The application process is similar to that of applying for a credit card or car loan. Users log in, and set up a personal account. The sign in process guides the user to enter graduating levels of personal information of each party to be included on the plan, and language of the site is basic includes short examples. Once identity is verified using abbreviated info from credit reports, the user can then begin to complete the detailed application. Once the application portion is completed, a PDF file is sent to a secure inbox and covers what plans the user and family members are eligible for and includes next steps to complete the process. If users are approved for coverage the next steps are to decide on medical and dental plans.
The healthcare marketplace offers an array of plan types covering
a range of high premium/lower cost to higher premium and lower costs and also
offers plans with out of network flexibility. There stipulations for income verification in
order to qualify for lower rates or tax credits, and also includes provisions
for individuals who did not realize the impact of the mandates that require
health insurance.
The general plan types are as follows3:
·
The Exclusive Provider Organization (EPO) :
services are covered only when health care organizations are in the plan
network
·
Health Maintenance Organization (HMO): Coverage
limited to health care providers who either work for the HMO or are contracted
to provide care for the HMO
·
Point of Service (POS): Costs is less when health care providers are
in the POS plan network. These do offer coverage out of network but require
referrals for visits to a specialist.
·
Preferred Provider Organization (PPO): Cost is
less where providers are in network but no referral is required for specialists
Plans are divided into 5 large categories as follows2:
·
Bronze: The lowest premium plans which covers
approximately 60% of healthcare costs.
·
Silver: Health plans in this category pay 70% of
healthcare costs on average.
·
Gold: Higher level, where health plans pay 80%
of healthcare costs on average.
·
Platinum: Highest level, where 90% of costs are
covered on average.
·
Also included is a catastrophic category, where
less than 60% is covered (similar to older ‘major medical’ plans) and are
offered only for those with special exemptions or are under 30 years old.
After running through the process on the Healthcare.gov site
a few times to compare, there were a few issues to note. One specific drawback
is how the user presents their income. The income itself is based on user
estimates, with income verification linked to tax returns down the road1.
The declaration is a bit muddy, and for the
unemployed or the self employed, the options are not as clear and only after a
few tries or a call to support do the best options become apparent. At this point, the site is still clunky
compared to sites such as Amazon or USPS, but not so much to be unusable. Changing personal information such as income,
for instance, requires the user to start at the beginning and step through all
of the screens across all applicants and this process takes approximately 15
minutes. Another drawback is the dental plan options are not visible until the
health plan options are selected.
The support by phone was very easy to access, and the
support representatives can also step through the entire application with the
users. On the site itself, there seems to be much effort to leave questions
open and optional. This might make it easier for anyone with good intentions
but limited knowledge of health care, but also leaves a lot of avenues and
choices. The support phone representatives are available to clarify and guide,
but better online documentation and descriptions could be used as many
important details can be missed. Also, the best way to navigate, compare plans,
or change information is not made obvious until the user calls support or makes
several attempts to try things different ways.
The overall experience of getting healthcare coverage
through this site was somewhat time consuming, and could be improved with
better tool tips, guides for income and other personal information entry, and
also more readily available plan information.
References:1 Healthcare.gov, 2015. Health coverage options if you’re unemployed. Retrieved 4/9/15 from https://www.healthcare.gov/unemployed/coverage/#unemployedincome
2 Healthcare.gov, 2015. Marketplace insurance categories. Retrieved 4/9/15 from https://www.healthcare.gov/choose-a-plan/plans-categories/
3 Healthcare.gov, (2015). Type of plan and provider network.
Retrieved 4/8/15 from https://www.healthcare.gov/choose-a-plan/plan-types/
Looking back a year or so later, the larger flaw has to do with the learning curve to fully use the site and find all the price comparison tools. A quick reference matrix could be used to compile all options to pdf download for off line reviewing. I had gone through the site numerous times to get the hang of it, but The site needs to be tailored to the non-IT person and non healthcare person.
ReplyDelete...also, the possibility for fraud exists, understating income and getting lower rates is possible and not checked until the next year tax return, when income is adjusted and individuals are billed during their tax return. This also may be further opportunity for enhanced fraud detection and data analytics, and may be a boost to the IT sector in general.
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