Healthcare.gov's shop-around feature for 2015 went live last night. While there are some notable improvements, I see a couple of problems that I want to highlight right away.
In the quest to design a website that helps people find the health insurance that's right for them, there's a tension between making the process easy and providing essential information. The new shop-around has come down on the side of "more info" than the prior one. But the info is not always more accessible.
First problem: sometime in the off-season, on the shop-around feature, hc.gov added pop-up definitions of "deductible" and "out-of-pocket maximum" and "co-payments/co-insurance" on all price quotes. Inexplicably, they're gone in the 2015 shop-around. Maybe they'll be coming online shortly? (Shop-around for the remainder of 2014 is still live if you want to compare.)
Second problem: One of the most common errors that unassisted healthcare.gov shoppers (according to one navigator extraordinaire) made was to answer "no" when asked if they planned to file a tax return. That answer disqualifies the applicant from obtaining tax subsidies to help pay for the insurance. The new shop-around addresses this, indirectly, by breaking out the "household income" question (one of about just three questions one has to answer to get price quotes) on its own page. It includes a link: "find out what income and household information you should give to the marketplace." That's good -- but you have to travel through three more screens to get to a warning that you can't apply for help at all unless you file a tax return -- regardless of whether you pay federal taxes. Further, if you do click through to get information about reporting income, that info does not open in a separate tab, and there's no on-page back button.
Third problem: When you've filled out the essential info and move on to price quotes, there are more options for sorting the results, and that's good. They include a pull-down menu to sort by monthly premium or by deductible. That can highlight a stark choice. If you're 35 and single in Essex County, NJ, and earn $19k, you can toggle between a bronze plan with a $38 premium and a $2,500 deductible and a silver plan with a $134 premium and a $0 deductible.
There are two problems with this. First, the choice is too stark. Lowest premium vs. lowest deductible is the wrong frame. There is a silver plan available with a premium of $72 and a deductible of $500.
Second: what's left out of this equation is a clear highlighting of the essential fact a person in this income range: she qualifies for Cost Sharing Reduction (CSR) that radically lowers the deductible and out-of-pocket costs, but only on silver plans. That fundamental choice -- access my CSR or not -- is not highlighted.
A user can choose to view plans by metal level. But that's one of several choices, and not highlighted. In my view, the results should either default to silver -- at least for people whose incomes qualify them for CSR -- or clearly emphasize metal level choice.
In fact, I suffered a double confusion by first sorting by deductible and then sorting by metal level. I didn't realize at first that a silver plan with a reasonably low deductible would be available at half the monthly premium of the $0-deductible plan. Again, I think that the fundamental choice for a CSR-eligible buyer is metal level. Within the metal levels, it's more logical to sort by premium price.
The major structural shift from shop-around 2014 to shop-around 2015 is to isolate each premium-determining question (location, household size, income) on its own page and thus highlight opportunities to get more information about how to define household size and income in context -- while still keeping the process short for those who can easily answer the questions. That makes sense in principle, but I think the presentation of the extra info could be improved.
Another major change is to offer more sorting options for the search results -- including finding plans with special programs for managing medical conditions such as asthma or diabetes. That's great. Again, though, I think the metal level choice should be highlighted, particularly with reference to CSR.
P.S. I believe that the healthcare.gov home page has already changed since I first logged onto the shop-around this morning. Now you can't miss the "See plans and prices" tab that gets you to shoparound. That's good! That's the natural starting point, and last year it was buried.
P.P.S. For a good rundown of the shop-around's new features, with screen shots, see Charles Gaba.
See also:
Evidence from Kaiser: Most ACA shoppers made informed choices
How to reboot Healthcare.gov
In the quest to design a website that helps people find the health insurance that's right for them, there's a tension between making the process easy and providing essential information. The new shop-around has come down on the side of "more info" than the prior one. But the info is not always more accessible.
First problem: sometime in the off-season, on the shop-around feature, hc.gov added pop-up definitions of "deductible" and "out-of-pocket maximum" and "co-payments/co-insurance" on all price quotes. Inexplicably, they're gone in the 2015 shop-around. Maybe they'll be coming online shortly? (Shop-around for the remainder of 2014 is still live if you want to compare.)
Second problem: One of the most common errors that unassisted healthcare.gov shoppers (according to one navigator extraordinaire) made was to answer "no" when asked if they planned to file a tax return. That answer disqualifies the applicant from obtaining tax subsidies to help pay for the insurance. The new shop-around addresses this, indirectly, by breaking out the "household income" question (one of about just three questions one has to answer to get price quotes) on its own page. It includes a link: "find out what income and household information you should give to the marketplace." That's good -- but you have to travel through three more screens to get to a warning that you can't apply for help at all unless you file a tax return -- regardless of whether you pay federal taxes. Further, if you do click through to get information about reporting income, that info does not open in a separate tab, and there's no on-page back button.
Third problem: When you've filled out the essential info and move on to price quotes, there are more options for sorting the results, and that's good. They include a pull-down menu to sort by monthly premium or by deductible. That can highlight a stark choice. If you're 35 and single in Essex County, NJ, and earn $19k, you can toggle between a bronze plan with a $38 premium and a $2,500 deductible and a silver plan with a $134 premium and a $0 deductible.
There are two problems with this. First, the choice is too stark. Lowest premium vs. lowest deductible is the wrong frame. There is a silver plan available with a premium of $72 and a deductible of $500.
Second: what's left out of this equation is a clear highlighting of the essential fact a person in this income range: she qualifies for Cost Sharing Reduction (CSR) that radically lowers the deductible and out-of-pocket costs, but only on silver plans. That fundamental choice -- access my CSR or not -- is not highlighted.
A user can choose to view plans by metal level. But that's one of several choices, and not highlighted. In my view, the results should either default to silver -- at least for people whose incomes qualify them for CSR -- or clearly emphasize metal level choice.
In fact, I suffered a double confusion by first sorting by deductible and then sorting by metal level. I didn't realize at first that a silver plan with a reasonably low deductible would be available at half the monthly premium of the $0-deductible plan. Again, I think that the fundamental choice for a CSR-eligible buyer is metal level. Within the metal levels, it's more logical to sort by premium price.
The major structural shift from shop-around 2014 to shop-around 2015 is to isolate each premium-determining question (location, household size, income) on its own page and thus highlight opportunities to get more information about how to define household size and income in context -- while still keeping the process short for those who can easily answer the questions. That makes sense in principle, but I think the presentation of the extra info could be improved.
Another major change is to offer more sorting options for the search results -- including finding plans with special programs for managing medical conditions such as asthma or diabetes. That's great. Again, though, I think the metal level choice should be highlighted, particularly with reference to CSR.
P.S. I believe that the healthcare.gov home page has already changed since I first logged onto the shop-around this morning. Now you can't miss the "See plans and prices" tab that gets you to shoparound. That's good! That's the natural starting point, and last year it was buried.
P.P.S. For a good rundown of the shop-around's new features, with screen shots, see Charles Gaba.
See also:
Evidence from Kaiser: Most ACA shoppers made informed choices
How to reboot Healthcare.gov
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