2.2M who qualify for health insurance subsidies don't access them
Though health insurance subsidies were at the heart of the latest Supreme Court challenge to the Affordable Care Act, a new poll finds that many Americans aren't accessing the cost-sharing reductions (CSRs) for which they qualify.
Such is the case for 2.2 million health insurance exchange enrollees, according to an analysis from Avalere, which notes that 8.1 million people qualify for a CSR because they earn incomes between 100 and 250 percent of the federal poverty level.
This may be happening because many consumers often focus on signing up for health plans with low premiums rather than calculating their out-of-pocket costs, according to Avalere CEO Dan Mendelson. Individuals must enroll in a silver plan to qualify for a CSR.
"As a result, some patients may be paying more than they need to for care," he says in a statement that accompanies the analysis.
And the trend is likely to continue, as the Congressional Budget Office estimates that 3 million people who are eligible will miss out on CSRs by signing up for a bronze plan after 2015, Avalere notes.
However, the exchanges and insurance companies could help by stepping up efforts to engage and educate consumers.
"Specifically, consumers need tools that highlight the tradeoff between monthly premiums and out-of-pocket costs and demonstrate the benefits of cost-sharing reductions," says Elizabeth Carpenter, vice president at Avalere.
Many online exchanges have indeed improved the decision-support tools they feature to help customers choose health plans, according to recent research. But among the sites involved in the study, only three offered tools that allow consumers to calculate their out-of-pocket costs.
In addition, about 60 percent of uninsured adults who are eligible for subsidies say they choose to forgo insurance because it is too expensive, FierceHealthPayer has reported.
To learn more:
- here's the analysis
1.8 million Americans could lose subsidized coverage due to tax-filing issues
Health insurance marketplaces improve consumer-friendly tools
Survey: Uninsured adults say coverage costs are too high
3 ways to improve consumer experience on health insurance exchanges