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Health Benefits Marketplace Perceptions of Consumers in Iowa Pete Damiano Suzanne Bentler Dan Shane Iowa Safety Net Network Leadership Group Meeting August 6, 2013

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Health Benefits Marketplace. Perceptions of Consumers in Iowa Pete Damiano Suzanne Bentler Dan Shane Iowa Safety Net Network Leadership Group Meeting August 6, 2013. In this presentation. Consumer survey Methods Demographics Insurance coverage and factors affecting choice - PowerPoint PPT Presentation

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Page 1: Health Benefits Marketplace

Health Benefits Marketplace

Perceptions of Consumers in Iowa

Pete DamianoSuzanne Bentler

Dan Shane

Iowa Safety Net Network Leadership Group MeetingAugust 6, 2013

Page 2: Health Benefits Marketplace

In this presentation

• Consumer survey– Methods– Demographics– Insurance coverage and factors affecting choice– Knowledge and Attitudes toward the ACA– Marketplace preferences and assistance

Page 3: Health Benefits Marketplace

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

Page 4: Health Benefits Marketplace

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

Page 5: Health Benefits Marketplace

Type of Assistance

• Who helped choose coverage:– Myself-39%– Work/HR-37%– Friends/family-10%

Page 6: Health Benefits Marketplace

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

Page 7: Health Benefits Marketplace

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

Page 8: Health Benefits Marketplace

Current coverage related questions

• How well meets needs• Importance of costs– Non-covered services– Delay care– Worry

• Importance of having coverage– Self– Family

Page 9: Health Benefits Marketplace

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

Page 10: Health Benefits Marketplace

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

Page 11: Health Benefits Marketplace

Current cost: Delayed care

Yes0%

10%

20%

30%

40%

50%

60%

70%

80%

30%

71%

Employer Insurance

Not Employer Insurance

Page 12: Health Benefits Marketplace

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

Page 13: Health Benefits Marketplace

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

Page 14: Health Benefits Marketplace

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

Page 15: Health Benefits Marketplace

ACA related questions

• Aware– Source

• Knowledge overall– Specifics– Support

Page 16: Health Benefits Marketplace

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

Page 17: Health Benefits Marketplace

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

Page 18: Health Benefits Marketplace

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

Page 19: Health Benefits Marketplace

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%)

Page 20: Health Benefits Marketplace

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

Page 21: Health Benefits Marketplace

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

Page 22: Health Benefits Marketplace

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

Page 23: Health Benefits Marketplace

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%)

Page 24: Health Benefits Marketplace

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

Page 25: Health Benefits Marketplace

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

Page 26: Health Benefits Marketplace

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

Page 27: Health Benefits Marketplace

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

Page 28: Health Benefits Marketplace

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

Page 29: Health Benefits Marketplace

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

Page 30: Health Benefits Marketplace

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

Page 31: Health Benefits Marketplace

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

Page 32: Health Benefits Marketplace

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

Page 33: Health Benefits Marketplace

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%)

Page 34: Health Benefits Marketplace

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

Page 35: Health Benefits Marketplace

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

Page 36: Health Benefits Marketplace

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

Page 37: Health Benefits Marketplace

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

Page 38: Health Benefits Marketplace

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

Page 39: Health Benefits Marketplace

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

Page 40: Health Benefits Marketplace