After some initial bumps, New York State was extremely successful in enrolling people into health insurance coverage plans during the first open enrollment period under Obamacare. Nearly 1 million people enrolled through New York State of Health, the State's health insurance marketplace, between October and April. And improvements are continuing: it was announced recently that a Spanish-language version of the marketplace will be ready this fall, and key materials have been developed in seven languages other than English.
Yet we know (at least anecdotally) that many people enrolling in health insurance coverage--in New York and across the country--found the experience confusing, overwhelming, or challenging. This challenge was mitigated somewhat by robust, effective consumer outreach and assistance through Navigator and Certified Application Counselor programs; 49% of all enrollees received help from an in-person assister and another 11% received online assistance.
But as the next open enrollment period begins this fall, what more will be needed to ensure that more New Yorkers not only sign up for coverage, but have a positive experience doing so? In conversations I've had with consumer advocates from across the State, a few issues have stood out as the most important priorities that would make New York's enrollment system even more customer-friendly:
Make it easy to compare plans. Another priority for consumers is understanding what they'll be paying for different health insurance options. What does the policy cost? How much is the deductible? What are the co-pays? What if I go out of network? (Oh, wait. Am I allowed to go out of network?!) Boiling all of this information down into an easily-digestible, Consumer Reports-type summary would help consumers make better decisions about the policy that will be right for them. And making this information available upfront for consumers who are "window shopping" before going through the whole enrollment process, would be most helpful.
Reduce the overwhelming number of nearly-identical product offerings. New Yorkers want to have options, but many consumers find the number of similar plan offerings overwhelming. Last year, the New York State of Health marketplace offered plans by 16 health insurers--perhaps not an excessive number of insurers for a large and diverse state like ours. But the number of plan options offered by each insurer was sometimes dizzying. It's often hard for people to get their heads around the various "metal tiers" of coverage--platinum, gold, silver, and bronze--but add to that mix multiple silver policy options that are nearly indistinguishable from each other, and it becomes impossible. I've heard numerous anecdotes of people just giving up entirely, or choosing a plan almost at random (navigators are not permitted to give advice about which plan is the best fit for a particular consumer). Some of this problem may fade naturally over time as less popular plan options get pulled, or some intervention from the State may be needed (Massachusetts eventually cut the number of plans offered on its exchange). But it also seems that more standardization of products would help consumers compare options and make informed choices more easily.
Get direct feedback from consumers. Navigators and assisters who are helping consumers enroll into coverage options are an important source of information about common enrollment challenges. But more could be done to get a better, more direct sense of consumers' experiences, to understand where the stumbling blocks are. Assessing patterns of inquiries to the help line or on social media posts related to enrollment; feedback loops with health plans; and even customer satisfaction surveys could provide some richer data to help the State set priorities for improvements to the user experience.
- Make it easy to determine which providers are participating in each plan. One of the first things consumers want to know when they're shopping for a health insurance policy is whether their preferred doctors and hospitals are in-network, but the current system makes it nearly impossible to find out. A lack of accurate, consistent, easily accessible information about provider participation in plans is one of the biggest concerns consumer advocates hear. An improved enrollment system would allow customers to search providers' names to determine upfront which plans include those providers. It would also include alongside each plan option a list of the individual providers and institutions participating in the plan, along with information about the quality of care delivered by each provider. Importantly, this information needs to be kept up to date.
There is much that New York got right in the first open enrollment season: effective navigators and certified application counselors; a responsive help line; solid consumer protections and resolution of complaints; a website that ran relatively smoothly. But as we move ahead with an eye toward enrolling a million more New Yorkers, a few key changes could make New York even more successful.
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