Health Benefits Marketplace
Perceptions of Consumers in Iowa
Pete DamianoSuzanne Bentler
Dan Shane
Iowa Safety Net Network Leadership Group MeetingAugust 6, 2013
In this presentation
• Consumer survey– Methods– Demographics– Insurance coverage and factors affecting choice– Knowledge and Attitudes toward the ACA– Marketplace preferences and assistance
Methods-Consumers• Mixed mode (On-line and written in person)• Convenience sample:
– IA Caregivers Assoc. (both)– one Iowa FQHC (written)– Iowa State Extension (written)– IA Public Health Association (online)– AARP (online)– IDPH partners and local agencies
• 85 questions maximum– 43 questions with some tables of multiple subquestions
• 498 responses so far– 367 On-line– 131 Written
Insurance Coverage Types
• Employer-based (<HBMP)-80% (n=396)• Non-employer-based (>HBMP)-20% (n=102)– Uninsured now or in last 12 months (5%; n=24)– Self insured (5%; n=25) – Public (10%; n=53)• Medicaid• IowaCare• CHAMPUS• VA• Military
*Medicare was excluded
Type of Assistance
• Who helped choose coverage:– Myself-39%– Work/HR-37%– Friends/family-10%
Age & Marital Status
70%6%
3% 10%
11%
Marital Status
MarriedLiving as marriedWidowedDivorced/ SeparatedNever married
Age
18 to 29
30 to 39
40 to 49
50 to 64
65 +
0%
10%
20%
30%
40%
50%
60%
11%17% 17%
55%
1%
24% 24%19%
30%
0%
Employer Insurance
Not Employer Insurance
Health Status
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
18%8% 4% 11%
46%
43%
17%
30%
31%
37%
38%
40%
5% 12%
39%
16%
Fair/PoorGoodVery GoodExcellent
Current coverage related questions
• How well meets needs• Importance of costs– Non-covered services– Delay care– Worry
• Importance of having coverage– Self– Family
Current coverage meets needs
Excellent
Very good
GoodFair/Poor
0%
5%
10%
15%
20%
25%
30%
35%
40%
31%
36%
24%
9%
15%
29%
33%
22% Employer Insurance
Not Employer Insurance
Public Insurance rated higher for kids than private: IA Household Health Survey
Current cost: Non-covered services
Very serious
Serious
Somewhat
Not serious
0%
10%
20%
30%
40%
50%
60%
70%
4%8%
27%
60%
13%17%
24%
43%Employer Insurance
Not Employer Insurance
Public Insurance rated higher for kids than private: IA Household Health Survey
Current cost: Delayed care
Yes0%
10%
20%
30%
40%
50%
60%
70%
80%
30%
71%
Employer Insurance
Not Employer Insurance
Current cost: Worry about pay for self
Very wor...
Worried
Somewhat
Not worried
0%
10%
20%
30%
40%
50%
60%
14%11%
25%
50%
41%
22% 20%17%
Employer Insurance
Not Employer Insurance
Current cost: Worry about pay family
Very wor...
Worried
Somewhat
Not worried
0%
10%
20%
30%
40%
50%
60%
70%
8% 10%
22%
59%
36%
20% 20% 22%
Employer Insurance
Not Employer Insurance
Importance of coverage: self/family
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%89%
9%2% 1%
71%
18% 20%
1%
92%
5% 3% 0%
Self: Employer Insurance
Self: Not Employer Insurance
-
All Family
ACA related questions
• Aware– Source
• Knowledge overall– Specifics– Support
How much HEARD about ACA
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1% 4%15%
43%
46%
57%
38%
15%
A lotSomeNot muchNot sure
How much KNOW about ACA
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1% 6%9%
24%33%
35%
48%
27%
9% 9%
A lotSomethingHeard of butNot anythingNot sure
Support/Knowledge of ACA
Preexist
Prev Cov
Biz credits
Kids to 26
HBMP
Lg Biz Cover
Mcaid exp
Support HI
Ind Man
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%91%
86% 85%80%
70% 68%64%
58%
45%
58%
43%36%
73%
41% 40%44%
29%
52%
Support
Know
Support=Strongly and support; Know=strongly and know
Knowledge less, support similar, : For those most likely to use Marketplace
Knowledge less for all areas• Age 26 coverage (77% vs 59%)• Denial of coverage (64% vs 38%)• Individual mandate (56% vs 34%)• Medicaid expansion (49% vs 26%)• Preventive coverage (47% vs 29%)• Marketplace existence (46% vs 21%)• Large business mandate (44% vs 24%)• Business tax credits (40% vs 20%)• Marketplace tax credits (32% vs 16%)Support• Age 26 coverage less (83% vs 69%)• Marketplace credits more (65% vs 57%)
How learned about ACA
• Television: 54%– Employer 58%– Non employer 46%
• Newspaper: 41%– Employer 47%– Non employer 23%
• Family/friends: 35%– Employer 36%– Non employer 30%
• Internet: 33%
– Employer 36%– Non employer 28%
• Public health agencies: 29%– Employer 34%– Non employer 16%
Radio 27%; All others less than 20%: HI agents, Direct Mail, informational meetings at Hosp, Brochures at MD, Public forums, social media
Health Benefits Marketplace1. Factors affecting choice (current & future)2. Comfort with online system3. Amount of help with online system4. Preference for how to get help5. Amount of help for particular plan info6. Post-purchase need for help7. Confidence in possible sources of help8. Plan preferences9. Marketplace naming and source of information
Factors affecting choice of plan*
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
72% 71% 70%
55%
38%
28%
17%
83%79% 77%
65%
38% 39%
22%
Current
Future
*Percentage Responding Very Important
Plan factors similar for those most likely to use Marketplace
Current plan choice• Monthly cost more (80% vs 70%)Marketplace plan choice• Providers less (67% vs 54%)
Preference for number of plans
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
23%39%
57%
47%
15%13%
6% 1%
Not sure
Just a few
A moderate number
As many as possible
Choice guidance preference
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
14% 17%
30% 22%
53%55%
3% 7%
Not sure
Combination
Guide to best plan
Simply show options
Comfort w/online system choosing plan
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
17% 20%
24% 19%
28%24%
26%29%
5% 8%
Not SureNot ComfortSomewhatComfortableVery Comfort
Need for help with online system
Employer Insured Not Employer Insured0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
25%40%
52%
42%
17% 12%2% 1%4% 4%
Not SureNoneVery littleSomeA lot
Preference for how to get help: Marketplace
0%
10%
20%
30%
40%
50%
60% 57%
41%
32%
26%23% 22%
1%
47%43%
30%27%
30%
21%
3%
Employer
Not Em-ployer
How much help with plan info: Marketplace*
Out pocket
Services
Monthly$
PlanQuality
Reputation
Providers
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
37%39%
30%
23%19%
22%
43%40%
35%
30%
25% 25%Employer
Not Em-ployer
*Percentage Responding A lot of help
Confidence in sources for help*
0%
10%
20%
30%
40%
50%
60%
70% 65%
56% 56% 54%48%
45% 44% 44%
33%
22%
54% 55% 56% 54%51%
39%45%
39%34%
28% Employer
Not Em-ployer
*Percentage Responding Confident or Very Confident
Plan information post-purchase help
Services
Out pocket
Monthly$
Claims pa...
Providers
Billing pro...
Adjustm...
Appeals
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
75%
65%58% 60%
44%
65%
48% 48%
77% 75%67%
55% 53% 52%
41% 40% Employer
Not Em-ployer
Trusted sources for post-purchase help with previous services
0%
10%
20%
30%
40%
50%
60% 56%53%
34%31% 29%
26%
14%
36%39%
28%
44%
29%26%
19%
Employer
Not Em-ployer
Naming
Not Employer1. Iowa Health Insurance
Marketplace (40%)2. Iowa Health Choices (18%)3. Iowa Health Benefit
Marketplace (9%)
Employer4. Iowa Health Insurance
Marketplace (43%)5. Iowa Health Choices (15%)6. Iowa Health Insurance
Exchange (14%)
How would you learn about Marketplace
• Employer: 57%– Employer (67%)– Non employer (45%)
• Television: 51%– Employer (57%)– Non employer (50%)
• Newspaper: 37%– Employer (42%)– Non employer (35%)
• Internet: 36%
– Employer (38%)– Non employer (45%)
• Radio: 32%– Employer (36%)– Non employer (30%)
Other: Friends/family, HI Agent, Direct mail, Local Hosp meetings, Brochures at MD, Public events, Social media, PH Agencies, Non profits
Top 5 most trustworthy sources of Marketplace information
Employer
Pub Hlth
Ins. agent
Fam/Frie
Brochures
0%
10%
20%
30%
40%
50%
60%55%
49%
28%24% 23%
40%43%
27% 29%24% Employer
Not Em-ployer
Conclusions:For those most likely to use Marketplace
• Non-employer are sicker– not as sick as IowaCare
• Current coverage doesn’t meet needs as well– Cost for non-covered services more important– More likely to delay care for costs– Much more likely to worry about costs for self and family
• Having coverage less important for self– As important for family
• Much less knowledgeable about the Marketplace– Heard less, know less– Similarly supportive of components
Conclusions:For those most likely to use Marketplace
• Prefer more plans to choose from• Need more help with selecting plans• Less comfortable with online selection system– Would need more help– Prefer one-on-one type assistance• Phone, in person
• Need more help post selection– Trust providers most following purchase
Conclusions: General
• Cost is more important than quality when choosing a plan– Even more for choosing plan in the marketplace
• Learned about ACA from:– Television, Newspaper Family/friends, Internet, Public health
agencies• Preferred moderate to many plans to choose from on MP• Prefer at least some guidance in online system when
choosing plan • Want help with cost and services covered
Conclusions: General
• Most likely to learn about Marketplace from:– Employer, TV
• Trusted sources for marketplace information– Work HR, Public Health Agencies
• Trusted sources for marketplace purchase help– Work HR, Print, Community resources
• Trusted sources for post-purchase help– Work HR, Marketplace website, Community resources,
providers– Preferred Marketplace name over Exchange