By Sandy Ahn and Emily Curran
For the expected 13.8 million people estimated to select a marketplace plan this year, Healthcare.gov has come a long way to make the consumer shopping experience smoother and easier. Now that Healthcare.gov is open, we’re updating our earlier post on what to expect when shopping for 2017 coverage.
Assessing Medical Needs and Costs
Healthcare.gov administrators have tweaked the Out-of-pocket Calculator, an interactive tool that allows consumers to estimate their health care costs based on projected health care needs. There are now lower thresholds for expected medical care at the low, medium and high levels. For example, low medical use is defined as having 1 doctor’s visit and 2 prescriptions as opposed to the previous definition of 3 doctor visits and 5 prescriptions, see below. As one study has found that on average, adults have four doctor visits a year, this alignment may project more accurate health needs and costs.
|1 Dr visit||4 Dr visits||13 Dr visits|
|N/A||1 lab or diagnostic test||6 lab or diagnostic tests|
|2 prescriptions||6 prescriptions||28 prescriptions|
|N/A||N/A||1 day in hospital|
|Minimal other medical expense||$100 in other medical expenses||$10,300 in other medical costs|
* As of October 31, 2016
Healthcare.gov has also updated the Doctor Lookup & Prescription Drug Check tools this year to allow consumers to see what doctors are available in plans and whether a health plan covers a prescription drug. This year dosage amounts come up in prescription search results so consumers can select the specific dosage of their prescription. The system also categorizes search results by doctors, facilities, and prescription drugs.
Like last year, consumers will also be able to use the filtering function or refine health plan results on Healthcare.gov to narrow down health plans based on certain preferences: metal levels, maximum total yearly costs, maximum monthly premiums, maximum yearly deductibles, medical management programs, insurance companies, and health plan types (including by plans that are health savings account eligible). Filtering functions for maximum monthly premiums, deductibles, and annual costs have been expanded up to $1,000 plus. Consumers will also be able to compare up to three plans, but unlike last year, the comparison will be on one screen so consumers can do a true side-by-side comparison. Another feature for plan comparison that’s new this year are Simple Choice plans, which are standardized plan designs with fixed cost-sharing amounts. The availability of these plans, however, vary by state, which we blog about here.
Two tools that will be in limited scope as pilots this year are the quality rating and network breadth tools, which we’ve blogged about previously. The quality rating tool, available now only in Virginia and Wisconsin, provides up to five stars based on member experience, medical care, and plan administration; a quality rating for new health plans will not be available and noted as such on Healthcare.gov. The network breadth tool, piloting in Maine, Ohio, Tennessee, and Texas, will be phased in during open enrollment.
Healthcare.gov continues to be not just a marketplace, but a tool itself to educate consumers on health insurance terms. This year an “i” icon is available throughout the plan selection and shopping pages. It provides definitions and additional information for terms like out-of-pocket maximum when consumers hover above the icon. Consumers can also find much more detailed information about terms such as deductible and out-of-pocket costs as well as cost-sharing amounts for listed, covered services for each health plan. Healthcare.gov is also providing information for consumers about post-enrollment issues. They’ve created a new landing page that reminds consumers to pay their first month’s premium to effectuate coverage and to follow-up with the marketplace when they experience any life changes that may affect their marketplace coverage and if eligible, financial assistance.
Choosing a health plan is a lot like putting a puzzle together because of all the separate pieces that make up having coverage: the monthly premium costs, the cost-sharing amounts when using coverage, the availability of doctors and hospitals, covered prescriptions, and the quality of health care as well as the quality of the health plan’s customer service and administration. Healthcare.gov is continuing to make it easier for consumers to put that puzzle together with shopping tools and information so that consumers can have as much of a complete picture of costs and coverage when selecting a marketplace plan.