Let's Go Shopping: Helping Consumers Navigate Plan Selection

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PowerPoint Presentation05.13.16 Let's Go Shopping: Helping Consumers Navigate Plan Selection 2016 Enroll America | StateOfEnrollment.org Today we will learn:Tips and tricks on how to explain certain health insurance concepts to non-expertsHow certain plan design features can impact cost and where to look to find important plan information How tools can help make an in-person assistance appointment more effective and efficient Session Goals 2016 Enroll America | StateOfEnrollment.org Todays SpeakersAdam FoxDirector of Strategic Engagement, Colorado Consumer Health InitiativeDave ChandrasekaranHealth Care Consultant & Certified Application CounselorJennifer SclarChief Executive Officer,Clear Health AnalyticsSophie Stern (moderator)Deputy Director, Best Practices Institute,Enroll America 2016 Enroll America | StateOfEnrollment.org The Uninsured are Price Sensitive59% of those that said they cannot afford had not heard of financial help 2016 Enroll America | StateOfEnrollment.org Thinking about the last time you looked for health insurance on your own, which of the following things did you consider before deciding NOT to purchase a plan? Source: GMMB and PerryUndem Research and Communication, May 2015, https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2014/10/Reaching_Consumers_in_OE3.pdfThe Uninsured are Paying Attention to Premiums and Deductibles 2016 Enroll America | StateOfEnrollment.org Marketplace Enrollees Also Considered Cost SharingThinking back to when you were deciding whether to purchase a plan, which of the following things did you consider? Source: GMMB and PerryUndem Research and Communication, May 2015, https://s3.amazonaws.com/assets.enrollamerica.org/wp-content/uploads/2014/10/Reaching_Consumers_in_OE3.pdf 2016 Enroll America | StateOfEnrollment.org Choosing a plan starts with health insurance literacyAdam Fox, Director of Strategic Engagement, Colorado Consumer Health Initiative 2016 Enroll America | StateOfEnrollment.org OutlineMaking health insurance literacy more accessibleCCHIs work - CoveredU.org digital toolHealth insurance Fun with analogiesKeys to understanding Health InsuranceLearnings from CCHIs work & consumer testingHealth Insurance Literacy: Explaining Copays, Coinsurance, Deductibles, and more!!CoveredU.org (en Espaol SeguroTU.org)cohealth.co/covereduinfographMajor Goals:Interactive content - gamelikeContextualize terms/conceptsMake it less intimidating & dont try to explain everything at onceDemonstrate Value of InsuranceEmphasize importance of utilizing primary careGo-to resource for individual consumers and health enrollment assisters+Keys to adult learning = contextualization, relatable examples, interactivity, and application.Interesting ways to describe HIAuto Repair$$?While online and print tools are great to explain health insurance, they dont necessarily make health insurance literacy feel much more accessible for consumers, and sometimes we have to boil it down to something more basic. The challenge is that analogies for health insurance are tough since its a bit of a unique construct. However, there are some comparisons we can draw to help consumers better grasp health insurance and the terminology.One of the ways I heard a local assister describe health insurance more generally is using auto repair. Your health insurance generally covers the preventive maintenance items like oil changes and tire rotations, but if something more significant happens, you are going to have to pay some amount out of pocket to cover it. Auto repair is also similar to health care costs in that when something happens, you dont necessarily know what it is or what its going to cost when you go in.12Interesting ways to describe HI termsPremiumPremiums are one of the easier things to describe because there are a lot of things that people are used to paying for monthly. For instance a gym membership, similar to health insurance premiums, grants you access to a network of facilities or providers, but you still have to put in the effort to use your coverage to get the value out of it. You also still have to pay your monthly amount if you still want to have access to the services, regardless of whether you use them or not.Similarly, most people have a cell phone and understand the idea of paying monthly to be able to use their phone. Others: other insurances, subscription services, etc.13Interesting ways to describe HI termsCopayCopays can also be described with relative ease. They are pretty comparable to entry fees, for instance a cover charge into a club or an entry fee to a carnival. That entry fee gets you in the door, but you may end up paying more depending on what you want/need once youre there.14Interesting ways to describe HI termsDeductible and coinsuranceDeductibles and coinsurance are where things get a bit tougher in helping people understand health insurance basics. These examples are definitely a bit more of a reach, but may still be helpful. For a deductible, How about a coffee punch card, where you have to pay a certain amount in before you start getting more of a benefit in return. If you dont fulfill the punches on that card or meet your deductible, you dont get that benefit in return.Our experience is that coinsurance is where consumers often have the most trouble, particularly because its based on a percentage, not a set amount. Once someone reaches their deductible, they get discounts on additional services. One possible example is Amazon Prime, you pay your fee/deductible to be a member, and then you get discounts on additional services. Another way to look at coinsurance is its a bit like splitting the check with your insurance company, you pay a percentage and they pay a percentage.Another example weve been experimenting with is a bicycle analogy. Most people own a bike, or have in the past. Lets say the bike frame and handle bars are like your deductible. That gets you most of the way there, but you dont get to ride that bike for free without a bit more expenditure. You still have to pay for tires, brakes, a helmet, and ongoing maintenance (coinsurance). So, youre paying less than before, but you still have to chip in to keep riding. You could also use bike lanes and bike share programs as an analogy for in-network coverage. You can ride your bike outside those designated bike paths or share stations, but youll pay more and take on a higher risk of flat tires, accidents, and traffic tickets that could cost you big time, so theres a big benefit to staying in-network. 15Interesting ways to describe HI termsIn-Network vs. Out-of-NetworkIn addition to the bike lanes or bike share analogy. You could talk about a public transportation pass for explaining insurance network basics. Typically the pass allows you to travel within certain areas, but if you go outside those areas, your pass doesnt cover you. Cell phone networks are another easy one. Everyone understands their cell phone is attached to a particular network. As long as they try to use their phone in that network, they shouldnt have any problems, but if you find yourself out of network, you could end up paying big time on your bill.16Keys to understanding HIKeep it Simple both in language and complexityTry to keep it engaging and relevant (try to use examples you think will resonate with a person)Comparisons can help provide contextShameless plug check out our enrollment rap videos online cohealth.co/rapSEPs & cohealth.co/enrollmentrapGetting people to the point of choosing a plan that suits them is tough, and making sure they understand the basics of health insurance is key for them making an informed decision. Before I pass it off, I want to leave you with a few learnings from some testing of CoveredU and other health insurance literacy efforts.First, keep things simple whenever possible, both in the language youre using and the complexity and depth of explanation. Throwing everything at someone at once, nuances and all, is likely to be overwhelming. If youre making print materials, try to have them readability tested.Try use engaging/relevant examples. If you use an example that doesnt align with somebodys background, it wont mean as much.If you can draw simple comparisons, it can really help cut through the insurance jargon. Using quick calculations, say, to show what a $7,500 broken arm would look like under two or three plans. That can help someone weigh the difference between different metal tiers of plans or plans within the same tier. A few dollars more in premium could end up saving a consumer money if something significant happens, but most consumers wont make that choice unless they understand the value.17Tips and Trends in Plan SelectionDave Chandrasekaran, Health Care Consultant & Certified Application Counselor 2016 Enroll America | StateOfEnrollment.org PremiumPlan Design/Cost SharingCovered Benefits/Drug FormularyProvider NetworkElements of Marketplace Health Plans1919PremiumPlan Design/Cost SharingDeductibleOut-of-Pocket MaximumCopays and CoinsuranceElements of Marketplace Health Plans2020Total Annual Medical ExpensesInsurer paysInsurer paysConsumer paysConsumer pays full amount of medical billsConsumer pays Co-pays/CoinsuranceConsumer does not pay anythingAnnual Deductible: Annual Out-of-Pocket Maximum:Consumer Pays$2000$6000$2000$4000$021Explaining Deductibles and Out-of-Pocket Max2122deductible appliesHealthCare.gov, Anthem Blue Cross and Blue Shield Silver Blue Priority X WI 4000 25 plan in Green Bay, WICopays/Services Exempt from the Deductible2223deductible does not applyCopays/Services Exempt from the DeductibleHealthCare.gov, Anthem Blue Cross and Blue Shield Silver Blue Priority X WI 4000 25 plan in Green Bay, WI2324Terms used by health plans:Exempt from the deductibleDeductible does not applyDeductible is waivedBefore the deductibleCopays/Services Exempt from the DeductibleHealthCare.gov, Anthem Blue Cross and Blue Shield Silver Blue Priority X WI 4000 25 plan in Green Bay, WI2425Partial Exemptions from the DeductibleSummary of Benefits and Coverage for Anthem Healthkeepers Bronze X 4650 35 plan in Fairfax County, VA2526Partial Exemptions from the DeductibleHealthcare.gov, Anthem Healthkeepers Bronze X 4650 35 plan in Fairfax County, VA2627Partial Exemptions from the DeductibleHealthcare.gov, Anthem Healthkeepers Bronze X 4650 35 plan in Fairfax County, VA2728HealthCare.gov, Kaiser Permanente Bronze 4500/50/HSA/Dental/Ped Dental and Bronze 4500/50/Dental/Ped Dental plans in Fairfax County VA (2014)HSA vs. non-HSA Plans28Deductible-only PlansHealthcare.gov, Humana Bronze 6450/Detroit HMOx plan in Wayne County, MIPremiumPlan Design/Cost SharingCovered Benefits/Drug FormularyProvider NetworkElements of Marketplace Health Plans3030Elizabeth Hagan (EH) - Change to section title slide31Essential Health Benefits3132Dental Coverage for Children and AdultsHealthcare.gov, Coventry Bronze Deductible Only HSA Eligible Bon Secours plan in Richmond, VA, and Kaiser Permanente KP VA Bronze 6000/20%/HSA/Dental/Ped Dental plans in Arlington County, VA3233Other Covered ServicesSummary of Benefits and Coverage for Kaiser Permanente KP VA Bronze 6000/20%/HSA/Dental/PedDental in Arlington County, VA3334CareFirst BCBSInnovation HealthKaiser PermanenteUnited HealthcareAbortionsAcupunctureBariatric surgeryChiropractic careDental care (adult)Infertility treatmentHearing aidsLong-term carePrivate duty nursingRoutine eye exam (adult)Routine hearing tests (adult)Routine foot care Other Covered ServicesSummary of Benefits and Coverage for CareFirst BlueCross Blue Shield, Innovation Health, Kaiser Permanente and UnitedHealthcare plans in Arlington County, VA34PremiumPlan Design/Cost SharingCovered Benefits/Drug FormularyProvider NetworkElements of Marketplace Health Plans353536TypeNamePCP Required?Referrals Required?Out-of-Network Coverage?PPOPreferred Provider OrganizationNoNoYesPOSPoint of ServiceYesMaybeYesHMOHealth Maintenance OrganizationYesYesNo*EPOExclusive Provider OrganizationNoNoNo**except for emergency careHealth Plan Network Types36Health Plan Provider NetworksHealth Plan Provider NetworksPrimary Care ProvidersHospitalsOrange Health Plan PPOHealth Plan Provider NetworksPrimary Care ProvidersHospitalsRed Health Plan HMO vHealth Plan Provider NetworksPrimary Care ProvidersHospitalsGreen Health Plan Integrated HMO41SpecialtyCareFirst BCBSInnovation HealthKaiser PermanenteUnited HealthcarePCP/Internal Medicine (in 10 miles)500743 (15 miles)79402 Cardiologist (in 10 miles)377437 (15 miles)4 124 Hospitals(in 10 miles)203 (15 miles)?3Health Plan Provider NetworksProvider search sites for CareFirst BlueCross BlueShield, Innovation Health, Kaiser Permanente, and UnitedHealthcare for Arlington County, VA4142Tiered Provider NetworksPlan Brochure for Independence Blue Cross HMO Silver Proactive Plan in Philadelphia County, PA4243Summary of Benefits and Coverage for Independence Blue Cross HMO Silver Proactive Plan in Philadelphia County, PATiered Provider Networks4344Source: healthcare.govGrayHealthcare.gov Provider Search Tool4445Source: healthcare.govHealthcare.gov Provider Search Tool4546Healthcare.gov Out-of-Pocket Cost Calculator4647Source: healthcare.govHealthcare.gov Out-of-Pocket Cost Calculator4748Finding Plans that Meet the Consumers NeedsApplicants (age): Pamela (43) and Stephanie (16)Location: Detroit, MICounty (Zip): Wayne (48201)Annual Income: $35,000APTC:$145CSR?:Yes (73%)Doctors for Pamela?YES Susan Berman MD (OB/GYN)Doctors for Stephanie?NOPrescription Drugs for Pamela?YES Metformin 500mg XRPrescription Drugs for Stephanie?NOHospital?YES St John Macomb Oakland Hospital4849Finding Plans that Meet the Consumers Needs4950Finding Plans that Meet the Consumers Needs5051CompanyPriceDocRxHospDeductibleOOP MaxPCPSpecialistGeneric1Humana Bronze 6450/Detroit HMOx (HSA)$133$12,900$12,900$0 after$0 after$0 after2Molina Marketplace Bronze$145$10,000$13,700$25 after$75 after$153BC Network of MI Metro Detroit HMO Bronze Saver (HSA)$148 $12,900$12,900$0 after$0 after$0 after4BC Network of MI Metro Detroit HMO Bronze (HSA) $158$11,900$12,700$30 after$50 after$4 after5HAP Personal Alliance 5000 (HSA)$163 $10,000$12,90020% after20% after20% after6Harbor Health Plan Choice Bronze$164 $12,300$13,700$30$55$257BC Network of MI Select Bronze Saver(HSA)$177 $12,900$12,900$0 after$0 after$0 after8Humana Silver 3800/Detroit HMOx$182 $6,500$9,500$20$40$169BCBS of MI Select Bronze (HSA)$188 $11,900$12,700$30 after$50 after$4 after10HAP Personal Alliance 6850 HMO$206 $13,700$13,700$0 after$0 after$0 after11Harbor Health Plan Choice Silver$207$4,600$10,900$5$10$1019BC Network of MI Metro Detroit HMO Silver Saver$223$3,600$10,000$30$50 after$4 afterFinding Plans that Meet the Consumers NeedsSource: heathcare.gov, plans for a family of two (43 and 16 years old, $35,000/year) in Wayne County, MI51Elizabeth Hagan (EH) - I might think about taking this one out and just using hte one before it, but I am not sure if there is something different you are trying to conveyPREMIUMTarget premium range (upper limit)?PLAN DESIGNBalancing monthly cost vs. deductible amountFirst dollar coverage (for primary care/generic drugs)?Frequently used services (which copays are most important)?Health status/healthcare needs (to estimate annual OOP costs)? BENEFITS/PRESCRIPTION DRUGSDental coverage included (for kids? for adults?)Need for Other Covered Services?Coverage of current prescription drugs?PROVIDER NETWORKCurrent doctor in network?Size of provider network (out-of-network coverage?)52Helping Consumers Identify their Priorities52Elizabeth Hagan (EH) - I might move this up to the begining to set the stage..explain that there are many things to consider, but some consumers only care about certain aspects.One Size Does Not Fit All: Helping Consumers ChooseJennifer Sclar, CEO, Clear Health Analytics 2016 Enroll America | StateOfEnrollment.org OverviewThe importance of decision support tools helping consumers find the best plan to fit their needsOverview of available tools and how they workDeep-dive into the Plan Explorer5/6/2016ClearHealthAnalytics - Confidential54All Plans Are Not Created EqualIndividual variables include likely utilization, income, availability of subsidies and/or CSR, network and formularyThe best plan for an individual or family will vary depending on some combination of theseManual calculation of out-of-pocket cost is impossible because of lack of pricing information, variation in plan design, and tedious mathSelecting the wrong plan can have significant impact on financial and physical well-being of consumers5/6/2016ClearHealthAnalytics - Confidential55Digital Tools Are EssentialDigital tools allow consumers or those assisting consumers to see how each plan will behave and what it will really cost Tools allow doctor and formulary look-upMany new tools are available including HC.Gov, Consumers Checkbook and Stride HealthTools replace intuition and anecdote with unbiased, data-driven analysis5/6/2016ClearHealthAnalytics - Confidential5656Married Couple:43 year-old male, controlled diabetes40 year-old female, no known conditionsIncome: $59,000/yearHeres How it Works5/6/2016ClearHealthAnalytics Proprietary & Confidential57Tell us about your health.Utilization Drives Total Cost5/6/2016ClearHealthAnalytics Proprietary & Confidential58Medical Services They are Likely to Use:Total Cost Drives Plan Selection5/6/2016ClearHealthAnalytics Proprietary & Confidential59Top plans if utilization is edited to reflect 50 mental health visits/year.Top plans if the suggested utilization is used to determine total cost.Total Cost Drives Plan Selection5/6/2016ClearHealthAnalytics Proprietary & Confidential60Top plans if the female is pregnant and income is $35,000/yearTop plans if the female is pregnantTools Will Not Replace HumansPlan selection is highly individualized, idiosyncratic, and anxiety-provoking Many will continue to rely on navigators, assisters and brokersDecision support tools can help navigators, assisters and brokers by saving time, and reducing variability and subjectivity in recommendations5/6/2016ClearHealthAnalytics - Confidential61Questions? 2016 Enroll America | StateOfEnrollment.org