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Most Americans with health insurance say they face barriers to coverage, including denials of medical services, high bills and lack of doctors on plans, according to a new survey by the nonprofit health research organization KFF. As a result, some people delay or skip treatment.
Those most likely to need medical care—those who reported fair or poor health—reported more trouble; three-quarters of people receiving mental health treatment experienced problems.
“Due to the complexity of the system, the consequences of delays and missed treatments are severe, especially for patients,” said Drew Altman, CEO of KFF (formerly the Kaiser Family Foundation).
The survey also highlights ongoing affordability issues as people struggle to pay their share of health care costs. About 40% of respondents said they were delayed or accidentally left due to expenses in the last year. People in fair or poor health were more than twice as likely as those in better health to report problems paying for their health care, and black adults were more likely than white adults to say they had trouble.
Why it matters: Delaying care can endanger health.
Nearly half of those who had an insurance problem said they could not resolve it satisfactorily. Some were unable to get the care they sought, while others said they were paying more than they expected. Nearly 60 percent said they were having trouble with their insurance coverage, with 15 percent reporting a decline in their health.
Karen Pollitz, co-director of KFF’s Patient and Consumer Protection Program, said: “This survey shows that simply having a card in your pocket is not enough – insurance has to be active or it won’t provide full coverage.”
People struggle to understand their insurance coverage and benefits, with 30% or more reporting that they have difficulty figuring out what they need to pay for care or what their insurance actually covers.
“Insurance is more complicated than they should be,” said Amanda Parente, a 19-year-old college student in Nashville who is covered under her mother’s employer plan. She was surprised to learn that her out-of-pocket costs had skyrocketed recently when she sought treatment for strep throat. While she realizes her copay will be higher, “I don’t think we know how drastic it will be,” she said.
Background: Everyone is confused about insurance coverage.
The complexities of navigating coverage and benefits are similar no matter what type of insurance people have. At least half of respondents who received private insurance, through their employer, Obamacare or government programs such as Medicare or Medicaid said they had difficulty.