Private Insurance Satisfaction: How Many Are Truly Happy?

A survey by KFF found that 81% of insured adults gave their health insurance a positive rating. The percentage of people who were satisfied with their health insurance was higher among those who described their physical health as good (84%) than those who described it as fair or poor (68%). Additionally, a Gallup poll from 2019 showed that 71% of Americans rated their private health insurance coverage as excellent or good. Similarly, a 2018 Gallup poll found that 51% of those with private insurance were satisfied with the cost of their personal healthcare.

People with private insurance are more concerned about costs than those with government coverage

While many Americans are satisfied with their private health insurance, those with private insurance are more concerned about costs than those with government coverage.

According to a 2019 Gallup poll, 55% of people with private plans are "satisfied" with the total cost they pay for healthcare, compared to 78% of those with Medicare or Medicaid. This is reflected in another survey by KFF, which found that affordability of premiums and out-of-pocket costs are a particular concern for those with private health coverage.

The high cost of medical care has been a growing concern, with an increasing number of people putting off treatment due to cost. This is especially true for lower-income Americans, who are generally most likely to delay treatment because of the cost.

The cost of private insurance varies by plan type and coverage levels. Factors that affect the cost of private insurance include the age of the person, the benefits of the plan, and out-of-pocket expenses. Generally, private insurance costs more than Medicare. Medicare plans may also cost more because they do not have an out-of-pocket limit, which is a requirement of all Medicare Advantage plans.

Private insurance premiums can also vary depending on a person's location and age. For example, high-deductible plans often cost less per month than plans with a low deductible. This is because insurers cover their costs by having people contribute more towards their healthcare expenses before the company funds any treatment.

While people with private insurance are more concerned about costs, it is important to note that private insurance is still the largest single source of funding for healthcare expenditures. In 2022, private insurance programs accounted for 30% of national healthcare spending, or about $1.3 trillion. In comparison, government insurance programs such as Medicare and Medicaid made up 45% of national healthcare spending.

The preference for private insurance over government-run healthcare also differs based on political affiliation. While 65% of Democrats favored a government-run system, only 13% of Republicans did.

People with private insurance are more likely to delay or forgo care due to cost

The high cost of medical care has been in the spotlight, and Americans are feeling the squeeze. The share of Americans who have put off treatment for a "very serious" or "somewhat serious" condition rose to a record high of 25% in 2019. This is particularly true for lower-income Americans, who are generally the most likely to delay treatment due to cost.

In 2022, more than 1 in 4 adults (28%) reported delaying or not getting healthcare due to cost. This included dental care, prescription drugs, mental health care, or medical care. A smaller share of adults (15%) reported foregoing medical care, prescription drugs, or mental health care due to cost.

Hispanic adults, adults in worse health, and uninsured adults are more likely to delay or forgo healthcare due to cost. In addition, uninsured adults and adults with worse health are twice as likely to report difficulty paying medical bills.

Nearly half of adults worry about their ability to pay medical bills if they get sick or have an accident. This is particularly true for Hispanic adults, who were the most likely to report being worried about being able to pay medical bills in case of an illness or accident (62%).

Overall, people with private insurance are more likely to delay or forgo care due to cost compared to those with public insurance or no insurance. This is likely due to the higher out-of-pocket costs associated with private insurance, including co-pays and deductibles.

People with private insurance are more likely to experience problems with their insurance

Among the 58% of insured adults who had a problem with their insurance in the past year, about one in six (17%) say they were unable to receive recommended care as a direct result of their problems. Furthermore, 15% experienced a decline in their health, and about 30% paid more than expected for care.

The types of problems people experience also differ across health coverage types. For instance, those with private coverage are more likely to encounter claims payment issues, with their insurance paying less than expected for a medical bill. They are also more likely to face provider network issues, such as not having access to in-network doctors with available appointments.

People with private insurance are also more likely to experience prescription drug problems, with their insurance not covering needed medications or charging high copays. This is a particular concern for those with private health coverage, contributing to individuals not getting the care they need.

Overall, while most people with private insurance rate their coverage positively, many still experience significant problems that can impact their health and finances.

People with private insurance are more likely to experience claims denials

While many Americans are satisfied with their private health insurance, people with private insurance are more likely to experience denied claims than those with public coverage. A KFF survey found that 18% of insured adults experienced denied claims in the past year, with the problem being more common among people with employer-sponsored insurance (21%) and marketplace insurance (20%). This is in contrast to people with Medicare (10%) or Medicaid (12%).

The survey also found that people who use more health services are also more likely to experience denied claims. Among high utilizers (patients with more than 10 provider visits in a year), 27% experienced a denied claim, while moderate utilizers (3-10 visits a year) had a rate of 21%. People with fewer than three provider visits in a year experienced a lower rate of 14%.

The KFF survey also found that consumers with denied claims were more likely to have encountered other problems using their coverage. On average, insured adults with denied claims experienced about four different types of insurance problems in a year. These could include issues such as reaching the limit on covered services, not being able to find or access an in-network provider, and prior authorization problems.

The consequences of insurance problems, including denied claims, can be serious and have financial implications. The survey found that nearly 1 in 5 insured adults (18%) experienced a denied claim in the past year, and this figure rose to 27% for people who use the most health care. Claims denials are connected to the complexity of insurance for consumers, and half of all insured adults find some aspect of insurance difficult to understand. This figure rises to nearly 8 in 10 for those who experience claims denials.

The survey also revealed that consumers whose problems include a denied claim are far less likely to have resolved their biggest insurance problem satisfactorily compared to those whose problems do not include a denied claim (29% vs 59%). This suggests that denied claims may be especially challenging for consumers to resolve on their own.

Furthermore, consumers with denied claims often do not know their appeal rights or which government agency to call for help. Most consumers with denied claims (69%) are unaware of their appeal rights, and the vast majority (85%) do not file formal appeals. Strategies to simplify the appeals process and make consumer notices about how to appeal more prominent and understandable could help improve this situation.

While the KFF survey cannot determine how often claims denials are incorrect, increased oversight and data collection could help supply this information. A federal law requiring private plans to disclose data on denied claims remains largely unimplemented, and such data could be an important tool to monitor trends and hold insurers accountable to legal standards.

People with private insurance are more likely to experience pre-authorisation issues

A survey by KFF found that 58% of insured adults reported experiencing problems with their health insurance in the past year. This included issues with denied claims, provider network problems, and pre-authorization problems. Notably, 16% of insured adults reported experiencing pre-authorization issues.

Pre-authorization, also known as prior authorization or precertification, is a requirement by health plans for patients to obtain approval for a health care service or medication before receiving care. This process allows the plan to evaluate whether the care is medically necessary and covered by insurance. While pre-authorization is intended to control spending and promote cost-effective care, it has been criticised for causing delays and negative clinical outcomes.

People with private insurance are more likely to experience pre-authorization issues due to the higher costs associated with private coverage. Private insurance plans often have higher out-of-pocket costs, premiums, and copays, which can lead to more frequent pre-authorization requirements. Additionally, private insurance companies may use pre-authorization more aggressively to control costs.

The consequences of pre-authorization issues can be significant. People with pre-authorization problems are more likely to experience serious health and financial consequences. They may face delays in receiving medical care, be unable to access recommended treatments, and incur higher out-of-pocket costs.

Furthermore, the pre-authorization process can be time-consuming and burdensome for both patients and physicians. Physicians may spend a significant amount of time fighting pre-authorization rejections and filling out paperwork. This diverts time and resources away from patient care.

While pre-authorization is intended to control spending, it can ultimately lead to increased costs for patients and delays in receiving necessary medical treatments. These issues disproportionately affect people with private insurance, who may face additional barriers to accessing timely and affordable healthcare.

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