March 13, 2014
By Sara Gilgore
After months of nationwide struggle to purchase insurance coverage in the Affordable Care Act online exchanges, a new health plan comparison tool has been implemented in Illinois to make enrollment less complicated for consumers.
The independent nonprofit consumer organization, Consumers’ Checkbook, created HealthPlanRatings.org in response to the federal website’s failure to offer a comparable resource, to help with assessing the distinctions between health plans.
Robert Krughoff, the organization’s president, said HealthCare.gov lacks components essential for helping consumers pick health care plans, and that this is true of many state online marketplaces, including Illinois’.
“When the Affordable Care Act came along, we thought that we had something to share on that front,” Krughoff said, “to describe for people what we thought were the key elements of helping consumers get health plans that would be best for them in terms of price and quality.”
The new tool addresses some of the federal website’s missing parts, according to Krughoff. Among them, he cited the total costs of plans, which physicians are covered by the plans, potential cost changes in the event of illness, and overall plan quality.
“Unfortunately, the language of the Affordable Care Act is that these health insurance exchanges are to assist consumers in making easy health plan choices,” Krughoff said. “So when you don’t see that being done, it’s surprising and disappointing to watch as a consumer organization.”
When the open enrollment period for the new health care law began in October, President Barack Obama’s administration received tremendous criticism for launching a faulty website. Though improvements have been made, it is still not comprehensive.
As an in-person counselor for the Campaign for Better Health Care, Jessica Palys has been working with families and individuals during ACA registration, helping them navigate the website, work through technical glitches and discover their options. The new plan comparison tool clarifies HealthCare.gov, according to Palys, as well as the complexities associated with health care and the registration process.
“Insurance is confusing to, I think, almost everyone,” Palys said. “It’s hard to compute what your costs might actually be when you’re handling the premiums, and the deductibles, and the coinsurance, and the copays.”
When selecting their plans, people might be unaware of key factors they should consider, such as out-of-pocket costs and fees for varying services, or they might overlook the probability of needing different types of services in the future, according to Krughoff. There is no tool on HealthCare.gov to help consumers understand the complexity of these crucial factors, in addition to premiums.
“The federal government lists its plans in order of premiums.” Krughoff said, “So most people would most likely choose the lowest premium.”
Throughout the enrollment period, Palys said consumers identify their desired plans based on the information that is available to them. This can lead them to making partially uninformed decisions.
Searching for insurance providers can be challenging, according to Palys. For example, consumers might have to choose specific types of plans within each company.
“If you don’t realize that you have to do that, then you could very easily think you’ve found your provider on the website, and actually you didn’t,” Palys said.
A plan’s suitability differs for each individual. The calculator for Consumers’ Checkbook allows health care customers to pinpoint their priorities and make comparisons between different plan options, under different circumstances. It also creates model profiles of every person, Krughoff said, and runs them against each plan’s benefit structure.
Because many factors determine the ultimate costs associated with each plan, Krughoff said it is vital that consumers have the ability to consider them on a case-by-case basis.
Palys said she finds HealthPlanRatings.org effective in helping clients to look for doctors and hospitals, as well as to understand limits of yearly costs.
“[Consumers] have been really happy to have an estimate on what their costs will be,” Palys said, “and have it all spelled out in a way that is normal to them.”
Illinois was selected for the tool’s application because it is a big state with a varied population that includes urban and rural areas, among other reasons. Krughoff said the “variety of clients” in Illinois makes it possible to draw comparisons.
Leading up to the March 31 open enrollment deadline, state marketplaces, grassroots organizations and independent groups have been pushing for people to register for coverage under the ACA. Palys said the new resource would have been beneficial prior to this point. She is currently working with clients who purchased a plan that prevented them from going to their doctor.
“They found out that the plan they selected was actually a less comprehensive network,” Palys said, “so now they’re unhappy, and if they had had this tool ahead of time, then they would’ve picked the right plan.”
Palys said she would like to see HealthPlanRatings.org add estimated costs for more health conditions than it currently offers. But she said this tool would be helpful to improving operations in the exchanges, even after the open enrollment deadline.
Palys said it is only after people have had their first health scare that they begin to realize how costs add up.
“They’re going to take a much closer look at it,” Palys said, “and next time they sign up, this tool will probably come in very handy to explain that for them.”