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From Health Affairs:


Most Americans Don't Grasp Basic Health Insurance Concepts


Bethesda, MD -- The Urban Institute's Health Reform Monitoring Survey (HRMS), initiated in 2013, is a valuable way to obtain early data about the American public's ability to understand health insurance concepts and the Affordable Care Act (ACA), before federal government survey data are available. A new study, being released today as a Web First by Health Affairs, provides results from the round of the survey that was fielded in the summer of 2013. The survey found that more than 60 percent of the target market for the health insurance exchanges indicated that they did not understand key concepts related to health insurance. Among the population targeted by the exchanges, only 39.9 percent of respondents understood all nine key concepts: premiums, deductibles, copayments, coinsurance, maximum annual out-of-pocket spending limits, provider networks, covered services, annual limits on services, and noncovered or excluded services. Only 23.6 percent of uninsured respondents, and less than a third of those ages 18-30, were confident that they understood these concepts. The HRMS results are based on a nationally representative, probability-based Internet panel that is fielded each quarter.

The Health Reform Monitoring Survey: Addressing Data Gaps To Provide Timely Insights Into The Affordable Care Act


By Sharon K. Long, Genevieve M. Kenney, Stephen Zuckerman, Dana E. Goin, Douglas Wissoker, Frederic Blavin, Linda J. Blumberg, Lisa Clemans-Cope, John Holahan, and Katherine Hempstead


Long, Kenney, Zuckerman, Goin, Wissoker, Blavin, Blumberg, Clemans-Cope, and Holahan are affiliated with the Urban Institute in Washington, D.C.; Hempstead is with the Robert Wood Johnson Foundation, in Princeton, N.J.


The study, which was supported by the Robert Wood Johnson Foundation, will also appear in the January issue of Health Affairs.


Another important finding: respondents reported their primary source of health insurance information was interpersonal--friends, coworkers, and family members. These sources could share the target population's confusion about key insurance concepts. Although knowledge gaps appeared across many different types of individuals, confidence in understanding these concepts was lower among young adults, Spanish speakers, the uninsured, and people who had lower levels of education. According to the authors, "confusion around these concepts would make it difficult for consumers to understand trade-offs between different health insurance plans and to choose the plans that best meet their needs." Moving forward, they suggest that "assisting people as they attempt to enroll in health coverage will require targeted education efforts and staff to support those with low health insurance literacy."

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.