© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org Click to edit master title style. 1 Plan selection: The Devil Is In The Details Sophie Stern Deputy Director, Best Practices Institute Enroll America

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 2 Consumers Are Highly Price Sensitive Source: GMMB and PerryUndem Research and Communication, May 2015,

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 3 The Uninsured Look At More Than The Premium Source: GMMB and PerryUndem Research and Communication, May 2015,

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 4 Marketplace Enrollees Also Consider More Than Just Premiums… Source: GMMB and PerryUndem Research and Communication, May 2015,

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 5 Top Reasons for Purchasing Coverage: Protection From Medical Bills and Fine Source: GMMB and PerryUndem Research and Communication, May 2015,

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 6 Host Of New Tools For OE3

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 7 Anticipated Findings From OE3 Who’s selecting what? What makes users more likely to enroll? Does the number of plans in a market area influence behavior? What aspects take users longest?

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 8 TAKING A CLOSER LOOK: PICKING THE “RIGHT” PLAN

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 9 Taking A Closer Look Using the Get Covered Plan Explorer Jose Gonzales Lives in Fairfax County, VA Annual Income: $48, years old and uninsured Excellent health Prostate cancer (still awaiting results)

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 10 Taking A Closer Look Using the Get Covered Plan Explorer

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 11 Type of careEstimated Use Lab test1 Hospitalization1 Outpatient non-surgery4 Specialist visit2 Well visit1 Taking A Closer Look Using the Get Covered Plan Explorer

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 12 Taking A Closer Look Using the Get Covered Plan Explorer

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 13 Taking A Closer Look Using the Get Covered Plan Explorer

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 14 Taking A Closer Look Using the Get Covered Plan Explorer

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 15 Taking A Closer Look Using the Get Covered Plan Explorer

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 16 Gold $0 Deductible Higher Premium and Overall Cost Silver $2,000 Deductible Lower Premium and Overall Cost Hospital staySpend 30% of the total bill. May hit the out-of- pocket maximum of $6,850 in one visit. No fee after the deductible. Likely spend $2,000 out-of- pocket for a hospital stay + the hotel room fee of $1,250. Outpatient surgery Spend 30% of the total bill. May hit the out-of- pocket maximum of $6,850 in one visit. Will likely pay $2,000 (to hit the deductible). Additional co-pays would apply until the out-of-pocket maximum of $6,500 is reached. Emergency/Serious Medical Procedure

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 17 Gold $0 Deductible Higher Premium and Overall Cost Silver $2,000 Deductible Lower Premium and Overall Cost Hospital staySpend 30% of the total bill. Will likely hit the out-of-pocket maximum of $6,850 in one visit. No fee after the deductible. Likely spend $2,000 out-of-pocket for a hospital stay + the hotel room fee of $1,250. Outpatient surgery Spend 30% of the total bill. May hit the out-of- pocket maximum of $6,850 in one visit. Will likely pay $2,000 (to hit the deductible). Additional co-pays would apply until the out-of- pocket maximum of $6,500 is reached. Emergency/Serious Medical Procedure Less overall for a hospital stay or outpatient surgery and less money per month

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 18 Gold $0 Deductible Higher Premium and Overall Cost Silver $2,000 Deductible Lower Premium and Overall Cost Primary carePay a flat $30 for each visit Hit deductible ($2,000) then pay $25 for each visit Specialist visitPay a flat $60 for each visit Hit deductible ($2,000) then pay $50 for each visit Mental health visit Pay a flat $30 for each visit Hit deductible ($2,000) then pay $25 for each visit Standard Services

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 19 Gold $0 Deductible Higher Premium and Overall Cost Silver $2,000 Deductible Lower Premium and Overall Cost Primary carePay a flat $30 for each visit Hit deductible ($2,000) then pay $25 for each visit Specialist visitPay a flat $60 for each visit Hit deductible ($2,000) then pay $50 for each visit Mental health visit Pay a flat $30 for each visit Hit deductible ($2,000) then pay $25 for each visit Standard Services Budget doesn’t allow for unexpected and/or large expenses, but can afford to pay more monthly.

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 20 What It Boils Down To… Comfort with risk and actual budget may drive choice – regardless of whether it’s “logical” Tools are helpful… but in-person help remains critical!

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 21 KEY TAKEAWAYS FOR CONSUMERS

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 22 Things For Consumers To Consider

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 23 Things For Consumers To Consider

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 24 Things For Consumers To Consider Picking a plan that meets your needs and budget means looking at more than the premium and deductible. The lowest cost is the total you'll spend on monthly premiums in one year. The highest cost is the total you'll spend on monthly premiums plus the out-of-pocket maximum for the plan for one year. You will fall in between the minimum and maximum numbers based on how much health care you need in 2016.

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 25 What does your budget allow? Pay the bulk of the costs up front, and then relatively little for the remainder of the year? Spread the cost out over the course of the year, but possibly spend more money overall? Cost sharing for specific services? Out-of-network or in-network? Things For Consumers To Consider Looking at the differences in cost for emergency/major services and non- emergency care is important

© 2016 Enroll America and Get Covered America EnrollAmerica.org | GetCoveredAmerica.org 26 QUESTIONS?