A new KFF survey finds that nearly one in five potential marketplace and Medicaid enrollees – an estimated 7 million people – say that they got assistance applying for Affordable Care Act (ACA) marketplace plans or Medicaid in the past year, while one in eight – an estimated 5 million – tried and failed to obtain help.
The survey suggests a shortage of consumer assistance prior to the COVID-19 pandemic, which has disrupted job-based health insurance for millions of Americans. Consumer assistance programs could help people shopping for replacement coverage understand and evaluate their options.
The national survey examines the experiences of consumers most likely to use consumer assistance to obtain health coverage — non-elderly adults with marketplace or Medicaid coverage, or who are uninsured.
Nearly one in five (18%) who enrolled, actively renewed, or looked for coverage in the past year reported getting help from someone other than a family member or friend to explore their coverage options. The most commonly cited reasons for seeking help included a lack of understanding of the available coverage options (62%), and concern that the enrollment process would be too complicated to complete without professional help (52%).
Those who successfully utilized consumer assistance report a high level of satisfaction with the guidance they received, with 94% rating it as very or somewhat helpful. Many who received help also say that without consumer assistance, they may not have found coverage at all.
Among consumers who said they tried unsuccessfully to obtain help with the enrollment or shopping process, many reported problems finding in-person services. Three in ten said they could not find services close to where they live or were unable to schedule an appointment. One in ten were Spanish speakers who reported problems finding services in Spanish.
The ACA established in-person consumer assistance programs to help people identify their plan options and enroll in coverage. Services are delivered by a combination of state and federally funded marketplace Navigators, insurance brokers, community-based nonprofits, and health care providers. Since 2017, the Trump administration reduced Navigator funding by 84% on average in federal marketplace states and has encouraged increased reliance on brokers to provide enrollment assistance for consumers.
The report found most people who are uninsured or have marketplace or Medicaid coverage do not know or are unsure if the ACA has been overturned, if their state has expanded Medicaid eligibility, or time frames when they can apply.
The report also includes data on the demographic characteristics of people seeking assistance, consumer satisfaction with marketplace plans and Medicaid, and attitudes toward coverage options among people without insurance.
Designed and analyzed by researchers at KFF, the survey is based on online interviews conducted March 28 through April 14 among a sample of 2,049 adults ages 18-64 who reported having health insurance purchased from a state or federal marketplace, being covered by Medicaid (excluding those who receive Supplemental Security Income), or being uninsured. The survey was conducted using Ipsos KnowledgePanel, a probability-based panel designed to be representative of the U.S. population. Results based on the full sample have a margin of sampling error of plus or minus 3 percentage points.