Websites for national and state health insurance marketplaces show evidence of improved efforts to assist patients in choosing health insurance plans, such as providing decision support tools, experts from the Perelman School of Medicine at the University of Pennsylvania have found. However, in a letter published in the August 18 issue of the Annals of Internal Medicine, the Penn team recommends taking more steps to better support consumers in making informed health plan decisions.

The marketplaces, also called health exchanges, were established by the Patient Protection and Affordable Care Act to allow consumers to compare and choose health insurance plans.

“Selecting a plan is a complex task for just about anyone, regardless of your knowledge of the marketplaces or health insurance, and the way plans are presented on the exchanges and the tools available there can influence consumers' choices,” said the study’s lead authorCharlene A. Wong, MD, a Robert Wood Johnson Foundation Clinical Scholar and fellow in Penn's Leonard Davis Institute of Health Economics. “Performance of the health insurance marketplaces will significantly depend on such features as the order in which plans are displayed, the plan features listed, and the availability of decision-support tools created for consumers. While we generally found improvement in the second versus the first open enrollment period, additional measures can and should be added in the future to further improve the selection process for consumers.” 

The Penn investigators examined HealthCare.gov, the national marketplace used by the majority of states, and 12 state-based marketplaces during the first and second open enrollment periods (October 1, 2013 to March 31, 2014 and November 15, 2014 to February 15, 2015, respectively). They collected data that consumers would see while browsing before creating an account (“window shopping”) and after creating an account and having their identities verified (“real shopping”).