Roughly 11 million people gained health care coverage for the first time as of mid-December — but millions more remained uninsured despite being eligible for assistance.

Forty-eight percent of the 30 million who were uninsured at the end of 2014 could have received government assistance — 30% were eligible for tax credits under the Affordable Care Act and 18% qualified for Medicaid — according to a Kaiser Family Foundation survey of more than 10,000 adults. A majority of assistance-eligible people, 59%, didn’t try to get health coverage through Healthcare.gov, the state marketplace or Medicaid last year, the study says.

Cost was a major reason. Of those eligible for subsidies under the ACA, 53% said health insurance was too expensive, however, about half said they plan to get coverage in 2015. Many also cited confusion regarding eligibility.

“Among the uninsured who were eligible, and who sought coverage, 37% say there were told they were ineligible for it,” the study says. “While it is possible that they were ineligible at the time they applied, it is likely that these people received incorrect information or misinterpreted information they were given.”

More effective strategies needed

Twelve percent remained without coverage because their application was still pending, the survey says, and 8% had an incomplete application. “The findings show how important it is to come up with more effective strategies — in person, online and elsewhere — for educating people about their eligibility for coverage and financial assistance under the law,” says Rachel Garfield, a KFF senior researcher.

The other half of the 30 million uninsured people were not eligible for any government assistance, the survey found. About 4 million fell into the “coverage gap” — “those living in states that have not expanded Medicaid who earn too much to qualify for their state’s current Medicaid program but not enough to get ACA marketplace subsidies.” Other ineligible groups include those who opt out of employer-sponsored coverage, undocumented immigrants and those who earn too much to qualify for subsidies.

“No matter how well the ACA works, there are still substantial numbers of uninsured people with no affordable option for health coverage,” says Diane Rowland, KFF executive vice president. 

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