Significant Disparities Exist in Consumer Health Insurance Literacy: Implications for Health Care Reform

Abstract

Background: Health insurance literacy (HIL) is defined as a person's ability to seek, obtain, and understand health insurance plans, and once enrolled use their insurance to seek appropriate health care services. Objective: The objectives of this study were to assess sociodemographic disparities in HIL, including knowledge of health insurance terms and costs, and confidence in using insurance to access health care in a nationally representative adult sample. Methods: We conducted a secondary data analysis of the Health Reform Monitoring Survey, which included 15,168 adults age 18 years and older who responded to surveys in the third quarter of 2015 and first quarter of 2016. Rao-Scott chi-square tests and weighted logistic regression were used for analysis. Key Results: The majority of our sample (51%) reported having inadequate HIL as measured by knowledge of basic insurance terms, and close to one-half (48%) had low confidence in using their insurance to access health care. Logistic regression analysis indicated significant disparities in HIL, with multiple groups identified as being at higher risk for having inadequate HIL (as measured by both knowledge and use of health insurance). These included young adults, women, those with Hispanic ethnicity, those who were not U.S. citizens, and those who were currently unmarried. Also identified to be at risk were those who are unemployed, uninsured, and enrolled in public health insurance plans, and those with lower levels of education and income. Most had inadequate knowledge of their annual out-of-pocket costs and insurance plan's deductible amounts. Conclusions: One-half of U.S. adults rate themselves as having inadequate HIL. Sociodemographic disparities in self-reported HIL underscore the need for increased consumer education, as well as efforts to simplify the health care system by promoting value-based care, supporting delivery system reforms, and designing services to be responsive to consumer HIL needs and abilities. [ HLRP: Health Literacy Research and Practice . 2019;3(4):e250–e258.] Plain Language Summary: In a nationally representative sample of 15,168 adults, the majority had low knowledge about basic health insurance terms and had difficulty using health insurance to access needed health care services. These findings indicate that health insurance literacy is a major concern in our community that disproportionately affects some underserved groups more than others, including young adults, groups with low-income, and people who are uninsured.

Availability of Health Insurance Literacy Resources Fails to Meet Consumer Needs in Rural, Appalachian Communities: Implications for State Medicaid Waivers

“…Our findings are comparable to other studies that have identified low HIL as a barrier to accessing health insurance and health care services 4,5,12,13 . Consumers in the United States report feeling confused with health insurance terminology and with the difficulty of navigating a convoluted health care system 20,21 . A national study comparing urban populations with rural populations revealed that rural populations demonstrate lower literacy levels related to health and other types of literacy, which can be explained by known confounders such as education 22 .…”

“…4 , 5 , 12 , 13 Consumers in the United States report feeling confused with health insurance terminology and with the difficulty of navigating a convoluted health care system. 20 , 21 A national study comparing urban populations with rural populations revealed that rural populations demonstrate lower literacy levels related to health and other types of literacy, which can be explained by known confounders such as education. 22 Future studies are needed to further explore the intersection between HIL and social determinants of health to better understand how they impact health care decision‐making in rural populations.…”

A Cross-Sectional Study on the Affordable Care Act from the Perspective of People Living with HIV: The Interplay between Knowledge, Stigma, Trust, and Attitudes

“…However, future strategies to combine trusted and commonly used sources, HIV clinicians and case managers, with websites, which were the only source of ACA knowledge in this study that was associated with correct ACA knowledge, should be explored. While there will be variable health insurance literacy [ 33 ], HIV clinics could develop low-cost websites with videos to share accurate and actionable ACA knowledge with PLWH. Videos could be disseminated via a private YouTube channel or a clinic-specific mobile health application.…”

Acceptability, feasibility and implementation of a web-based U.S. Health Insurance Navigation Tool (HINT)

“…Study findings show that approximately one-half of U.S. adult consumers report having inadequate health insurance literacy (i.e. ability to seek, obtain, understand and use health insurance plans) and 48% have low confidence using their insurance to access health care services [ 1 ]. In a survey of 202 insured US adults, only 14% could answer 4 simple questions on the definition of cost-sharing features [ 2 ].…”