Most Consumers Don’t Know About Health Insurance Exchanges

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A recent survey by CVS Caremark found that 78% of consumers who qualify for healthcare reform subsidies have never heard of state-based healthcare insurance exchanges where they will have to shop for coverage next year [1]. Although the exchanges are being promoted as transparent and user friendly, 60% of respondents said they believe they will need help to understand health insurance terms and navigate the system.

Health insurance exchange

Respondents to the online CVS Caremark survey included more than 1,000 consumers. Of those surveyed, 70% currently have no healthcare coverage and 30% are covered by individual insurance policies. The survey excluded people with employer-sponsored insurance and those currently covered by Medicare or Medicaid.

More than three quarters of consumers who would be eligible for new healthcare coverage under the Patient Protection and Affordable Care Act (PPACA) reported that they have never heard of healthcare exchanges. The state-run insurance exchanges, which will serve as online marketplaces where consumers can compare health plans based on price and quality of care, are scheduled to go into effect on January 1, 2014. An estimated 20 million uninsured or underinsured Americans will receive private, subsidized coverage through the exchanges while another 16 million will enroll in Medicaid or the Children’s Health Insurance Program (CHIP) [2].

Helena Foulkes, CVS Caremark executive vice president and chief health care strategy and marketing officer said:

Despite all the news coverage about health care reform, these survey results clearly show that consumers are confused about the potential changes to our health care system. While awareness of the new law may grow over the next year as new services are put in place, consumers need help understanding the coming changes and support on how to sign up and participate in the exchanges. Given our focus on helping people on the path to better health, we expect to play an active role in meeting consumers’ needs in an expanding health care system and will be talking with government, health care advocates and other organizations to see how we can be an active participant in providing information and services to these consumers.

The PPACA requires that each state establish a new marketplace where individuals and small businesses can buy affordable health benefit plans. The marketplace, called an insurance exchange, will offer a choice of plans that meet certain benefits and cost standards.

Starting in 2014, all healthcare plans sold through the exchanges must cover 10 categories of “essential health benefits” (EHBs), which must be equivalent to the scope of benefits provided under a typical employer plan, including:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

Respondents to the CVS Caremark survey also indicated that doctors are the most credible source for talking about exchanges, followed by pharmacists, nurse practitioners and independent insurance consultants.


  1. CVS Caremark Research Finds 78 Percent of Consumers Who Qualify for Health Care Reform Subsidies Never Heard of State Insurance Exchanges. CVS Caremark. 2012 Jun 1.
  2. Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act. United States Congressional Budget Office. 2012 Mar.
About the Author

Walter Jessen, Ph.D. is a Data Scientist, Digital Biologist, and Knowledge Engineer. His primary focus is to build and support expert systems, including AI (artificial intelligence) and user-generated platforms, and to identify and develop methods to capture, organize, integrate, and make accessible company knowledge. His research interests include disease biology modeling and biomarker identification. He is also a Principal at Highlight Health Media, which publishes Highlight HEALTH, and lead writer at Highlight HEALTH.