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 CoveredCA.com). 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.

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