Consumer Testing of the Coverage Facts Label

Among other goals, Federal health care reform seeks to expand access to quality, affordable health insurance coverage.

Achieving that goal hinges on well-functioning insurance markets and consumers understanding the health insurance options available to them. To promote informed decision-making, the Affordable Care Act requires health insurers to use a new, standardized Summary of Benefits and Coverage form (Summary) to convey the benefits and cost-sharing provisions of their health plan offerings. A required component within the Summary is a consumer aid called the “Coverage Facts Label.” The Label will take traditional health plan information and calculate what consumers would have to pay out of pocket under different medical scenarios.

With support from the New York Health Foundation and the Missouri Foundation for Health, Consumers Union conducted testing of the Coverage Facts Label prototype to answer questions regarding how the Label would help consumers understand their health benefits coverage.