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.