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Health Insurance & Affordable Care Act

Patients Struggle to Learn Health Insurance Lingo

WebMD News from Kaiser Health News

By Anna Gorman

Sat, Jun 14 2014

As soon as Deb Emerson, a former high school teacher from Oroville, Calif., bought a health plan in January through the state’s insurance exchange, she felt overwhelmed.

She couldn’t figure out what was covered and what wasn’t. Why weren’t her anti-depressant medications included?  Why did she have to pay $60 to see a doctor? The insurance jargon - deductible, co-pay, premium, co-insurance - was like a foreign language. What did it mean?

“I have an education and I am not understanding this,” said Emerson, 50. “ I wonder about people who don’t have an education -- how baffling this must be for them.”

Health officials have spent much of the past year promoting the Affordable Care Act and enrolling people in coverage. Now they need to help consumers understand the basics of health insurance and how to use their policies, health care providers and researchers say.

“Giving somebody an insurance card and not really telling them what that insurance is going to do for them is not going to produce the health outcomes that we all want to see,” said Brendan Saloner, a post-doctoral researcher at the University of Pennsylvania. “If the goal is to improve health and lower costs … it is really important to equip consumers with the education they need.”

Patients who don’t grasp fundamental health and insurance concepts are less likely to make smart decisions about when and where to seek care, experts said. In fact, people with low “health literacy,” as experts put it, are more likely to be hospitalized and use costly emergency rooms, according to the Institute of Medicine.

It’s a big problem. About one in 10 people in the U.S. have a proficient level of health literacy, according to an assessment by the U.S. Department of Education – that is, they could understand and use health-related information in daily activities.

And researchers at the USC Schaeffer Center for Health Policy & Economics determined that just weeks before open enrollment began last year for state and federal insurance exchanges, more than 40 percent of Americans couldn’t explain a deductible – the amount patients owe for health services before insurance kicks in. The authors found that those likely to benefit most from the health law – uninsured and low-income Americans – had the least awareness.

“There is a huge void,” said Bonnie Braun, a health literacy expert and professor at the University of Maryland School of Public Health.

Insurance is often perplexing even to savvy consumers. Acronyms abound: HMOs, PPOs, ACOs. Letters arrive in the mail saying “this is not a bill” yet appear to be just that. Some detail exorbitant prices that have nothing to do with what is actually owed.

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