Empowering Health Care Consumers

Grantee Name

IMPAQ International, LLC

Funding Area

Empowering Health Care Consumers

Publication Date

November 2019

Grant Amount

$286,380

Grant Date:

November 2016 - December 2017

When shopping for a health plan, many consumers make enrollment decisions solely based on premium costs, and then find themselves having to pay significant costs out-of-pocket for certain drugs or treatments after they have enrolled.

These hidden out-of-pocket costs can vary significantly by plan product, and for people with certain conditions or life events, the costs can be high. Many of these hidden costs only show up after treatment in unexpected bills—putting higher cost burdens on patients. Existing tools that offer consumers estimates of their out-of-pocket costs often provide generalized estimates that can be confusing or misleading.

In 2016, NYSHealth awarded IMPAQ International a grant to create a consumer transparency tool that provides New Yorkers with meaningful and transparent out-of-pocket cost estimates—by health plan—for specific high-cost, common conditions. IMPAQ was one of a cohort of grantees selected to fund ambitious, large-scale projects and studies that help to arm consumers with tools and resources to inform their decision-making.

Outcomes and Lessons Learned

  • Created the NYPlanCosts Calculator, the first-in-the-nation calculator that lets New Yorkers compare out-of-pocket costs for individual and small group market health plans in their areas, available on and off the New York State of Health Marketplace, and filter the results by key criteria, such as metal level and plan type.
  • Conducted extensive stakeholder engagement as part of the website’s development and external testing, particularly with New York State-based Navigator and consumer groups such as the Community Service Society of New York (CSS) and the Columbia County Community Healthcare Consortium.

The calculator allows consumers to compare out-of-pocket costs for up to 10 chronic conditions (e.g., diabetes, multiple sclerosis, heart disease) by health plan. The estimates are also tailored based on several other criteria, such as sex, height, weight, county, and income, and users can filter results by preferences such as metal level and insurance company. The calculator also redirects consumers who may be eligible for Medicaid or Essential Plan coverage under the Marketplace to appropriate resources for more information.

Navigator and consumer advocate feedback was an integral part of the project and yielded valuable insights into how IMPAQ shaped the website’s overall user interface, layout, and content. User-experience surveys with these groups found that the calculator was very useful in helping them assist clients. For example, 88% of the Navigator respondents have used the tool to assist a client with at least one of the featured conditions, and the Navigators believed that those clients could benefit from the calculator during plan selection. The survey results also highlighted how the calculator filled a gap in Navigator resources and that it can be used to make enrollment sessions more efficient. IMPAQ found that engaging consumer advocates and incorporating their feedback in all stages of the calculator’s development and dissemination was essential to creating a consumer-friendly tool.

Additionally, IMPAQ coordinated with the Marketplace throughout development and testing to ensure the calculator’s website aligned with existing New York State consumer tools, such as the NYS Provider & Health Plan Look-Up Tool.

The calculator filled a need for an information transparency tool that New York consumers can use to find and compare out-of-pocket costs, better inform their decision-making, and help them select the plan that will be most affordable in the long run. As similar consumer assistance tools do not exist in other states, the calculator can be used as an innovative model to meet consumer needs across the country. By shedding light on the significantly different out-of-pocket costs under various health plans, which previously had been invisible to consumers, the tool also offers a policy opportunity for New York State to reduce cost variation faced by New Yorkers with chronic conditions.

Being the first tool of its kind was not without challenges. Under the scope of this project, premiums were not included, which in retrospect should have been prioritized over some of the other search criteria used. Timing was also an issue, as the calculator was not publicly available until only a few weeks before the 2018 open enrollment deadline for consumers to sign up for health insurance on the Marketplace. As a result, New Yorkers had shortened the amount of time in which to use the tool for comparing and selecting plans.

With additional NYSHealth funds, IMPAQ updated the calculator to include 2019 health plan data and relaunched it in December 2018, giving consumers more lead time in using the tool for 2019 open enrollment. The revised tool offered out-of-pocket cost estimates for all 2019 health plan offerings, on and off the Marketplace, to ensure that New Yorkers had a comprehensive view of all available options. IMPAQ also integrated feedback received from consumers and health insurance Navigators to improve website usability and clarify language to make explanations more intuitive and easy-to-understand. It then collaborated with CSS and other Navigator groups to raise awareness about the updated calculator.

Co-Funding and Additional Funds Leveraged: N/A