Finding Information in Healthcare Exchanges

January 28, 2015

It’s an understatement to say that the Affordable Care Act health insurance enrollment process is going smoother this year than it did at this same time in 2013. In contrast to last year’s seemingly endless website difficulties, the open enrollment period saw nearly half a million Americans sign up for plans in the first week. Nearly half of those were new customers, leading to hopes that this year’s sign-up period may make a significant dent in the nation’s uninsured population.

Questions still remain though. Do the consumers who are newly enrolled in health insurance plans know exactly what they’re purchasing with their monthly premiums? Can they keep their doctors? If they have a serious illness or incur one, will they have affordable access to the medications they need?

Finding the answers to these questions can be incredibly challenging. Having ready access to information that is understandable to consumers has been a significant problem with the health insurance exchanges. For example, consumers should be able to easily look up a health plan’s drug formulary to see if their medicines are covered and at what cost before making a decision. That’s not always the case, though. Too often, formularies are not readily accessible or are written in ways that are difficult for most consumers to understand.

For the one in two Americans living with a chronic condition, even minor obstacles navigating this new healthcare landscape can be particularly troubling. In a report this summer, the research firm Avalere Health uncovered that buying a health plan in the exchange does not ensure that critically-needed medications are accessible. Consumers managing costly chronic conditions, who thought themselves to be well insured, are finding that the medicines they need to stay healthy are beyond their financial reach.

With chronic illnesses like diabetes and heart disease on the rise, we need improved, not sharply restricted, access to treatments that manage these conditions and avoid costly complications. Costs in the Medicare program are skyrocketing because of the growing population of people with two or more chronic conditions. If we don’t better prevent and manage chronic disease with younger and middle-aged consumers, our publicly funded health programs like Medicare and Medicaid will implode.

There are common sense steps to improve the health exchanges. To the Obama Administration’s credit, recent proposals include greater oversight to ensure adequate provider networks and affordable access to medicines and appeals processes for those who need it, but ideas like these wouldn’t take effect until 2017. That said, action is being taken now to ensure that information on coverage and consumer costs can be easily found and understood before someone signs up for a plan. Some efforts of note include:

  • PFCD is in the process of exploring some of the challenges consumers have faced when purchasing healthcare coverage in the state and federal exchanges and is examining the most efficient ways to uncover necessary information to ensure provider consistency and prescription coverage. A growing series of consumer experience videos can be found here.
  • Caregiver Action Network (CAN) has established a Community for a Healthy Exchange, to provide resources that will aid in more efficient and effective navigation of the exchange and ensure that patients and their families have access to support throughout the process.
  • The National Health Council has published an out-of-pocket calculator designed to help consumers think about anticipated healthcare needs and what that means in terms of out-of-pocket costs with different types of insurance coverage.
  • Access Better Coverage, an educational resource designed to help consumers understand the ABCs of health coverage and access to prescription medicines, has developed a series of whiteboard videos focused on health literacy in shopping for exchange plans. The most recent video and a blog post on the issues point out that while improvements are being made there is still a need to ensure information is accessible and understandable to consumers so that consumers can make informed decisions about their coverage options.