Oversight of Private Health Insurance Submissions to the HealthCare.gov Plan Finder
Download the complete report
Adobe® Acrobat® is required to read PDF files.
WHY WE DID THIS STUDY
The HealthCare.gov Plan Finder is the first comprehensive, online portal that assists consumers in comparing their health insurance coverage options. All private health insurers in the individual and small group markets are required to submit information to populate the Plan Finder. The data collection conducted by CMS to populate the Plan Finder represents the first national attempt to identify these insurers and the products and plans they offer. To realize the benefits of expanded consumer information, the data displayed on the Plan Finder must be complete and accurate.
HOW WE DID THIS STUDY
We reviewed CMS's policies and procedures, survey responses, and interview responses regarding oversight of insurers' data submissions. We selected a purposive sample of 98 small group products and 94 individual plans displayed on the Plan Finder for its November 2011 and January 2012 updates, respectively. For each sampled product and plan, we identified aberrant or inconsistent data displayed on the Plan Finder and determined whether displayed data were consistent with information provided by insurers' telephone customer service representatives.
WHAT WE FOUND
Most private insurers reported data to the Plan Finder. However, gaps exist in CMS's oversight of private insurers' compliance with Plan Finder reporting requirements. CMS did not conduct targeted followup with insurers that did not report detailed pricing and benefit information. CMS also has not been able to identify the entire population of insurers required to report basic company and product information. In addition, CMS has not asked insurers to certify to the completeness of submitted data in accordance with Federal regulation. CMS implemented numerous strategies to monitor data accuracy. However, the data displayed on the Plan Finder for the sample of products and plans contained some inconsistencies that may confuse consumers. The products and plans displayed were not always available for sale or were not always recognized by insurers' representatives. When products and plans were available and were recognized, 81 percent of their data displayed on the Plan Finder matched the information provided by insurers' representatives.
WHAT WE RECOMMEND
Our findings indicate that additional efforts are needed to oversee private insurers' compliance with reporting requirements for the HealthCare.gov Plan Finder and to ensure that the data displayed on the Plan Finder are accurate. Therefore, we recommend that CMS: (1) establish and implement procedures to identify and pursue private insurers that do not submit required data to the Plan Finder, (2) ensure that each private insurer's Chief Executive Officer or Chief Financial Officer certifies to the completeness of data submitted to the Plan Finder, (3) design and implement additional strategies to ensure Plan Finder data accuracy, and (4) validate that products and plans submitted to the Plan Finder are available for sale. CMS generally concurred with our recommendations and is taking steps to address them.
Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.
Let's start by choosing a topic
Priority recommendations summarized.
FY 2016 Work Plan
OIG projects planned for 2016.
Significant OIG activities in 6-month increments.