Coverage Details Elude ACA Exchange Patients, New Study Reports

by Amanda Conschafter, blog editor


Patients using a state or the federal health care exchange want basic details about their coverage plan: which providers are in network, what co-pay requirements exist and which medications are covered. But a new survey from Lake Research Partners and the National Health Council reveals that patients may find such data difficult – if not impossible – to obtain.

The study, conducted via an online survey in three different U.S. cities, focused on chronic disease patients’ experience with exchange health care coverage. Participants acknowledged that premiums weighed heavily in their choice of a plan, and that they found premium costs relatively easily. Comparing plans on other factors proved more difficult. Patients reported difficulty finding a list of providers included in particular plans or a list of prescription drugs included in the plan formulary. Figures on deductibles and co-pays also proved challenging to locate.

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Without the data they needed, some of these patients picked plans based on certain assumptions. Not all of those assumptions proved to be accurate. Younger patients and those with bronze-level plans in particular reported not knowing for certain if their physicians or their prescription drugs were covered under their plan when they chose it. Consequently, nearly a third of surveyed enrollees had to switch their physicians; roughly one quarter had to change their prescription medication.

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The National Health Council produced this study in conjunction with its initiative for a “patient-friendly insurance market.” It urges more transparency, standardized information, search features and online calculators to better equip patients with chronic disease to make informed decisions about their health insurance coverage.

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