Determinants and Effects of Plan Selection in the Non-Group Health Insurance Market

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  • March 19, 2019
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  • Gillen, Emily
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • Effective 2014, the Patient Protection and Affordable Care Act (ACA) required US citizens to be enrolled in an adequate health insurance plan. To provide a platform where individuals could compare and purchase health plans deemed to provide sufficient levels of coverage, the ACA required states to establish (or allow the federal government to establish) health insurance Marketplaces. Plans qualified to be sold on the exchange had to adhere to ACA regulations, for example replacing medical underwriting with community modified premiums. In addition, federal assistance was available on a needs basis. As a result of ACA devised changes, the non-group health insurance market increased 211% from 2013 to 2015 (Carman, Eibner, & Paddock, 2015a). The objectives of this research were to understand: (1) how consumers behaved in year one of the new health insurance Marketplaces; and (2) how they responded to plan benefits in the non-group health insurance market. This study utilized claims data from a large insurer with over 85% market share in the state non-group health insurance market (The Kaiser Family Foundation State Health Facts, 2013). I found that individuals with premium tax credits who were less healthy were more likely to use their tax credits to purchase more generous health plans. Individuals were more likely to access additional outpatient services after they reached their out-of-pocket maximum and self-selection into a narrow network plan had no impact on number of outpatient visits but did increase the percentage of visits with participating providers. Narrow network plans were also associated with a reduction in out-of-pocket costs. Historically, the non-group market has not often been studied, but it’s becoming increasingly important (Nadash & Day, 2014; M. V. Pauly & Nichols, 2002; Sommers, 2014). With each year of operation the non-group market continues to grow and the Marketplaces continue to evolve. Industry leaders and policymakers need to understand the behavior of the unique consumers in this market in order to create future policies that preserve or increase access to quality care while containing costs.
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  • In Copyright
Advisor
  • Trantham, Laurel
  • Hassmiller Lich, Kristen
  • Holmes, George M.
  • Weinberger, Morris
  • Silberman, Pam
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2015
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  • Chapel Hill, NC
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  • There are no restrictions to this item.
Date uploaded
  • January 21, 2016

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