A Look At Self-Insured Adults

Is November 1, 2015 circled on your calendar? Unless it is your birthday, probably not — but if you were required to purchase your own health insurance through the mandate of the Affordable Care Act (aka “Obamacare), November 1st is an important date. It is the first day of open enrollment for 2016 health care coverage through the marketplace exchanges. The sooner you get started, the more time you will have to evaluate the options.

New Health Insurance Survey Shows Need for Education and Services

A new survey conducted on behalf of ConnectedHealth suggests that you are likely to need that extra time, and maybe more information, to make an informed health insurance decision. The answers to survey questions from 400 self-insured US adults over the age of 18 provide some insight into the healthcare law and the shopping experience and results provided by the exchanges.

One striking note is that, for a law that generates constant criticism and complaints, people were surprisingly satisfied with the health insurance purchasing process. 79% of respondents reported being either very satisfied or somewhat satisfied with their health insurance purchasing process. Online purchasers were slightly less satisfied, with 26% dissatisfaction compared to 21% overall. On a scale of 1-10, with 10 being the highest level of satisfaction with the purchasing process, the average value was a 7.

Even with this level of satisfaction, 88% of respondents agreed that certain features could have made the process easier. A more streamlined and time-efficient process was selected by 43% of respondents — a logical response given that the overage online purchasing time was 117 minutes, and 70% of respondents spent more than an hour with the online process.

Despite the reported satisfaction level, over two-thirds of respondents experienced at least one issue with their health insurance purchase. The largest concern was higher than expected out-of-pocket costs, with 44% of respondents making this claim. Other issues included more restrictions than expected (32%), or unexpected hidden fees (19%).

Tight Budgets Affect Decisions

Tight budgets make it increasingly important to make the correct health insurance decision. The average monthly healthcare budget of respondents was $334, and $413 for families with dependents. With their selected plan, one-third of respondents were not confident that they could pay their full deductible in case of a medical emergency, and 35% were not confident they could pay their premiums given a 10% increase.

As a result, 50% of respondents reported that a cost-comparison tool would make the health insurance purchasing process much easier, while 42% would have welcomed personalized recommendations based on their financial needs and 32% would welcome on-demand customer service representatives. In essence, people are looking for guidance and/or verification on their choices. Are they balancing costs and coverage correctly, and are they correctly assessing their options?

Deductibles, Premiums and Payments

Further education on health insurance basics could help produce not only a better health insurance shopping experience, but also better purchasing outcomes. For example, only 61% of respondents correctly identified a deductible as the amount of money that must be paid out-of-pocket before an insurer will cover health-related services. Others mistook deductibles for premiums, payments per visit, or estimates for specialized healthcare services.

Given that finding, it is no surprise that unexpectedly higher out-of-pocket costs were the largest issue. If you do not understand what a deductible is, you are likely to make the choice based only on premium costs without meaningful regard to your likely medical expenses or your ability to pay them.

The poll results suggest general satisfaction with the process but less satisfaction with the results, especially in economic terms. People may not realize how to properly compare options, making the purchasing process easier but less complete than it should be to find the best deal.

In short: if there are terms and concepts that you do not understand when purchasing your health insurance, seek competent advice. Start early enough in the enrollment period so that you can research a plan in depth and get all your questions answered before you decide. Take the time to find the best balance between costs and coverage.

Your health and that of your family are too important to rely on guesswork and hunches.

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