About a quarter of those surveyed said their insurance didn’t cover a needed prescription drug or charged a very high copay.
About 23% of U.S. consumers said their insurance did not cover a needed prescription or charged a very high copay, according to a new survey by the KFF. Patients with Medicare (27%) commonly experienced this, and 13% of those surveyed with Medicaid delayed or went without their prescription drugs in the last year because of costs
People with poor health with employer-sponsored insurance, Medicare and Medicaid experienced more problems with prescription drugs than healthier adults (see table below).
The survey aimed to assess people’s experience with their insurance coverage. KFF surveyed people who receive insurance through their employer, Medicare and Medicaid, as well as through the ACA marketplace.
In addition to prescription drugs, KFF asked participants about their experiences with providers, mental health coverage, and claims, as well as their health status. More than half (58%) had problems with their insurance and of these 17% said they couldn’t receive care. About one in six people said their health status declined as a result.
Affordability of premiums and out-of-pocket costs are concern for many. Overall, one in six insured adults (16%) say they have had problems paying or an inability to pay for medical bills in the past year.
And about half of adults with marketplace plans (55%) or employer-sponsored insurance (46%) rate their insurance negatively when it comes to premiums, compared with 27% of people with Medicare and 10% of Medicaid enrollees.
Most of those surveyed said they experience problems when they try to use their coverage –denied or mishandled claims, provider network issues, and preauthorization requirements. Among high users of healthcare and people who use mental healthcare, about three in four people experience problems with their insurance.
“The types of problems people experience vary depending on the type of coverage they have,” the authors said. “For example, people in marketplace and Medicaid are more likely to experience provider network problems compared with people with traditional Medicare. People with marketplace and employer coverage more often experience claims denials than people with public coverage, though Medicaid enrollees report problems with pre-authorization denials more often than consumers with any other type of coverage.”
Almost all of those surveyed (94%) support requiring explanations of benefits be written in simple, easy-to-read language that explains the reasons for coverage decisions. And respondents also support requiring health insurance companies to tell people in advance if a service is covered and, if so, how much they would be required to pay out-of-pocket. In 2021, Congress passed a law applying this requirement to private health plans, though this requirement has not yet been implemented.