Theme Issue: State Health Policy Research
Determinants of Coverage Decisions in Health Insurance Marketplaces: Consumers' Decision-Making Abilities and the Amount of Information in Their Choice Environment
Version of Record online: 30 APR 2014
© Health Research and Educational Trust
Health Services Research
Volume 50, Issue 1, pages 58–80, February 2015
How to Cite
Barnes, A. J., Hanoch, Y. and Rice, T. (2015), Determinants of Coverage Decisions in Health Insurance Marketplaces: Consumers' Decision-Making Abilities and the Amount of Information in Their Choice Environment. Health Services Research, 50: 58–80. doi: 10.1111/1475-6773.12181
- Issue online: 29 JAN 2015
- Version of Record online: 30 APR 2014
- VCU Massey Cancer Center
- Virginia Tobacco Indemnification and Community Revitalization Commission. Grant Number: 2585
- Affordable Care Act;
- health insurance exchanges/marketplaces;
- insurance choice;
- health insurance comprehension;
To investigate the determinants and quality of coverage decisions among uninsured choosing plans in a hypothetical health insurance marketplace.
Two samples of uninsured individuals: one from an Internet-based sample comprised largely of young, healthy, tech-savvy individuals (n = 276), and the other from low-income, rural Virginians (n = 161).
We assessed whether health insurance comprehension, numeracy, choice consistency, and the number of plan choices were associated with participants' ability to choose a cost-minimizing plan, given their expected health care needs (defined as choosing a plan costing no more than $500 in excess of the total estimated annual costs of the cheapest plan available).
Primary data were collected using an online questionnaire.
Uninsured who were more numerate showed higher health insurance comprehension; those with more health insurance comprehension made choices of health insurance plans more consistent with their stated preferences; and those who made choices more concordant with their stated preferences were less likely to choose a plan that cost more than $500 in excess of the cheapest plan available.
Increasing health insurance comprehension and designing exchanges to facilitate plan comparison will be critical to ensuring the success of health insurance marketplaces.