Health Insurance Literacy: Key Considerations for Stakeholders

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EnrollAmerica.org | GetCoveredAmerica.org 10-20-2014

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Health Insurance Literacy:Key Considerations for Enrollment Stakeholders

Sophie Stern, Deputy Director, Best Practices Institute, Enroll

America

Lynn Quincy, Associate Director, Health Policy, Consumers Union

Ricky Gonzales, Deputy Director, Analytics, Enroll America



Agenda

Introduction Sophie Stern (moderator), Deputy Director, Best Practices Institute, Enroll America

Things to Consider When Engaging Consumers Lynn Quincy, Associate Director,

Health Policy, Consumers Union

Testing Consumer Materials to Improve Health Insurance

Literacy

Ricky Gonzales, Deputy Director, Analytics, Enroll America

Sophie Stern, Deputy Director, Best Practices Institute, Enroll America

Q&A Sophie Stern, Deputy Director, Best Practices Institute, Enroll America



Engage on Twitter

#HealthInsLit



INTRODUCTION TO HEALTH INSURANCE LITERACY

Sophie Stern, Enroll AmericaDeputy Director of the Best Practices InstituteOctober 20, 2014



Goals for Today

1. Why health insurance literacy (HIL) matters

2. Manage expectations for OE2

3. Learn about concepts consumers are struggling with and how to help



Health Insurance Literacy

Source: Consumers Union, Measuring Health Insurance Literacy: A Call to Action, February 2012. Can be found online at: http://consumersunion.org/pub/Health_Insurance_Literacy_Roundtable_rpt.pdf

Financial Literacy

Health LiteracyHIL



HIL Levels are Very Low

• Americans are confident, but actual understanding is very low

• Only 14 percent of all respondents accurately understood deductible, copay, co-insurance and out-of-pocket maximum

• 44 percent of consumer assistance programs had seen people who did not understand how to use insurance

Sources: Loewenstein, “Consumers’ misunderstanding of health insurance,” Journal of Health Economics, September 2013; Kaiser Family Foundation, Survey of Health

Insurance Marketplace Assister Programs, July 2014



The Role of the Enrollment Community

To Help Consumers Get Covered and

Stay Covered



HIL and Its Link to Retention

Source: Enroll America, Knowledge is Power: Focusing on Health Insurance Literacy May Increase Health Coverage Retention, August 2014,

http://www.enrollamerica.org/blog/2014/08/health-insurance-literacy-coverage-retention/

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Feel like they have enoughinformation

Feel like they do not haveenough information

Con

fiden

ce in

pay

ing

prem

ium

Enrollees who have more information about the law are more confident that they can pay their premium

86%

56%



HIL and Its Link to Retention

0%

10%

20%

30%

40%

50%

60%

70%

80%

Feel like they have enoughinformation

Feel like they do not haveenough information

73%

Enrollees who have more information about the law are more likely to renew coverage

Plan

to re

new

cov

erag

e

Source: Enroll America, Knowledge is Power: Focusing on Health Insurance Literacy May Increase Health Coverage Retention, August 2014,

http://www.enrollamerica.org/blog/2014/08/health-insurance-literacy-coverage-retention/

56%



What Do Consumers Need to Know?

Our Wish List

Why health insurance matters

When and how to get covered (and renew!)

Financial help (or low or no cost coverage) is available

How to find a plan that meets needs and budget

How to use health insurance• Using a health insurance card• Finding a doctor or hospital in-network and knowing what’s covered• Understanding out of pocket costs• Knowing how to appeal a coverage decision

How to keep coverage



But the Bottom Line is…

Consumers need to Know Where to Get Help!

https://www.getcoveredamerica.org/locator/Email [email protected] if interested in learning more

https://www.getcoveredamerica.org/locator/

mailto:[email protected]

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Lynn Quincy Associate Director, Health PolicyOctober 20, 2014

Things to Consider When Engaging Consumers

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What DO Consumers Know?

Copays

Sometimes premium

Low health insurance literacy is ubiquitous:

All income levels

All education levels

Includes even those that have been insured most of their lives

Cost sharing terms are the hardest of all

Top Tips: Health Insurance Basics

Source: https://www.healthcare.gov/why-should-i-have-health-coverage/

Few of Us Can Pay for Health Care Out of Pocket

Source: Milliman, Benefit Designs for High Cost Medical Conditions. Note: 2010 costs inflated to 2014 using Medical CPI.

$350,322

$193,012

$137,228

$112,683

$83,676

$80,329

$68,056

$0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000

Respiratory Failure on Ventilator

End-Stage Renal Disease

Cancer patients who receive

surgery or chemotherapy

Premature baby with extreme

problems

Coronary Artery Disease

Heart Attack including Cardiac

Revascularization

Stroke

With Insurance…

You pay a fixed premium each month…

BUT the cost of most medical care is shared between you and the insurance company.

You benefit because the insurer has negotiated lower payment rates with doctors.

PLUS, the most you have to pay in a year is capped. If you get an really expensive illness, insurance will pay the majority of those bills

Financial help: least understood feature of ACA…

.. and a motivator to get covered.

Financial help was the single greatest motivator to get consumers to

explore options and get covered during the initial open enrollment

period

1 in 5 Knew About Financial Help

“I can’t afford insurance.”

-Number one reason respondents gave for not

enrolling

Source: PerryUndem Research and Enroll America, Voices from the Newly Enrolled and Still Uninsured: A survey about the Affordable Care Act’s First Open Enrollment Period, July 2014, http://www.enrollamerica.org/resources/public-education/voices-from-the-newly-enrolled-and-still-uninsured/

Top Tips: Picking the “Best” Plan

What’s covered?

Health plans you buy on your own now cover a standard set of benefits:

Doctor, hospital, maternity, prescription drugs, mental health and more.

But some things may not be covered:

Adult dental

Children’s dental

Certain drugs

Check the Drug Formulary

Tier 1: Generic $

Tier 2: Brand $$

Tier 3: Specialty Drugs $$$$

Some drugs aren’t

covered at all

HOW? Use Marketplace website or ask the health plan for the link to the formulary online (won’t be listed on the SBC)

Cost-sharing Terms are Very Difficult for Consumers

Deductible

Copay

Coinsurance

Benefit Limit

Out-of-Pocket Maximum

Balance Bill

Individual vs. Family

Aggregate vs. Embedded

Allowed Amount

Visits, days

In- vs. Out-of-Network

Separate deductibles for drugs or other services

Deductible is What You Pay First

22Jan DecJulMar

Visit Doc for Flu:$150Todd pays: $150

Colonoscopy$450Todd pays: $0 (an exception to the

deductible)

Broken arm (waterskiing)$3,850Todd pays: $850 (deductible) then coinsurance

Todd’s plan has a $1,000 deductible:

$150

$850

$450

$3,000

Todd pays:

Plan pays:

Todd & plan share the

cost

Exceptions to Deductible

Free Preventive Health Services including some vaccinations, mammograms and other

cancer screenings, contraception, including birth control pills, and periodic physicals. But prevention services do not include treatment for an illness, such as the flu.

See: https://www.healthcare.gov/what-are-my-preventive-care-benefits/

Some plans offer 1-3 primary care visits before deductible – you have to look.

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If the price for a doctor visit followed by the phrase "after the deductible is met" the consumer must pay the full deductible before getting doctor visits for indicated copayment or coinsurance amount.



Summary of Benefits and Coverage

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Individual vs. Family

Separate Medical and Prescription Drug vs. Combined

Types of Deductible

Types of DeductibleIn-Network vs Out-of-Network

Coinsurance is Hard for Three Reasons

1) WHO does the indicated percentage apply to?

2) Low numeracy – can’t calculate percentages.

3) Can’t get to a bottom line - most times, you don’t learn what the allowed or contracted amount is until you get your bill.

80%

20%

Doctorvisitcosts$300

Healthplanpays$240

Youpayco-insuranceof$60

Example

Keep paying your premiums

Find a primary care doctor –don’t use the emergency room for routine care

Report changes in income and family size to the Marketplace (if you are receiving a tax credit)

Congratulations! Got Coverage. Now What?

Explain the info on the Insurance Card

Adapted with permission from Texas Association of Community Health Centers presentation

For Example

For more information: http://www.ahrq.gov/apps/qb/

Adapted with permission from Texas Association of Community Health Centers presentation

Making the Most out of Doctors Appointments

During your appointment, ask:

Why do I need this treatment? What is the test for? Are there any alternatives? What are the possible complications? How many times have you done this

procedure? When will I get the results? Does the medication have any side effects? Will this medicine interact with medicines

that I'm already taking?

http://www.ahrq.gov/apps/qb/

You have options!

Start with health plan’s 1-800 number

Call number at the bottom of your “Explanation of Benefits”

If that doesn’t help, contact the Department of Insurance

Insurer didn’t pay for a service? Got a bill that seems too high?

http://www.naic.org/state_web_map.htm

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Action Steps

Continue to provide in-person help

Simplify health insurance information

Develop effective materials on HIL



TESTING CONSUMER MATERIALS TO IMPROVE HEALTH INSURANCE LITERACYRicky Gonzales, Enroll America Deputy Director of Analytics October 20, 2014

Sophie Stern, Enroll AmericaDeputy Director of the Best Practices InstituteOctober 20, 2014



Designing Consumer Lit for OE2



Question of What to Emphasize?

Information• Financial help, in-person assistance, why insurance matters

(preventive care, no denials, prescriptions, etc.), fineTools• Subsidy calculator, locator tool for in-person help, plan help

available on GetCoveredAmerica.orgStories• Highlight someone who got covered during OE1Fine• No mention of fine vs. mentioning fine vs. amount of fine



Online Survey to Test Different Messages

7,000

Respondents

120 Possible

Combinations

⁞

Source: Enroll America, Literature Test, 2014



48% 23%29%

Consumers Had a Clear Cover Preference




Consumers Had a Clear Cover Preference

48% 23%29%

58%42%Source: Enroll America, Literature Test, 2014



“Affordable Health Insurance” Resonated More

58%42%




Combining Multiple Types of Content Performed Better

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

Likely to GetInsurance

Has EnoughInformation

Knows Howto Find Cost

Info

Knows Howto Set Appt

KnowsFinancial

Help Exists

Knows Feb2015

Deadline

Stories Tools Information Stories+Tools+Info




Consumers Underestimate the Fine without More Info

No Fine Fine Nona Fine Amount

Knows Fine is $300+

14% 14% 12% 72%

Has Enough Information

41% 42% 46% 48%

Likely to Get Insurance

36% 33% 36% 37%




Tools and Resources for Partners

http://www.enrollamerica.org/hil/

http://www.enrollamerica.org/hil/



The Get Covered Calculator was created to help consumers understand the cost of purchasing coverage with financial help: https://www.getcoveredamerica.org/calculator/

Get Covered America:Premium Calculator

https://www.getcoveredamerica.org/calculator/



The Plan Picker was created to help consumers understand their options across metal levels: https://www.getcoveredamerica.org/plans/

Get Covered America: “Plan Picker”

https://www.getcoveredamerica.org/plans/



Beyond the Basics: Assister Plan Compare Tool

http://www.healthreformbeyondthebasics.org/wp-content/uploads/2014/03/CBPP-Marketplace-Plan-Comparison-Worksheet-March-2014.pdf



Consumer Reports:‘Nutrition Facts Label’



Families USA: How to Keep Coverage

http://familiesusa.org/sites/default/files/product_documents/Consumer_HealthInsuranceBasics_FACTSHEET_KeepingHealthInsurance.pdf



Consumers Union: Tax Credit Brochure and Online Tool

Consumer-tested paper brochure and online tool-customized for each state

http://consumersunion.org/taxcredit/US_2014_EN.pdf



CMS:Coverage to Care in Spanish

http://marketplace.cms.gov/technical-assistance-resources/c2c.html



QUESTIONS?Lynn Quincy, Consumers Union, [email protected] Gonzales, Enroll America, [email protected] Stern, [email protected]






Engage on Twitter

#HealthInsLit



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Health Insurance Literacy: Key Considerations for Stakeholders