Let's Go Shopping: Helping Consumers Navigate Plan Selection

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05.13.16 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 literacy

Adam Fox, Director of Strategic Engagement, Colorado Consumer Health Initiative

2016 Enroll America | StateOfEnrollment.org

OutlineMaking health insurance literacy more accessibleCCHIs work - CoveredU.org digital tool

Health insurance Fun with analogies

Keys to understanding Health InsuranceLearnings from CCHIs work & consumer testing

Health Insurance Literacy: Explaining Copays, Coinsurance, Deductibles, and more!!

CoveredU.org (en Espaol SeguroTU.org)cohealth.co/covereduinfograph

Major 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.12

Interesting ways to describe HI termsPremium

Premiums 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.13

Interesting ways to describe HI termsCopay

Copays 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.14

Interesting ways to describe HI termsDeductible and coinsurance

Deductibles 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. 15

Interesting ways to describe HI termsIn-Network vs. Out-of-Network

In 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.16

Keys 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/enrollmentrap

Getting 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.17

Tips and Trends in Plan Selection

Dave Chandrasekaran, Health Care Consultant & Certified Application Counselor

2016 Enroll America | StateOfEnrollment.org PremiumPlan Design/Cost SharingCovered Benefits/Drug FormularyProvider Network

Elements of Marketplace Health Plans19


PremiumPlan Design/Cost SharingDeductibleOut-of-Pocket MaximumCopays and Coinsurance

Elements of Marketplace Health Plans20


Total Annual Medical Expenses

Insurer paysInsurer paysConsumer pays

Consumer pays full amount of medical bills

Consumer pays Co-pays/Coinsurance

Consumer does not pay anythingAnnual Deductible:

Annual Out-of-Pocket Maximum:Consumer Pays$2000$6000$2000$4000$021Explaining Deductibles and Out-of-Pocket Max


22deductible applies

HealthCare.gov, Anthem Blue Cross and Blue Shield Silver Blue Priority