Tag: health insurance

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.

Understand your health insurance  coverage for COVID-19 treatment

Understand your health insurance coverage for COVID-19 treatment

Health insurance companies are taking proactive and supportive positions when it comes to COVID-19.  According to public announcements made by many of the national insurance carriers in the United States, the cost of testing for COVID-19 may be covered at 100%.

What type of treatment and services should I expect to see billed to my insurance?

All of the major insurance companies, including Medicare, have indicated they will cover the cost of testing at 100%.  This means no co-pays or coinsurance, and not applying the fees towards your deductible. LabCorp, one of the largest clinical networks in the world, may charge around $51 to provide the results of the test.  Insurance companies are scrambling now to setup their systems to accept new claim codes for the COVID-19 test.

Beyond covering the lab testing itself at 100%,  you may see variations at each insurance carrier on what and how they are covering treatment related to COVID-19.  Even within each insurance company, employer groups may decide to cover services differently.  For example, self-insured medical plans can opt-out of paying for the COVID-19 testing at 100% and require that you contribute your co-pay or coinsurance. While most probably won’t opt-out, it’s prudent to know whether your employer group is self-insured and if they plan to opt-out of covering this test at 100%.

COVID-19’s affect on the economy may trickle down into people’s pockets if they get sick and require sustained medical treatment.  You may feel that it’s not your fault you got COVID-19 and don’t want to bear the cost of treatment.  It’s not uncommon for people to have large medical plan deductibles where they have to pay upwards of $3,000, $4,000 or more before the plan starts to pay.  Given that we’re at the beginning of the calendar year, most people probably haven’t met their annual deductible yet.

While it’s financially beneficial to covered members if a health insurance plan covers the cost of testing, people may wonder how their health insurance will cover treatment if they get sick from COVID-19 and end up in the hospital or needing extensive treatment.  At this point, it appears your health insurance plan will cover such treatment the same as any other illness or diagnosis.

For a limited time, you may also see insurance carriers do the following to support customers:

    • Waive customer cost-sharing for office visits related to COVID-19 testing

    • Waive customer cost-sharing for telehealth screenings for COVID-19

    • Makes it easier for customers to be treated virtually for routine medical examinations by in-network physicians

    • Waive early 30-day refill limits on prescription drugs

    • Provide free home delivery of up to 90-day supplies for Rx maintenance medications available

    • Offer supportive resources for customers, clients and communities for managing anxiety and improving resiliency (EAP)

If you do get sick from COVID-19 and need to be out of work for an extended period of time (say more than a week), you may want to consider applying for short term disability benefits. Your employer or state-funded disability plan may pay a portion or all of your salary while out on an approved short term disability.  A COVID-19 diagnosis may require a quarantine period of 14 days which could meet the definition of a disability under your plan. Ultimately, your doctor would certify your health status for disability claims.

To learn more about what your health insurance is doing, visit their website, call them directly or contact your Human Resources/Benefits Department. Here are links to several of the major national health insurance companies and their public positions on COVID-19.

Cigna

UnitedHealthcare

Aetna

Blue Cross Blue Shield

Kaiser Permanente

Medicare