ACA's Second Act

Despite Coverage Satisfaction, Medical Costs Rank as Top Fear

Image courtesy Michael Coté

Analyzing Public Perception of Health Care Value & Quality

in Final Weeks of Affordable Care Act's Second Open Enrollment Period

MOUNTAIN VIEW, CA–(Marketwired – January 26, 2015) – eHealth, Inc. (NASDAQ: EHTH) (, the nation's first and largest private online health insurance exchange, today released a study showing that while the majority of Americans identify themselves as healthy (84%), financially secure (66%), and satisfied with the value of their health insurance (86%), the cost of health care and inability to afford a medical emergency rank as top financial fears.

These findings come from eHealth's Coverage Satisfaction Index (CSI), a new study tracking national consumer sentiment toward health insurance correlated with Americans' feelings about their health and financial standing. When asked to indicate their top three financial fears, American adults ranked an expensive medical emergency (54%), funding their retirement (53%) and paying for health care (44%) ahead of not being able to afford mortgage or rent, losing their job, or paying for a child's or future child's education.

Fears related to health care and medical emergencies were consistent across age groups. Consumers' perceived inability to afford deductibles was another key finding of eHealth's CSI study, with over half (53%) of U.S. adults expressing concern about covering their deductible in the case of a medical emergency. Results from eHealth's CSI survey come at a time when eHealth's Price Index1 recently showed a trend in shoppers purchasing plans with higher deductibles in the first half of the current open enrollment period.

Average monthly health insurance premiums have also seen significant increases in recent years. Average premiums in the first half of the current open enrollment period represent an increase of 54% for individuals and 76% for families when compared to average premiums before the full implementation of the Affordable Care Act2. eHealth's CSI poll surveyed more than 1,000 American consumers and was conducted by Wakefield Research between December 12 and December 19, 2014.

For details on survey methodology, refer to the Methodology Note below.

"It's encouraging to see that with the implementation of the Affordable Care Act more Americans are getting health insurance, and satisfaction with their coverage is relatively high. At eHealth, however, we talk to health insurance shoppers every day and know that the cost of coverage and medical care is still a big concern," said Carrie McLean, eHealth's Director of Customer Care.

"Today's results from our Coverage Satisfaction Index survey illustrate this. When paired with the cost data published in our eHealth Price Index, it gives a clearer picture of how consumers feel about the coverage they are paying for." The following results from eHealth CSI study highlight trends in Americans' satisfaction with health insurance coverage and how factors like financial standing, health, and age affect consumer attitudes.

Drowning in Deductibles

Half (50%) of U.S. adults who consider themselves financially secure said they would struggle to afford their deductible in a medical emergency, and younger adults feel even more exposed. Adults age 25 to 39 are more likely to consider themselves financially secure (72%), optimistic about their financial outlook (82%), and physically healthy (87%) than other generations.

However, an overwhelming 69 percent in this age group say that they would likely be unable to afford their deductible in the event of an emergency, versus 53 percent of all adults. On the other hand, consumers over age 55 are most confident they could afford the cost of their deductible, at 63 percent. Across all ages, 60 percent of those who choose a health plan based on affordability do not believe they could afford their deductible in the case of an emergency.

Purchasing behaviors support this trend: the eHealth Price Index shows that during the first half of the current open enrollment period, eHealth shoppers selected plans with deductibles that averaged 4 percent higher for individuals and 6 percent higher for families than during the prior enrollment period.

Correlating Coverage Satisfaction

A total of 86 percent of Americans say that they are satisfied with the value of their health insurance policies, with 40 percent indicating they are very satisfied. eHealth's CSI study also found the following related to overall satisfaction with health insurance coverage: When asked the top reasons why people chose their health insurance plan, nearly 1 in 3 Americans (32%) cited affordability as the number one factor they considered.

Receiving the best health insurance benefits ranked second (26%). However, affordability does not guarantee satisfaction: though most Americans (94%) who chose a plan based on the best health benefits available are satisfied with their plans, that number drops by 12 percent for individuals who chose a policy based on affordability. Satisfaction did not vary between those who purchased their own insurance and those who received health insurance through an employer, though highly subsidized plans like Medicare, Medicaid and Military-sponsored insurance yield significantly higher satisfaction (90%, 94%, and 97%, respectively).

Millennials and young adults under age 40 viewed the impact of the ACA more positively compared to older adults

Financial health has a greater impact than physical health on consumers' satisfaction with their insurance plan. Healthy individuals were more satisfied with their plans (87%) than those who consider themselves unhealthy (81%). Meanwhile, 89 percent of those who are secure in their financial health are satisfied with their plans, compared to 78 percent of those who are financially insecure.

Generation Gaps

When it comes to health insurance, as age increases, dissatisfaction with cost increases. eHealth's CSI survey found that: Thirty percent of Americans under 40 cite cost as the element of their health insurance plan with which they are most dissatisfied. This jumps to 37 percent for adults age 40 to 54, and up to 41 percent for those 55 and older. However, younger policyholders, including those in the Millennial generation, are more dissatisfied than older generations with their access to preferred doctors.

Twenty-two percent of Americans under age 40 are most dissatisfied with doctor access, dropping to 20 percent for those 40 to 54 and down to just 12 percent for adults 55 and over. Younger generations are far more sensitive to poor customer service. Approximately one in three (35%) adults under 40 cited customer service as the most dissatisfactory element of their health insurance policies or care providers. For those 40 and older, only 10 percent hold this sentiment.

Impact of the Affordable Care Act

When it comes to the Affordable Care Act, a sizeable 40 percent of the general population does not believe the law has had an impact on the quality of their health insurance benefits. For those buying their own insurance, however, the impact is felt. Almost half (46%) of those purchasing coverage on their own feel as though the ACA has had a somewhat positive to very positive effect on the quality of the benefits provided by their plan.

Additional findings:

Millennials and young adults under age 40 viewed the impact of the ACA more positively compared to older adults. Forty-five percent of insured adults under the age of 40 say that the law positively affected the quality of their coverage. Dissatisfaction with health insurance plans, however, is highly correlated with a negative view of the ACA.

Among those dissatisfied with the value of their health insurance plans, only 11 percent believe that the ACA has had a positive impact on the quality of their coverage, with 62 percent seeing it having a decidedly negative impact. Fifty percent of those dissatisfied with their plans also believe they now have fewer options in terms of access to doctors and specialists.

On the other hand, 55 percent of adults overall do not think that the ACA has had an effect on their access to doctors and specialists. Younger generations are more likely to believe that they have more options (approximately 1 in 3) while more than 1 in 4 adults age 40 and older believe they have fewer options.

Methodology Note

The eHealth CSI survey was conducted by Wakefield Research ( among 1,000 nationally representative U.S. adults ages 18+, plus oversamples up to 500 respondents who purchased private insurance, between December 12th and December 19th, 2014, using an email invitation and an online survey.

Quotas have been set to ensure reliable and accurate representation of the U.S. adult population 18+. Results of any sample are subject to sampling variation. The magnitude of the variation is measurable and is affected by the number of interviews and the level of the percentages expressing the results. For the interviews conducted in this particular study, the chances are 95 in 100 that a survey result does not vary, plus or minus, by more than 3.1 percentage points for the nationally representative sample, and 4.4 percentage points for the self-insured sample, from the result that would be obtained if interviews had been conducted with all persons in the universe represented by the sample.

1 eHealth Price Index data from the first half of the 2015 open enrollment period, with comparisons to the first half of the 2014 open enrollment period, can be found in eHealth's January 15, 2015 press release.
2 These figures are arrived by comparing average premiums for plans selected by eHealth customers in the first half of the current open enrollment period with average premium for plans selected by eHealth customers with coverage in effect as of February 2013. See eHealth's December 2013 Cost and Benefits report.

About eHealth
eHealth, Inc. (NASDAQ: EHTH) operates, the Nation's first and largest private health insurance exchange where individuals, families and small businesses can compare health insurance products from leading insurers side by side and purchase and enroll in coverage online. eHealth offers thousands of individual, family and small business health plans underwritten by more than 200 of the nation's leading health insurance companies. eHealth is licensed to sell health insurance in all 50 states and the District of Columbia. eHealth, Inc. also provides powerful online and pharmacy-based tools to help Medicare beneficiaries navigate Medicare health insurance options, choose the right plan and enroll in select plans online through ( and ( For more health insurance news and information, visit the eHealth consumer blog: Get Smart – Get Covered or visit eHealth's Affordable Care Act Resource Center at