The Maryland health exchange is a nearly broken process

11/3/2017

The Hon. Al Carr                                  The Hon. Jeff Waldstreicher

The Hon. Ana Sol Gutierrez              The Hon. Richard Madaleno

Dear Mr. Carr, Mr. Waldstreicher, Ms. Gutierrez, and Mr. Madaleno:

As your constituent, I must bring to your attention the broken process that is the Maryland health exchange: http://www.marylandhealthconnection.gov. I hope that my experience can help make the process of applying through the exchange better.

This is my fourth year purchasing health insurance through the exchange for my family and each year the process and the website have gotten progressively more difficult to navigate and more broken. I’m a web consultant who works on forms, applications, search engines, and website design, so I know how a site like this should work. In addition, I have handled my family’s health insurance needs for the last 20 years. If I have found myself frustrated to tears multiple times, I can’t imagine how other Maryland families feel.

In sum, the website content and design are confusing and difficult to navigate, important information is missing or impossible to find, and the website itself has many bugs.

In the Beginning

Happily, I saw lots of people reminding me that the open enrollment period for health insurance began Nov. 1. So in mid-October, I went to the website in order to shop for a new plan. (As always, my insurer dropped the plan I had bought last year.)

When I got to the site and logged in, there was an option to change my information and renew coverage but there was nothing that explained where I should go to browse plans. After trying every other option on the site, I finally settled on renew coverage. This took me into an official application process.

The system actually took me through the entire application (and submitted it!) without letting me browse insurance plans. At this point, the system notified me I was eligible for a special enrollment period for the end of 2017. (Note: I wasn’t actually eligible, since nothing had changed in my circumstances or salary and I said so in the application.)

I had no interest in a special enrollment period for 2017; I wanted to shop for 2018. But there was no way to do that before Nov. 1, at least not one I was able to find. Of course, now the system was engaged in sending me multiple messages about 2017, but I decided to just wait for Nov. 1 and shop then.

A Diversion Into MCHP

On Nov. 1, when I logged in again, I found a notice that my children, who are separately insured through MCHP/Medicaid, had been dropped from their managed care organization.

mhc pic 1

I attempted to call the exchange to get an explanation, but the phone system was down and every way I went down the phone tree, the system hung up on me.

When I finally did get through to someone the following day, she explained that I was supposed to have already re-applied for the children’s Medicaid coverage. I went back through the notices and found two messages I had missed telling me I had to renew the children’s MCHP coverage. But when I tried to renew in mid-October, the system kept telling me it was a special enrollment period. There was no clear path to renew their coverage that didn’t seem to also affect my own coverage. I have no idea what I was supposed to have done differently.

I have reapplied and I’m fairly confident that the children’s coverage will be renewed shortly.

Back to Adult Coverage

Now that I was no longer in a special enrollment period, I resumed trying to get coverage for my husband and myself. Every time I tried to go through the process, I received numerous confusing notifications. Here’s just part of one message I received (this is one section of the chart, leaving out the entirely correct denial of Medicaid coverage for me and some other options):

mhc pic 2

My personal favorite notification was the one that on page 4 gave my correct monthly income and on page 5 listed a yearly income that was twice the correct number. That happened last year as well, and it took me weeks of repeated phone calls to get it fixed.

As I mentioned, I spoke on Nov. 2 to a woman at the exchange. She was able (as far as we can tell) to reset the yearly income and convince the system that I was eligible for a plan with financial assistance. At that point, I went back to trying to browse for insurance plans.

I went through the application and this time it worked, I was able to reach the point of looking at the plans I was eligible for. I spent about 20 minutes comparing several plans in detail, chose the one that would work, then clicked on the link to check if my doctors participate in the plan.

I checked, found all the doctors I expected, and looked for a link to get back to the plan details. There was no such link. After a while, I gave up and hit the back button. This took me back to the area of the site before browsing plans.

When I re-entered the application, the plans I was offered were different and didn’t include the one I had chosen. I found one that was similar enough and quickly chose it, because I was afraid it might disappear as well.

Other Broken Things on the Website and App

  • When you get to the landing page at https://secure.marylandhealthconnection.gov/
    AHCT/LandingPageCTHIX, your options are 1) get an estimate, 2) apply for coverage, and 3) small businesses. The first principle of web design is to put the most popular options front and center, to reduce the amount of time people spend searching. I don’t have any hard data, but I’d bet my small yearly salary that the majority of people who arrive on this site are looking for something that says “browse insurance plans” and don’t feel they’re ready to apply. If it’s not possible for someone to browse without starting the application (which I can understand), there should be a big box that explains why and what you have to do.
  • The message center is less than helpfully organized. This area breaks at least three design principles I can think of off the top of my head. To find my actual messages, I have to click on “view more”.

mhc pic 3

  • Once you do click “view more”, you get to another screen that still doesn’t have the most recent notifications. (It looks like it here, only because it puts my recent uploads on top. The next item below is account creation from 2014.) And you can’t sort by date. The only way to find the most recent messages is to use the search boxes.

mhc pic 4

As a side note, this screenshot also shows how I had to upload the same information multiple times. I uploaded my tax return, the system marked it as verified, then an hour later, the system would ping me and insist my insurance was going to be cancelled if I didn’t upload proof of income.

  • The new phone app has similar design problems. For example, the menu options in “My Inbox” are
    • Messages
    • Notices
    • Documents
    • Verification
    • My Enrollments
    • View Tax Forms
    • View/Update My Application
    • Update Security Questions
    • My Notifications

The one bright spot I can report in the entire process is that the people I have spoken to at the exchange have been uniformly polite and helpful. They have sounded genuinely concerned about my problems and done their best to help me.

I would be happy to explain any of this further and provide any additional information necessary. I can be reached at [contact information redacted for the web, because really now…].

Sincerely,

Mara Greengrass

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