As skimpy health plans with limited coverage become more available, people shopping for insurance are at risk of buying a plan that doesn’t meet their needs — because it can be hard to tell the difference.

That’s what happened to Stephanie Sena, an adjunct Villanova University professor whose story was published in The Inquirer on Monday. She isn’t eligible for coverage through the university because her position is part-time, so she turned to the internet for health insurance. She found out the plan she bought wasn’t real insurance when she was hospitalized with sepsis and needed an amputation — and the plan refused to pay a dime.

Some readers were quick to criticize the 39-year-old Philadelphia resident, saying she should have read the plan more closely, done her research, and understood what she was buying before signing up. But a small survey by consumer advocates for the National Association of Insurance Commissioners suggests that Sena’s experience is not unusual.

Interviewers spent an hour going over a short-term health-plan pamphlet with nine individuals of varying income, education, and insurance levels. They found that people often had difficulty identifying how the short-term plan was different from an Affordable Care Act-compliant plan, which is required to cover preexisting conditions, pregnancy, preventive care, and other basics. Participants also had difficulty identifying how the short-term plan would pay for services and whether it would meet their health needs.

“These are people who spent an entire hour with the marketing brochure, with someone helping them, and they still didn’t get it. … This is almost a best-case scenario, and they still didn’t understand,” said Katie Keith, a part-time researcher at Georgetown University’s Center on Health Insurance Reforms, who is part of the group of consumer advocates appointed by the National Association of Insurance Commissioners.

The group commissioned Kleimann Communication Group to conduct the survey in St. Louis, with funding from the Robert Wood Johnson Foundation.

Though small, the survey points to a troubling lack of understanding about health insurance, Keith said, as Republicans loosen ACA restrictions to make plans with varying levels of coverage more accessible.

Here’s what the survey found:

  • Few participants understood the difference between a short-term plan and an ACA plan. Short-term plans are not required to cover prescription drugs, pregnancy, and mental health, among other services. But survey participants expected the plan they were reviewing would cover those services because that’s what they’ve come to expect under the ACA, Keith said.
  • They thought their preexisting conditions would be covered. At least a quarter of non-elderly adults have what could be considered a preexisting condition because the list is long and expansive — obesity, dementia, pregnancy, cancer, asthma, diabetes, depression, to name a few. Even survey participants who understood the plan’s coverage for preexisting conditions was limited wrongly thought their condition would still be covered.
Survey respondents had trouble understanding how the plan would pay for services and comparing options with these charts included in the plan pamphlet.
Courtesy
Survey respondents had trouble understanding how the plan would pay for services and comparing options with these charts included in the plan pamphlet.
  • They struggled to compare options and understand how the plan paid for services. One reason people often don’t understand how their short-term plans work — and are surprised when they get a big bill — is because they are provided with less information about the plan. ACA-compliant plans must provide a summary of benefits that outlines in detail what services are included, how medications are covered, and the way costs are shared between the insurer and the member, and even includes care scenarios, such as a pregnancy. Non-ACA plans may have a pamphlet with a chart that outlines coverage, but they are not required to provide this information before enrolling members.
  • No one surveyed read the mandatory federal disclosure about the plan’s coverage limitations. Keith said this finding was particularly troubling because advocates of expanding access to non-ACA plans point to these disclosures as a key consumer protection, notifying anyone who may be shopping for full coverage that this isn’t the plan for them. In the pamphlet survey participants reviewed, the disclosure was in small, condensed print beneath a feature photo on the cover — not one survey participant initially noticed it.
Survey participants skipped right over this disclosure noting that the plan doesn't meet ACA coverage requirements.
Courtesy
Survey participants skipped right over this disclosure noting that the plan doesn't meet ACA coverage requirements.

Based on the survey’s findings, the group concluded that regulators need to do more to distinguish ACA plans from those that do not meet the law’s coverage requirements, such as more meaningful disclosures that are harder for consumers to overlook.

Want to read more about how to navigate the insurance market? Read the tips at the bottom of this story or visit the Pennsylvania Health Department’s website.