Transcript for the audio podcast:
Oversight of Private Health Insurance Submissions to the HealthCare.gov Plan Finder
From the Office of Inspector General of Department of Health and Human Services
[Linda Ragone] I'm Linda Ragone, Deputy Regional Inspector General in Philadelphia for the Office of Evaluation and Inspections, and I'm speaking with Amy Sernyak, a Program Analyst in our Office of Evaluation and Inspections, to discuss the report titled, Oversight of Private Health Insurance Submissions to the HealthCare.gov Plan Finder. So Amy, what is the HealthCare.gov Plan Finder?
[Amy Sernyak] The HealthCare.gov Plan Finder is a Federal web site with information on private and public health insurance options. You can't buy health insurance on this web site, but you can use it to research options for yourself, your family, or your small business. It was created to help consumers under the health insurance reform law, the Affordable Care Act.
[Linda Ragone] Can't you already find health insurance information online?
[Amy Sernyak] Actually, before the Plan Finder, there was not one central web site to help consumers search and compare all health insurance options. Now, health insurance companies are required to submit their information to the Plan Finder.
[Linda Ragone]: Is the information easy to find and does it give a complete picture?
[Amy Sernyak]: Information about public programs is readily available, but for private plans, the Centers for Medicare and Medicaid Services, or CMS, is responsible for making sure they submit required information to the Plan Finder. We looked at whether CMS ensured that private health insurers submitted the required information.
[Linda Ragone] What did you find?
[Amy Sernyak] CMS did make numerous efforts to oversee that private insurers submitted the required information. But, we also found some gaps in CMS's oversight that suggests more should be done. For example, CMS expected insurers that initially submitted basic information, to then submit detailed information. During the time periods we reviewed, CMS expected 1,026 insurers to report all of the required information. Of these, 129 insurers, or 13 percent, did not do it.
[Linda Ragone] Did CMS follow up with these insurers?
[Amy Sernyak] No. CMS only contacted 1 of these 129 insurers to follow up about their failure to submit the required information.
[Linda Ragone] But these insurers still submitted basic information. What if an insurer did not submit any information to CMS for the Plan Finder - not even the basic information?
[Amy Sernyak] Then CMS did not know that the insurer existed. CMS attempted to use existing data sources to identify insurers that are required to report to Plan Finder, however CMS hasn't been able to identify all of the insurers nationwide that are required to submit information.
[Linda Ragone] That seems like a gap in oversight, if you might be missing insurers entirely.
[Amy Sernyak] You're right. We recommended that CMS implement procedures to find and pursue private insurers who do not submit required information for Plan Finder. CMS expects that it will be better able to identify insurers as other Federal efforts to collect private health insurance information unfold.
[Linda Ragone] So, if I look up an insurance plan on the Plan Finder, would I see the same information that I would get from the insurer's telephone customer service representative?
[Amy Sernyak] Ideally, yes. We actually called some insurers and spoke to customer service representatives to see if the information they gave us matched the plan information displayed on Plan Finder.
[Linda Ragone] Did the information match?
[Amy Sernyak] Most of the information matched up. But, we did find some inconsistencies. For example, the Plan Finder displayed the copayment options for a set of small business health plans as ranging from $20 dollars to $60 dollars. But, a customer service representative told us that the copayment options for that same set of plans ranged from $15 dollars to $40 dollars.
[Linda Ragone] So was the Plan Finder wrong, or was the customer service representative wrong?
[Amy Sernyak] We can't say, but we recommended that CMS devote more attention to ensuring the data displayed on the Plan Finder are accurate.
[Linda Ragone] Overall, what did CMS say about your report's recommendations?
[Amy Sernyak] CMS agreed with each of our recommendations and is taking steps to close the oversight gaps we identified.
[Linda Ragone] Thank you, Amy Sernyak, Program Analyst for the Office of Evaluation and Inspections, for sharing this important work on the HealthCare.gov Plan Finder.
[Amy Sernyak] Thank you, Linda.
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