Category: Strategies

Is our Health Insurance Literacy improving?

Is our Health Insurance Literacy improving?

Health insurance literacy or HIL is a foreign concept to most people, but if understood and achieved at even basic levels, one can yield long-lasting effects on their health. The greater one’s understanding of health insurance the higher the likelihood for access to health care, getting medical treatment and ultimately staying healthy.  Nevertheless, health insurance literacy continues to remain at low levels in the United States.  

Defined by the Health Insurance Literacy Expert Roundtable, health insurance literacy is the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their own or family’s financial and health circumstances, and use the plan once enrolled.  The degree of HIL that one possesses falls on a spectrum from none to high.

In 2003, the U.S. Department of Education conducted a National Assessment of Adult Literacy and found that one’s overall health (from poor to excellent) is a function of the level of health literacy, and that your level of HIL correlates with which type of insurance you have: employer-sponsored, military, Medicare, Medicaid or uninsured. However, the average literacy scores of those with poor health compared to those with excellent health varied, but not significantly.  53 percent of adults had Intermediate health literacy. About 22 percent had Basic and 14 percent had Below Basic health literacy.

In 2010, shortly after the Affordable Care Act’s (ACA) went into effect, the Kaiser Family Foundation conducted a survey to shed light on Americans’ understanding of basic health insurance terms and concepts. Over half (52 percent) answered at least 7 out of 10 answers correctly, with only 4 percent answering all 10 questions correctly.  Using a grade-school scoring method, the remaining 44% would not have received a passing grade.

(Take the Kaiser Family Foundation 10-question quiz to identify your level of literacy with health insurance terms and compare yourself to others who took the quiz. You may be surprised to learn you’re as smart as a sixth grader.)

With several years of enrollment and experience in ACA health insurance exchanges, the expectation is HIL would increase.  Think again. In an analysis performed by the Institute for Healthcare Advancement in 2019, they found more than one-half (51%) of survey respondents had inadequate HIL as measured by knowledge of health insurance terms, and close to one-half (48%) had inadequate HIL as measured by confidence in health insurance use.  

If people are not grasping even the basics of health insurance or feeling confident in using it, how can we expect them to be active consumers of health care services?  Knowing how to find a doctor, fill a prescription, obtain and pay for a medication, understand the medical provider’s explanations, as well as insurance EOBs are all measures of health literacy.

HIL is not taught in school. Often, people learn about health insurance through a baptism by fire experience. If we receive a significant charge or invoice in the mail from our doctor, a common thought is “I thought my insurance covered this?”  Unwittingly, people put a lot of reliance and trust on a medical community who is driven by revenue and on an insurance system designed to minimize their risk.  Motivated financially, people become investigative sleuths navigating an itemized billing labyrinth to only discover they didn’t meet their deductible or went out-of-network not by conscious choice.

The healthcare system is flanked by healthcare providers on one side and health insurance plans on the other leaving employees figure out how it all works. If they’re lucky, their employers can step in to help.

Political efforts attempt to fix problems in our healthcare system to make it fair for people, like surprise medical billing, but legislation cannot address unintended consequences. Our healthcare system is financed by fee-for-service players driven to maximize revenue through itemized billing, and with minimal or no upfront transparency to the patient in any consolidated manner.

HIL continues to be an uphill battle for employees.  

Years ago, High Deductible Health Plans (HDHP) with Health Savings and Health Reimbursement Accounts were designed to be the great equalizer motivating people (begin treated like consumers) to take more ownership in their healthcare decisions.  Now, with over 40% of Americans enrolled in a HDHP, you would expect HIL to have increased.

A study published in Health Affairs, March 2019 illustrated how most people are not engaged in consumer behaviors.  Only one in four enrollees (24.9 percent) had even talked with a medical provider about how much a service would cost. Fewer had compared prices for a service at different facilities (14.4 percent), compared quality for a service at different medical facilities (14.0 percent), or tried to negotiate a price for a medical service (6.5 percent).  The perception of futility fuels a lack of engagement in consumer behaviors.

Employers, insurance companies, the government and even non-profits offer tools and resources for people to learn about health insurance. Ultimately, people need to take action to learn how to be active consumers and increase their health insurance literacy, and not wait for a health care system to change.

Telemedicine: Overcoming barriers

Telemedicine: Overcoming barriers

People looking for alternative ways to get treatment for health issues are discovering telemedicine.  Working-from-home and social distancing practices in recent months has increased awareness of telemedicine. Even before the onset of COVID-19, over 60% of health insurance plans, health institutions and hospital systems were offering telehealth as a viable, cost-effective and convenient option to treat patients for non-urgent medical issues.

A recent survey by the National Business Group on Health (NBGH) estimates that virtually all large employers (96 percent) are making telehealth services available in states where it is allowed. In addition, more than half of employers (56 percent) offer telehealth for behavioral health services, which is more than double the number in 2017.1

Access is to a virtual medical provider is convenient.  Providers are available 24/7, including after hours, nights, weekends and even holidays.  You can typically access one within 30 minutes for a wide-range of non-urgent conditions, and they are able to prescribe medications.  The cost of a telemedicine visit is can be less expensive than an actual in-office visit.

A recent study in JAMA found that the average time for an in-office medical visit is 121 minutes, including time for travel, waiting, paying and completing paperwork. Within these two hours, only 20 minutes is actually spent face-to-face with the doctor. The entire encounter costs patients $43 in lost productivity.1

The global telehealth market expects to grow to $19.5 billion by 2025.2

Regardless of these statistics, telemedicine continues to have low utilization rates mainly because of number of barriers.

Quality of Physician

The practitioner using telemedicine technologies must be licensed to practice medicine in the jurisdiction where the patient receives treatment as dictated by current law.  Generally, telemedicine providers require practitioners be board-certified which raises the level of quality.Apprehensive may still exist if you’re used to seeing your own doctor.  Telemedicine providers, who maintain private practices, are professionally trained just like your own doctor to evaluate and treat patients.  Telemedicine providers are experienced in handling telemedicine; they can quickly develop rapport and engage in the medical evaluation.   At the end of the day, it’s up to you whether to implement their treatment recommendation.

Unclear on Conditions Treated

Telemedicine can support the evaluation and treatment of a wide range of non-urgent medical issues including:

Allergies Earache Pink eye
Bronchitis Fever Respiratory
Cold, Flu, Cough Headache Sinus infections
Constipation & Diarrhea Insect Bites Skin and rash problems

If the medical condition is not something they can treat, they will provide recommendation for follow up with your own provider or referral to an emergency room if urgent/life threatening.

A number of telehealth providers offer specialty services to treat chronic conditions, as well as behavioral health.

Used to seeing doctor in the office

The in-office experience often includes a series of steps such as check-in with the front office, interview by the nurse including check of your vitals, and then an interaction/meeting with the actual doctor.
The telemedicine process has similar steps, but instead you’re going through the process virtually.

Essentially, the doctor will first have a conversation with you about your situation to understand and evaluate.  If needed, they will ask for visual confirmation of the body part with the medical issue.  This can be done either by uploading a photo or sharing via two-way video chat through your mobile device or PC.

A telemedicine visit can be seen as a low-cost way to triage your situation starting small before embarking upon more time intensive, costly medical appointments that require in-person visits.

IT/Technology limitations

Mobile devices are ubiquitous.  While you can access telemedicine through your computer, you have the option to download the telemedicine App to your mobile device utilizing all of the same features and tools as the web browser access.  Therefore, access to telemedicine is limited by your own access to the internet or mobile service.

Laws are also in place to protect privacy. The HIPAA Privacy Rule is designed to be a minimum level of protection. Some states have even stricter laws in place to protect your personal health information. Telemedicine providers can share your information with your primary care physician in accordance with applicable state and federal laws.

Other Concerns

Underutilization of telehealth is widely attributed to a gap in benefit literacy or a lack of awareness.  People also express an apprehension to use a credit card when paying for telehealth services.

Keep in mind that the cost of a telemedicine visit through your regular doctor may cost the same as if you were to visit your doctor in their office.   Telemedicine providers like Teladoc, MDLIVE and AmWell who offer access 24/7 are different, and may charge significantly less than what your regular doctor would charge.

Ask your health insurance company or your employer whether telemedicine is available.

Medical offices, like where your regular doctor practices medicine, may provide access to virtual medical visits, which may include access to your own primary care doctor or others within the same practice.  MyChart, an online health connection for patients, provides for face-to-face video sessions with doctors.  Check with your medical provider to see if they offer MyChart.   Keep in mind the cost of a telemedicine visit through your regular doctor may cost the same as if you were to visit them in person for an office visit.  Ask up front what the cost of the visit may be to avoid surprises later.

Telemedicine is here to stay.  Access to healthcare is important. Learning how to use telemedicine can be a viable, cost-effective alternative to support our healthcare needs. To learn more about the telehealth industry, visit the American Telehealth Association website.


  2. Transparency Market Research. Telehealth market: global industry analysis, size, share, growth trends, and forecast 2017–2025 Mar 2018p1–2240 Rep Id: TMRGL41591 accessed 11/1/18.
Being an active consumer can maximize your health insurance!

Being an active consumer can maximize your health insurance!

Are you getting the most out of your health insurance plan?

Most of us leave money on the insurance table, not deliberately. We’re busy living our lives. We think about health insurance when we need it. Sometimes we consider our health insurance annually or when a life event happens like a birth, marriage or other significant life change.

But even then, we’re overwhelmed by insurance. About 50% of people in the United States spend less than one hour researching benefit plan options on an annual basis. Given that over half of the U.S. population gets health insurance through their employer or through the open market, that’s a lot of people (over 150 million) making decisions that can and will adversely impact their pocket.

It’s estimated that 42% of people waste about $750 each year (at least) by making mistakes with their insurance benefits or by not taking advantage of features readily available to them.

What would you do with $750? Would you be willing to spend more than one hour a year to keep $750 (or more) in your pocket, perhaps a few hours?

Be an active consumer of your health insurance throughout the calendar year, not just when the need arises. Focusing on the little things is probably the most important strategy you can take to get the most out of your health insurance:

• Read the fine print
• Keep good notes
• Learn how to navigate your health insurance plan
• Don’t assume what you’re told is accurate; trust but verify

To learn more about how to maximize your health insurance, follow periodic blog posts or read the Maximize Your Health Insurance book, available on Amazon Kindle or in paperback from Amazon, as well.

Maximize Your Health Insurance