2 in 3 Americans Are Unaware of Financial Aid for ACA Marketplace Health Plans: Survey 

Healthcare Writer

Updated on February 29th, 2024

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Healthcare.com’s 2023 Health Insurance Literacy Survey: A Deep Dive into Public Understanding and Challenges

By improving literacy on health insurance, Americans take stronger charge of their health and gain a deeper understanding of their options and potential savings. 

Our 2023 Health Insurance Literacy Survey findings dive into the understanding and challenges in health insurance comprehension. Our analysis reveals moderate confidence in understanding their health insurance plans’ basics. However, there are notable gaps, especially in grasping specific terms like Coinsurance and Qualifying Life Events (QLE).

Key Highlights 

66% Americans are unaware of ACA plan subsidies.

73% lack confidence in estimating future healthcare costs.

56% Don’t understand HSAs’ pretax benefits for medical expenses.

45% believe health insurance is not affordable without employer coverage.

27% faced higher medical bills due to insufficient health insurance knowledge.

Gauging Confidence in Health Insurance Terminology

Over 70% of Americans understand Basic Health Insurance Terms, Benefits, and Premiums. However, comprehension declines, with less than half grasping Copays (47%) and Deductibles (43%) and only 32% and 26% understanding Coinsurance and Qualifying Life Events (QLE), respectively. This underscores the need for improved education.


Many respondents struggle with estimating future healthcare costs, indicating a need for better financial planning tools and guidance. The data also reveals the real-world impact of insurance literacy, with over a quarter of participants receiving unexpectedly high medical bills due to misunderstandings about their coverage.

There’s room for improvement, especially in public knowledge about ACA subsidies and Medicaid, particularly in light of increased subsidy aid and the unwinding of Medicaid recipients. More educational resources should be directed to better understanding network limitations and Health Savings Accounts (HSAs) to allow individuals to optimize their financial resources while ensuring access to preferred and necessary medical services.

The influence of health insurance plays a major role in employment decisions, with many staying in or taking jobs primarily for insurance benefits, highlighting the critical role of employer-sponsored coverage in healthcare affordability.

“Our Literacy Survey highlights the critical gaps in public understanding of health insurance, especially with government subsidies for ACA plans and the nuances of qualifying life events,” said Howard Yeh, co-founder of Healthcare.com. “By enhancing comprehension, we can empower individuals to make more informed decisions, potentially leading to savings and better health outcomes.”


Healthcare.com conducted this survey utilizing a SurveyMonkey Audience on February 28, 2023, among a national sample of 1,056 U.S. adults ages 18 and up. The modeled error estimate for this survey is plus or minus 2.0 percentage points. The sample was balanced for age, gender, and U.S. Region according to the Census Bureau’s American Community Survey.

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