Pregnant, Two-Year Old Billionaire Smoker Shops for Health Insurance

A User Experience Review of the Redesigned Healthcare.gov
Rob Tannen & Steve Jones, Intuitive Company

Around this time last year we were patiently trying to evaluate Healthcare.gov. You’re probably familiar with what transpired, which can be best summed up by the modern adage: bad performance trumps good usability, or more accurately, terrible performance crushes average usability.

Since then, major changes have been made to the site’s technology and design, affording us the opportunity to dive into the workflow and interactions.

We found the user experience significantly improved, but still lacking in the critical area of decision support, arguably its most important function.

But first, one of the quirks we found:
Healthcare.gov allows you to browse coverage options without logging in -
a helpful feature to get a sense of the available plans. To do so, you simply enter your ZIP code, estimated income and information about each household member (as shown above). But there are practically no constraints in place to ensure that you enter reasonable information. So, you can browse the options for a two-year old smoker, or a 900-year old pregnant person (neither extreme seemed to change the plan options very much). Maybe the development team had a sense of humor. Fortunately, there are some guidelines in the full application to prevent you from submitting Methuselian family members.

General Observations

If nothing about Healthcare.gov but the back-end technology changed, it would still be a major improvement over last year. This year we visited the site several times over the first couple of days of open enrollment and were able to quickly access and navigate both the public and authenticated sections.

The public site is responsive, arranging itself to fit smaller screen sizes, which is important considering that about 2o% of applicants were using mobile devices last year. On the other hand, the application and enrollment processes are not responsive, meaning that you will need to do a lot of scrolling and zooming to see what’s going on with a smartphone. We wouldn’t recommend filling out the application or browsing plan details using a smartphone if you have a larger alternative (which corroborates our own research on device/enrollment preferences).

The public pages (left) adapt to smartphone screens; the enrollment screens (right) do not.

A significant, if subtle, change in the site design has been the flip-flopping of the primary and secondary navigation. Last year, visitors first chose an action from the primary navigation bar (Learn, Get Insurance), and then identified themselves in the secondary navigation (Individuals & Families, Small Businesses). This year, the primary and secondary navigation structure is reversed, as depicted below.

The primary navigation is now user-based, rather than action-based.

By allowing visitors to self-identify as the first step, the site can more efficiently drive people to relevant content via two different landing pages -with Individuals & Families as the default home page.

The Application

We went through the Individual & Families application (not the Small Business workflow) using a laptop. Compared to last year, the new application has more visible calls to action, allows you to use your email address as your username (instead of creating a separate username), and clearer communication of password requirements.

At first glance the application seemed like a junior version of TurboTax — major sections such as personal information and income each broken out into a series of succinct questions. In fact, we found ourselves accessing Turbo Tax to find some of the data for the Healthcare.gov application.

Application workflow is made up of five primary sections.

It took about 45-minutes to enter all of this information for a family of four. The questions kept coming and coming, each one repeated for every family member. Some of the questions seemed unreasonable — has my 9-year old daughter recently been married? Is she paying alimony deductions? This made us reconsider whether the developers were indeed being humorous, open-minded, or just short-sighted.

Also, while several questions were noted as “Optional”, there was no provision for skipping. Some savvy users may realize they could just “Save & Continue” without answering the questions, but we’ll bet most applicants will assume all information is required. Perhaps not a true dark pattern, but certainly some shade of gray.

Some questions are optional, but there is no explicit means to skip them.

While the application was simple to navigate, the inflexibility of the application workflow turned out to be a source of frustration. Once all of the application data has been entered it can be reviewed before submission. An “Edit” button is displayed next to each household member, presumably to allow individual corrections (e.g. correcting a mistyped date of birth). But selecting any individual’s edit button returns to the beginning of the Family & Household section, where information for all household members must be reviewed/re-entered. If the application logic necessitates editing all household members collectively, the user interface should reflect this rigidity.

Enrollment

Upon successfully submitting the application one arrives at what can best be described as an enrollment landing page. It provides status information and key dates, but not a clear call to action. Process of elimination led us to the “SET” button — while we did not know what we were setting, it was the only clickable area.

To get to enrollment, click on “SET”.

The “SET” button ultimately led us to the enrollment page, listing 40 plans to choose from. We were reminded of Barry Schwartz’s Paradox of Choice, where too many options can be overwhelming and lead to poorer decision-making.

The site provides various helpful filters to narrow the selection based on costs, coverages and programs. For example, health plans with yearly deductibles under $5,000 that also provide child dental coverage (that narrowed it down to 16 plans). But the experience of reviewing and selecting plans could be improved by providing more holistic guidance.

Filter tools help manage the 40 plans that were presented.

Ironically, the application presents dozens of direct questions to generate a list of plans, but the enrollment process does not ask any to help narrow the field. We feel many applicants would benefit from guidance tools, such as a set of question and answers, or a consolidated checklist to help narrow down the field or, at least, prioritize it. We’d also like to see alternative ways of displaying plans rather than just a linear list; there are untapped data visualization opportunities to more intuitively show the relationships between plans and applicant needs.

The plan comparison feature is probably the most valuable view in the enrollment process, providing side-by-side details on plans of interest.

Side-by-side plan comparisons support informed selection.

Since applicants will likely make great use of the comparison view to dig into the specific differences between plans, it is essential that they understand what they are reading. Unfortunately, this view does not provide contextual definitions of fundamental terms such as “deductible” and “coinsurance”. There is a dictionary accessible via the global help menu, but it opens definitions on a separate page. Applicants are much more likely to use and understand the meaning of terms in the context of the specific data they are viewing.

Finally, critical information that would influence selection, such as which plans include your current doctor, require navigating to each of the insurance providers’ own websites, a giant usability hurdle that is not unique to Healthcare.gov.

Conclusions

While we were critical of the Healthcare.gov user experience, we want to stress that it has made significant improvements in performance and usability, and there’s a good chance that it’s better then whatever benefits enrollment system you may be using at work.

The main improvements have been in getting to, and through, the application process. Now it’s time to focus on the deeper challenge of helping people understand and choose the best fitting plans.