Simplifying Choices in the Marketplace-Simple Choice Plans and Quality Star Ratings

Source: CMS
Simplifying Choices in the Marketplace-Simple Choice Plans and Quality Star Ratings

By Kevin Counihan, CEO of & Dr. Patrick Conway, Principal Deputy Administrator of CMS

It’s hard to believe the fourth year of Open Enrollment for the Health Insurance Marketplaces is just six months away. We’re continuing to learn how to make the consumer experience even better, and have been working hard to make improvements for this year. We’ve learned about what information consumers need to make decisions and how to improve the help and support we provide throughout the enrollment process. Because shopping is so important to make sure consumers have the plan that is right for them, we are making sure consumers have clear, easy-to-understand information. We’re excited to announce some new ways we’re doing that. We want to layout two new innovations we plan to pilot with in the next year.

Simple Choice Plans

This year for the first time, consumers will have the option to select “Simple Choice plans”. These are plans that have a uniform set of features – enabling consumers to compare plans on fewer important plan factors like monthly premiums and providers in the plan’s network with the confidence of knowing that the benefits won’t vary from plan to plan.

We expect these plans will be a core part of the shopping experience on this year. To improve decision making, Simple Choice plans will display prominently in Plan Compare, with clear visual cues that show consumers the plans that are easy to compare vs. the ones that should be researched for differences.  Consumers also will be able to choose to only see these types of plans, if they want to quickly compare them.

We will make sure that consumers understand that these plans have a fixed deductible and out-of-pocket limits, and standard copayments within a metal tier (bronze, silver, gold, and platinum). And, for certain services, for instance a primary care appointment, a consumer would pay the same amount in any Simple Choice plan, regardless of the metal tier. These plans emphasize coverage of core services before the consumer has reached their deductible.

We are testing with consumers display options and descriptions for these plans, so that consumers can best understand what they offer, a clear, easy-to-understand choice. Importantly, our approach does not stifle innovation so health plans can continue to offer all kinds of benefit options that will also be easy for consumers to find.

Many of our other consumer tools, such as the physician and prescription drug lookup, as well as the quality ratings discussed below will work together with these plans to help consumers make the most informed decisions they can. Simple Choice plans will help consumers make apples-to-apples cost-sharing comparisons as they shop, enabling them to choose plans with features they find valuable, such as particular providers or a plan’s experience managing chronic conditions.

Quality Ratings

In 2014, we began development of the Quality Rating System (QRS) to provide comparable and useful information to consumers about health plans offered through the Marketplace. The information provided through the rating system can inform consumers about the quality of health care services and enrollee experience, as well as assess the overall patient and consumer experience, for health plans offered on the Marketplaces.

We designed the star rating system with input from health care quality experts and other interested parties to inform the consumer-decision making process. Star ratings provide health plan quality information on important topics, such as how well physicians coordinate with enrollees and other physicians to provide the best care, whether the plan’s network providers give members health care that achieves the best results, and how other enrollees rate their doctors and the care they receive.

In the 2017 Open Enrollment period, CMS will pilot the display of star ratings using a 5-star rating scale. The pilot will be in several selected states that use the platform. During this period, we’ll continue testing consumer use and experience and improve the display of quality rating information. We also have provided the opportunity for state-based Marketplaces to choose to display quality rating information on their websites in the 2017 Open Enrollment period.

The pilot will include plans in Michigan, Ohio, Pennsylvania, Virginia, and Wisconsin — states that CMS selected because they have a large number of health plans participating. As with all quality ratings, they simplify a lot of information and in some cases, consumers would be wise to go beyond what they see here. Piloting the display of QRS star ratings will provide CMS with key feedback to inform the best way to provide quality rating information to consumers nationwide.

The introduction of Simple Choice plans and quality star ratings are just a few new features that will give consumers the information they may need to find a plan that is right for them and their families. We will continue to listen and learn as we get nearer to the next Open Enrollment period.


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Simplifying Choices in the Marketplace-Simple Choice Plans and Quality Star Ratings

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