Shopping online for health insurance is harder than many other types of e-commerce. Ultimately, a health plan is not so much a product as it is a legal contract with a maze of provisions and dependencies (not the least of which are covered medical services and the doctors who provide them). With the implementation of the Affordable Care Act, millions of consumers will be expected to purchase a health plan for themselves and many of these consumers have not previously shopped for health insurance.
HealthPocket surveyed 998 people nationwide to uncover their expectations for shopping within the new government health insurance marketplaces known as exchanges. Specifically, HealthPocket asked, "Do you believe shopping for a new Obamacare health insurance plan within a government exchange will be an easy process?" 54% of respondents answered “No, I think it will be complicated.” These pessimistic respondents outnumbered those people expecting the shopping process to be easy by 3-to-1. In fact, those who don’t know what an exchange is (29%) also outnumbered those consumers who believe health insurance shopping on an exchange will be easy (17%).
The importance of simplicity and ease-of-use for exchanges was made abundantly clear to the government earlier this year when a preview of the exchanges’ insurance application form was released. The insurance application design contained 21 pages, though the number of pages needing completion varied depending on the total household enrollees. With respect to the application’s income questions alone, there were questions on multiple jobs, self-employment, and 10 different additional categories of income ranging from dividends to alimony. The resulting criticisms led to the release of a simplified version of the form.1 However, this shorter form, 3 pages for individuals and 11 pages for families, was released in May and, according to the results of the HealthPocket poll, has not resulted in the majority of people believing that the exchange shopping experience will be easy.
Exchanges are mindful of the challenges facing consumers in the health plan purchase process. They will be providing the option of in-person assistance from groups known as “navigators.” Navigators will answer questions on subjects such as the insurance application and the exchange. However, these navigators are prohibited from recommending insurance choices to consumers.
Simplicity and ease-of-use is important for internet tools in general but especially for exchanges, which will be primarily an online experience. The Kaiser Family Foundation’s research suggests that exchange enrollees will average lower education levels then those people who receive their health insurance through their employer.2 Additionally, Kaiser expects that one-out-of- four of the exchange enrollees speak a language other than English at home.3 An overly intricate shopping workflow or complex input descriptions within the process are likely to present problems to the exchange users. Both of these risks are inherent to exchanges inasmuch as they will require users to answer questions about taxes and dependents to determine subsidy eligibility. After the subsidy issue is settled, there will still be the matter of the available health plans, their costs, benefits, and provider networks.
While apprehensions about the exchanges’ ease-of-use have no bearing on the actual usability of those web sites, these low usability expectations could prove to be an advantage for the new health insurance exchanges. Broad public satisfaction with the exchanges might be achieved if the online shopping experience even modestly exceeds the current low expectation level. If the exchanges faced high expectations for ease, on the contrary, there would be a greater opportunity for dissatisfaction.
However, should expectations for shopping difficulty be realized, exchanges may face several challenges. Notably, the number of consumers needing assistance may exceed the capacity of the recently-trained navigators. Many of these navigators will be new to the insurance industry and may take time to reach peak efficiency with consumer assistance. A second challenge, perhaps more important for the exchanges, is the risk of missing enrollment targets due to consumers abandoning a process they find too complex.
Results are based on 998 responses to a nationwide online survey conducted from August 22, 2013 to August 24, 2013. Respondents were asked "Do you believe shopping for a new Obamacare health insurance plan within a government exchange will be an easy process?" Respondents had the option of selecting one of the following answers: “Yes, I think it will be easy,” “No, I think it will be complicated,” and “I don’t know what an exchange is.” The answer options were displayed in randomized order. The survey was displayed within a network of over 100 different news web sites and other content sites. Demographic inferencing and methodology to acquire survey respondents who approximate national statistics on age, gender, income, and region was performed by Google-administered technology. Race, education, and health insurance status were not examined. Margin of error across survey responses is estimated at + 3.8/-3.8.
This survey analysis was completed by Kev Coleman, Head of Research & Data at HealthPocket.com. Correspondence regarding this study can be directed to Mr. Coleman at firstname.lastname@example.org.
Feedback and questions are welcome but, given the volume of email, personal responses may not be feasible.
1 Meghashyam Mali. "Officials cut application for ObamaCare benefits down to three pages" The Hill. April 30, 2013. http://thehill.com/blogs/healthwatch/health-reform-implementation/296851-report-white-house-cuts-obamacare-application-form-to-three-pages. Accessed August 27, 2013.
2 "A Profile of Health Insurance Exchange Enrollees." Kaiser Family Foundation. March 2011. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8147.pdf. Accessed August 27, 2013. p.3.
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