While complex changes are coming to healthcare next year, a majority of Americans — including those currently uninsured — are confident in their ability to choose health coverage, according to a national survey released today by Express Scripts.

With a new marketplace of health insurance exchanges coming in January 2014 for the more than 30 million uninsured Americans, conventional wisdom and reporting indicates public confusion around much of the process. However, according to the new survey of 2,765 Americans, more than half of those most likely to enroll in these exchanges say they're prepared for the challenge.

The national survey, which included employer-insured, self-insured and uninsured Americans, found that 53 percent of those currently uninsured are confident they will be able to select the best health plan for themselves and their family. Additionally, 60 percent of those who now purchase health insurance on their own are sure they're ready to make the right choice.

"Given some of the complexities surrounding healthcare reform changes and the new options being made available to Americans, it is encouraging to learn that the majority of those being most affected are confident they will be able to navigate the system successfully," said Julie Huppert , vice president, Healthcare Reform, Express Scripts. "That said, our survey also shows that nearly half are not as prepared for this opportunity and will require both education and support from companies like ours and our health plan partners to ensure they choose appropriate coverage."

People ages 45 to 64 tend to be more confident about their ability to choose a plan than those ages 18 to 44, with the exception of the uninsured, where the younger group is slightly more confident they will make the right choice. Additionally, females tend to be more ready for the task than males, with the exception again being the uninsured, where males and females are nearly equal in their certainty that they can handle the decision.

The survey also examined Americans' attitudes toward prescription-drug plan preferences, revealing that consumers are amenable to their pharmacy coverage mirroring the medical benefit when it comes to deductibles.

The majority of those surveyed and particularly the long-term uninsured are willing to pay a $100 deductible for prescription drugs; while deductibles are common for medical insurance, they are not commonplace within drug benefit plans.

The poll also found that many consumers are open to an in-network and out-of-network pharmacy system similar to the network-based approach used in medical care that would require higher copayments for medications purchased at pharmacies that are not part of the plan's preferred network.

"The pharmacy benefit is the most frequently used healthcare benefit, so it is important to understand consumer preferences. This survey shows a definite shift in consumers' mindset around their prescription-drug benefit," Huppert said.  "No matter what their current insurance status, most people surveyed appear willing to accept a drug plan that utilizes cost-saving strategies that are commonplace within medical insurance. This type of information may assist health plans, which will be competing in the public exchanges, in developing their pharmacy benefit strategy heading into 2014."

Additional insights include:

• The long-term uninsured (more than one year) displayed more price sensitivity to plan premiums than drug copayments and showed a willingness to accept a plan with more restrictions than those currently insured.
• As subsidies neutralize premiums, factors such as pharmacy network, formulary and copayment amounts can influence plan choice more heavily.