Uninsured Americans may struggle choosing health-care plans

As Obamacare rolls out across the United States, making health insurance accessible to millions of Americans who have never had it before, a new study finds they may struggle to choose the right plans, especially if they are not familiar with the terminology.

Choosing the right health coverage is a daunting prospect even for those who are already used to it. But researchers at Washington University School of Medicine in St. Louis suggest uninsured Americans who have never had health insurance before are likely to face extra difficulties, and the newly created state and federal health insurance exchanges designed to help them make their choices need to be aware of this.

They write about their study, which took place before enrollment under the new federal Affordable Care Act came into force last month, in a recent online issue of the journal Medical Care Research and Review.

In their study, titled Knowledge of Health Insurance Terminology and Details Among the Uninsured, the team questioned 51 uninsured Missourians from rural, urban and suburban parts of the state, about their understanding of key terms used in descriptions of health plans.

Uninsured American have unidentified gaps in knowledge

They identified gaps in knowledge that appear common among the uninsured. Participants struggled with terms like “coinsurance” (sharing of risk between insurer and insured), “deductible”, “out-of-pocket maximum”, “prior authorization” and “formulary”.

Even participants with previous experience of health insurance were confused about the difference between similar terms – for instance between “urgent care” and “emergency care”, or “co-insurance” and “co-payment”.

Lead author Mary Politi, an assistant professor of surgery, says:

“We need to do a better job communicating information about health insurance to help people make the choices that work best for them.”

Prof. Politi and colleagues suggest health-care navigators – hired under the new law to help Americans sign up for health insurance – will play a key role. They could explain unfamiliar terms using visuals and more familiar contexts (for instance, the study found people with car insurance were more likely to grasp some of the terms).

The team is now looking at how communication about health insurance and the new exchanges might be improved to help uninsured Americans make their choices – especially those who struggle to understand health terms and have poor math skills.