Dominated plans are bad choices. A dominated plan is tied or beaten on all relevant criteria. This means a buyer is either limited in choice or is paying more than they should for a given level of accepted risk.
Decision support tools are supposed to help make good choices easier. Good tools should encourage good choices and either completely eliminate dominated choices or at least make it clear that these are inferior choices.
Healthcare.gov is not helping on this matter.
A Durham, NC resident earning $15,000 buys at Healthcare.gov. Here is a screenshot from Healthcare.gov of the BCBS-NC plan choices. Blue Cross and Blue Shield is offering a single network and a fairly significant Silver Gap so that their cheapest Silver plan is a $0 net premium plan and they also offer three $0 premium Bronze plans.
https://t.co/eycJJS2vFK emphasizes dominated plans (example single 55 y/o in Durham County earning $15,000 year showing only BCBS-NC plans)
Bronze #1-3 and Silver (CSR) are all $0 premium plans but Silver has a $250 deductible /$600 OOPMax vs Bronze all at $6,000+ pic.twitter.com/e3suRDZo6a
— David Anderson (@bjdickmayhew) November 6, 2018
The CSR Silver plan is the clearly superior plan. It is the plan that (assuming the network is adequate) that this person should buy because it provides a low deductible and a very low out of pocket maximum. The Silver CSR plan is useful protection while the Bronze plans don’t provide protection until someone has spent three to four months of income on medical expenses.
Yet, Healthcare.gov displays the three Bronze plans first. We know that people cue on the top option when they have to make a choice under uncertainty. We hope that the monetary differences is enough to move someone from anchoring on the first displayed plan, a Bronze plan, and moving to the much better for them Silver plan at #4 but we can’t guarantee this.
Emphasizing dominated plans is a problem that Healthcare.gov has always had as the exchange management function is to validate that a file load fits parameters and little else. There is not a lot of direct, embedded decision support in the platform. Decision support should change decision patterns so that would produce significant winners and losers and therefore significant opposition.
Buying insurance without good support is hard. Healthcare.gov does not make it easier.
On the Road and In Your Backyard
JR
What if they displayed the plans in columns with tabulated benefits and expenses? That layout really is quite bad, I agree.
Sab
What is a “dominated” plan?
David Anderson
@Sab:
” A dominated plan is tied or beaten on all relevant criteria. ”
So in this case, same network, same insurer, same plan type (so all ties)
And then much higher deductible and out of pocket cost sharing.
jonas
There’s a lot of stuff like this that could be vastly improved. Unfortunately HHS is now filled with people dedicated to sabotaging it in every way possible. Maybe some better House oversight can help, but I doubt it on stuff like this. The fumigation job the next Dem president will have to do on the entire executive branch to get rid of the Trump stank will be enormous.
David Anderson
@jonas: Dominated plan choices are not a Trump administration problem. It is a HC.Gov business/service model problem. HC.Gov accepts anything approved by the states and provides very little decision support. It gives a sort and filter option but that is buyer driven instead of a shaped experience which is then buyer modified.
marduk
Are there any good resources out there to help me pick an optimal plan? We buy on the SHOP exchange in NY so the only subsides are an employer match.
Butch
So one good thing from my layoff last June is that we’re now eligible for a subsidy – but does your column here mean that I should be looking beyond the most expensive Bronze, which is what I had initially settled on? It’s $391 a month with the subsidy ($7,000 deductible, coverage for prescriptions and good coverage for doctors visits); I hadn’t even looked at Silver or Gold because I assumed I’d be priced out of them.
David Anderson
@Butch: look around
Sergio Lopez-Luna
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