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Most people generally give their health insurance a positive grade, but according to a new KFF survey, those who are in poorer health tend to give lower ratings. The sicker they are, the less positively they feel about their coverage.
About 81% of those polled said their health insurance was “excellent” or “good,” but there were discrepancies. Eighty-four percent of people who describe their physical health status as at least “good” rate insurance positively, compared to 68% of people in “fair” or “poor” health.
People on Medicare also tend to rate their insurance more positively (at a rate of 91%), compared to a 73% favorable rating from those on Affordable Care Act Marketplace coverage.
And yet, despite their positive insurance rating, most insured adults have had problems using their health coverage. People in poorer health are more likely to report problems. A majority of insured adults (58%) say they have experienced a problem using their health insurance in the past 12 months – such as denied claims, provider network problems, and pre-authorization problems. Looking at responses by health status, two-thirds (67%) of adults in fair or poor health experienced problems with their insurance, compared to 56% of adults who say they are in at least “good” physical health.
WHAT’S THE IMPACT?
About three in four adults who received mental healthcare in the past year, or who visited providers more than 10 times in a year, experienced insurance problems. At least half of adults across insurance types say they experienced a problem, although the nature of the problems varies somewhat more based on their type of coverage.
Half of consumers with insurance problems say their problem was resolved to their satisfaction. Among the 58% of insured adults who had a problem with their insurance in the past year, about one in six (17%) said they were unable to receive recommended care as a direct result of their problems; 15% said they experienced a decline in their health and about three in 10 (28%) said they paid more than they expected to care for all as a direct result of their problems
Those with greater mental health needs felt their coverage was lacking, and had largely forgone needed care, the survey showed. Among insured adults who report being in “fair” or “poor” mental health, four in 10 (43%) say there was a time in the past year when they did not get mental health services or medication they thought they needed, and a a similar share (45%) gives their insurance a negative rating when it comes to the availability of mental health providers.
One in five of this group (19%) said there was a time in the past year when a particular mental health service or treatment they needed was not covered by their plan. People with Medicare – who are less likely overall to say they are in fair or poor mental health – are also somewhat less likely than adults with other types of insurance to say a need mental health therapist or treatment is not covered by their insurance.
Adults with marketplace and Medicaid coverage are more likely than those with employer-sponsored insurance or Medicare to negatively rate their insurance when it comes to the availability of mental health providers.
About nine in 10 say they support requirements on insurers to maintain accurate and up-to-date provider directories, provide simpler, easier-to read EOBs, disclose their claims denial rates to regulators and the public, and provide in advance, upon request, information about whether care is covered and their out-of-pocket cost liability. Nearly eight in ten say they would be likely to use the services of a publicly established consumer assistance program when they encounter insurance problems.
THE LARGER TREND
A 2022 PhRMA/Ipsos poll uncovered some frustrations over paying for and navigating the healthcare system.
Many frustrations with healthcare hinge on inadequate health insurance coverage, the confusion with navigating insurance barriers to access, and the unexpected expenses and coverage issues that patients experience.
Conducted among 2,510 American adults, the poll found a bipartisan supermajority (87%) of Americans feel politicians have lost touch with what the public needs from their healthcare.
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