Cost Estimators and Insurance Exchange Consumers

By March 7, 2017Commentary

Everyone wants patients to be good consumers and make smart decisions about their health and health care.  (Well, maybe not everyone, the drug companies and some providers would just as soon they use as much of their products and services as possible.)  This is a lot to ask of the average patient.  So people are developing tools to help these overwhelmed consumers.  One critical decision for a subset of these consumers is which health plan to pick on the reform law’s exchanges.  (The decision is getting easier, since so many insurers have stopped offering plans!)  A brief from the Commonwealth Fund examines the use of cost estimator tools on these exchanges.   (Comm. Fund Brief)   Cost estimators attempt to help consumers understand, based on their health status and health care needs, which plan may be most cost-efficient for them to enroll in, taking into account premium amounts, premium subsidies which may be available and cost-sharing structure.

The authors interviewed a number of exchange officials and other experts to ascertain the value of a cost estimator and potential issues in implementing them.  Most of the interviewees indicated that such tools were critical to success and said that feedback from consumers was very positive.  Some expressed frustration that IT and other difficulties had made it hard to get a tool selected or built and implemented until several years after the exchanges began operation.  Most states relied on an outside vendor.  The estimators use a wide variety of data inputs.  While some exchanges are trying to keep the tools simple, they don’t seem to incorporate enough information to make the output particularly accurate or useful.  The brief contains no objective testing of the accuracy of the tools nor is there any survey of actual consumers to identify how they used the tools and how helpful they found them.  So this brief is about as helpful as many of the estimator tools.

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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