How's your health insurance literacy? Groups in Kansas are trying to improve it
Monday, September 8, 2014
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The easiest way to understand health insurance is to know there's no easy way to understand health insurance.
"If you've seen one insurance plan, you've seen one insurance plan," said Joe Pedley, chief financial officer at Lawrence Memorial Hospital.
That's why groups across the state are trying to improve residents' health insurance literacy. They want to make sure Kansans, particularly those who are newly insured, understand their policies and don't end up with unexpected medical bills, which often lead to bankruptcy. This is particularly important at a time when millions of Americans are gaining coverage under the Affordable Care Act, the 2010 health care expansion often known as Obamacare.
The Kansas Association for the Medically Underserved has started training the navigators who help people enroll in the Affordable Care Act's health insurance marketplace about insurance literacy. Kansas State University is teaching county extension agents to be experts in health insurance, so they can then go into their communities and give presentations on the subject. The U.S. Department of Health and Human Services has started an initiative, "From Coverage to Care," to help the newly insured better understand their benefits and cost responsibilities.
A major part of their work is encouraging consumers to spend time researching the different policies before deciding on a plan.
"There's no one-size-fits-all in health insurance," said Debbie Berndsen, navigator project director for the Kansas Association for the Medically Underserved. "Everyone has their unique circumstances: Do they have health issues that require them to go to the doctor a lot? Do they have doctors they want to be sure are in their network? Are they already on medications, and are they covered in the plan they want?"
Roberta Riportella, a professor of community health at Kansas State University, pointed to a recent Aflac survey that found that 41 percent of people spend 15 minutes or less picking a health insurance plan. The same study also discovered that 74 percent of employees in the United States have trouble understanding their policies.
"I don't think the American public has a really good sense of how important a purchase this is and that they really need to understand how insurance works to be able to use it most effectively," she said. "If we're going to purchase a car, we might do a lot of research. But a lot of people are buying insurance because it's a safety net. They don't plan to use it besides maybe going to the doctor once a year. They're not as aware of it. They're not thinking about it on a daily basis."
Health policy experts say the Affordable Care Act has highlighted a problem that has long existed in America.
"People have never understood health insurance," said Sheldon Weisgrau, director of the Kansas Health Reform Resource Project. "It's one of the most complicated things anyone will ever buy in the course of their lifetime, and we spend less time trying to understand it than we do a microwave oven."
Obamacare put in place some standards for the health insurance industry. It required that 100 percent of the costs of preventive screenings be covered by insurers. It standardized the forms that detail a policy holder's benefits. It required that plans offered on the marketplace cover certain essential health benefits, such as emergency services, maternity care and mental health.
"The Affordable Care Act is the closest I've seen to anything being standardized," said Cindy Hermes, director of public outreach for the Kansas Insurance Department. "If you buy a policy and your next-door neighbor buys a policy, you're going to have the same benefits. It's just how much you're going to pay and how much your neighbor's going to pay."
But consumers must still understand concepts like provider networks, copays and cost sharing. However, the Kaiser Family Foundation recently found that 37 percent of people who enrolled in the marketplace didn't know the amount of their deductible — if they even knew what a deductible was in the first place (31 percent reported not being confident in their understanding of the term).
Hermes said those numbers aren't surprising given that many of those who bought coverage on the marketplace were previously uninsured.
"If you were a vegetarian and you walked into McDonald's and wanted to order a hamburger, you're not going to know what you want. You won't know if you want onions or pickles or mayonnaise," she said. "We're talking about people who have never dealt with insurance. They've always just gone to safety-net clinics or emergency rooms when they got sick or had an accident." To make insurance easier to understand, the Kansas Insurance Department writes its brochures at an eighth-grade reading level (HHS uses a sixth-grade level).
Many of those who are newly insured assume that once they pay their premiums their health care services will be free.
"I think that might be one of the biggest things that people who didn't have insurance have a hard time understanding," said Bob Hanson, a spokesman for the Kansas Insurance Department. "They may have thought it was going to pay for everything."
But those in the health policy field have noticed and are taking steps to ensure that all consumers understand how to use their coverage.
"There needs to be a broad effort to provide better education," said Weisgrau. "You're going to see a lot more focus put on it as more and more people come into the insurance market."