How to pick the best marketplace health plan? Officials, researchers consider improvements

Federal health officials are reviewing new ways to improve the federally run marketplace established under the Affordable Care Act that went live in the fall of 2013.

 “While we have made the process of purchasing insurance more transparent and made it simpler for consumers to get covered through HealthCare.gov, we know there is still work to do to make it easier for consumers to find the right plan for their families’ health needs and budgets, including the right provider or costs associated with plans,” stated Centers for Medicare and Medicaid Services spokesman Aaron Albright in an email.

No date has been set for when updates might occur, and exchange leaders are in the early stages of developing possible out-of-pocket cost calculators to help people choose a marketplace plan.

Illinois is the only state that has some version of a decision-making tool up and running.

Researchers, including Tom Baker from the University of Pennsylvania, say the sooner these tools are available, the better.

“What’s easy to know is your premium, and what’s easy to know is the deductible,” he said. “What is very hard to know without a good decision support tool is what your costs are likely to be over the course of the year, given your situation.”

Baker is co-founder of a company that’s developing such decision-making tools. Making decisions based on a huge list of plan options on federally run marketplaces in Pennsylvania and elsewhere may lead to poorer choices.

People may pay too much for a plan and for services they won’t need, or they may pay too little upfront, with even greater costs down the road. That’s what his research and that of others is finding in private-employer marketplaces.

Federal marketplace leaders are currently meeting with experts about this, and they’ve also solicited public comments on the issue. Other marketplace changes involve requiring insurers to update their provider networks monthly.