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Survey: Obamacare shopping leaves a lot to be desired

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Improvements can be made at HealthCare.gov.
Improvements can be made at HealthCare.gov. - (Thinkstock)

There is plenty of room for improvement in the online health insurance shopping experience at the new federal HealthCare.gov portal and state-run websites where Americans are now buying government-subsidized health insurance under the Affordable Care Act, according to the first-ever J.D. Power Health Insurance Marketplace Shopper Study.

The government has spent millions to create the Obamacare online insurance marketplace and to award subsidies to lower-income Americans so they can afford to buy health plans there. Yet J.D Power found that many Americans remain “uninsured and underserved due to obstacles not based on cost,” but rather on “technical problems and lack of information from health insurance companies and health exchanges.”

The survey of 1,632 Obamacare shoppers found overall satisfaction with the Obamacare shopping experience averaged 615 on a 1,000-point scale.

J.D. Power, a leading consumer polling firm, on Thursday released its inaugural survey of the nation’s shopping experience via the ACA, which it said it will conduct every year.

Rick Johnson, senior director of the health care practice at J.D. Power, said that 615 average satisfaction score is indeed low — but he said it is not out of line with an annual survey that J.D. Power does of Americans’ satisfaction with their health insurance plans overall. Johnson said that large survey of 35,000 U.S. health insurance consumers typically find satisfaction levels in the mid-600 range.

“Health insurance, out of all the different service studies that we do, tends to be one of the lowest, if not the lowest, consumer satisfaction score that we see,” Johnson said.

The nationwide survey of Obamacare enrollees did not break down results by state, nor did it rate the performance of individual health insurance companies.

Johnson said an average score of 615 suggest plenty of room for improvement for the Marketplace and the insurers selling plans there: “There is plenty of room to grow.”

He said J.D. Power pays the cost of conducting the survey. The comprehensive annual health insurance survey, which was conducted at the same time as the Marketplace survey, is also financed by J.D. Power and sold to health insurers or other clients.

Three insurers sell policies to New Jerseyans at HealthCare.gov: Horizon Blue Cross Blue Shield of New Jersey, AmeriHealth New Jersey and Health Republic Insurance of New Jersey. UnitedHealthcare announced it will enter the New Jersey ACA market when open enrollment for 2015 begins in Nov. 15, 2014.

About half the states have built their own online markets while the rest, including New Jersey, use the federal HealthCare.gov portal. The survey did not find significant satisfaction differences between state and federal websites.

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According to the federal Department of Health and Human Services, 162,000 New Jerseyans bought policies under the ACA for its inaugural year of 2014, with most getting subsidies that in many cases significantly reduced their health insurance premiums.
 
The survey found cost is the key reason shoppers who have wanted health insurance in the past were unable to obtain it (89 percent). Other reasons were pre-existing conditions and not knowing where to buy insurance.
 
J.D. Power found many consumers began the online insurance shopping process, then had problems completing enrollment at the time of the survey for three main reasons:

•    Technical problems experienced during the enrollment process (40 percent);
•    The application process took too long (19 percent);
•    The website lacked sufficient information about the plans (18 percent).

The survey also found that the 49 percent of shoppers who did not complete enrollment at the time of the survey did not choose a plan during their initial shopping experience because they had not decided which plan they wanted.

Johnson said the results point to a need for improved consumer information and awareness about the Obamacare marketplace. The controversy that swirled around the ACA during its trouble-plagued 2013 launch “created a level of awareness and news saturation, and whether it was bad or good, it was almost free advertising: ‘People need to go and shop for insurance,’” Johnson said. “Is that going to be at the same level the second time around? I don’t know, but I would think probably not.”

He said eventually the free media advertising goes away: “What is the plan to stay in front of people so they know they need to shop for health insurance?”

He said insurers need to provide information “about health insurance that is jargon-free and easy to understand so that people who are shopping are able to get the information they need to make an educated choice about the brand that is best for them.”
 
Johnson said, “Ensuring a technologically error-free experience, along with streamlining the online enrollment process will be most impactful to future Marketplace shoppers.”
 
The inaugural study was designed to assess the health insurance shopping experience of the previously uninsured, and polled 1,632 U.S. consumers who shopped for health insurance under the Affordable Care Act from November 2013 through April 2014. Nearly 90 percent of those polled were uninsured at the time of the survey.

Respondents reported that the key factors of satisfaction are the amount of time it takes to complete the enrollment process (23 percent); ease of enrolling (21 percent); variety of information available about the plans (15 percent); ease of understanding benefits and coverage (15 percent); ease of navigating the website (14 percent); and clarity of instructions (13 percent).
 
Although in-person is the least common method of enrollment, the survey found overall satisfaction is highest among the 13 percent of consumers who enrolled via this channel (719). The majority (67 percent) of consumers enrolled online, among whom overall satisfaction is 122 points lower, at 597. Among the 14 percent who enrolled by phone, satisfaction was 623. Using a navigator — a certified agent or broker used by 17 percent of shoppers — during the shopping process also improved satisfaction (631 vs. 611).

J.D. Power said health insurance companies and the exchanges “should continue to find ways to personalize the insurance shopping experience for consumers.”
 
Marketplace shoppers, like all health care consumers, heavily weigh cost when selecting a plan, with 59 percent citing monthly premiums as an important reason for their plan selection. Doctor visit co-pays, out-of-pocket maximums and annual deductibles were also key factors.
 
Under the Affordable Care Act, health insurers can offer policies with four types of payment structures, known as metal tiers. Bronze plans are the least expensive because insurers pay 60 percent of health expenses and the consumer pays 40 percent; silver plans have a 70-30 split; gold, 80-20 and platinum, 90-10.

The J.D. Power survey found the silver plan was the most popular, chosen by 55 percent of enrollees. Satisfaction among consumers with the silver plan is 621. The gold and platinum plans have the lowest enrollments (14 percent and 9 percent, respectively), but the highest satisfaction: (655 and 766, respectively). Satisfaction was lowest among the 23 percent of enrollees with a bronze plan (556).
 
The survey found that customer satisfaction varied significantly by age, with the highest satisfaction among shoppers younger than 30 years old (647) and lowest among those between the ages of 50 and 64 (591).

Among other key findings:
 
•    Enrollment satisfaction is higher among consumers shopping for an individual plan than among those shopping for a family plan (625 vs. 586, respectively).
•    The top reason cited by consumers for shopping via the Marketplace is to comply with the law, at 50 percent, while 40 percent shop because they wanted health insurance couldn’t obtain it in the past.
•    More than half (55 percent) first heard about the Marketplace from the news media, while only 4 percent learned about it in a notification from a state or federal agency.

Founded 45 years ago, J.D. Power analyzes and rates the customer experience for a wide range of industries, including autos, travel, financial services, health care and telecommunications, that seek this consumer satisfaction intelligence to boost customer loyalty and retention.

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Beth Fitzgerald

Beth Fitzgerald

Beth Fitzgerald reports on health care, small business and higher education. She joined NJBIZ in 2008 after a 34-year career at the Star-Ledger and has been reporting on business in New Jersey since 1978. Her email is beth@njbiz.com and she is @bethfitzgerald8 on Twitter.

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