In the past years, many Americans have been experiencing hardships in healthcare. According to PhRMA's third Patient Experience Survey, healthcare availability is not the only hurdle that patients are experiencing. Patients also have crucial problems about the frustration and confusion on how to use their coverage. Administrative hurdles and other barriers that health insurers and Pharmacy Benefit Managers (PBM) impose, such as time-consuming paperwork or prior authorization, are some things that are challenging for many insured Americans.
Below are some ways that insurance barriers stand between patients and care, as well as Americans' desired solutions.
- Insurer and PBM-imposed cost sharing continues to leave Americans financially vulnerable. Too many insured patients report challenges with their out-of-pocket costs. About thirty percent of insured Americans face this barrier to care also with their lack of savings to cover unforeseen expenses. And even with insurance, 15% say that they couldn’t afford health care if they ever become seriously ill because of these expensive out-of-pocket costs. 36% of these people cite the deductibles as the primary reason for their difficulty in their out-of-pocket costs.
- Insured Americans are struggling to navigate their coverage. Many insured Americans are not familiar with their insurance coverage. As the survey reported, insured Americans can’t anticipate what they will pay for their health care services, and about 1 of 5 of them spent more hours on paperwork and phone calls and on other administrative tasks with their insurance company.
- Insured Americans support policy reforms that make their coverage more affordable and predictable. A survey of over 5,000 insured Americans reported that most Americans favor solutions that improve their insurance coverage. About 33% of them ask their insurance company to cover more products and services before meeting with deductibles. This makes the top two desired solutions overall. Adding to this, about 90% of insured Americans prefer their insurance policy to be more predictable in their out-of-pocket costs so that they can anticipate the costs they need to pay, like for prescription drugs they need to buy monthly. Lastly, about 58% of these insured Americans prefer to pay more for them to have better coverage.
Even though there are lots of insured Americans, the problem with our healthcare system and insurance companies are still on a rise. Our government is finding ways to help our people have lesser problems in healthcare and hoping in the near future that they may solve these problems.