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ACA Consumers Dissatisfied After Private Payer Exchange Exit

The decision of major private payers to exit the health insurance exchanges contributed to decreased quality for consumers with coverage under Affordable Care Act.

As major payers exited ACA exchanges, consumer satisfaction lowered.

Source: Thinkstock

By Thomas Beaton

- Consumer satisfaction with the Affordable Care Act fell following the departure of three private payers from the health insurance exchange, according to recent findings from Black Book.

The survey comprises feedback from 34,800 consumers continually enrolled in ACA plans between January 2015 and February 2017 polled following the beginning of open enrollment in November 2016.

Based on the findings, 2017 plans proved to be a turning point for consumer satisfaction, with 58 percent of respondents claiming the quality of their ACA plans services has changed for the worse in a year’s time. Additionally, three out of four private healthcare marketplace plans experienced significant declines in member satisfaction.

The departure of the likes of Aetna and  Humana, both of which will stop selling health insurance plans through the ACA exchanges altogether by 2018, is having an effect on  marketplace options for ACA enrollees.

“Maintaining a high level of support has been nearly impossible since this last open enrollment began as several plans accepting the bulk of 2017 regional enrollees failed to congruently ramp up member services support to process claims, respond to enrollment issues, answer provider questions, denials, authorizations, and payment postings,” said Black Book Managing Partner Douglas Brown.

In February 2016, a previous Black Book survey found that 77 percent of 21,800 ACA enrollees scored their private ACA coverage between “good” and “very excellent.” This year however, only 22 percent of 44,200 private ACA enrollees scored their coverage the same way.

The number of individuals covered by private ACA coverage increased over that time, but so too did general dissatisfaction with the quality of their plans. As private insurers drop exchanges there is less competition for ACA enrollees to choose from in terms of quality, service, and affordability.

“The downward slide in competition means that in 2017, consumers in 70 percent of US counties are left with just one or two insurer options on the exchanges, up from 36 percent in 2016.”

 Of the consumers surveyed, 96 percent were declined customer support services. Member service interaction dropped, as 92 percent of survey respondents noted substandard service.

Members with private ACA coverage encountered increased member problem resolution times from the previous year. The length of time it took to resolve a problem extended from 12.5 days in 2016 to 31.4 days in 2017. Forty-eight percent of surveyed enrollees complained of website downtime that lasted weeks and call center wait times of over an hour since November of last year.  

Insurance premiums increased for 90 percent of respondents and 80 percent experienced a narrowing of provider networks or exclusions from their former providers. Seventy-seven percent of consumers saw curtailed benefits within their ACA coverage.  

These outcomes reveal the importance of a healthy, competitive insurance market needed to meet healthcare consumer demands and expectations.

“Insurance firms have struggled with a group of enrollees that have been sicker and older than expected leading to large losses,” Black Book reported. “This has been especially acute in states that did not expand their Medicaid offerings such as South Carolina. On the positive side most of the premium increase, while intense, appear to be a normalization after insurers underpriced plans when Obamacare first rolled out.”

Additional information appended to the study found that five states with one only ACA insurer ranked in the bottom ten percent for customer satisfaction: South Carolina, Alabama, Alaska, Oklahoma, and Wyoming. Meanwhile, Florida, California, Texas, and North Carolina had the highest amount of ACA signups, but reported the highest rates of member service and claims staff dissatisfaction.

State averages for ACA satisfaction showed noticeable geographic disparities.

ACA consumers in Florida using ACA coverage under a Blue Cross Blue Shield plan reported 2017 customer satisfaction rates of nine percent. Conversely, Connecticut Blue Cross Blue Shield members with ACA coverage reported satisfaction rates of 87 percent.

Lowest Satisfaction for Private ACA Policyholders

Source: Black Book Market Research

Major private healthcare payers last year started to reduce the number of health insurance exchanges they planned to sell through, based on several losses financially ranging from millions to deficits in the billion-dollar range.

“The declining number of marketplace plans are evidently losing the consumer-centric approach to keep their members engaged, particularly as compared to the commercial or employer health plans that are not participating in Obamacare,” said Brown.

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