AFFORDABLE CARE ACT Tracking Survey

A Majority of Marketplace and Medicaid Enrollees Are Getting Health Care They Could Not Have Afforded Prior to Having Coverage

The latest wave of The Commonwealth Fund Affordable Care Act (ACA) Tracking Survey indicates that 65 percent of marketplace and Medicaid enrollees who have used their coverage said they would have not have been able to access or afford this care prior to getting their insurance.

Latest Results
Coverage And The Remaining Uninsured
14%
The uninsured rate among adults 19–64 has declined from 19.9 percent in Jul–Sep 2013.
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Enrollment Experiences
42%
Four in 10 adults who visited the marketplace described their most recent visit as good or excellent.

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Affordability
48%
Half of adults in marketplace plans who pay all or some of their premium are aware of their premium amounts and found it easy or somewhat easy to afford their premiums.
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Value of Coverage
65%
A majority of marketplace and Medicaid enrollees who have used their coverage said they would have not have been able to access or afford this care prior to getting their insurance.
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Explore Survey

Coverage And The Remaining Uninsured

14%
Current uninsured rate among working-age adults in the U.S., down from 19.9 percent in July–September 2013
16%
Current uninsured rate among
young adults (ages 19–34) down
from 28 percent in July–September 2013

The Uninsured Rate for U.S. Adults Has Fallen Since 2013

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 14 percent in March–June 2017. This represents an estimated decline of 11 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

While young adults have made dramatic gains in coverage since the law took effect, the uninsured rate rose among 35-to-49 year olds since last year.

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 declined steeply for low- and moderate-income adults in 2014. Since then uninsured rates for adults below 400 percent of poverty remain about the same. The uninsured rate rose among adults with incomes too high for premium tax credits.

Percent uninsured by income see details

Adults ages 19–64


45 percent of adults who enrolled in marketplace plans or Medicaid were uninsured before getting their new plan

Insurance status of current marketplace and Medicaid enrollees prior to getting new plan (Mar–Jun 2017) see details

Adults ages 19–64 who are currently enrolled in marketplace or Medicaid coverage


The majority of enrollees in marketplace or
Medicaid had been uninsured for a long time

Forty-one percent of adults with a marketplace plan and 46 percent of adults with Medicaid were uninsured before they enrolled. Of this group, 38 percent of those enrolled in a marketplace plan and 49 percent of those with Medicaid had been without insurance for more than two years or never had insurance.

Adults ages 19–64 who were uninsured before gaining
their Medicaid or marketplace coverage
see details


*Includes those who reported never having had insurance.

Who Are the Remaining Uninsured?

The remaining uninsured are more likely to be young, Latino, low-income, and/or work in small firms.

Latinos have become a growing share of the uninsured, rising from 29 percent in 2013 to 36 percent in 2017. Thirty percent of uninsured adults have incomes below the federal poverty level.

Composition of the remaining uninsured population see details

By Age

By Race

By Income

By Employer Size*

*Employer size only includes adults who are employed full or part-time

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

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, since 2014 it has leveled off.

Awareness of the health insurance marketplaces

Six of ten American adults who are uninsured are aware of the marketplaces where they can shop for health plans.

Percent who are aware of marketplaces,
July–Sept. 2013 to March–June 2017
see details

Uninsured adults ages 19–64

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


Awareness of financial assistance to pay for health insurance

Half of uninsured adults are aware that financial assistance for health insurance is available under the Affordable Care Act.

Percent who are aware of financial assistance,
July–Sept. 2013 to March–June 2017
see details

Uninsured adults ages 19–64

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experiences in the marketplace

Are Americans Using the Health Insurance Marketplaces?

Over one-quarter of all U.S. adults had visited a marketplace to shop for health insurance by March–June 2017.

Percent who visited marketplace,
April–June 2014 to March–June 2017
see details

Adults ages 19–64


How Easy Is It for People
to Use the Marketplaces?

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

Two of three adults who visited the marketplace and were eligible for marketplace coverage said it was very or somewhat easy to compare the premium costs, while two of five said it was easy to compare different plan networks.

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

Adults ages 19–64 who went to the marketplace and are marketplace eligible*

*Marketplace eligible includes adults in expansion states who are above 138% FPL
and adults in non-expansion states who are above 100% FPL.

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


How Do Visitors View Their Experience Trying to Get Health Insurance Through the Marketplace in Their State?

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

Experience with the marketplace, April–June 2014 to March–June 2017 (percent) see details

Adults ages 19–64 who went to the marketplace.

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.


Over One of Three Adults Who Switched Marketplace Plans Did So Because Their Old Plan Was No Longer Being Offered

Reasons changed plans, March–June 2017 (percent) see details


Adults ages 19–64 who changed marketplace plans*

*42% of adults ages 19–64 who have had marketplace coverage since before January 2017 switched plans since enrolling.


Nearly Two of Five Adults Stayed in the Same Marketplace Plan Because They Were Satisfied with It

Reasons kept the same plan, March–June 2017 (percent) see details


Adults ages 19–64 who changed marketplace plans*

*55 percent of adults ages 19–64 years who had marketplace coverage since before January 2017 stayed in the same plan since enrolling.

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Affordability

What Are People Paying for Health Coverage?

Adults with single policy plans in the marketplace paid monthly premiums comparable to those with employer coverage.

About 51 percent of adults with marketplace coverage and 54 percent with an employer plan paid either nothing for their policies or less than $125 per month.

Monthly premium distributions (percent) see details


Adults ages 19–64 with single policies

FPL refers to federal poverty level.

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.


Lower-Income Adults with Marketplace Plans More Likely to View Their Premiums as Affordable Than Adults with Higher Incomes

Ability to afford premium costs (percent) see details


Adults ages 19–64 who pay all or some of premium and are aware of their premium amount.

FPL refers to federal poverty level.

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.


Cost-Sharing Subsidies Have Lowered Deductibles for Lower-Income Adults with Marketplace Plans

Nearly three of ten low-income adults with marketplace coverage have deductibles of $1,000 or more, the same as those with employer coverage. But nearly seven of ten higher-income adults with marketplace coverage have high deductibles.

Percent of adults who have deductibles of $1,000 or more see details

Adults ages 19–64 with marketplace coverage

FPL refers to federal poverty level.


6 of 10 Adults with Marketplace Coverage Were Somewhat or Very Confident They Could Afford Care They Needed

Confidence in ability to afford care they need, March–June 2017 (percent) see details

Adults ages 19–64

Segments may not sum to indicated total because of rounding; bars may not sum to 100 percent 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

Seventy-nine percent of adults with marketplace or Medicaid coverage said they had used their plans to go to a doctor or hospital, or fill a prescription. Of those, 65 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 who have marketplace or Medicaid coverage
Percent who would not have been able
to access and/or afford this care without their new plan
see details
Adults ages 19–64 who have marketplace or Medicaid coverage and have used their new health insurance plan
Percent who got appointment within two weeks see details
74%
Three-fourths of adults with marketplace or Medicaid coverage who tried to find a new doctor were able to book an appointment within two weeks.
Percent who got specialist appointment within two weeks see details
59%
Nearly two-thirds of adults with marketplace or Medicaid coverage who needed to see a specialist were able to book an appointment within two weeks.
Percent who said it was somewhat or very easy to find a new primary care or general doctor see details
Adults ages 19–64 who have marketplace or Medicaid coverage and tried to find a primary care doctor or general doctor since getting coverage
Percent who said they are very or somewhat satisfied with their health insurance see details
89%
89% of adults with marketplace of Medicaid coverage or somewhat or very satisfied with their health insurance.
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