In the July issue of CJR and on CJR.org, we introduced readers to a woman we called Carol, who had contacted me about her health insurance options. Carol lives in a Philadelphia suburb, works as a freelance proofreader, and has an individual market policy from Aetna—which had just sent a letter advising that her monthly premium would increase $100 and suggesting she hang on to her policy, because the new ones she could buy on the insurance exchange would contain benefits she might not need. (Aetna’s letter didn’t mention she might qualify for subsidies.)
Carol decided to check out her options. Since the Pennsylvania exchange is run by the federal government, that has meant shopping on HealthCare.gov. I’ve spoken to her frequently over the past week, and her experience shows just how hard it is to be a good consumer of health insurance—despite the pledges of the Obama administration, which promised that buying a policy would be as simple as buying an airline ticket. The frustration starts with the troubled government website, of course, but Carol’s story is also about a lack of help and good information from Independence Blue Cross, the carrier whose policies she thought she wanted. It is also a tale that shows how important shopping tools—good, accurate, and complete information, along with consumer protections—often remain either hidden or nonexistent. It’s caveat emptor in the insurance jungle!
It’s fair to ask whether informed consumer choice is even truly possible, given how complex policies are and the myriad features that must be examined to make a good comparison. To have a chance, shoppers will need a press that’s on their side—consumer-focused coverage that delves into the details and explains risks and trade-offs. (As we’ll see later, there’s been a bit—but only a bit—of that in the leading media outlet in Carol’s region.) We hope our look at Carol’s story serves as a model for reporters doing similar stories around the country.
Carol’s search for a new policy began on Nov. 5. She hoped that the continued fixes the government claimed it was making to HealthCare.gov had made it possible to shop, but she knew going in it would be a challenge. “I’m totally mixed up,” she told me. “Like everybody else in the U.S., it’s not like insurance is the number one thing I think about when I get up.” One thing she did think she knew: she didn’t want another policy from Aetna, where she’d been disappointed with customer service. “I can’t get any issues resolved without several phone calls,” she explained.
On her first try with the website, she found a page that listed 27 plans for her county: 15 sold by Blue Cross, 12 by Aetna. While that might appear to be a fair amount of choice, there were only two carriers, one of which she had ruled out. She was pretty much at the mercy of one carrier that dominates her state, a predicament faced by other consumers across the country. Also, the website provided only estimated premiums for the policies—some of which sported fanciful names like Aetna Advantage Plus, Keystone HMO Silver Proactive, or even Personal Choice PPO Bronze Reserve, which sounded more like a wine label than the name of an insurance policy. The webpage advised that Carol would get final quotes for specific plans after she had completed a Marketplace application.
She tried to do that, but couldn’t get beyond the security questions. The site told her she couldn’t use the same answer to more than one question, but when she complied, she was still stuck. She tried again the following day. Same problem that day, too—and the next, and the next, and the next. (All told, she made 24 visits over eight days.) Frustrated, she called the 800 number listed on the site and talked to a person who gave the administration’s standard line about computer glitches, and then offered to create an account with her on the phone. She also suggested Carol call the insurance companies directly and ask for details, or complete a paper application and mail it in.
But Carol didn’t have enough details about the policies to sign up over the phone or on paper. She decided to investigate further, using the website of Independence Blue Cross. I had suggested that she ask about a document called the Summary of Benefits & Coverage, a good consumer disclosure statement; insurers are not required to provide these summary forms, but consumers have the right to receive one if they ask. But what Carol got from Blue Cross was not the official coverage document—it offered some details, but not enough to make a fully informed decision.