Do You Speak Health Insurance? It’s Not Easy
By Mark Zdechlik, Minnesota Public Radio
Mon, Jan 4 2016
Solicit opinions about health insurance and you’re almost guaranteed to find consensus: It’s mystifying and irritating.
“It just seems like a lot of the buzzwords are intended to just complicate the whole thing and make it more expensive,” said David Turgeon, 46.
Health-plan enrollment season rolls on, and people shopping on healthcare.gov and the other marketplaces have until Jan. 31 to pick a plan.
But even people trying to pick from their employers’ options can find the process complicated and difficult to understand. The jargon can be overwhelming, and it can lead people to make to costly mistakes or avoid care all together.
Ronen Ben-Simon, 28, said some basic health insurance terms are lost on him — even though he’s a nurse. “I don’t even know what ‘coinsurance’ is, to be honest,” he said.
“Coinsurance,” if your plan has it, kicks in after you’ve met your deductible and requires you to pay a set percentage of medical bills.
Seanne Thomas, a 50-year-old real estate broker, said she’s gotten good at figuring out how health insurance policies work. She’s had to, because her family members are covered under three different plans. “So I had to compare copays, I had to compare out-of-pocket, you know, deductible and maximum coverage and …”
With all that grappling with insurance plans she’s done, Thomas was game for a quiz. Here’s a scenario, developed by American Institutes for Research:
A guy goes to the doctor to get a wart removed. The bill is $530. He has a copay of $30, a deductible of $100 and coinsurance of 20 percent. How much is he on the hook for?
Thomas nailed the copay and deductible, but then ran aground at “coinsurance.”
Most people would be in the same position. A couple of years ago, American Institutes for Research, which is a social science research firm, asked hundreds of people and found that only 1 in 5 got the right answer, which is $210.*
Even Clare Krusing, spokesperson with America’s Health Insurance Plans, had trouble with the equation and said she wished she had a calculator. Ultimately, she blamed that low deductible for getting between her and the right answer.