving it two days later when I was fortunate enough to get an opportunity to try and create an account.
    Many people saw the page where all the security questions are blank and it becomes impossible to move forward

    Many people saw the page where all the security questions are blank and it becomes impossible to move forward

  • Unknown issues. This example appeared when trying to login after having created an account (at least I thought so at the time, but later found my account had not actually been created). This is an unusual sight that has not appeared again, but obviously shows that the information meant to be filled in on the page was not available in time to display the page.
    Unknown problem with login page

    Unknown problem with login page

  • No help at all. On October 1, if you clicked on the link for “Live Chat”, you saw this message stating that “Live Chat isn’t available right now.” I am not sure when the link was activated. I know the Live Chat option functions now, but last time I tried it and filled in my name and email address, I did not receive a response to my “live” request in the 30 minutes I was willing to wait.
    Message that Live Chat was not available when the Marketplace launched

    Message that Live Chat was not available when the Marketplace launched

  • Account verification failure. Account creation and verification is the most frustrating portion of the Federal Marketplace. Without a valid account, you can not view the health insurance options available in your area. Besides the missing security question issue, regular crashes and long waiting times, once you complete the initial phase of creating an account, you have to wait for an email from the Marketplace to verify your account. On a few attempts, the email never came. On other attempts, the email from the Marketplace came, but the website could not process the verification link. In the most egregious example, the first time I was able to go completely through the process, I completed the account creation process around 9:30pm on October 1 after trying all day long to get through. I received a link from the Marketplace at 10:06pm and immediately clicked on that link to verify my account. I tried it more than 10 times over the next hour, always receiving a system is unavailable message or some other error message. I finally gave up a little after 11pm on October 1. First thing the following morning (around 6:30am October 2), I received a message saying I waited too long to verify my account, therefore, I must repeat the entire process. Ahhhh!
    Reached someone unspoken limit trying to verify my identity

    Reached someone unspoken limit trying to verify my identity

  • Identity verification problems. After finally creating a valid account on October 2, I spent the next few days trying to verify my identity. Despite knowing personal information intimately and answering truthfully all questions presented, the system would not recognize my identity. I received numerous error messages and system busy or system shutdown notes, forcing me to start the process over from the beginning. At one point I was told the I had tried too many times to verify my identity and therefore must now contact Experian via telephone to verify my identity. This happened on Saturday (October 5), so I called Experian’s tool-free number. The recorded message immediately informed me that the waiting period was longer than normal due to unexpected high call volume (expected on a weekday, but not on a Saturday at 12pm) – then the system hung up on me. I thought the hang up might be a mistake, so I called about an hour later, only to be hung up on again. I then tried uploading an approved document to the Marketplace, but never received any acknowledgement of the upload or contact of any kind from someone at Experian or HHS (no telling where that document actually went or who has seen it). I ultimately was able to verify my identity on October 9, after having created and verified a third Marketplace account.
    One of many examples where identity verification failed

    One of many examples where identity verification failed

Posted in Health insurance exchanges | Leave a comment

Covered California exchange has room for improvement

Congratulations to everyone working on the Covered CA marketplace for getting the site up and running before the October 1, 2013 deadline (see for yourself at The site is attractive and functional, but leaves both users and insurance carriers wanting for more. We know this site is a work in progress, but wanted to comment on what has been published so far.

Issues found with site

After a cursory review of the “Shop and Compare” portion of the website, here are some things we noticed:

  • No assistance is provided for selecting a health plan. There is a link to seek personal assistance from a navigator and there are glossaries and general benefit descriptions, but no mechanism for helping consumers determine which benefit package will best meet their needs. An interactive plan comparison tool or means of helping consumers rank order the importance of premiums, deductibles and out-of-pocket expenses is needed to help consumers make a more informed decision regarding the differences between Bronze, Silver, Gold and Platinum plan designs.
  • Can’t verify if your doctor is in the network. Those who already have a personal doctor or clinic they are familiar with have no way of determining whether that doctor or medical facility is included in any of the plans being offered. There is no option to eliminate carriers that do not include a particular doctor or hospital and no external links to provider directories for specific carriers. Even those consumers who do not have a personal doctor relationship, have opinions of hospitals and other health care providers in their neighborhood or just want to know how many doctors are available within a few miles of their home or work location. It is not clear how consumers will obtain network information at this point.
  • Limited listing of carriers may be misleading. Only four carriers are shown at a time when evaluating plan options within a metal tier. The number of options is reasonable given the amount of space available, but the way in which the first four plans are displayed makes it appear to the casual viewer that these are the only options available. You have to place your cursor over one of the plan designs and notice that a small arrow appears to the right of the fourth plan design, suggesting that other options might be available. There is also two or three dots under each list of four products, indicating that there are two or three screens of products to view, but this might be overlooked by some as a cosmetic detail. So any plan design that is not among the four lowest cost options for a metal tier may be far less likely to even be viewed by many consumers, placing it at a distinct disadvantage.
  • Pricing data may be confusing. Three price figures are shown for each plan option, Total monthly premium, Monthly premium assistance (tax credit) and Your total monthly payment. Someone new to health insurance and not fully understanding the federal subsidy / tax credit may be confused by all the pricing information, particularly since it may not be obvious that the third price is the result of subtracting the second price from the first. Focus on the price each individual will pay, then show how that price is calculated (if necessary) to keep things as simple as possible. The plan names are allowed to take a variable amount of space so that the pricing information does not always line up across carriers. This makes it more difficult to quickly scan across plans to compare prices or confirm that the same level of subsidy is offered on all plans in a metal tier.
  • No out-of-pocket cost estimates provided. An easy way to determine which metal tier is a better fit for a consumer is to provide an estimate of out-of-pocket costs under different assumptions regarding health care usage levels (e.g. the costs for a light user versus someone with a chronic condition or the difference between plans if an ER visit or hospitalization is incurred). Adding the projected out-of-pocket costs for services to the monthly premium provides a more realistic picture of what the consumer is likely to spend under each plan. No cost projections are provided in the current iteration of the marketplace.
  • Biased towards Silver and Bronze plans. No matter what your income level, the Bronze or Silver metal tier is listed first. While it makes sense for the lowest income consumers to focus on Silver plan designs where they may be eligible for substantial cost-sharing, they are not even allowed to view or compare the benefits for a Gold or Platinum plan to the Bronze and Silver options being displayed. Those with incomes over 400% of the Federal Poverty Level are initially shown only the Bronze and Silver metal tiers. They must look carefully to the upper left-hand corner of the screen to notice that they can toggle between these two metal tiers and the Gold and Platinum options.

All in all, the consumers most targeted for health reform (i.e. the uninsured and low income) are likely to find the Covered California website unable to effectively assist in selecting a health plan that is right for them. Expect lots of calls to the marketplace’s call center and overwhelmed navigators in the weeks and months ahead. Unless you are one of the four lowest priced Silver plan designs (or one of the lowest cost Bronze plans for higher income consumers), carriers risk not being seen by many consumers who do not expend the time and energy to fully review all available options.

Posted in Health insurance exchanges, Health insurance reform, Uninsured | Comments Off on Covered California exchange has room for improvement