Do You Speak Health Insurance? It's Not Easy : Shots - Health News Even savvy consumers stumble over the meaning of coinsurance and other jargon. The misunderstandings can be costly, especially when picking a health plan.
NPR logo

Do You Speak Health Insurance? It's Not Easy

  • Download
  • <iframe src="https://www.npr.org/player/embed/459346426/461352942" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
Do You Speak Health Insurance? It's Not Easy

Do You Speak Health Insurance? It's Not Easy

  • Download
  • <iframe src="https://www.npr.org/player/embed/459346426/461352942" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

STEVE INSKEEP, HOST:

Here's one thing that will not immediately change in the new year - many people will still have trouble understanding their complicated health insurance plans. Mark Zdechlik of Minnesota Public Radio reports on a shortage of insurance literacy.

MARK ZDECHLIK, BYLINE: Solicit opinions about health insurance, and you're almost guaranteed to find consensus. It's mystifying and irritating.

DAVID TURGEON: A lot of the buzzwords are intended to just complicate the whole thing and make it more expensive.

ZDECHLIK: That's 46-year-old David Turgeon sitting in a food court in Minneapolis. Over in St. Paul, outside a grocery store, 50-year-old Seanne Thomas, a real estate broker, says she's pretty health insurance savvy. Her family members are covered under three different plans.

SEANNE THOMAS: So I had to compare co-pays, I had to compare out-of-pockets, deductibles.

ZDECHLIK: So how about a quiz?

I have a scenario for you.

THOMAS: OK.

ZDECHLIK: A guy goes to the doctor to get a wart removed. The bill is $530. How much is he on the hook for?

He has a co-pay of $30, he has a deductible of $100 and he has co-insurance of 20 percent.

THOMAS: Well, his deductible has to be maxed out first.

ZDECHLIK: Thomas nails the co-pay and deductible but then runs aground.

THOMAS: I don't know what you mean by the term co-insurance.

ZDECHLIK: Co-insurance, if your plan has it, kicks in after you've met your deductible and requires you to pay a set percentage of medical bills. American Institutes for Research came up with that quiz and put the question to several hundred people. Only 1 in 5 got it right. Kathryn Paez researches health insurance literacy for the organization.

KATHRYN PAEZ: People really struggle with understanding health insurance for a variety of reasons. One is just the volume of information. There's a lot to know. The other is because the language is unfamiliar to them.

ZDECHLIK: And that unfamiliarity, Paez says, is greater among African-Americans, Hispanics and people with low incomes and low levels of education. Your health insurance premium is the amount you pay every month regardless of whether you seek care. A co-payment is a fixed amount you pay every time you go to the clinic. A deductible is how much you have to pay before certain benefits kick in. The maximum out-of-pocket cost is the absolute most you would ever have to pay for care in a year. By the way, all of this so-called cost sharing could change if you go out of network.

KATHLEEN CALL: We've created a monster, and it's not surprising to me that there's literacy issues.

ZDECHLIK: That's University of Minnesota School of Public Health professor Kathleen Call. She worries confusion surrounding health insurance could keep people away from the doctor.

CALL: People are treating it more like car insurance - you don't use it until something happens. And that's not the way we want health insurance to be used.

ZDECHLIK: Call says avoiding care could threaten public health. She also says not understanding what's covered and what's not can leave people on the hook for big medical bills.

CALL: That can mean the difference between, you know, paying that medical bill or paying rent.

ZDECHLIK: Remember that quiz? We ran it by the industry group that represents health insurance companies. Clare Krusing is a spokesperson for America's Health Insurance Plans.

CLARE KRUSING: I totally understand why this is confusing and can be challenging, but the deductible itself...

ZDECHLIK: Krusing mentioned that she did not have a calculator in front of her and blamed the $100 deductible for tripping her up.

KRUSING: I just don't know of anyone that would have a $100 deductible.

ZDECHLIK: So who's to blame for all the confusion? Krusing says the industry is using increasingly complicated cost-sharing schemes to hold down the cost of monthly premiums. She also says plans are trying harder than ever to help consumers understand their policies.

KRUSING: Whether it's on mobile apps, whether it's on email reminders, whether it's, you know, videos, health plans are doing all of that.

ZDECHLIK: The industry and consumer advocates agree if something's unclear, demand clarification from the insurance company. For NPR News, I'm Mark Zdechlik in St. Paul.

INSKEEP: His story comes to us thanks to a reporting partnership with NPR, Minnesota Public Radio and Kaiser Health News.

Copyright © 2015 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Shots - Health News

Shots

Health News From NPR

About