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Most Americans Have Problems With Their Health Insurance

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The majority of Americans have had problems utilizing their health insurance in the last year, but the majority still enjoy their coverage, according to a new research.

According to a survey issued on Thursday by KFF, formerly the Kaiser Family Foundation, 58% of insured individuals experienced at least one difficulty in the previous year. Approximately three-quarters of those requiring additional care or getting mental health treatment had at least one difficulty.

The issues, which include insurers denying care, providers not being covered, or plans paying less than promised, affect all types of health insurance. KFF polled those with coverage through their workplace, Medicare, Medicaid, or the ACA marketplace.

Nonetheless, 81% of covered adults rated their health insurance as excellent or good. Medicare enrollees were generally pleased with their coverage, with 91% rating it favorably. In comparison, 73% of individuals with Obamacare plans rated their insurance positively.

Sicker adults, on the other hand, were dissatisfied with their coverage. Almost two-thirds of individuals in fair or poor health rated their insurance positively.

While much of the talk around health insurance is around its cost, the survey found that half of people are unaware of the coverage they have.

“The survey finds that the complexity of health insurance and lack of understanding is a problem that rivals affordability of coverage, especially for those who are sicker and for those who have behavioral health challenges,” said Kaye Pestaina, co-director of KFF’s Program on Patient and Consumer Protections.

The stakes can be high, she said. Those who need care may face unnecessary delays or denials of service, while others may wind up saddled with bills that should have been paid.

“How does this coverage really work for people?” Pestaina said.

Nikole Coester, a Chattanooga, Tennessee, resident who took part in the poll, has had many problems with her TennCare Medicaid coverage.

She has fought TennCare over invoices, which has required her to make repeated phone calls and appeal rulings at times. One case involving a visit to an orthopedist for an injury took six months to resolve in her favor.

Furthermore, Coester discovered that many providers do not take TennCare, which is a widespread issue among individuals with Medicaid and marketplace coverage, according to the poll. She has had difficulty getting visits and treatment from another expert because there is only one in the area who accepts her insurance.

“I’m just stuck here with no doctors,” said Coester, 33, who works full time in the medical industry but can’t afford her employer’s coverage. “If I had a commercial plan, I’d get better treatment.”

According to the poll, coverage concerns differ little depending on the type of insurance. According to 35% of individuals with workplace plans and 28% of those with Obamacare coverage, their insurance paid less than they expected.

A third of Medicaid recipients stated that a doctor covered by their plan did not have accessible appointments, while 27% of Medicare recipients claimed that their insurance did not cover a prescription drug or required a very high cost.

Approximately half of insured individuals reported having difficulty understanding at least one component of their insurance, such as what is covered, how much they will have to pay out of pocket, or what their explanation of benefits statement means.

A quarter of those polled indicated they have difficulties comprehending terms like deductible and copay, as well as determining which doctors are in network.

Half of those who reported a problem said they were able to resolve it satisfactorily, while 28% were unhappy with the outcome, and 19% said it remains an issue. 60% of adults are unaware that they have the legal right to appeal.

Affordability is still an issue, which has caused some people to miss or postpone care in the last year. When it comes to rates, 55% of individuals with Obamacare plans and 46% with employment coverage gave their insurance a bad score, compared to 27% of Medicare recipients and 10% of Medicaid participants.

Those who rate their mental health as fair or poor reported having more hurdles getting care.

Some 45% rated the availability of mental health therapists and providers as fair or poor, while 37% rated the quality of those professionals as fair or poor.

Many people indicated they did not receive the necessary mental health care in the previous year, including 43% of those who rated their own mental health as fair or bad and 55% of those under the age of 30.

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