Jane Dotson
Health insurance surveys are a critical tool for understanding the experiences and satisfaction levels of insured individuals. They help identify gaps in coverage, address pain points, and improve overall plan relevance. The KFF Survey of Consumer Experiences with Health Insurance and the Commonwealth Fund Biennial Health Insurance Survey are notable examples of health insurance surveys. These surveys provide insights into the state of health insurance coverage, including issues related to affordability, mental health access, and consumer experiences with private health plans. By conducting these surveys, policymakers can make informed decisions to enhance coverage and address challenges, such as medical debt and billing errors. Regularly assessing consumer feedback through surveys enables insurers to foster trust, tailor their communications, and prioritize improvements that align with the evolving needs of their members.
| Characteristics | Values |
|---|---|
| Survey Name | KFF Survey of Consumer Experiences with Health Insurance |
| Survey Name | Commonwealth Fund Biennial Health Insurance Survey |
| Survey Name | National Health Interview Survey |
| Survey Purpose | To identify gaps in coverage, understand member satisfaction, and address pain points like claims delays or limited provider networks |
| Survey Purpose | To collect feedback from participants regarding their satisfaction with key elements of their health insurance plans |
| Survey Purpose | To describe the state of Americans' health insurance coverage in 2024 |
| Survey Purpose | To collect data about teens from teens |
| Survey Recommendations | Keep surveys short (under 5 minutes) using simple language to avoid confusion |
| Survey Recommendations | Send surveys annually to track satisfaction trends |
| Survey Recommendations | Use neutral language and assure anonymity when discussing sensitive topics like costs |
| Survey Findings | Nearly six in 10 people with health insurance experienced a problem using their insurance in the past year |
| Survey Findings | The relentless growth in the cost of healthcare is at the root of the nation's medical debt and affordability crisis in commercial insurance |
| Survey Findings | Among insured working-age adults in the US with high out-of-pocket costs relative to their income in 2024, the majority were in employer plans |
| Survey Findings | About 9 in 10 insured adults support government policy to require health insurers to provide accurate and up-to-date information about who is in their network |
| Survey Findings | More than 8 in 10 (85%) insured adults support a requirement for health insurance companies to disclose claims denial rates to consumers |
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What You'll Learn
Consumer experiences with health insurance
The KFF Survey of Consumer Experiences with Health Insurance interviewed a nationally representative sample of 3,605 U.S. adults with health insurance. The survey found that nearly six in 10 people with health insurance experienced a problem using their insurance in the past year, with even larger shares among people who are sick or who have mental health needs.
The survey also explored how well consumers understand their health insurance, their rights, and the government agencies to contact if they need help. It found that half of insured adults have some difficulty understanding at least some aspects of their insurance. This includes determining what services are covered and what providers are in-network. For example, 18% of insured adults indicated that their health insurance did not pay for a service that they thought was covered.
The survey also covered the varied problems insured adults experience when using their insurance, especially for people who are sick. This includes difficulty accessing mental health care and affordability concerns, which are prominent issues among many insured adults. The survey found that about three in four insured adults who received mental health care in the past year experienced insurance problems.
The survey also asked about several public policies that might help people avoid insurance problems or resolve them more easily. It found broad support for each, including large majorities across insurance types and across partisans. For example, nearly all insured adults (94%) support requiring health insurance statements (explanations of benefits, known as EOBs) to be written in simple, easy-to-read language that explains the reasons for coverage decisions and how to appeal if one disagrees. About nine in ten also support government policies requiring health insurers to provide accurate and up-to-date information about who is in their network.
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Disclosure of claims denial rates
The KFF Survey of Consumer Experiences with Health Insurance and the Commonwealth Fund Biennial Health Insurance Survey are two notable surveys that provide insights into the disclosure of claims denial rates in private medical insurance.
The KFF Survey of Consumer Experiences with Health Insurance found that a significant majority of insured adults, approximately 85%, support increased transparency in the claims denial process. Specifically, respondents indicated a desire for health insurance companies to disclose their claims denial rates to both regulators and consumers. This preference for transparency is aligned with the requirements set forth in the Affordable Care Act; however, the survey highlights that this mandate has not been effectively enforced. The survey also underscores the importance of easily understandable explanations of benefits (EOBs) and the role of Consumer Assistance Programs (CAPs) in helping individuals navigate insurance challenges, including claims denials.
The Commonwealth Fund Biennial Health Insurance Survey, conducted in 2024, offers a comprehensive overview of the state of Americans' health insurance coverage. While it does not specifically address claims denial rates, the survey sheds light on the broader challenges faced by insured individuals. It highlights the relentless growth in healthcare costs, which has led to a significant number of underinsured individuals, particularly in employer plans. The survey emphasizes the need for improved cost protection to ensure timely access to medical care, indicating a potential link between high out-of-pocket costs and claim denials or disputes.
Both surveys underscore the importance of transparency and consumer protection in private medical insurance. By disclosing claims denial rates and providing clear and accessible information, insurance companies can empower consumers to make informed decisions and navigate the complex landscape of health insurance coverage. Additionally, the surveys highlight the role of government policies and regulations in addressing these issues, including the need for accurate provider network directories and easily understandable EOBs.
In summary, the KFF Survey of Consumer Experiences with Health Insurance and the Commonwealth Fund Biennial Health Insurance Survey provide valuable insights into the experiences of insured individuals and their perspectives on claims denial rates and transparency in the private medical insurance industry. These surveys advocate for enhanced transparency, consumer-friendly practices, and regulatory interventions to address claims denial-related concerns and improve overall consumer satisfaction and protection.
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Satisfaction with health insurance plans
A 2024 Biennial Health Insurance Survey by the Commonwealth Fund found that the majority of insured working-age adults in the US with high out-of-pocket costs or deductibles relative to their income were in employer plans. This was followed by plans purchased in the individual market or the marketplaces, and those enrolled in Medicaid or Medicare. The survey also highlighted the relentless growth in healthcare costs, driven by the prices that commercial insurers and employers pay to providers and for pharmaceuticals.
The KFF Survey of Consumer Experiences with Health Insurance found that nearly six in ten people with health insurance experienced a problem with using their insurance in the past year. The survey also found that uncertainty over who to contact is an issue, particularly among those with private health coverage. About eight to nine in ten adults with ESI or a Marketplace plan said they did not know which government agency to contact for help with insurance problems.
The KFF survey also found that most people with either public or private healthcare insurance like their coverage, but their satisfaction drops when they are sick. About 81% of insured adults give their health plan an “excellent” or “good” rating, with Medicare beneficiaries feeling the most positive about their coverage (91%), while those in ACA marketplace plans felt the least positive (73%).
Another survey by PubMed found that individuals with private insurance were more likely to report poor access to care, higher costs of care, and less satisfaction with care compared to individuals covered by publicly sponsored insurance programs. The survey also found that compared to those covered by Medicare, individuals with employer-sponsored insurance were less satisfied with their care.
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Health insurance affordability
The accumulation of chronic health conditions and the association between a lack of health insurance and adverse health and financial outcomes further emphasize the critical need for health insurance during this life stage. The Affordable Care Act (ACA) has expanded options through Marketplace plans and Medicaid coverage, but legislative challenges create additional uncertainty.
To address affordability, the Health Insurance Affordability Enterprise law in Colorado aims to reduce consumer costs for individual health coverage plans by assessing fees on health insurers and hospitals. The law also expands subsidies for those not eligible under the ACA. Similarly, the Commonwealth Fund's 2024 Biennial Health Insurance Survey highlights the need for policymakers to protect coverage gains and extend comprehensive coverage.
Surveys also reveal broad support for public policies that improve insurance experiences. The KFF Survey of Consumer Experiences with Health Insurance found that 94% of insured adults support requiring health insurance statements to be written in simple, easy-to-understand language. Additionally, about nine in ten insured adults support accurate and up-to-date provider network directories and disclosure of claims denial rates.
While these efforts aim to enhance health insurance affordability and transparency, the relentless growth in healthcare costs, driven by commercial insurers and employers, remains a significant challenge, contributing to the nation's medical debt and affordability crisis.
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Health insurance coverage
Health insurance is a plan or policy that covers a percentage of doctors' visits and hospital bills. It helps to offset the costs of planned and unplanned medical needs. It can also help you stay healthy through preventative care and wellness programs. There are a variety of health insurance plans that fit different needs. For example, if you're over 65 or have a qualifying disability, you may be eligible for Medicare. If you have a lower income, you may qualify for Medicaid. If you want to purchase an individual plan, you could consider an Affordable Care Act (ACA) plan. You may also have the option to get health insurance through your employer.
The KFF Survey of Consumer Experiences with Health Insurance found that nearly six in 10 people with health insurance experienced a problem using their insurance in the past year. The survey also found broad support for several public policies that could help people avoid or resolve insurance problems more easily. For example, nearly all insured adults (94%) support requiring health insurance statements (explanations of benefits, or EOBs) to be written in simple, easy-to-read language. About nine in ten insured adults also support government policy to require health insurers to provide accurate and up-to-date information about who is in their network.
The Commonwealth Fund 2024 Biennial Health Insurance Survey described the state of Americans' health insurance coverage in 2024. The survey found that many people across the insurance system, both public and private, have plans that don't provide them with the cost protection needed to get timely care. The relentless growth in the cost of healthcare is at the root of the nation's medical debt and affordability crisis in commercial insurance. Federal and state policymakers could help by creating new public plan options.
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Frequently asked questions
The KFF Survey of Consumer Experiences with Health Insurance is a survey that focuses on public policies that could help people avoid or resolve insurance problems.
The Commonwealth Fund Biennial Health Insurance Survey is a survey that describes the state of Americans’ health insurance coverage. The 2024 survey highlighted the relentless growth in the cost of healthcare and the affordability crisis in commercial insurance.
Health insurance evaluation surveys are critical for identifying gaps in coverage, understanding member satisfaction, and addressing pain points like claims delays or limited provider networks. They can also help insurers foster trust, tailor communications, and prioritize improvements.
