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New Federal Rules Simplify Shopping for Health Plans: HRA helps CA Stay Ahead of the Game

New Federal Rules Simplify Shopping for Health Plans—
HRA Helps California Stay Ahead of the Game. (2/23/2012)

“Which health plan is best for me? What will I pay? What are the benefits?”

These are the questions we ask when we shop for health insurance. But the answers are hard to find. The current patchwork of inconsistent and intricate consumer disclosures makes health care shopping inefficient and intimidating. Both consumers and employers suffer from the lack of information in plain English.

The Affordable Care Act is changing that. New rules announced this week will help consumers get consistent, clear information upfront, before they buy insurance, helping them to choose the plan that best meets their needs.

A strong supporter of this goal, Health Research for Action has developed numerous resources to help consumers choose and use their health plans. Our guides to HMOs, Medicare plans, and Medi-Cal plans have been distributed to hundreds of thousands of Californians. Working closely with state agencies, including the Office of the Patient Advocate and the Departments of Aging, Health Care Services, Insurance, and Managed Health Care, HRA has listened carefully to consumer needs and produced a wide variety of plain language tools.

Under section 2715 of the Public Health Service Act, created by section 1001 of the Affordable Care Act and implemented in the new rules announced this week, health plans will provide clear and consistent information about their benefits and costs. Consumers will be able to get a short, easy-to-understand Summary of Benefits and Coverage (SBC) about each health plan they are interested in, beginning September 23, 2012. The SBC will use a set of consistent definitions (the Uniform Glossary). The SBC and glossary were developed by the Departments of Labor, Health and Human Services and the Treasury, based primarily on model forms created through a public process led by the National Association of Insurance Commissioners (NAIC) and a working group of consumer and industry stakeholders.

At HRA, we have over 25 years of experience assisting government agencies, non-profits, and health plans meet the literacy and communication needs of diverse audiences. Our resources explain complex health issues and insurance options to audiences with widely different cultures, literacy levels, and languages. We use evidence-based best practices in health literacy to help all consumers, especially those with limited literacy skills, understand and act on important health information. The resources we create have shown statistically significant changes in knowledge and behavior.

Below are links to some of the work we have done to explain health benefits and insurance options to consumers.

  • "What Are My Medi-Cal Choices?" is an award-winning guidebook for seniors and people with disabilities who have Medi-Cal. (See Medi-Cal Access Project.)
Medicare literacy: HRA worked with California’s Department of Aging to develop outreach and education resources for California’s Health Information, Advocacy, and Counseling Program (HICAP), which assists Medicare members throughout the state. 
(See Medicare Health Literacy Project.)

"California’s HMO Guide for Seniors" is a unique, user-friendly resource for seniors who are in, or considering, a Medicare Advantage HMO or PPO. HRA worked with California’s Office of the Patient Advocate to develop the guide.
 (See California’s HMO Guide for Seniors

  • "How to Use Your Health Plan" is a user-friendly resource for people who are in HMOs or PPOs or thinking about enrolling in one. HRA worked with California’s Office of the Patient Advocate to develop the guide.
 (See How to Use Your Health Plan

  • The California Health Communication Project provided individually tailored services to help health plans and health advocacy programs develop easy-to-use information for health plan members.
 (See California Health Communication Project

  • DMHC Consumer Website: HRA worked with the California Department of Managed Health Care (DMHC) to redesign, rewrite, and reorganize its consumer website, in English and Spanish. (See DMHC Website Redesign

  • HRA worked with California’s Department of Managed Health Care to develop the Sample Evidence of Coverage (EOC) to provide health plans with language, designs, and ideas to create EOCs that their members can easily read, understand, and use. (See Evidence of Coverage Project

  • OPA Consumer Website: HRA worked with the California Office of the Patient Advocate (OPA) to design, write, and organize sections of its consumer website, in English, Spanish, and Chinese. (See OPA Consumer Website Project.)

  • Read more about the new ACA regulation at

February 2012