Survey: Exchange Participants Less Happy, More Cost-Conscious

Health care consumers who purchased their insurance through an exchange are less satisfied with their coverage but were more cost-conscious when considering their plans.

Insurance exchanges are online marketplaces for purchasing health insurance that conforms with the Affordable Care Act, or Obamacare.

According to a 2015 survey of health care consumers by the Deloitte Center for Health Solutions, only 30% of those who purchased insurance through their current plan are satisfied. Higher percentages expressed satisfaction when receiving insurance through an employer plan (42%), Medicaid (48%) and Medicare (58%).

Health insurance exchange participants also were less confident they could afford their health care costs. In the survey, 24% said they were confident they would have access to affordable care when they needed it – a lower percentage than recipients of health insurance in employer plans (27%), Medicaid (36%) and Medicare (38%).

Only 16% of health insurance exchange participants felt financially prepared to handle future health care costs – lower even than Medicaid recipients (17%), many of whom qualify for that program because of their low incomes. Meanwhile, only 24% of employer-sponsored insurance recipients and 27% of Medicare recipients felt financially prepared to handle future health care costs.

At the same time, exchange purchasers were more cost-conscious when selecting their plans. In the survey, 76% said they considered the amounts they would pay in premiums, deductibles and copays in selecting their plans, compared to 65% in employer plans and 69% in Medicare plans. Among Medicaid recipients, 62% said they considered those factors even though most can participate in plans that don’t charge premiums and involve little cost-sharing.

Also, 65% of current insurance exchange enrollees have used their plans to receive care or buy medication. Of that group, 36% said they would not have been able to access and/or afford that care prior to being on the exchange plan, while another 36% said they maybe could have afforded it. One-third of all exchange enrollees who were covered for the entire year had trouble paying out-of-pocket expenses.

Comparing 2013 to 2015, health consumers as a whole were more willing to accept a smaller network of hospitals (52% increasing to 59%) and a smaller network of doctors (50% increasing to 58%) in exchange for lower payments.

The survey involved 3,887 adults 18 years or older, including 406 covered through the federal HealthCare.gov or a state health insurance exchange. Deloitte is an international firm offering auditing, consulting, financial, tax and other services. To see the entire survey, go here.