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Marketplace Governance and Consumer Decision-Making in Health Insurance Marketplaces
Introduction to Health Insurance Marketplaces
Health insurance marketplaces, established under the Affordable Care Act (ACA), are designed to facilitate the purchase of health insurance by providing a platform where consumers can compare and select plans. These marketplaces can be state-based, federally facilitated, or a hybrid of both. The governance and management models of these marketplaces significantly impact consumer experiences and outcomes.
Decision Support Tools in Marketplaces
Enhanced Decision Support Tools
The third enrollment period of the ACA marketplaces saw an expansion in decision support tools aimed at assisting consumers in making informed health plan choices. Tools such as total cost estimators and integrated provider lookups were more widely adopted. These tools varied in their implementation; some required consumers to categorize their own utilization, while others used detailed questionnaires to assign a utilization profile1. The availability of these tools also differed between the window-shopping period and the real-shopping period, with some marketplaces providing more comprehensive tools only after account creation1.
Impact of Plan Recommendations
Behaviorally informed policy tools, such as plan recommendations, have been shown to improve decision-making among vulnerable populations. A study involving lower-income, minority, rural residents of Virginia demonstrated that plan recommendations increased the likelihood of choosing the most cost-effective plan by 21 percentage points. Recommendations from government or providers were particularly effective in reducing annual healthcare costs2. This suggests that incorporating behavioral insights into marketplace design can significantly aid consumers in selecting optimal plans.
Marketplace Management Models
Clearinghouse vs. Active Purchaser Models
State-based marketplaces using "clearinghouse" plan management models, where all plans meeting certain criteria are accepted, were associated with lower premiums compared to "active purchaser" models, where states negotiate various aspects of the plans. This finding highlights the potential cost benefits of less restrictive plan management approaches3.
Insurer Participation and Consumer Enrollment
Insurer participation is crucial for maintaining consumer enrollment in marketplaces. The exit of insurers from the marketplaces has been linked to increased disenrollment, particularly among unsubsidized consumers. This trend was observed to be more pronounced in areas where premiums increased following insurer exits4. Ensuring robust insurer participation is therefore essential for sustaining consumer engagement and controlling premium costs.
Consumer Experiences and Challenges
On-Marketplace vs. Off-Marketplace Enrollment
Consumers who enrolled in health plans through the marketplaces reported fewer difficulties in finding affordable plans compared to those who enrolled off-marketplace. This was especially true for families with chronic health conditions, who reported better overall experiences when using the marketplaces. However, individuals with low health insurance literacy faced challenges regardless of the enrollment method, indicating a need for targeted consumer assistance5.
State-Run Marketplaces Using HealthCare.gov
Some states have opted to establish their own exchanges while utilizing the federal HealthCare.gov platform for eligibility and enrollment. This hybrid approach allows states to exert local control over their insurance markets while mitigating financial risks. States like Idaho, Nevada, New Mexico, and Oregon have successfully implemented this model, balancing state influence with federal support6.
Conclusion
The governance and management of health insurance marketplaces play a critical role in shaping consumer experiences and outcomes. Enhanced decision support tools and behaviorally informed policy interventions can significantly aid consumers in making optimal health plan choices. Additionally, the choice of marketplace management models and the level of insurer participation are key factors influencing premium costs and enrollment stability. As marketplaces continue to evolve, these insights can guide future improvements to better serve consumers.
Sources and full results
Most relevant research papers on this topic
For Third Enrollment Period, Marketplaces Expand Decision Support Tools To Assist Consumers.
The third enrollment period saw greater adoption of decision support tools like total cost estimators and integrated provider lookups, aiding consumers in making complex health plan choices.
Observational StudyCan Plan Recommendations Improve the Coverage Decisions of Vulnerable Populations in Health Insurance Marketplaces?
Plan recommendations can significantly improve the coverage decisions of vulnerable populations in health insurance marketplaces, increasing their likelihood of choosing the most beneficial plan and reducing annual costs.
RCT
Large Human Trial
Rigorous JournalState-based Marketplaces using 'clearinghouse' plan management models are associated with lower premiums.
State-based Marketplaces using 'clearinghouse' plan management models have significantly lower premiums compared to active purchaser models and federally facilitated exchanges.
Observational StudyAs Insurers Exit Affordable Care Act Marketplaces, So Do Consumers.
Maintaining insurer participation in the Affordable Care Act Marketplaces could encourage continued enrollment and limit premium increases, particularly among unsubsidized consumers.
Observational StudyDecision-Making Experiences Of Consumers Choosing Individual-Market Health Insurance Plans.
Consumers who choose individual health insurance through the federal Marketplaces have less difficulty finding the best or most affordable plan, but off-Marketplace enrollment is more challenging for those with chronic health conditions and low health insurance literacy.
Observational StudyThe Experiences of State-Run Insurance Marketplaces That Use HealthCare.gov.
State-run insurance marketplaces using HealthCare.gov can maximize influence over insurance markets while limiting financial risk.
Marketplaces: Prospects for Social, Economic, and Political Development
Marketplaces can be valuable tools for planning and public policy, advancing public goals through social, economic, and political development.
Literature Review
Highly CitedObama vows to persevere with healthcare changes
President Obama vowed to complete the Affordable Care Act despite technical difficulties and opposition, even if it takes another three years to ensure its success.
Rigorous JournalThe new health insurance marketplace.
The Health Insurance Marketplace, a key part of the Affordable Care Act, allows individuals to compare and purchase health insurance plans online, with plans available through the BSA medical plan.
An Early Look At SHOP Marketplaces: Low Premiums, Adequate Plan Choice In Many, But Not All, States.
SHOP Marketplaces offer lower premiums and multiple carriers in most states, but lack broker buy-in and burdensome enrollment processes, hindering their future success.
Observational Study