RESUMO
The new health insurance marketplaces aim to improve consumers' purchasing experiences by setting uniform coverage levels for health plans and giving them tools to explore their options. Marketplace administrators may choose to limit the number and type of plans offered to further simplify consumer decision-making. This issue brief examines the policies set by some state-based marketplaces to simplify plan choices: adopting a meaningful difference standard, limiting the number of plans or benefit designs insurers may offer, or requiring standardized benefit designs. Eleven states and the District of Columbia took one or more of these actions for 2014, though their policies vary in terms of their prescriptiveness. Tracking the effects of these different approaches will enhance understanding of how best to enable consumers to make optimal health insurance purchasing decisions and set the stage for future refinements.
Assuntos
Comportamento de Escolha , Participação da Comunidade/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Trocas de Seguro de Saúde/legislação & jurisprudência , Benefícios do Seguro/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Governo Estadual , Tomada de Decisões , Trocas de Seguro de Saúde/economia , Política de Saúde , Humanos , Benefícios do Seguro/economia , Cobertura do Seguro/economia , Seguro Saúde/economia , Patient Protection and Affordable Care Act/economia , Patient Protection and Affordable Care Act/legislação & jurisprudência , Estados UnidosRESUMO
Value-based insurance is a relatively new approach to health insurance in which financial barriers, such as copayments, are lowered for clinical services that are considered high value, while consumer cost sharing may be increased for services considered to be of uncertain value. Such plans are complex and do not easily fit into the simplified, consumer-friendly comparison tools that many state health insurance exchanges are formulating for use in 2014. Nevertheless some states and plans are attempting to strike the right balance between a streamlined health exchange shopping experience and innovative, albeit complex, benefit design that promotes value. For example, agencies administering exchanges in Vermont and Oregon are contemplating offering value-based insurance plans as an option in addition to a set of standardized plans. In the postreform environment, policy makers must find ways to present complex value-based insurance plans in a way that consumers and employers can more readily understand.