AFFORDABLE CARE ACT Tracking Survey

Premiums Cost for Affordable Care Act Marketplace Plans Are Similar to Employer Coverage for Lower-Income Enrollees

The latest wave of The Commonwealth Fund Affordable Care Act (ACA) Tracking Survey indicates that the share of working age adults who are uninsured was 13 percent in March–May 2015, compared with 20 percent just before the law’s major coverage expansions went into effect. Fifty-three percent of people with marketplace plans said it was easy to pay their premiums, and 60 percent of marketplace enrollees and 55 percent of those with employer plans reported they pay either nothing or less than $125 a month for individual coverage.

Latest Results
Coverage
13%
The uninsured rate
among adults 19–64
has declined from
20 percent in Jul–Sep 2013.
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Use & Experience
25%
One of four adults ages 19–64 have visited the marketplaces.
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Awareness
59%
Nearly six of 10 adults
who are uninsured are aware of the marketplaces.
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Value of Coverage
86%
Nearly nine of 10 adults who are currently insured through the ACA marketplaces or newly insured in Medicaid are satisfied with their health insurance.
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Explore Survey

Coverage

13%
Current uninsured rate among working-age adults in the U.S., down from 20 percent
in July–September 2013
19%
Current uninsured rate among
young adults (ages 19–34) down
from 28% in July–September 2013

The Percentage of U.S. Adults Who Are Uninsured Continues to Fall

The survey finds declines in the rate of uninsurance among U.S. adults since the law’s major reforms took effect in 2014.

Uninsured rates in the United States

The percentage of adults ages 19–64 who are uninsured fell to 13 percent in March–May 2015, down from 20 percent in July–September 2013. This represents an estimated decline of 12.1 million uninsured adults since the coverage expansions took effect.

Percent uninsured see details

Adults ages 19–64

Coverage gains across all age groups in
the wake of the law’s insurance expansions

In March–May 2015, the uninsured rate among older adults ages 50 to 64 continued to decline. While young adults have made dramatic gains in coverage since the law took effect, in this wave of the survey there was no significant change from the prior year in the uninsured rate among adults under age 50.

Percent uninsured by age see details

Adults ages 19–64

Low- and moderate- income groups have made significant gains in coverage since the major expansions took effect

Uninsured rates continued to fall among adults with incomes between 138 and 249 percent of poverty.
In contrast, the survey findings indicate no further declines in uninsured rates among people
with incomes under 138 percent of poverty in 2015.

Percent uninsured by income see details

Adults ages 19–64


More than half of adults who enrolled in marketplace plans or
Medicaid were uninsured before getting their new plan

Status of current marketplace and Medicaid enrollees
prior to getting new plan (Mar–May 2015)
see details

Adults ages 19–64 who are currently enrolled in marketplace coverage
or have had Medicaid for less than 2 years


Uninsured rates among low-income adults in states
that have not expanded Medicaid are more than twice that
of those in Medicaid expansion states

Percent uninsured see details


Adults ages 19–64 with incomes below 100 percent of poverty

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Awareness

59%
Uninsured adults who are aware
of health insurance marketplaces
46%
Uninsured adults who are aware of financial
assistance to pay for health insurance

Are Uninsured Americans Aware of the Health Insurance Marketplaces?

While awareness of the marketplaces and financial assistance to help pay for health insurance rose significantly among uninsured adults from 2013 to 2014, it did not change between 2014 and 2015.

Awareness of the health insurance marketplaces

Nearly six of 10 American adults who are uninsured are aware of the new marketplaces where they can shop for health plans.

Percent who are aware of marketplaces, July–Sept. 2013 to March–May 2015 see details

Adults ages 19–64 who are uninsured

Note: Question wording was slightly different between the three surveys.


Awareness of financial assistance to pay for health insurance

Fewer than half of uninsured adults are aware that financial assistance for health insurance is available under the Affordable Care Act, unchanged from April–June 2014.

Percent who are aware of financial assistance, July–Sept. 2013 to March–May 2015 see details

Adults ages 19–64 who are uninsured

Note: Question wording was slightly different between the three surveys.

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Use & experience

Are Americans Using the Health Insurance Marketplaces?

A quarter of all U.S. adults had visited a marketplace to shop
for health insurance by March–May 2015.

Rates of visits were highest among young adults ages 19–34 (29%) and adults with incomes under 250 percent of poverty (31%).

Percent who visited marketplace, Apr–June 2014 to March–May 2015 see details

Adults ages 19–64


How Easy Is It for People to
Use the Marketplaces?

Adults who visited the marketplaces found it easy to compare benefits and costs of plans. Fewer found it as easy to compare which doctors, clinics, and hospitals were available.

About two-thirds of adults who obtained marketplace coverage said it was very or somewhat easy to compare the premium costs or the benefits covered of different insurance plans. In contrast, just over 2 of 5 adults who did not enroll said it was easy to make these comparisons between plans.

How easy or difficult was it to... (percent) see details

Adults ages 19–64 who went to the marketplace

*Potential out-of-pocket costs from deductibles and copayments.

**“Compare the doctors,clinics, hospitals available” was not asked in the October 2013 or December 2013 surveys.

Bars may not sum to 100 percent because of ”don‘t know“ responses or refusal to respond; segments may not sum to subtotals because of rounding.


How Do Visitors Rate the Marketplaces?

Two of five adults who went to the marketplace describe their experience as good or excellent.

Those who enrolled gave a higher rating to their marketplace experience than those who did not enroll. More than half (52%) of adults who obtained coverage rated their experience getting health insurance as good or excellent compared with just 18 percent of those who did not enroll.

Rating experience with the marketplace, October 2013 to March–May 2015 (percent) see details

Adults ages 19–64 who went to the marketplace

Segments may not sum to indicated total because of rounding; bars may not sum to 100 because of "don't know responses" or refusal to respond


What Are People Paying
for Health Coverage?

Adults with marketplace coverage with incomes under
250 percent of poverty paid monthly premiums comparable to those
with employer coverage.

About 60 percent of adults with marketplace coverage and 55 percent with an employer plan paid either nothing for their policies or less than $125 per month.

Premium distributions, March–May 2015 (percent) see details

Adults ages 19–64 with single policies

FPL refers to federal poverty level. 250% of the poverty level is $29,175 for an individual or $59,625 for a family of four.

Bars may not sum to 100 percent because of rounding, "don't know" responses or refusal to respond.

“All adults” include adults who do not provide their income and may therefore not be the average of adults below and above 250% FPL.


Over Half of Adults with Marketplace Coverage
Found It Easy to Pay Their Premiums

Ability to afford premium costs, March–May 2015 (percent) see details

Adults ages 19–64 who pay all or some of premium

Segments may not sum to indicated total because of rounding; bars may not sum to 100 because of "don't know responses" or refusal to respond


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Value of Coverage

The Value of New Health Insurance Coverage

Adults Are Using Their Marketplace or
Medicaid Coverage to Access Health Care

Since the ACA’s major coverage expansions went into effect, there has been concern about difficulty new enrollees might have finding doctors, getting timely appointments, and whether they would be satisfied with their choice of doctors because of insufficient provider capacity or limited provider networks. The survey asked adults who had newly enrolled in coverage about their experience using their new health plans. In the latest survey, 68 percent of adults who gained marketplace or Medicaid coverage under the Affordable Care Act said they had used their plans to go to a doctor or hospital, or fill a prescription. Of those, 62 percent said they would not have been able to access or afford this care prior to getting their marketplace or Medicaid coverage.

Percent who used their marketplace
or Medicaid coverage to go to
a doctor or hospital, or fill
a prescription
see details
Adults ages 19–64 with marketplace or
Medicaid coverage
Percent who would not have been able
to access or afford this care without their new plan
see details
Adults ages 19–64 who used marketplace or Medicaid coverage

A large majority of adults with marketplace or Medicaid coverage who tried to find a primary care physician or general doctor found it very or somewhat easy to do so.

Percent who said it was somewhat or very easy to find a new primary care or general doctor (Apr.–June 2014) see details
Adults ages 19–64 with marketplace or Medicaid coverage who tried to find primary care or general doctor

Sixty percent of those who found a primary care or general doctor got an appointment
relatively quickly.

Percent who got appointment within one week or two weeks see details
Adults ages 19–64 with marketplace or Medicaid coverage who found a primary care doctor

More than half of adults with marketplace or Medicaid coverage who needed to see a specialist were able to get an appointment within two weeks.

Percent who got specialist appointment within one week or two weeks see details
Adults ages 19–64 with marketplace or Medicaid coverage
who needed specialist

Adults with marketplace or Medicaid coverage who have used their plans are satisfied with the doctors covered.

Percent very or somewhat satisfied
with the doctors covered
(March—May 2015)
see details
91%
Adults ages 19–64 who have used marketplace or Medicaid coverage to obtain health care

Adults with Marketplace Plans or Medicaid Held Positive Views of Their New Health Insurance

The survey asked adults who had newly enrolled in coverage about their views of their new health plans. In the latest survey, 52 percent of adults who gained marketplace or Medicaid coverage under the Affordable Care Act said that they are better off now than before they had their new health insurance plan. More than eight of 10 (86%) were very or somewhat satisfied with it.

More than half of adults with marketplace or Medicaid coverage said they were better off now than they were before.

Percent who said they are better
off now than before they had their new health insurance plan
see details
Newly enrolled adults ages 19-64 with marketplace or Medicaid coverage*

*For 2014, "newly enrolled" is defined as having marketplace or Medicaid coverage for less than 1 year. For 2015, "newly enrolled" is defined as having marketplace of Medicaid coverage for less than 2 years.

More than eight of 10 adults with
marketplace or Medicaid coverage were very or somewhat satisfied with it.

Percent who were very or
somewhat satisfied with their
new health insurance plan
see details
Newly enrolled adults ages 19-64 with marketplace or Medicaid coverage*

*For 2014, "newly enrolled" is defined as having marketplace or Medicaid coverage for less than 1 year. For 2015, "newly enrolled" is defined as having marketplace of Medicaid coverage for less than 2 years.


A Majority of Adults With Marketplace Coverage
Were Confident They Could Afford Care
They Needed or Get High-Quality Care

Confidence in ability to afford care they need, Apr—June 2014 to March—May 2015 (percent) see details

Adults ages 19-64

Segments may not sum to indicated total because of rounding; bars may not sum to 100 because of "don't know responses" or refusal to respond


Confidence in ability to get high-quality care, Apr—June 2014 to March—May 2015 (percent) see details

Adults ages 19-64

*For 2014, "newly enrolled" is defined as having marketplace or Medicaid coverage for less than 1 year. For 2015, "newly enrolled" is defined as having marketplace of Medicaid coverage for less than 2 years.

Segments may not sum to indicated total because of rounding; bars may not sum to 100 because of "don't know responses" or refusal to respond

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