Consumers' top complaints about marketplace coverage

People are satisfied with their health plans so far, following the Affordable Care Act’s (ACA) second open-enrollment period, but affordability remains a concern, according to a Kaiser Family Foundation (KFF) survey of those who buy their own health insurance.

Affordability remains a concern for people with both ACA-compliant and non-compliant coverage, with about four in 10 (38%) of the respondents saying they feel vulnerable to high medical bills, according to the survey. Also, nearly half (46%) of both those with ACA-compliant and non-compliant plans say that it is “very” or “somewhat” difficult for them to afford to pay their monthly health insurance premium.

Read more: The future of public and private exchanges

Those with high deductibles ($1,500 or more for an individual or $3,000 or more for a family) are less satisfied overall, and many of them say they would not be able to pay an unexpected medical bill of $1,500 without going into debt, according to the survey. Forty-three percent say they would have to go into credit card debt or borrow money to pay it, and 15% say they would not be able to pay such a bill at all.

Liz Hamel “Satisfaction is somewhat lower with deductibles than with other aspects of plans, but since high deductibles come with lower premiums-and premiums ranked as the number one factor in plan choice-there is bound to be a trade-off there,” Liz Hamel, KFF director, public opinion and survey research, tells Managed Healthcare Executive.

“Cost is people’s main focus when picking a health plan. When we asked people what factors went into their choice of plans, premiums ranked highest, and deductibles and copays were right behind. Provider networks and covered benefits are also an important factor for many, but these ranked below cost considerations,” she says.

“Going forward, it will be important to keep an eye on how those in high-deductible plans feel about the value of their coverage as they use health services and may be faced with high out-of-pocket costs,” Hamel adds.

Plans could structure benefits in a way that might make more people more satisfied with the level of cost-sharing, according to Larry Levitt, KFF’s senior vice president.

“For example, covering primary care visits before the deductible,” Levitt says. “But, overall value is standardized into actuarial value tiers, so on average people would still be paying the same. Ultimately, this is more a question of whether subsidies are adequate to make premiums and out-of-pocket costs sufficiently affordable for people. It’s also tied closely to what’s happening to people’s incomes. Right now, incomes are stagnant so people feel more vulnerable.”

Overall, the survey found that people with non-group health insurance coverage under the ACA give their plans good ratings and are satisfied with various aspects of their plans, including their choice of providers and cost-sharing arrangements.

NEXT: Survey Results: ACA Complaint Plans vs. Older, Non-ACA Compliant Plans

A majority (74%) of those in marketplace plans rate their coverage as excellent or good, the survey found. Fifty-nine percent also say their plan is an excellent or good value for what they pay for it, though the share rating the value as “excellent” declined somewhat from 23% last year to 15% in the current survey.

Majorities also say they are “very” or “somewhat” satisfied with seven different features of their plans, including their choice of primary-care doctors (75%), hospitals (75%) and specialists (64%); what they have to pay out of pocket for doctor visits (73%), prescription drugs (70%) and annual deductible (60%); and their monthly premiums (65%).

Compared to those with older, non-ACA compliant non-group plans, enrollees in marketplace plans are less likely to say they are satisfied with their plan’s choice of primary-care doctors and hospitals, but somewhat more likely to express satisfaction with their monthly premiums and annual deductibles.  This is likely because many are receiving premium tax credits and cost-sharing subsidies that are not available in non-compliant plans.

More than one-third (36%) of those with ACA-compliant plans did not have non-group coverage in 2014, most of whom (26% overall) were uninsured immediately prior to obtaining their current coverage.  Among those who were already in the non-group market last year, most chose to renew their existing plan rather than make a switch, while a small share (15% of all those in ACA-compliant plans) switched from a different non-group plan.

A large majority of those who renewed an ACA-compliant plan this year say it was very or somewhat easy to renew, including 77% of those with marketplace coverage.  Seven in 10 (69%) say they did not shop around before renewing, with the most common reason being that they were satisfied with their current plan.  Among those who did purchase new plans this year, most say it was easy to compare premiums and cost-sharing and to figure out if their income qualifies them for government financial assistance.