When Buying Insurance on the Exchanges, It Helps to Have Help

New online marketplaces don't do enough to let consumers weigh their options, experts say

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By Karen Pallarito
HealthDay Reporter

FRIDAY, Oct. 18 (HealthDay News) -- You have to wade through a lot of insurance jargon and be a skilled number-cruncher to choose the right health insurance plan on the new health exchanges, health literacy and consumer decision-making experts say.

By making informed choices, consumers not only help themselves, they help drive overall health-plan quality, efficiency and pricing, the experts pointed out.

But, many consumers are ill-prepared to make the best choices on their own because they lack the necessary math skills or can't accurately weigh their insurance risk, the experts noted. Plus, few health insurance exchanges currently offer the kind of help that many people need to make informed decisions.

"Comparing costs of plans is difficult," said Robert Krughoff, founder and president of the Washington, D.C.-based nonprofit Center for the Study of Services, and Consumers' CHECKBOOK, a publisher of health-plan ratings.

First consumers have to figure out whether, say, a $200 deductible with a $10,000 out-of-pocket limit is better than a $1,000 deductible with a $3,000 out-of-pocket limit for them, Krughoff explained. "Then you throw in different co-insurance rates and different co-payments and consumers just can't put all that together into a single number that they can compare," he said.

Even the language of insurance, with concepts like co-insurance and tax credits, is confusing, the experts noted.

"We're asking people to do a lot of heavy lifting right now when it comes to things that (studies show are) very problematic for the general public," said Christina Zarcadoolas, a professor at the City University of New York's School of Public Health at Hunter College.

It will be up to the staffers providing toll-free hotline help and the "navigators" who are offering one-on-one assistance to make sense of it all for consumers, said Zarcadoolas, founder of the New York Roundtable on Public Health Literacy. But when consumers don't even know to ask if there's a "network" or whether they can see their usual doctor, "we know that causes all kinds of problems," she said.

Consumers' math skills a concern

The new Internet-based health insurance exchanges opened for business on Oct. 1 but stumbled out of the blocks. Computer problems and unanticipated levels of website traffic made it difficult, if not impossible, for many people to review their health-plan options in the first week or two of open enrollment under the Affordable Care Act. The law is the Obama administration's controversial effort to bring health-care coverage to an estimated 30 million uninsured Americans.

HealthCare.gov, the federally run website serving as the exchange in 36 states, continues to experience the greatest level of disruption.

Once consumers successfully log onto an exchange -- whether the federally operated exchange or the 14 state-operated exchanges plus Washington, D.C. -- the next challenge is sorting through the coverage options available to them under the health reform law, also known as "Obamacare."

Ellen Peters, a professor of psychology at Ohio State University, said choosing a health plan involves financial decisions that even people with health insurance don't have to make very often. For the uninsured, the choices "may be quite unfamiliar," she said.

Peters is the lead author of a July 2013 paper commissioned by the Institute of Medicine's Roundtable on Health Literacy that showed that only 8.6 percent of uninsured adults have proficient "numeracy skills." These are defined as the math skills needed to take full advantage of the online exchanges.

Most consumers can figure out the difference between two plans' monthly premiums. But people need a greater level of math proficiency to estimate total health-plan costs based on expected health-care needs, the report noted.

'They were practically throwing darts'

Studies demonstrate ways to simplify the task by presenting options to people in a way that will help them make better choices.