Most Adults Experience Problems With Their Health Insurance

Analysis by Kaiser Family Foundation (KFF) examines consumer experiences with health insurance.

Though the majority of insured adults give their health insurance positive ratings, more than half experience problems when using their insurance, according to a KFF survey.

To better understand how people feel about their health coverage and how it works for them, the KFF Survey of Consumer Experiences with Health Insurance interviewed 3,605 insured adults with Medicare, Medicaid, or a health plan through the Affordable Care Act marketplace.

The data revealed that 81% of respondents give their insurance an overall rating of "excellent" or "good," with ratings varying based on health status.

Despite the positive ratings, 58% of adults said they have experienced a problem using their insurance in the past year, with issues including denied claims, provider network problems, and prior authorization snags.

Among those that reported issues with their insurance, nearly half said their biggest problem was either not resolved (19%) or resolved in a way they were unsatisfied with (28%). Furthermore, 17% said they were unable to receive recommended care as a direct result of their problems, while 15% reported they experienced a decline in their health and 28% said they paid more than they expected for care because of their problems.

The survey also asked the respondents how well they understand aspects of their insurance and found that 51% find at least one aspect of how their insurance works at least somewhat difficult to understand. Meanwhile, more than a third of adults (36%) said it is at least somewhat difficult for them to understand what their insurance will and will not cover.

Making health plans more understandable and easier to navigate can go a long way for payers in improving member satisfaction. According to the recent J.D. Power study, commercial health plans are struggling to meet patients' engagement needs as member satisfaction continues to decline.

"Having coverage is valuable to people, and so not surprisingly, most who have it rate it favorably overall," KFF wrote. "But we don't buy health insurance in case we stay healthy, so monitoring how coverage works for people who are sick is particularly important in gauging how well our health insurance system works when people need it the most."