Covered California contracted with the Center for Healthcare Decisions to design and conduct 10 discussion sessions with uninsured Californians who are potential Covered California customers. Approximately 120 Californians participated in two-hour discussions which included two groups conducted in Spanish. Recruitment criteria included participants who were:

• without health insurance for at least one year;
• between 200-400% of the FPL (eligible to qualify for some premium support, but not cost-sharing assistance);
• legal residents of California; between ages 30 and 64 (those under 30 would qualify for catastrophic coverage only); and,
• able to read and write English (eight groups) or speak Spanish as their first language (two groups).

Multiple Cost-Sharing Methods Studied

Since there are multiple ways to structure cost-sharing, Covered California wanted to learn how potential health plan members would respond to the question, What is the fairest way to structure cost-sharing when trying to meet the needs of many people? (Click image to enlarge.)

Responses to cost-sharing models

• Annual deductible: Disconcerting; a barrier to access.
• Co-payments: 80% chose Plan B for lowest co-pays.
• Co-insurance: Huh?
• Annual OOP maximum: Not as worried; playing the odds.

General Observations

• Participants tended to focus on those aspects of cost-sharing with which they were familiar. During the ‘choose your cost-sharing plan’ discussion, nearly 80% of participants in each group chose Plan B because of its reasonably-priced co-payments for office visits and medications - services participants most often used.
• Regardless of the annual deductible, participants still viewed the co-payment as the key to their ability to access health care. The primary concern for many participants was being able to afford to see a doctor when they needed one.

Coinsurance is Problematic

• Almost all participants were unfamiliar with this type of cost-sharing and did not give it much attention in their discussion and decision-making.
• As it was presented on the three cost-sharing models chart (Image above), co-insurance was often misunderstood, even after the facilitator gave a specific example of how it might apply.
• The different rates of co-insurance (30/35/40%) did not raise concerns; participants viewed the differences in co-payments as much more meaningful.