Despite the Affordable Care Act’s success in getting 16 million more Americans enrolled in programs, major hurdles still keep consumers from understanding their , finding a doctor and accessing , according to a study by RAND Corp.
Many the newly don’t understand the and benefits offered by their or such unfamiliar terms as “copays,” “coinsurance,” and “,” the study found. Many can’t find a provider who accepts their . As a result, these consumers don’t “fully engage in their ,” including getting the preventive that can help avoid serious illness.
The research firm, based in Santa Monica, California, based its findings on interviews with consumer organizations, healthcare and companies in four states chosen to represent diverse segments the population: Connecticut, Kentucky, Texas and Washington.
The emphasis during the ’s first two open periods was getting people enrolled, RAND notes. But “less attention has been given to the plan selection process and whether consumers are choosing a plan that meets their and financial needs,” including out--pocket costs and provider availability.
Many consumers “struggle with low literacy,” and information is often presented in dense text rather than simple diagrams. Often are selected based only on the premiums, without considering deductibles, copays and other costs.
Most informational materials are available only in English, with some translated to Spanish. But “little attention has been paid to the many other languages spoken by” consumers. One source estimated that by 2019, 23% enrollees will speak a language other than English.
Consumers appreciate the in-person support by "navigators;" individuals or organizations trained who provide free, unbiased help to consumers as they for through Marketplaces.
This help is especially useful for those with low literacy and English proficiency. But navigators can only help consumers sign up for ; they cannot guidance in selection .
RAND said the industry and regulators should consider simplifying plan benefits and -sharing provisions, to make it easier for consumers to understand them.
Even with the right , consumers can find it difficult to obtain . There are shortages doctors and healthcare facilities, particularly in rural or low-income areas. Because low reimbursement rates by some and by , a number are not accepting new patients.
Consumers who select with deductibles or co-pays, or who are not sure what their portion the a medical procedure or will be, often delay seeking , RAND notes.
Many these newly enrolled previously visited hospital emergency rooms to obtain . Even though their now enables them to see a personal physician, they may continue to visit the ER because it is familiar and convenient. Changing this behavior will require education.
Finding a provider and seeing the doctor are important first steps, but real improvements in also require long-term engagement by consumers, says RAND. This includes getting regular preventive checks and, if there are problems, taking the prescribed medication and keeping follow-up appointments.
Many consumers fail to appreciate the regular doctor visits and preventive services. Language barriers, lack transportation, concern about out--pocket costs, and cultural or social issues all can present barriers to consumers obtaining .