Health Insurance Literacy

Why Helping Patients Understand Health Coverage Helps You


Millions of Americans now have health insurance coverage under the Affordable Care Act, a.k.a. “Obamacare.” As of February 2015, about 11.4 million people had signed up for insurance through the marketplaces operated by the federal government and 14 states. On, consumers choose among plans with varying premiums, deductibles, copays, provider networks, and drug formularies to hopefully find the right coverage for their health care needs.

The problem is that surveys show many people don’t understand what those words even mean, according to a recent article in the Journal of the American Medical Association. And patients’ confusion can come at a big cost — to both their health and to care providers. What can doctors do to help patients better understand their health insurance?

The cost of health insurance illiteracy

The JAMA article looks at the results of a recent poll by the Kaiser Family Foundation assessing Americans’ familiarity with health insurance terms and concepts. The general public did reasonably well:

  • 68 percent answered more than half of the questions correctly
  • 79 percent knew that a health insurance premium has to be paid every month even if you don’t use any health care services
  • 72 percent could identify the correct definition of a deductible


Not surprisingly, uninsured individuals who took part in the survey had more difficulty. Only 64 percent of this group knew that a premium has to be paid every month, only 53 percent could correctly identify the definition of a deductible, and only 57 percent knew what a provider network is. Given that many patients newly insured under the ACA have little or no previous experience with health insurance, this is concerning.

This lack of health insurance literacy comes at a cost to both patients and providers alike. If patients don’t understand their coverage, they may stop taking necessary medications or scheduling appointments. And patients not using their insurance effectively means that health care providers pay the price.

It’s not safe to assume that even your educated, English-speaking patients understand their health insurance. A Kaiser Health News article discussed how in the wake of new coverage options, patients from all walks of life are struggling to make sense of health insurance lingo and the specifics of their plans. A 50-year-old former high school teacher was quoted as saying, “I have an education and I am not understanding this. I wonder about people who don’t have an education — how baffling this must be for them.”

What can doctors do to help?

Last year American Medical Association President Robert M. Wah, MD, wrote a post called “4 common misconceptions patients have about their insurance.” Wah lays out four questions that patients often ask their doctors or practice staff, and resources to which doctors can refer them. Number one is “What does my plan cover?” For patients who purchased their plan through a health insurance exchange, doctors can refer them to this link to obtain a Summary of Benefits and Coverage, even in another language if necessary. For patients struggling to understand terms like copayment and coinsurance and other common insurance terms, direct them to’s glossary of health care terms.

It may be impossible for you or your practice staff to know the ins and outs of every insurance plan. But as a provider who is far more familiar with health insurance than the general public, there is plenty you can do to help bridge the knowledge gap.

Make sure you explain the difference between generic and name-brand medications, for example, and maybe go the extra mile to find out if a certain prescription is covered for a patient. Explain if and when refills of a medication are required. If their health insurer has an online portal where patients can look up their claims or find out which doctors are in their network — many do — let patients know and perhaps consider typing up a how-to form to walk them through how to do this. You can even show this video that helps explain health insurance in simple, visual terms.

“Understanding health insurance is never as simple as we’d like,” writes Barbara L. McAneny, MD, in a blog post for the AMA. “Ensuring our patients are well-versed in their health plans up front will save them time later and allow them to get the care that’s best for them. And our patients are turning to us, their doctors, for answers.”

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