Health Benefits Marketplace

Health Benefits Marketplace

Perceptions of Consumers in Iowa

Pete DamianoSuzanne Bentler

Dan Shane

Iowa Safety Net Network Leadership Group MeetingAugust 6, 2013

In this presentation

• Consumer survey– Methods– Demographics– Insurance coverage and factors affecting choice– Knowledge and Attitudes toward the ACA– Marketplace preferences and assistance

Methods-Consumers• Mixed mode (On-line and written in person)• Convenience sample:

– IA Caregivers Assoc. (both)– one Iowa FQHC (written)– Iowa State Extension (written)– IA Public Health Association (online)– AARP (online)– IDPH partners and local agencies

• 85 questions maximum– 43 questions with some tables of multiple subquestions

• 498 responses so far– 367 On-line– 131 Written

Insurance Coverage Types

• Employer-based (<HBMP)-80% (n=396)• Non-employer-based (>HBMP)-20% (n=102)– Uninsured now or in last 12 months (5%; n=24)– Self insured (5%; n=25) – Public (10%; n=53)• Medicaid• IowaCare• CHAMPUS• VA• Military

*Medicare was excluded

Type of Assistance

• Who helped choose coverage:– Myself-39%– Work/HR-37%– Friends/family-10%

Age & Marital Status

70%6%

3% 10%

11%

Marital Status

MarriedLiving as marriedWidowedDivorced/ SeparatedNever married

Age

18 to 29

30 to 39

40 to 49

50 to 64

65 +

0%

10%

20%

30%

40%

50%

60%

11%17% 17%

55%

1%

24% 24%19%

30%

0%

Employer Insurance

Not Employer Insurance

Health Status

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

18%8% 4% 11%

46%

43%

17%

30%

31%

37%

38%

40%

5% 12%

39%

16%

Fair/PoorGoodVery GoodExcellent

Current coverage related questions

• How well meets needs• Importance of costs– Non-covered services– Delay care– Worry

• Importance of having coverage– Self– Family

Current coverage meets needs

Excellent

Very good

GoodFair/Poor

0%

5%

10%

15%

20%

25%

30%

35%

40%

31%

36%

24%

9%

15%

29%

33%

22% Employer Insurance

Not Employer Insurance

Public Insurance rated higher for kids than private: IA Household Health Survey

Current cost: Non-covered services

Very serious

Serious

Somewhat

Not serious

0%

10%

20%

30%

40%

50%

60%

70%

4%8%

27%

60%

13%17%

24%

43%Employer Insurance

Not Employer Insurance

Public Insurance rated higher for kids than private: IA Household Health Survey

Current cost: Delayed care

Yes0%

10%

20%

30%

40%

50%

60%

70%

80%

30%

71%

Employer Insurance

Not Employer Insurance

Current cost: Worry about pay for self

Very wor...

Worried

Somewhat

Not worried

0%

10%

20%

30%

40%

50%

60%

14%11%

25%

50%

41%

22% 20%17%

Employer Insurance

Not Employer Insurance

Current cost: Worry about pay family

Very wor...

Worried

Somewhat

Not worried

0%

10%

20%

30%

40%

50%

60%

70%

8% 10%

22%

59%

36%

20% 20% 22%

Employer Insurance

Not Employer Insurance

Importance of coverage: self/family

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%89%

9%2% 1%

71%

18% 20%

1%

92%

5% 3% 0%

Self: Employer Insurance

Self: Not Employer Insurance

-

All Family

ACA related questions

• Aware– Source

• Knowledge overall– Specifics– Support

How much HEARD about ACA

Employer Insured Not Employer Insured0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1% 4%15%

43%

46%

57%

38%

15%

A lotSomeNot muchNot sure

How much KNOW about ACA

Employer Insured Not Employer Insured0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1% 6%9%

24%33%

35%

48%

27%

9% 9%

A lotSomethingHeard of butNot anythingNot sure

Support/Knowledge of ACA

Preexist

Prev Cov

Biz credits

Kids to 26

HBMP

Lg Biz Cover

Mcaid exp

Support HI

Ind Man

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%91%

86% 85%80%

70% 68%64%

58%

45%

58%

43%36%

73%

41% 40%44%

29%

52%

Support

Know

Support=Strongly and support; Know=strongly and know

Knowledge less, support similar, : For those most likely to use Marketplace

Knowledge less for all areas• Age 26 coverage (77% vs 59%)• Denial of coverage (64% vs 38%)• Individual mandate (56% vs 34%)• Medicaid expansion (49% vs 26%)• Preventive coverage (47% vs 29%)• Marketplace existence (46% vs 21%)• Large business mandate (44% vs 24%)• Business tax credits (40% vs 20%)• Marketplace tax credits (32% vs 16%)Support• Age 26 coverage less (83% vs 69%)• Marketplace credits more (65% vs 57%)

How learned about ACA

• Television: 54%– Employer 58%– Non employer 46%

• Newspaper: 41%– Employer 47%– Non employer 23%

• Family/friends: 35%– Employer 36%– Non employer 30%

• Internet: 33%

– Employer 36%– Non employer 28%

• Public health agencies: 29%– Employer 34%– Non employer 16%

Radio 27%; All others less than 20%: HI agents, Direct Mail, informational meetings at Hosp, Brochures at MD, Public forums, social media

Health Benefits Marketplace1. Factors affecting choice (current & future)2. Comfort with online system3. Amount of help with online system4. Preference for how to get help5. Amount of help for particular plan info6. Post-purchase need for help7. Confidence in possible sources of help8. Plan preferences9. Marketplace naming and source of information

Factors affecting choice of plan*

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

72% 71% 70%

55%

38%

28%

17%

83%79% 77%

65%

38% 39%

22%

Current

Future

*Percentage Responding Very Important

Plan factors similar for those most likely to use Marketplace

Current plan choice• Monthly cost more (80% vs 70%)Marketplace plan choice• Providers less (67% vs 54%)

Preference for number of plans

Employer Insured Not Employer Insured0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

23%39%

57%

47%

15%13%

6% 1%

Not sure

Just a few

A moderate number

As many as possible

Choice guidance preference

Employer Insured Not Employer Insured0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

14% 17%

30% 22%

53%55%

3% 7%

Not sure

Combination

Guide to best plan

Simply show options

Comfort w/online system choosing plan

Employer Insured Not Employer Insured0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

17% 20%

24% 19%

28%24%

26%29%

5% 8%

Not SureNot ComfortSomewhatComfortableVery Comfort

Need for help with online system

Employer Insured Not Employer Insured0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

25%40%

52%

42%

17% 12%2% 1%4% 4%

Not SureNoneVery littleSomeA lot

Preference for how to get help: Marketplace

0%

10%

20%

30%

40%

50%

60% 57%

41%

32%

26%23% 22%

1%

47%43%

30%27%

30%

21%

3%

Employer

Not Em-ployer

How much help with plan info: Marketplace*

Out pocket

Services

Monthly$

PlanQuality

Reputation

Providers

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

37%39%

30%

23%19%

22%

43%40%

35%

30%

25% 25%Employer

Not Em-ployer

*Percentage Responding A lot of help

Confidence in sources for help*

0%

10%

20%

30%

40%

50%

60%

70% 65%

56% 56% 54%48%

45% 44% 44%

33%

22%

54% 55% 56% 54%51%

39%45%

39%34%

28% Employer

Not Em-ployer

*Percentage Responding Confident or Very Confident

Plan information post-purchase help

Services

Out pocket

Monthly$

Claims pa...

Providers

Billing pro...

Adjustm...

Appeals

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

75%

65%58% 60%

44%

65%

48% 48%

77% 75%67%

55% 53% 52%

41% 40% Employer

Not Em-ployer

Trusted sources for post-purchase help with previous services

0%

10%

20%

30%

40%

50%

60% 56%53%

34%31% 29%

26%

14%

36%39%

28%

44%

29%26%

19%

Employer

Not Em-ployer

Naming

Not Employer1. Iowa Health Insurance

Marketplace (40%)2. Iowa Health Choices (18%)3. Iowa Health Benefit

Marketplace (9%)

Employer4. Iowa Health Insurance

Marketplace (43%)5. Iowa Health Choices (15%)6. Iowa Health Insurance

Exchange (14%)

How would you learn about Marketplace

• Employer: 57%– Employer (67%)– Non employer (45%)

• Television: 51%– Employer (57%)– Non employer (50%)

• Newspaper: 37%– Employer (42%)– Non employer (35%)

• Internet: 36%

– Employer (38%)– Non employer (45%)

• Radio: 32%– Employer (36%)– Non employer (30%)

Other: Friends/family, HI Agent, Direct mail, Local Hosp meetings, Brochures at MD, Public events, Social media, PH Agencies, Non profits

Top 5 most trustworthy sources of Marketplace information

Employer

Pub Hlth

Ins. agent

Fam/Frie

Brochures

0%

10%

20%

30%

40%

50%

60%55%

49%

28%24% 23%

40%43%

27% 29%24% Employer

Not Em-ployer

Conclusions:For those most likely to use Marketplace

• Non-employer are sicker– not as sick as IowaCare

• Current coverage doesn’t meet needs as well– Cost for non-covered services more important– More likely to delay care for costs– Much more likely to worry about costs for self and family

• Having coverage less important for self– As important for family

• Much less knowledgeable about the Marketplace– Heard less, know less– Similarly supportive of components

Conclusions:For those most likely to use Marketplace

• Prefer more plans to choose from• Need more help with selecting plans• Less comfortable with online selection system– Would need more help– Prefer one-on-one type assistance• Phone, in person

• Need more help post selection– Trust providers most following purchase

Conclusions: General

• Cost is more important than quality when choosing a plan– Even more for choosing plan in the marketplace

• Learned about ACA from:– Television, Newspaper Family/friends, Internet, Public health

agencies• Preferred moderate to many plans to choose from on MP• Prefer at least some guidance in online system when

choosing plan • Want help with cost and services covered

Conclusions: General

• Most likely to learn about Marketplace from:– Employer, TV

• Trusted sources for marketplace information– Work HR, Public Health Agencies

• Trusted sources for marketplace purchase help– Work HR, Print, Community resources

• Trusted sources for post-purchase help– Work HR, Marketplace website, Community resources,

providers– Preferred Marketplace name over Exchange