Study of young Philadelphians’ experience on health insurance site may guide improvements

     What is the young adult experience with the Affordable Care Act website? Researchers (from left) Mike Kaiser, Charlene Wong and Cjloe Vinoya have some recommendations for improving it. (Emma Lee/WHYY)

    What is the young adult experience with the Affordable Care Act website? Researchers (from left) Mike Kaiser, Charlene Wong and Cjloe Vinoya have some recommendations for improving it. (Emma Lee/WHYY)

    This past year, insurers and the government went full force with outreach and marketing aimed at young adults during the inaugural enrollment period of the Affordable Care Act’s health-insurance marketplaces.

    And while young adults often have an edge when it comes to using the Internet, many may have hit major snags when trying to sign up for insurance through the government website,

    That’s according to a new analysis of young adult experiences in Philadelphia. 

    Charlene Wong, a researcher with the University of Pennsylvania and the Children’s Hospital of Philadelphia, wanted to know just how easy it was for young adults who were actively seeking coverage to actually enroll. At her lab, she watched 33 people, ages 19 to 30, try to do just that while talking through their process out loud. She then interviewed them about it.

    “This wasn’t a hypothetical study context, these were really young adults in Philadelphia, looking to buy health insurance for themselves,” she said.

    The group, Young Involved Philadelphia, helped recruit the 33 participants from its broad member base.

    Information overload

    Study coordinator Cjloe Vinoya, 24, might have known what was coming. Before conducting the study, she looked over herself, just to see her own potential options.

    “I had no idea what anything meant,” she said. “The only thing [term] I understood was ‘health care.'”

    She soon learned she wasn’t alone.

    “As i went through all the interviews, and I talked to all these people, they were in the same exact position as me,” she said.

    Vinoya and Wong discovered that while most “were impressed” with the website, the participants faced some common struggles. They had trouble understanding important terms such as “co-insurance” and “deductible.” They were also overwhelmed by comparing and choosing from the 27 plans offered through the marketplace in Philadelphia.

    “A lot of the young adults were just turned off,” said Vinoya. “They completely shut down and gave up, and were like, ‘I don’t need to deal with this right now.'”

    Wong said those who fared best had past experiences with health care.

    Some of the most important things to young adults, preventive services, weren’t highlighted enough, they found. And it wasn’t clear up front that such things were included in all plans with no out-of-pocket costs.

    “It was a little invisible because there was so much other information that was being presented,” Wong said.

    The health plans also don’t include dental coverage, but many didn’t realize they could purchase it separately, after signing up for a regular plan. In other instances, participants who were eligible for federal assistance got stumped when the metallic tiers didn’t match the pricing. This happened when the silver level plan, in particular, came out cheaper than the lower level one, due to its special cost-sharing component.

    “We have quotes from [some of] them saying, ‘You know, I feel like I’m just missing something, maybe they’re hiding something,'” Wong said. “So they were actually leaning toward the highest-value plans, but they were doubting themselves because it didn’t make sense the way those plans were presented without explanations of how discounts applied to those who did qualify.”

    Recommendations from an Internet-savvy generation

    Wong said participants’ ease of shopping on other websites such as and could shed light on how to improve the website during open enrollment’s next go-around.

    “This is the generation that has grown up online, shopping online and rating things online,” said Wong. “They wanted things like sliding bars so they could tell the computer ‘I’m willing to pay between this much and this much, show me the plans that fit that.'”

    Aside from the metallic levels, said Wong, there’s no way to filter or narrow plan options based, for example, on whether they offer multistate coverage or have a health savings account.

    “And they pointed to other websites that have these sorting and filtering tools to help make decisions when you’re buying online,” she said.

    They pointed to TurboTax as another example. With that site, when the cursor hovers on a term, a box pops up and explains what it means.

    The study focused on a small group of well-educated young adults. If they’re having trouble, Wong said, a lot of other people probably are, too.

    Some “small feasible changes” on the website could “increase understandability and usability,” she said.

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