by Jamie Kleinsorge, Director of Health Innovation at The Mission Center
The Affordable Care Act has undoubtedly given consumers more choice in terms of health insurance options, but it has also muddied people’s basic understanding of how insurance plans really work. Research has shown that in general, Americans know very little about health insurance. It’s not just about knowing what your deductible is or how much it will cost you to see your primary care physician for a cold anymore, instead, consumers need to understand more complex concepts like provider networks, specialty care referrals, and when and how to use preventive care services.
Unless you’re an insurance broker (and even then, you might not know) you probably can’t answer a simple, ten question survey about your health insurance plan. For example, ask yourself:
- Does your insurance plan cover the use of an urgent care facility outside of your state?
- Does your health insurance plan cover an appointment with a dietician if you’re overweight or obese?
- Does your health insurance plan provide free annual vision and hearing screenings for adolescents on your plan?
- Does your health insurance cover ambulance services? What about life flight?
- Can you get your blood pressure and cholesterol checked if you’re under the age of 40 without charge?
Without a good understanding of what your plan covers, most people are hesitant to get the care they need and do so in a timely manner.
What can we do about this and why does it matter?
I’ll start with the latter. It matters because access to preventative care and healthcare services in general is critical to the health and well-being of our communities, our families, and our economy. A world without health insurance literacy is a world where people continue to use the emergency room for non-emergency needs, a world where preventable and curable diseases cause unwarranted death, and a world where trying to be healthy causes unhealthy amounts of stress.
What can we do about it? We can start by slowing down. A friend recently told me she visited her physician and received HIPAA forms from the receptionist. She asked if there had been any changes to HIPAA since the last time she was there and the receptionist told her, “I don’t have the time to explain it.” This is unacceptable. Doctors, nurses, and healthcare staff are our front lines when it comes to educating consumers on the types of no or low-cost preventative care. Providing them with quick-talk tools and easy-to-read resources is a good first step.
Secondly, insurance companies need to explain benefits in plain language. As a broker I hear it all the time; insurance companies send out “explanations of benefits” that are overly complicated, use incomplete sentences, transcription jargon, and generally fail to explain anything to the consumers. This practice has to stop. Not only does it continue to turn people off from learning about their coverage, it makes the average person feel like understanding the scope of their benefits is an unattainable or overly time-intensive chore. Taking on the language used by insurance companies won’t happen overnight, but if we all start pushing for easier-to-understand communications, the more likely they are to respond.
Without better health insurance literacy we are looking at another twenty years of a failing healthcare system. Community clinical linkages will have to play a role in the new system and help create a new paradigm in patient education. If you are part of a health-focused community group or coalition, think about convening health care providers, pharmacists, social workers, Medicare and Medicaid specialists and others to start working on developing health insurance literacy materials – handouts, videos, “cheat sheets,” telephone help lines, social media campaigns, and other outreach materials – and get the ball rolling in your community.
Ask these folks what questions they hear the most from patients and respond to those first. If you have access to a literacy group, make sure to get them involved too – they will be vital to making sure your materials are produced at an appropriate reading level and with easy-to-understand graphics. Also, be sure to check back in on the Commons, as we will continue to explore the strategies and best practices in health insurance literacy as it evolves across the country.
Jamie Kleinsorge is the Director of Health Innovation at The Mission Center (TMC). Jamie leads the TMC healthcare reform accelerator, provides technical assistance to nonprofits across Missouri, and is a Certified Application Counselor working on ACA enrollment strategies.
Jamie received her Masters in Rural Sociology from the University of Missouri-Columbia, her Bachelor of Arts in Political Science from Western Illinois University, and is a licensed insurance producer in Missouri.