According to a recent Health Affairs report, federal and state marketplaces would do well to nudge consumers toward health plans that result in the best fit for the individual.
This would avoid consumers dropping plans after finding unexpected surprises when using their coverage, such as out-of-pocket costs that exceed their expectations, the authors said.
Because no gold standard or central authority exists for decision tools, consumers must rely on the online marketplace information to make decisions in choosing the appropriate coverage.
In some instances, there are numerous choices. On Healthcare.gov, the average number of health plans per county is 48, the report said.
In the third year of open enrollment, which ended in January, the authors found greater adoption of some decision support tools such as total cost estimators and integrated provider lookups.
[Also: Displaying exchange plan data with cost info drives better plan selections, report says]
However, the online tools vary across state marketplaces and the federal government's Healthcare.gov, especially in comparing what is available for window shoppers and what is available for shoppers ready to buy.
For example, Healthcare.gov's total cost estimator is available for window shoppers but not for real shoppers, according to the report.
The report offers several recommendations.
One is for a default option on the site that lists health plans in descending order of the individual's estimated out-of-pocket spending based on projected plan usage, preferences, or both.
Most sites, including Healthcare.gov, continue to list plans by the premium amount, from cheapest to most expensive.
Marketplaces should consider developing a simple network algorithm that would categorize networks by size, or that would be a composite measure of "convenient access to care" based on the number of doctors, total network size, type of insurance product, and consumer satisfaction, the authors said.
[Also: Insurers, providers fight California's insurance exchange threat to cut poor-performing hospitals]
These types of indicators would allow consumers -- particularly those who do not have preferred physicians or hospitals -- to choose a plan based on network size versus affordability, they said.
Additionally, consumers need a more explicit explanation that maximum out-of-pocket spending applies only to in-network services, they said.
More marketplaces this year, including Healthcare.gov, included integrated tools that allowed consumers to see if their providers or hospitals are in network.
For prescription drug coverage, only Colorado includes an integrated drug lookup tool in its window-shopping experience, the report said.
The study examined the 12 states and the District of Columbia that use their own state-based marketplaces and the 28 states that use Healthcare.gov.
When the third enrollment period established under the Affordable Care Act opened November 1, 2015, more than two million consumers selected plans in the first four weeks, with 35 percent of them new to the marketplace.
In the third year, more sites have added estimates for total out-of-pocket spending, or listed first the plans that are best for consumers who qualify for tax credits and cost-sharing reductions.
In some marketplaces, consumers categorize their own utilization, while in others, consumers answer detailed questions and are assigned a utilization profile.
[Also: Aetna supports Burwell, insurance exchanges, despite losses in marketplace last year]
Previous studies have shown that providing calculation aids help consumers make fewer mistakes, while listing plans by premium cost draws attention away from other relevant features, such as deductible and copayment amounts.
Six state-based Marketplaces allow consumers to search for participating providers without having to provide a name in one or both types of experience--for example, by providing a radius around a zipcode, a specialty, or a language spoken.
Two state-based marketplaces, California and Kentucky, listed plans by estimated out-of-pocket spending.
Massachusetts listed plans in the silver tier first, with a message that read, "The plans shown here are some of our most popular plans and offer a good balance between monthly premiums and out-of-pocket costs."
Minnesota listed plans in order of best fit, based on consumer preferences on variables of the availability of a health savings account, wellness programs, metal tier, and deductible amount.
Variables to information include the size of the state and its financial resources, and the vendors used to develop the sites. California assessed a per plan surcharge to improve online support, the report said.
Further research using claims data and web analytics would be needed to discern the value and impact of the most effective tools in helping consumers pick the optimal plan, or at least avoid a poor choice, the report said.
Twitter: @SusanJMorse