More than half, or 58%, of insured Americans have had at least one problem using their health insurance in the last year, including denied claims, provider network problems and issues with prior authorization, a new survey found.
The KFF survey, published Thursday, was conducted in February and March online and via phone. It included responses from 3,605 adults, including 978 adults with employer-sponsored insurance, 815 adults with Medicaid, 885 adults with Medicare, 880 adults with Marketplace plans and 47 adults with a military plan.
Those in “fair” or “poor health” were more likely to have issues with their health insurance, the survey showed. About two-thirds, or 67%, of those in fair or poor health had problems, versus 56% of those in good health. In addition, three in four insured adults who received mental health services in the last year, as well as three-quarters of those who had more than 10 provider visits, had problems with insurance.
The type of insurance issues people experienced varied by the type of coverage they had, according to KFF. For example, more people with employer-sponsored insurance and Marketplace coverage had issues with their insurance not paying for care they thought was covered than people with Medicare and Medicaid coverage.
About half of adults who had issues were not able to “satisfactorily resolve” them, KFF also found. Of the 58% who experienced a problem, 17% weren’t able to receive the recommended care, 15% saw their health worsen and 28% said they paid more than expected.
“The survey shows that the sheer complexity of insurance is as big a problem as affordability, particularly for those with the greatest needs,” said Drew Altman, KFF president and CEO, in a news release. “People report an obstacle course of claims denials, limited in-network providers, and a labyrinth of red tape, with many saying it prevented them from getting needed care.”
Additional findings from the survey:
- About 81% of adults rated their health insurance as “excellent” or “good,” but those with a poorer health status were less likely to provide a high rating.
- Of adults who said they had “fair” or “poor” mental health, 43% said there was a time when they couldn’t get needed mental health services, and 45% gave a negative rating to their insurance in terms of the availability of mental health clinicians.
- Cost is a major concern for consumers, especially those with employer-sponsored insurance and Marketplace coverage. For example, 55% of those with Marketplace coverage and 46% of those with employer-sponsored insurance rated their insurance poorly for their premiums, versus 27% of those with Medicare and 10% of those with Medicaid. Four in 10 adults skipped care or put it off because of cost.
- A little over half of insured adults have challenges in understanding their health insurance, such as what will be covered and what they’ll pay out of pocket. Many also don’t understand terms like a “deductible” or a “copay,” the report showed.
- About nine in 10 insured adults are in favor of making insurers maintain accurate provider directories, offer easily understandable explanations of benefits, disclose claims denial rates to regulators and take other actions.
Photo: Tero Vesalainen, Getty Images