Independent Consumer Research Reveals 25% of Insured Adults Delayed Emergency or Essential Treatment During Pandemic

Members Appreciate COVID Information, But Want Help Understanding Health Plan Benefits & Costs

BURLINGTON, Mass.–(BUSINESS WIRE)–HealthEdge Software today released the results of independent national consumer research revealing how American adults 26 and older delayed care and accessed social services during the pandemic, what criteria will drive their upcoming Open Enrollment decisions, and their attitudes toward their health plans. HealthEdge is a leading provider of next-generation technology solutions for healthcare payers and plan administrators across core administrative processing systems, payment integrity and care management. The electronic survey was conducted by Pollfish.

A concern among the findings is that 25 percent of the 3,000 respondents said they postponed “emergency care” or “essential treatment of a chronic condition” in the 12 months prior to the survey. Thirty-seven percent of physicians polled by a medical organization late last year reported their chronic care patients were in ”noticeably worse health” as a result of the pandemic, in part due to the postponement of care. The delay of “routine preventive care” is also likely to lead to long-lasting population health impacts, according to multiple industry sources, highlighting another concern in the Pollfish survey. Fifty-five percent of consumers who delayed care reported they had skipped routine preventive care.

Medicare Advantage Members Most Satisfied

The survey sample included a representative mix1 of ages and health plan types, with 35 percent of respondents in employer-sponsored coverage, 27 percent in Medicare, 14 percent in Medicare Advantage, and 11 percent in private insurance. Medicaid represented 9 percent of the sample and Marketplace Exchange plan members were 5 percent.

Medicare Advantage members exhibit the highest satisfaction with their plans, with 88 percent rating them four or five out of five stars. Health plans purchased by individuals on the Marketplace Exchange report the lowest levels of satisfaction, with nearly a quarter rating their plans one or two stars. More than half of these members plan to scan the market for other plans during Open Enrollment.

Consumers Credit Health Plans For COVID Communication

Nearly three-quarters of insured Americans (72 percent) credit their health plans with keeping them informed about COVID-19 testing, vaccines and other pandemic information during the previous year. Payers can take a cue from this, as more than half (55 percent) of respondents expressed interest in communication and tools to help them better understand their health benefits and costs. When offered a list of services health plans might offer, such as “substance use treatment, new mother groups, access to healthy foods or in-home care,” just 50 percent of the consumers surveyed were confident they understood all their plan benefits.

Community Resources Referrals Welcomed and Engaged

Social factors that influence a person’s access to healthcare (social determinants of health) were at the forefront as the pandemic and economic fallout intensified challenges in language, transportation, literacy and basic resources, hindering many Americans from receiving care. However, just 28 percent of survey respondents said they were offered a referral to a community organization like Meals on Wheels or housing assistance from a healthcare provider or a plan over the past year. Responses suggest these referrals were welcomed, with 81 percent of those who received them taking action to engage the resource.

Consumers Want Lower Costs, Better Tools, More Insight

With Open Enrollment around the corner for most insured Americans, consumers sounded off about the drivers of health plan choice and their overall satisfaction.

When asked which three factors most affect their choice of plans, nearly half mentioned cost. Overall, “out-of-pocket costs” are the chief driver for consumers (31 percent) when selecting a health plan. Seventeen percent specified monthly premiums, suggesting sensitivity around short-term budgeting and cash flow. The second most-cited factor (26 percent) was the ability to keep current doctors.

Cost has the largest negative influence on consumers’ satisfaction with their health plans (33 percent). Eighteen percent of respondents mentioned surprise billing and difficult transactions as dissatisfiers, a statistic that could change as Federal regulations addressing surprise billing go into effect in January 2022. Forty-four percent of survey respondents said they have contested a bill for healthcare services in the past, yet 75 percent now express confidence their health plans will pay their claims correctly the first time.

When asked to choose the three services that would improve their satisfaction with their current plan, 55 percent wanted “tools or information to help understand benefits and financial responsibility,” 49 percent said, “tools or information to help them find less costly care,” and 46 percent wanted “more incentives for healthy behaviors.”

For the complete results and analysis, please, download the complimentary Executive Report, part of the Voice of the Market Survey Series published by HealthEdge.

About HealthEdge

HealthEdge® is the health insurance industry’s first digital nervous system to provide automation and seamless connectivity between all parts of a payer’s administrative and clinical systems. HealthEdge provides modern, disruptive healthcare IT solutions that health insurers use to leverage new business models, improve outcomes, drastically reduce administrative costs, and connect everyone in the healthcare delivery cycle. Its next-generation enterprise solution suite is built on modern, patented technology and is delivered to customers via the HealthEdge Cloud or onsite deployment. In 2020, Blackstone became the majority owner. HealthEdge, along with its portfolio of mission-critical technology assets for payers, including The Burgess Group and Altruista Health, are collectively driving a digital transformation in healthcare. Follow HealthEdge on Twitter or LinkedIn.


1. HealthEdge commissioned the independent survey of 3,000 American adults (26 years and older), who have health insurance. It was conducted May 6 – 10, 2021. Each of the following age cohorts made up 21 percent of the sample: 26 to 40 years; 41 to 56 years; 57 to 64 years; and 65 to 75. Seventeen percent of respondents were 76 or older. Pollfish is an agile market research platform offering real-time responses from mobile consumers using a modern sampling methodology called Organic Sampling. This methodology merges mobile delivery, artificial intelligence and a global audience network of 650 million people. Pollfish narrowly targets highly specific audience segments.


Nora Brunner,, 703.707.8890, x626