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Comparative Study
. 2015 Feb;50(1):58-80.
doi: 10.1111/1475-6773.12181. Epub 2014 Apr 30.

Determinants of coverage decisions in health insurance marketplaces: consumers' decision-making abilities and the amount of information in their choice environment

Andrew J Barnes  1 , Yaniv Hanoch, Thomas Rice
Affiliations
Comparative Study

Determinants of coverage decisions in health insurance marketplaces: consumers' decision-making abilities and the amount of information in their choice environment

Andrew J Barnes et al. Health Serv Res. 2015 Feb.

Abstract

Objective: To investigate the determinants and quality of coverage decisions among uninsured choosing plans in a hypothetical health insurance marketplace.

Study setting: Two samples of uninsured individuals: one from an Internet-based sample comprised largely of young, healthy, tech-savvy individuals (n = 276), and the other from low-income, rural Virginians (n = 161).

Study design: We assessed whether health insurance comprehension, numeracy, choice consistency, and the number of plan choices were associated with participants' ability to choose a cost-minimizing plan, given their expected health care needs (defined as choosing a plan costing no more than $500 in excess of the total estimated annual costs of the cheapest plan available).

Data collection: Primary data were collected using an online questionnaire.

Principal findings: Uninsured who were more numerate showed higher health insurance comprehension; those with more health insurance comprehension made choices of health insurance plans more consistent with their stated preferences; and those who made choices more concordant with their stated preferences were less likely to choose a plan that cost more than $500 in excess of the cheapest plan available.

Conclusions: Increasing health insurance comprehension and designing exchanges to facilitate plan comparison will be critical to ensuring the success of health insurance marketplaces.

Keywords: Affordable Care Act; health insurance comprehension; health insurance exchanges/marketplaces; insurance choice; numeracy; uninsured.

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Figures

Figure 1
Figure 1
Three- and Nine-Plan Choice Condition
See this image and copyright information in PMC

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