Expanding Health Care Coverage

Project Title

Consumer Testing of the Coverage Facts Label

Grant Amount


Priority Area

Expanding Health Care Coverage

Date Awarded

April 28, 2011


Hudson Valley






Among other goals, Federal health care reform seeks to expand access to quality, affordable health insurance coverage.

Achieving that goal hinges on well-functioning insurance markets and consumers understanding the health insurance options available to them. To promote informed decision-making, the Affordable Care Act requires health insurers to use a new, standardized Summary of Benefits and Coverage form (Summary) to convey the benefits and cost-sharing provisions of their health plan offerings. A required component within the Summary is a consumer aid called the “Coverage Facts Label.” The Label will take traditional health plan information and calculate what consumers would have to pay out of pocket under different medical scenarios. With support from the New York Health Foundation and the Missouri Foundation for Health, Consumers Union conducted testing of the Coverage Facts Label prototype to answer questions regarding how the Label would help consumers understand their health benefits coverage.

Consumers Union conducted cognitive interviews to obtain a detailed assessment of consumers’ performance on and reactions to the prototype documents. The testing examined whether the Coverage Facts Label can be read and understood; provided the information consumers need, both in terms of the medical scenarios available and in terms of the information about each scenario; illuminated the usefulness of the information in the other parts of the Explanation of Coverage form; and made it easier for consumers to compare and select a health plan.