Stakeholders' perceptions of ways to support decisions about health insurance marketplace enrollment: a qualitative study.
Approximately 29 million individuals are expected to enroll in health insurance using the Patient Protection and Affordable Care Act (ACA) Marketplace by 2022. Those seeking health insurance struggle to understand insurance options and choose a plan that best suits their needs.



We interviewed stakeholders to identify the challenges associated with the ACA Marketplace health insurance enrollment and elicited feedback about what to include in health insurance decision support tools. Interviews were transcribed and themes were identified using inductive thematic analysis.



Stakeholders stated that consumers felt frustrated by unclear terminology, high plan costs, and complex calculations required to assess costs. Consumers felt anxious about making the wrong choice and being unable to change plans within a calendar year. Stakeholders recommended using plain language tables defining complex terms, grouping information, and using engaging graphics to communicate information about health insurance. Stakeholders thought that narratives of how others made decisions about insurance might be helpful to consumers, but recommended that they be tailored to the needs of specific consumers.



Strategies that clarify health insurance terms using plain language and graphics, acknowledge concern associated with making the wrong choice, calculate and enable cost comparison, and tailor information to consumers' unique needs could benefit those enrolling in ACA Marketplace plans, Narratives developed should be simple and inclusive enough for diverse populations.
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
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Housten
George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130-4899, USA.
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Furtado
Department of Communication, Huntsman Cancer Institute, University of Utah, 255 S Central Campus Dr., Room 2400, Salt Lake City, UT 84112, USA.
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Kaphingst
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
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Kebodeaux
George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130-4899, USA.
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McBride
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
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Cusanno
Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA. mpoliti@wustl.edu.
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Politi
D002755:Choice Behavior; D032882:Comprehension; D003657:Decision Making; D005260:Female; D062265:Health Insurance Exchanges / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics; D007407:Interviews as Topic; D008297:Male; D058991:Patient Protection and Affordable Care Act; D036301:Qualitative Research; D014481:United States
Affordable care act; Decision making; Decision support; Health insurance; Qualitative research