Even before the news broke that the cost of mid-range health insurance from the Affordable Care Act (ACA) exchanges will rise about 25%, millions of Obamacare customers were already skipping doctor visits to save money.

Recent GfK research – conducted before this week’s announcement of ACA premium hikes – showed that 50% of “Obamacare” customers were cutting back on care to help manage their health costs. This compares to 33% among the general insured population.

ACA customers were most likely to save money by going without doctor visits when sick (36%) – with women more likely to do so than men (43% versus 28%). 

In addition, exchange users with lower incomes (below $25,000 a year) are turning to urgent care facilities and “minute clinics” in huge numbers; 27% have done so in the past year, compared to just 12% of the overall ACA customer population. Visiting one of these outlets is often appealing to people who may not have formed lasting relationships with providers, especially as costs can be substantially lower.

Although “consumer-directed” care has been a key goal of the high-deductible health plan model that is common on ACA marketplaces, only 6% of exchange customers say they have shopped around among providers to find the best price. And only 5% have negotiated a cash discount with a provider to avoid using insurance.

More popular strategies for saving health dollars include insurance “shopping,” with roughly one-quarter (24%) of ACA users reporting that they have switched to a lower-cost insurance plan. (Such plans often come with higher deductibles and other trade-offs.) And 18% say they have used a pharmacy rewards program.

“Lower-income populations are still the most likely to stick with the ACA exchanges, and should be able to ride out the new premium increases thanks to the subsidies,” said Liz Reyer, Vice President, Consulting and health insurance practice lead at GfK. “Unfortunately, too many are unaware of these subsidies and may either drop coverage or – if their deductibles and co-pays rise – forego more doctor visits and possibly medication. To maintain the ideals as well as the cost models behind the ACA, consumer training in self-advocacy and educating consumers about care and coverage options, including subsidies, may be just as important as, say, promoting wellness visits.”

The GfK survey was completed by 921 US consumers, ages 18 and above, who have health insurance (including 48 who currently rely on the ACA for insurance) in August 2016. An additional sample of exchange purchasers was added to provide a more robust read of this population, bringing the total to 301. Respondents are members of GfK’s KnowledgePanel®, the only commercially available online probability panel in the marketplace; making the sample truly projectable to the US population.