Websites improve for second open enrollment cycle

The big news about the performance of the state and federally-facilitated health insurance exchange websites for the open enrollment period that began November 15 is that there wasn’t any big news.

“Both the federally managed exchange and most state exchanges performed reasonably well,” says John Barkett, MBA, director of Health Policy Affairs for Exchange Solutions at Towers Watson in Washington, D.C. “While some technical glitches occurred, such as customers having trouble accessing accounts they created in 2013 or not being able to complete their enrollment applications online, there have been nowhere near the number and magnitude of problems experienced in 2013.”

Rone George, president and chairman of Healthcare Nation Awareness Foundation, Inc. in Miami, Florida, was also pleased with the exchanges’ progress. “The websites are faster and more efficient, and users don’t have to navigate as many screens to enroll,” he said.

Ash Shehata, MBA, U.S. healthcare payers lead at Advisory KPMG LLP, in Cincinnati, Ohio, concurs. “One year ago there were many obstacles tied with determining eligibility and subsidies for waves of people looking to enter the health insurance market,” he says. “Many of the states took the year to resolve their exchange’s glitches.”

The vast majority of consumers had a smooth experience in getting covered on healthcare.gov, according to a represenative of the U.S. Department of Health and Human Services (HHS). On the first day of open enrollment, there were more than 500,000 successful log-ins and more than 100,000 people submitted applications, according to HHS.  As of December 15, the site had logged almost 10.9 million unique visitors. Four million visitors also “window shopped” on healthcare.gov during that timeframe, comparing plans without making a commitment. The window-shopping component was new to the second open enrollment cycle.

NEXT: Obstacles still abound for some.

Obstacles still abound for some

Given the magnitude of issues when HealthCare.gov debuted in 2013, any glitches the second time around didn’t seem as significant. But there definitely were some hiccups.

One area of concern is the auto-enrollment feature of the federal exchange, Barkett says. Auto enrollment is designed to automatically re-enroll consumers in plans they had the previous year if they did nothing. “But the premiums and deductibles of many exchange plans for 2015 have changed and consumers who don’t shop for plans this year may be shocked by how much more money they’ll have to pay for their health insurance premiums,” he says.

HHS estimates that as many as 5.1 million consumers could be automatically re-enrolled in their existing plans. “That’s potentially a lot of unhappy people,”  Barkett says.

Kasey M. Young, individual insurance specialist for Saxon Financial Consulting in Cincinnati, Ohio, says the headaches are still there. “I have had clients spend 15 to 20 minutes filling out the initial step of the application with their family’s basic information, and when they hit ‘submit’ they receive an error message and none of their information is saved,” she says. Ultimately, they spend hours repeating the same step--hoping for success.

Another challenge is that after selecting a plan, an applicant should be able to click “pay my premium” and be led to the insurance carrier’s website to make the first month’s premium payment in order for their policy to be issued. However, Young says some carrier portals almost never work. “This means that the applicant must remember to call and make the first payment via phone prior to the day before their effective date in order for their policy to be issued,” she says.

Shehata says issues range from e-mail transcription errors to password resets and overall customer navigation inquiries. “But the modernization of the back-end transactions and the segmentation of the enrollment steps has made the technical operation more stable,” he says.

Health plan websites are better

Overall, health plans’ websites have been performing better than the public exchange websites. “They are much simpler and take less time than the public exchanges,” Young reports. But there have been some snafus. “There isn’t a way for the applicant to download proof of a qualifying event [QE],” she notes. “If someone has a QE and is applying during open enrollment, we need to hunt down his or her QE documentation and send it to the carrier, or the applicant will automatically be assigned an effective date based on open-enrollment guidelines.”

Steven J. McAbee, president of Lang Financial Group, Inc. in Cincinnati, Ohio, says carrier websites are faster, easier to navigate, and provide more information for consumers to make educated decisions. “But problems arise when consumers are unsure of their subsidy status. Applicants shopping for health insurance coverage on carrier websites are redirected to healthcare.gov for subsidy determination. Then they are redirected back to the referring website to complete the application,” he says.

NEXT: Aggregator exchange websites have benefits

Aggregator exchange websites have benefits

Aggregator websites can play an important role in letting consumers get fast, anonymous baseline quotes for comparison. These sites typically can compare plans side by side, and are supported by licensed agents. Consumers can ask questions about network limitations, drug coverage and so forth. But consumers may have difficulty enrolling, McAbee says.

When using brokeroffice.com through Norvax, Young says not all carriers are represented when quoting. In fact, she may only see two to three carriers when providing a quote. 

Improvements still needed

Public exchanges are still in their early days; some basic functions are missing that consumers have come to expect from even the most basic of e-commerce sites in the commercial world.

For example, two of the most important things consumers need to know about a health plan are 1)if their physicians and other medical providers accept their plan, and 2) if the plan covers their prescription medications.

“On most exchanges, consumers have to look up their doctors and prescription drugs one by one. It’s tedious and error-prone,” Barkett says.

“Ideally, consumers should be able to fill out a profile once and have the exchange website automatically compare a consumer’s needs to the benefits and coverage of each plan he or she is considering.,” he continued.

Greater personalization tools could also help exchange websites.

“If consumers could enter their medical costs for the prior year and then match them with an assortment of the coverage and out-of-pocket costs, it would aid in the process of buying health insurance,” Shehata says.

Rebecca Ditmer, principal of EY’s Advisory Health Care practice in Cleveland, Ohio, believes that simplification of web design and the number of navigation pages may help the overall beneficiary experience.

“As enrollees experience more ‘one and done’ enrollment events, we may see an increased confidence in the enrollment counts being reported along with the reliability and quality of the data being reported,” she says. 

“There is also an opportunity to improve the number of times an enrollee enters the same data in an application.” For example, some sites require multiple entries of the same data such as date of birth, Social Security number and address. “This is a point of frustration for the enrollee, and can lead to data mismatches that can cause challenges,” Ditmer says.

Final thoughts

As with any complex service delivered via a website, public health insurance exchanges will never be perfect and they will never be finished.

“There will always be ways to improve their functionality and ease of use to make them more efficient and consumer-friendly,” Barkett says. “But for those of us who helped shape the Affordable Care Act [ACA] and are now involved in making it work better for more Americans, this is a gratifying time. At least nine million Americans have health insurance today through the ACA.” 

Karen Appold is a freelance medical writer based in Lehigh Valley, Pennsylvania.