Established by the Affordable Care Act, the Healthcare.gov exchange and its 14 state-run counterparts have enrolled more than 11 million people — 800,000 of whom were sent incorrect tax information, the Obama administration admitted last month.
Unfortunately, the exchanges have serious issues beyond simple paperwork errors. Exchanges are insufficiently transparent about key coverage details. As a result, shoppers often struggle to find plans that minimize their health care costs and deliver needed benefits. Many are unwittingly purchasing plans that don't meet their needs.
Regulators should step in and beef up transparency requirements for exchange-based plans. Increased transparency will allow the ACA to meet its full potential and provide patients with affordable, quality health insurance.
Consider a patient who takes a very specific heart medication because that is the only prescription that helps her condition. If she signs up for a plan that does not cover that pill, she will spend weeks — potentially months — appealing to her insurance company to obtain coverage. That waste of time, effort and money could have been avoided if regulators had made exchanges more transparent at the outset.
With some simple tweaks, regulators can ensure exchange enrollees get the information they need to make better decisions and secure coverage that fits with their health needs and budget.
First, exchanges should be required to provide full drug formularies online. A complete list of covered prescription pharmaceuticals — as well as any out-of-pocket costs — should be easily available and searchable so that enrollees can compare plans directly. Consumers should also receive complete information about the process for requesting that an insurer cover the cost of an essential drug that's not on the plan's list of covered drugs. Maryland's marketplace doesn't allow consumers to search for a specific prescription and the plans that cover them. In addition, Maryland doesn't provide estimates of total out-of-pocket costs associated with a particular plan as part of the anonymous browsing.
Exchange patients also need access to regularly updated physician directories. Most patients want to know if their current doctors are within a plan's network. And for patients who need to find a new physician, there should be a convenient way to check which in-network doctors are accepting new patients.
The exchange websites should further improve their navigation features. The National Partnership for Women & Families recently investigated and highlighted the best aspects of each exchange. States should work to upgrade their exchanges based on those findings.
For instance, several exchanges have adopted a common online shopping tool that allows users to anonymously browse plan details like cost and coverage features before creating an account. Maryland's marketplace offers integrated provider directories as part of the anonymous browsing function. This tool prompts the consumer to enter the name of a preferred provider and then generates a list of available plans that include that provider in their networks. Great, but what about the rest of the country? Other marketplaces should follow Maryland's lead.
The Affordable Care Act's exchanges have helped many Americans obtain health insurance. But these marketplaces are in desperate need of an upgrade. Regulators shouldn't leave enrollees in the dark about information that's critical to their health.
Alan Schulman is president of the Maryland Association of Health Underwriters. His email is Alan@insbenefits.com.