Young Adults Find Selecting Health Insurance Plans Confusing

While young adults are essential to the implementation of the Affordable Care Act (ACA), the process of applying for health insurance using the federal insurance marketplace HealthCare.gov can be confusing to them, according to a small, observational study.

Historically, a significant part of the young adult population in the U.S. has been uninsured. Under the ACA’s goal to expand access to health insurance for everyone, they have new choices when shopping for affordable insurance plans. They can compare insurance options on HealthCare.gov with plans outside the marketplace such as those offered by employers, schools, or their parents’ health insurance.

“Most of the young people in our study were buying health insurance for the first time since many had previously been on their parents’ plans, and they found the process of selecting from 30 plan options in Philadelphia challenging and overwhelming,” said Charlene Wong, MD, principal investigator of the study published in the Journal of Adolescent Health. “The young adults’ thoughts on health insurance and HealthCare.gov, for example what they are looking for and the challenges they identified, can inform more effective outreach efforts and improvements to the website.”

In the study conducted from January to March 2014, Dr. Wong and colleagues described young adults’ experiences using HealthCare.gov and their attitudes toward health insurance, health insurance literacy, and benefit and plan preferences. Thirty-three study participants’ ages 19 to 30 who lived in Philadelphia County and were highly educated spent up to 30 minutes exploring HealthCare.gov. During the sessions, the study team recorded study participants’ “think aloud” reactions in real-time.

For example, one participant said, “I just wasn’t able to comprehend all of the things on HealthCare.gov — I got confused. I’m not a person to give up, not at all — but with the system, I just wanted to quit.”

Study participants struggled with many of the basic insurance terms that appeared on the website. Of the 33 participants, 48 percent incorrectly defined “deductible” and 78 percent incorrectly defined “coinsurance.”

The investigators conducted follow-up interviews with the participants to discuss their perspectives in more detail and also to identify factors important to their enrollment decisions. The results showed that deductible and premium amounts and preventive care coverage were most important to the participants’ plan selection.

“Based on this study, we developed recommendations for improvements to HealthCare.gov that have been disseminated to the Office of Health Reform. For example, the young adults suggested that pop-up explanations that appear when your cursor is over an important term like ‘deductible’ would have been helpful. We also have ongoing work on the tools available to consumers on HealthCare.gov and other state-based insurance marketplaces to help simplify or support them in making informed health insurance choices,” said Dr. Wong, who is a fellow with the Craig-Dalsimer Division of Adolescent Medicine program at The Children's Hospital of Philadelphia.

The next open enrollment period for HealthCare.gov and other state-run health insurance marketplaces is November 2015.