A recent Kaiser study found that most marketplace enrollees like their health insurance plans under the Affordable Care Act, but many have grown dissatisfied with the costs since 2014. The ACA heads into its fourth year for enrollment in 2016. Over the past three years, marketplace enrollees have found greater access to affordable coverage. The Kaiser Family Foundation tracked consumer satisfaction in a multi-part study, revealing that 68 percent of marketplace customers would rate existing coverage “good” or “excellent.”
Kaiser researchers surveyed consumers with on- and off-marketplace ACA-compliant plans as well as those with employer-based plans. People with employer-sponsored plans are more likely to rate their plans more positively, especially when it comes to cost, most likely because employers pay a greater share of the monthly premiums. Since 2014, the dissatisfaction rate with monthly premiums and other costs has risen. Likewise, 54 percent of consumers with ACA-compliant plans rate these plans as an “only fair” or “poor” value – up 12 percent since 2015 and 15 percent since 2014.
Dissatisfaction may stem in part from lack of transparency. Many consumers reported feeling uncertain about what their policies actually covered. Cost and provider access play a crucial role in consumer choice. In 2016, more people felt at risk for costly medical bills than they did in previous years. Across the country, people have received bills for services that they thought were covered but weren’t.
According to the Kaiser study, 20 percent of consumers with an ACA-compliant plan were unaware that preventive services are covered under the new law with no cost-sharing. Lack of transparency and general confusion about coverage may impact consumer satisfaction.
Fortunately for enrollees, several important changes are coming to the marketplace in 2017 that may address widespread concerns about transparency and cost. In February, the administration issued a ruling making it even easier for consumers to learn more about their health care plans. Three changes are expected for next year, including fewer surprises in out-of-network costs, standardized costs for out-of-pocket expenses and better information about covered network providers.
As noted in the Kaiser survey, many consumers have been surprised by unexpected charges from services that they assumed would be covered under their plans. The new rules for 2017 would eliminate surprise charges by making coverage clearer. Insurers now have 48 hours to inform patients about out-of-pocket treatments, and some types of care will now be counted toward a patient’s out-of-pocket maximum, such as radiology and anesthesiology. Once a patient reaches that maximum, an insurer would be responsible for all remaining charges as provided for by law.
To address consumer confusion over out-of-pocket charges, the administration is also requesting that insurers provide standardized plans so that enrollees can more effectively compare similar policies against each other. This change would be voluntary and dependent on insurer participation. Some state marketplaces have already adopted standardized plans.
Despite the ACA’s success, transparency remains a consistent complaint among consumers, especially from those with policies that have limited networks. In general, marketplace plans tend to have fewer options for medical providers than employer-sponsored plans. In order to address the confusion over network providers, the administration is seeking to help consumers gain better access to information in 2017.
Under the new rules, insurers would have to give enrollees a 30-day notice if they plan on dropping a provider. Those who are currently receiving care would be able to continue seeing their provider for up to 90 days. In addition, marketplace plans will now provide information on the scope of a plan, including how wide a network it actually offers. The changes coming up for 2017 could help to boost consumer trust in the ACA and its ongoing mission of promoting affordable health care.