Health Insurance LiteracyThe Gateway to Healthcare

June 6, 2019

Denise Octavia Smith, MBA, CHWResearch Associate and Projects Manager

UCONN Health Disparities Institute

Objectives• Health insurance literacy (HIL) and why it

matters• HIL in Connecticut• Understand the relationship between HIL,

health insurance complexity and their impact on patients and providers

• Introduce recommendations for HIL education to patients/members/employees to optimize health and financial benefits

The Challenge of Selecting and Using Health Insurance

+ + = +

Patients’ Perspective

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What is Health Insurance Literacy?

Health insurance literacy measures the degree to which individuals have the knowledge, ability, and

confidence to find and evaluate informationabout health plans, select the best plan for their financial and health circumstances, and use the

plan once enrolled.

Source: Measuring Health Insurance Literacy: A Call to Action, Consumers Union and partners, February 2012

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Is HIL the Same as Health Literacy?

Financial Literacy

Health InsuranceLiteracy

Health Literacy

Why HIL Matters: #1Question: Does health insurance literacy and financial literacy predict being uninsured by Medicaid or marketplace private insurance?

Uninsured Insured

Low financial literacy: 8.3% lower Low health insurance literacy: 9.2% lower

Conclusion: A lack of understanding about health insurance concepts and financial illiteracy predict who remains uninsured. Recommendation: Consumer outreach and health insurance literacy education is critical in expanding coverage to more families.

Source: Med Care 2017 04. 55:428-435. 10.1097

Advanced Reading Level Required“COST-SHARE MAXIMUM means the Deductible and Coinsurance amounts which are paid by the Covered Person on a Calendar Year basis. The Cost-Share Maximum does not include Co-payments, Penalties, Cost-Shares applicable to Inpatient Hospital/Inpatient Facility Admission, Cost-Shares applicable to service beyond the Benefit Plan’s limits for those benefits, Cost-Shares for human organ and tissue transplants when the facility is not designated and approved by the Carrier, and charges that exceed the Maximum Allowed Amount. ”

11th GradeMasters LevelMasters LevelBachelor’s Level

Meaning of “Premium” in Everyday Life

Noun1. A prize, bonus, or award given as an inducement2. A gift, or sum additional to price, wages, interest, or the like.3. Insurance. the amount paid or to be paid by the policyholder for

coverage under the contract, usually in periodic installments.4. Economics. the excess value of one form of money over another of

the same nominal value.Adjective5. Of exceptional quality or greater value than others of its kind; superior:

a wine made of premium grapes.Idiom6. “Housing in that area is at a premium.”

Which health plan option would you choose? Assume the plans have identical coverage and provider network and

covers all costs after the deductible has been met.

Option Copay PCP- Spec AnnualDeductible

Monthly

A $10-25 $1,000 $72

B $10-25 $750 $110

C $10-25 $500 $118

D $10-25 $250 $163

Circle the correct answer: A B C D

#2: Low HIL + Complexity= $ Confusion

Modified from , S., Loewenstein, G. & Sydnor, J. (2017). Choose to Lose: Health Plan Choices from a Menu with Dominated Options. Quarterly Journal of Economics, 132(3): 1319-1372.

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Option Copays(PCP-Spec.)

AnnualDeductible

MonthlyPremium

AnnualPremium

A $10-25 $1,000 $72 X12 $864

B $10-25 $750 $110 X12 $1,320

C $10-25 $500 $118 X12 $1,416

D $10-25 $250 $163 X12 $1,956

Circle the correct answer: A B C D

You pay $456To save $250

Low HIL + Complexity= $ Confusion

Modified from , S., Loewenstein, G. & Sydnor, J. (2017). Choose to Lose: Health Plan Choices from a Menu with Dominated Options. Quarterly Journal of Economics, 132(3): 1319-1372.

#3: Complexity in Insurance Navigation

Source: Connecticut Insurance Department , 2016 Consumer Report Cardhttps://ct.gov/cid/cwp/view.asp?a=4903&Q=587026

Connecticut Managed Care Companies

HDI’s Health Insurance Advance5-Year Strategy Roadmap (12/2015-2020)

– Health Insurance Literacy (measure and report)– Health Insurance Navigation Support (create and test)– Health Insurance Simplification (learn and advocate)

6/10/2019 122015

2016

2017

2018

2019

Value of Health Insurance

Health Insurance Literacy and Equity• 62% average HIL score among adults with a

qualified health plan (HDI, 2017)

• Black/Hispanic adults with advanced degrees scored lower than Whites with only a high school diploma (HDI, 2017)

• $15-17m in medical debt collected in small claims annually (HDI, 2017)

• Too many “bad” choices for consumers (Quincy, 2017)

• Reduced and insufficient navigation support (AHCT, 2017)

• People think they know more than they do (Lowenstein, 2017)

• $15-17m in medical debt collected in small claims annually (HDI, 2017)

Goals: • Increase literacy• Improve navigation support and• Simplify health insurance complexity

CT HIL Education Pilot• Funding from the CT Health Foundation• Learning objectives developed with CHWs • Curriculum developed with our Coalition• Grants to Coalition to implement pilot• CHWs trained as HIL education facilitators• 477 CT residents completed 2hr. workshop• 132 pre-post survey matches• English, Spanish and Creole workshops• 94% persons of color• 50% Husky; 50% mixed insurance type• 7 Post Education Focus Groups

HIL Improvements

by Equal Coverage to Care

Coalition

Recommendations to Eliminate Complexity

• Boost HIL by carriers, CBOs, CHWS, and the state education system

• Shore up HIL training for CACs, Navigators and front desk personnel

• Display annual and monthly premiums with deductibles and out of pocket costs

• Promote decision support tools as part of enrollment process

• Guard against unintended consequences of metal tier naming

• Simplify plan designs (phase out coinsurance)

HDI Next Steps• Support Protect Our Care CT• Expand HIL Assessment (AHCT

partnership)• Online HIL Academy – expand

reach of HIL Training for CBOs and others

• Medical Debt Research –explore impact of doctors suing patients

Challenges of Selecting and Using Health Insurance

+ + = +

Patients’ Perspective

• Fewer, better HI choices• Improved labelling• Plan selection by

medical need• Elimination of deductibles

and co-insurance

• Public and private funding for consumer HIL education

• More, better HIL education by carriers

• Improved readability of HI information

• Public and private funding for HIL training of CHW, CACs, office staff, employers and others

Thank you