With open enrollment for Affordable Care Act starting in November, a survey finds that 42 percent of Americans say they probably won’t review a health insurance plan’s details before signing up.
An American Institutes for Research survey found wide gaps in Americans’ health insurance knowledge, with only 20 percent able to calculate correctly how much they owe for a routine doctor’s visit.
“Because many people believe they know more than they actually do about health insurance, they may not fully understand their options before committing to a particular health plan, or they may face the shock of high out of pocket expenses they didn’t expect,” said Kathryn A. Paez, Ph.D., an AIR researcher, and coauthor of the study.
Findings include:
- Consumers had a weak grasp of different plan types. About half could identify general characteristics of a health maintenance organization or HMO and 23 percent could identify the characteristics of a preferred provider organization or PPO.
- Participants correctly answered 60 percent of knowledge and skills items in the survey. While most could identify common insurance terms, such as "appeal" and "premium,” far fewer could identify more complicated concepts, such as "step therapy" or "medically necessary.”
- Three out of four of those surveyed said they were confident that they have the knowledge needed to use health insurance effectively. However, only about one in five could accurately calculate how much they’d pay for a visit to an in-network doctor that included a copayment, deductible, and coinsurance.
- When comparing insurance plans, 42 percent weren’t likely to check what a plan will and won’t cover before getting health services.
- Seventy-nine percent were likely to check which hospitals and physicians various plans cover, while 21 percent said they were not likely to consider this when selecting coverage.
- Younger people generally had less health insurance knowledge. For example, those aged 22 to 34 correctly answered 55 percent of the knowledge and skills items on the survey, compared with 63 percent of 55- to 64-year olds.
- Individuals who hadn’t seen a doctor in the past year got 49 percent of the knowledge and skills items correct, while those who saw a doctor several times a year scored 64 percent.
“Younger people, those who use health care less frequently, minorities, people with lower incomes, and those with less education have less knowledge about health insurance because all of these groups are more likely to be uninsured,” said Paez. “And, they are the people most likely to use the health insurance marketplaces.”
Under the ACA, millions of Americans gained health coverage – many for the first time – through Medicaid or by purchasing private coverage in the federal or state health insurance marketplaces.
During open enrollment for 2015 coverage, Nov. 15 through Feb. 15, people can sign up for coverage or change their health plan for the coming year.
