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US Health Insurance market report

"While the ACA (Affordable Care Act) was passed in 2010, health insurance is still a hot topic of conversation. Insurance companies and consumers are each finding out the benefits and challenges of healthcare reform. Changing demographics, innovative technology, and new expectations are shifting the landscape, and the upcoming presidential election is adding to the uncertainty. Insurers need to be nimble in this market and use all the tools at their disposal if they expect to successfully compete."

-Robyn Kaiserman, Senior Financial Services Analyst

This report discusses the following key topics:

  • Costs are still a primary concern – and they are still rising 
  • Most consumers don’t understand the information their insurance company provides
  • How will the upcoming election affect the Affordable Care Act (ACA)?

This Report covers the state of the health insurance industry in America. Issues include the changing demographics of America, the effect of the ACA, and the impact technology is having and will continue to have on the industry.

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Table of contents

  1. Overview

    • What you need to know
      • Definition
      • Executive Summary

        • The issues
          • Uncertainty about the ACA
            • Fewer than half are satisfied with their plan
              • Figure 1: Satisfaction with coverage, by generation, July 2017
            • Most don’t know what their plan covers
              • Figure 2: Knowledge of plan, by generation, July 2017
            • Few research their options
              • Figure 3: Health plan behaviors, by type of insurance owned, July 2017
            • The opportunities
              • Women want incentives to stay healthy
                • Figure 4: Attitudes toward health insurance, by gender, July 2017
              • Range of benefits and cost are major concerns
                • Figure 5: Most important features of health care plan, July 2017
              • What it means
              • The Market – What You Need to Know

                • Fewer are uninsured
                  • Private insurance and Medicaid enrollments are increasing
                    • The US is aging
                      • Unemployment continues to fall
                        • The uncertainty about the ACA
                        • Market Size

                          • Percentage of uninsured continues to fall
                            • Figure 6: Percentage of US uninsured, 2005-15
                        • Market Breakdown

                          • Private insurance and Medicaid enrollments are increasing
                            • Figure 7: Type of health insurance owned, 2013-15
                        • Market Factors

                          • The US is aging
                            • Figure 8: Percent of US population aged 18+, by age, 2012-22
                          • Unemployment continues to fall
                            • Figure 9: US unemployment rate, August 2012-August 2017
                          • The uncertainty about the ACA
                            • Figure 10: ACA enrollment, 2014-17
                            • Figure 11: ACA enrollment, by age, 2016-17
                        • Key Players – What You Need to Know

                          • Telehealth is growing
                            • Mobile apps are not being used
                              • Incentives are not working
                                • HSAs are a growing part of retirement planning
                                • What’s Working?

                                  • Telehealth is growing
                                    • Figure 12: Anthem LiveHealth email, 2016
                                • What’s Struggling?

                                  • ACA Exchanges
                                    • Mobile apps are not being used
                                      • Figure 13: Health plan behaviors, by Hispanic origin, July 2017
                                    • Incentives are not working
                                      • Figure 14: Existence and use of incentives, by generation, July 2017
                                  • What’s Next?

                                    • HSAs are a growing part of retirement planning
                                      • Figure 15: Optum HSA email, 2017
                                    • Wearables and health insurance
                                    • The Consumer – What You Need to Know

                                      • Young consumers more likely to own individual insurance
                                        • Hispanics less likely to have major types of insurance
                                          • Benefits and premiums are equally important
                                            • Women are more influenced by incentives
                                              • Most feel their health plan can do more
                                                • Medical costs are a challenge
                                                  • Opportunities for technology-based start-ups
                                                    • Health care costs in retirement a major concern for 55+
                                                    • Health Insurance Owned

                                                      • Young consumers more likely to own individual insurance
                                                        • Figure 16: Type of insurance owned, by generation, July 2017
                                                      • Hispanics more likely than non-Hispanics to buy individual insurance
                                                        • Figure 17: Type of insurance owned, by Hispanic origin, July 2017
                                                      • Men more likely than women to buy individual insurance online
                                                        • Figure 18: How insurance was purchased, by gender, July 2017
                                                    • Type of Coverage

                                                      • Hispanics less likely to have major types of insurance
                                                        • Figure 19: Type of insurance owned, by Hispanic origin, July 2016
                                                      • Urban dwellers least likely to have coverage
                                                        • Figure 20: Type of insurance owned, by location, July 2016
                                                    • Important Factors in Purchase

                                                      • Benefits and premiums are equally important
                                                        • Figure 21: Important factors in purchase, July 2017
                                                      • Importance of premiums increases with age
                                                        • Figure 22: Important factors in purchase, by generation, July 2017
                                                    • Incentives

                                                      • Women are more influenced by incentives
                                                        • Figure 23: Incentives, by gender, July 2017
                                                        • Figure 24: AARP At Your Best email, 2016
                                                        • Figure 25: Kaiser Permanents Wellbeing Dollars email, 2016
                                                      • Income affects incentive preferences
                                                        • Figure 26: Incentives, by household income, July 2017
                                                    • Health Plan Behaviors

                                                      • Most feel their health plan can do more
                                                        • Figure 27: Health plan behaviors, by generation, July 2017
                                                      • Medical costs are a challenge
                                                        • Figure 28: Health plan behaviors, by race and Hispanic origin, July 2017
                                                    • Attitudes toward Health Insurance

                                                      • Opportunities for technology-based start-ups
                                                        • Figure 29: Attitudes toward health insurance, parental status, July 2017
                                                      • Health care costs in retirement a major concern for 55+
                                                        • Figure 30: Attitudes toward health insurance, by gender and age, July 2017
                                                    • CHAID Analysis

                                                      • Wealthy pre-retirees most concerned about healthcare costs in retirement
                                                        • Figure 31: Attitudes toward health insurance – CHAID – Tree output, June 2017
                                                        • Figure 32: Attitudes toward health insurance – CHAID – Table output, June 2017
                                                      • Methodology
                                                      • Turf Analysis – Which Incentives Help Most?

                                                        • Cash incentives likely to be most influential
                                                          • Figure 33: TURF analysis – Incentives, June 2017
                                                      • Appendix – Data Sources and Abbreviations

                                                        • Data sources
                                                          • Consumer survey data
                                                            • Direct marketing creative
                                                              • Abbreviations and terms
                                                                • Abbreviations
                                                                • Appendix – The Consumer

                                                                    • Figure 34: Type of health insurance owned, by generation
                                                                    • Figure 35: Type of health insurance owned, by generation
                                                                    • Figure 36: Type of health insurance owned, by household income
                                                                    • Figure 37: Type of health insurance owned, by Hispanic origin
                                                                    • Figure 38: Health account ownership, by generation