Skip Navigation Archive: U.S. Department of Health and Human Services U.S. Department of Health and Human Services
Archive: Agency for Healthcare Research Quality
Archival print banner

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

  • Publication # 14-RA002

Based on the Massachusetts experience, consumers will need help navigating health insurance exchanges

Health Insurance

With the passage of the Affordable Care Act, some U.S. consumers will soon be joining health insurance exchanges (HIEs). These HIEs allow people to select from a variety of commercial health plans offering different levels of coverage generosity, benefit structures, and monthly premiums. Since 2006, Massachusetts has offered its own version of an HIE called the Health Connector. 

A new study analyzes the Massachusetts experience as an example of how people will deal with enrolling in health plans via HIEs. Researchers from the Harvard School of Public Health, Harvard Pilgrim Health Care Institute, and Harvard Medical School surveyed Massachusetts consumers enrolling in the Massachusetts Exchange in 2010. 

Nearly half of respondents had significant difficulty understanding plan information. In addition, a majority of respondents either needed help selecting the appropriate plan or solicited assistance with plan selection, most often from friends and family. Consumers enrolled in an HIE plan for 6 months or more were eligible to participate in the survey. Questions were asked about their satisfaction and experience with selecting a health plan and after they enrolled. 

The survey also collected information about socioeconomic and clinical characteristics of the subscribers and their families. Overall, more than 40 percent of enrollees found their plan information difficult to understand. In addition, one-third reported that they recruited someone to help them narrow down their plan choices. Another 20 percent wished they had had assistance in this process. More than a quarter of respondents (28 percent) felt that selecting a plan would have been easier if they had fewer plan options. Even after they were enrolled in a particular plan, nearly a quarter (23 percent) said they still found their plan difficult to understand. Forty-five percent reported that their out-of-pocket expenses were higher than expected. 

Those more likely to be dissatisfied with the affordability of plan options were respondents with incomes less than 400 percent of the Federal poverty level. These consumers also reported having higher-than-expected out-of-pocket costs. While all respondents were enrolled in unsubsidized plans, the researchers discovered that 30 percent of respondents had incomes that would have qualified them for a subsidized Connector plan. 

As HIEs emerge and become active, they will need to provide resources and decision support to consumers in a variety of ways to reduce confusion and help people choose the best plan for them, suggest the researchers. Investigators participating in this study are supported in part by AHRQ (HS10391).

More details are in "The experience of Massachusetts shows that consumers will need help in navigating insurance exchanges," by Anna D. Sinaiko, Ph.D., Dennis Ross-Degnan, Sc.D., Stephen B. Soumerai, Sc.D., and others, in the January 2013 Health Affairs 32(1), pp. 78-86.


Page last reviewed November 2013
Internet Citation: Based on the Massachusetts experience, consumers will need help navigating health insurance exchanges: Health Insurance. November 2013. Agency for Healthcare Research and Quality, Rockville, MD.


The information on this page is archived and provided for reference purposes only.


AHRQ Advancing Excellence in Health Care