Health Insurance Literacy: Helping Consumers Understand Their Coverage Options

Transcription

1 Health Insurance Literacy: Helping Consumers Understand Their Coverage Options 2013 Enroll America and Get Covered America EnrollAmerica.org GetCoveredAmerica.org

2 Health Insurance Literacy: Hard to Enroll Without it! Lynn Quincy Getting America Covered June 18,

3 What is Health Insurance Literacy? Health insurance literacy measures 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 financial and health circumstances, and use the plan once enrolled. Source: Measuring Health Insurance Literacy: A Call to Action, Consumers Union and partners, February

4 What Does a Health Insurance Literate Consumer Need to Know? Basic Idea of How Insurance Works and Why High Health Costs Create a Need for Coverage How to Shop: 1. Premium and resources that reduce premium costs 2. Adequacy of Coverage: Out-of-pocket Costs and Covered Services 3. Adequacy of Provider Network 4. How to make tradeoffs across these plan features How to Use Health Insurance: 1. Identifying and using in-network providers 2. Reading an Explanation of Benefits (EOB) 3. Consumers rights of appeal 4

5 Is this the same as or different than Health Literacy? There are at least 13 tools to measure health literacy BUT health insurance literacy is different. A compilation of over 200 studies, none of which examine health insurance. 5

6 Health Insurance Literacy Requires Different Skills and Measurement Tools Financial Literacy (multiple measures) Health Insurance Literacy (measure under development) Health Literacy (multiple measures) 6

7 I think medical insurance is probably one of the hardest things for me that I shop for. And I think one of the hardest things is to figure out what s covered. -quote from CU report: Early Consumer Testing of New Health Insurance Disclosure Forms

8 How Can We Help Consumers? Get robust, nuanced information about the challenges consumers face Use this information to: improve the underlying products, improve the way products are communicated and inform and activate consumers. 8

9 Thank you! Please with questions: lquincy at consumer.org 9

10 Open Enrollment (Nov Dec) is a prime opportunity to educate consumers about health insurance.

11 What Works? From a trusted source Just-in-time Actionable information Cognitive Short-cuts Reach them where they are Consumer Tested 11

12 Center on Budget and Policy Priorities Health Plans in the Marketplace Enroll America Conference Dave Chandra Senior Policy Analyst Center on Budget and Policy Priorities June 18, 2014 cbpp.org

13 Center on Budget and Policy Priorities Qualified Health Plan (QHP) Details (FFM) cbpp.org Source: healthcare.gov, Silver plan for 35 year old in Fairfax County, VA

14 Center on Budget and Policy Priorities Qualified Health Plan (QHP) Details (SBM) Source: access health CT 14 cbpp.org

15 Center on Budget and Policy Priorities Qualified Health Plan (QHP) Details 1. Premium 2. Cost Sharing Deductible Co pays/co insurance Out of Pocket Maximum 3. Benefits 4. Provider Network cbpp.org

16 Center on Budget and Policy Priorities Overview of Health Plan Cost-Sharing Insurer pays Consumer does not pay anything $0 Annual Out of Pocket Maximum ($4000) Consumer Pays Insurer Total Medical pays Expenses Consumer pays Co pays/coinsurance $3000 Annual Deductible ($1000) Consumer pays Consumer pays total amount 16 $1000 cbpp.org

17 Center on Budget and Policy Priorities Deductible cbpp.org

18 Center on Budget and Policy Priorities Individual vs. Family Types of Deductible Separate Medical and Prescription Drug vs. Combined Source: healthcare.gov, Innovation Health Classic 5000 plan in Fairfax, VA cbpp.org

19 Center on Budget and Policy Priorities Types of Deductible In network vs. Out of network Source: Summary of Benefits and Coverage for Innovation Health Classic 5000 plan in Fairfax, VA cbpp.org

20 Center on Budget and Policy Priorities Types of Deductible Aggregate vs. Embedded Family Composition = 2 parents, 1 child Family Deductible = $6000 Aggregate deductible Embedded Deductible Parent Parent Parent Child Parent $2,000 Child $6,000 $2,000 $2,000 $6,000 Entire family deductible must be met before co pay or coinsurance is applied for any individual family member. Each family member only needs to meet his/her individual deductible prior to receiving plan benefits. cbpp.org

21 Center on Budget and Policy Priorities Co-pays and Coinsurance Co pays Fixed dollar amount per visit or per day paid by the enrollee. Coinsurance Percent of a medical fee/bill paid by the enrollee Source: healthcare.gov, Kaiser Permanente KP VA 0/20/Dental and KP VA 1000/20/Dental Gold Plans for Fairfax County, VA cbpp.org

22 Center on Budget and Policy Priorities In Network vs. Out of Network Co-pays cbpp.org 22 Source: Connect for Health Colorado, Cigna mycigna Health Flex 2750 Silver PPO in Denver, CO cbpp.org

23 Center on Budget and Policy Priorities Prescription Drug Co-pays cbpp.org Source: healthcare.gov, Innovation Health 2000 PD Gold Plan for Fairfax County, VA

24 Center on Budget and Policy Priorities Services/Co-Pays Exempt from Deductible Source: healthcare.gov, Innovation Health Classic 5000 Silver PPO plan for Fairfax County, VA 24 cbpp.org

25 Center on Budget and Policy Priorities High Deductibles Equaling Out-of-Pocket Maximum Source: healthcare.gov, Innovation Health Advantage 6350 Bronze PPO plan for Fairfax, VA 25 cbpp.org

26 Center on Budget and Policy Priorities Pediatric Dental Benefit cbpp.org Source: MNsure

27 Center on Budget and Policy Priorities Adult Dental Benefit Source: healthcare.gov, Kaiser Permanente KP VA Silver 1750/25%/HAS/Dental Silver plan for Fairfax County, VA cbpp.org

28 Center on Budget and Policy Priorities Other Covered Services Source: Summary of Benefits and Coverage for CareFirst Blue Choice Silver and Kaiser Permanente KP VA Silver 1750/25%/Has Dental plans in Fairfax County, VA cbpp.org

29 Center on Budget and Policy Priorities Plan Types Type PPO HMO Name Preferred Provider Organization Health Maintenance Organization PCP Required? Referrals Required? Out of Network Coverage? No No Yes Yes Yes No* POS Point of Service Yes Maybe Yes EPO Exclusive Provider Organization No No No* *except for emergency care 29 cbpp.org

30 Center on Budget and Policy Priorities Narrow networks Tiered networks Trends in QHP Networks Source: Independence Blue Cross HMO Silver Proactive Plan Brochure 30 cbpp.org

31 Center on Budget and Policy Priorities Trends in QHP Networks Source: Summary of Benefits and Coverage for Independence Blue Cross HMO Silver Proactive Plan in Philadelphia County, PA 31 cbpp.org

32 Center on Budget and Policy Priorities Trends in QHP Networks Confusion and inaccuracies in provider directories Source: Provider Search site for Innovation Health for Fairfax County, VA 32 cbpp.org

33 Center on Budget and Policy Priorities Trends in QHP Networks Providers not accepting Obamacare versions of plans Providers no longer in network after open enrollment 33 cbpp.org

34 Center on Budget and Policy Priorities Health Reform: Beyond the Basics Contact Information Dave Chandra Center on Budget and Policy Priorities 820 First St. NE Suite 510 Washington, DC cbpp.org

35 + Beyond the Application: Helping Consumers Choose a Health Insurance Plan Jillian Phillips Chicagoland Organizer & Certified Navigator Campaign for Better Health Care [email protected]

36 + First things first: Dammit, Jim! I m a navigator, not a broker.

37 + Help the consumer assess her needs and budget How much can you afford to pay each month? Do you have medical needs? Do you take prescriptions? How often do you go to the doctor?

38 + Pre-assess consumer s health insurance literacy How would you rate your understanding of how private health insurance works? Have you had private insurance in the past? Was it an HMO, PPO, something else? Did you have a deductible, co-pays, out-of-pocket costs? Are you familiar with provider networks?

39 + Be aware of consumer s preconceived notions PPOs are good! HMOs are bad! I ve had this BCBS PPO network before. XXX is always covered. Bronze is bad and Platinum is the best. XXX takes Coventry. I know that for sure. Cheaper plans will cost me more in the long run.

40 + Don t just explain, illustrate! Definitions are nice (thanks, healthcare.gov hyperlinks!) but they don t always adequately illustrate how health insurance works. How I came up with the Worst Board Game Ever Weighing premiums vs. deductibles vs. out-of-pocket costs Worst Board Game EVER

41 + Assess consumer s understanding Avoid asking does that make sense? okay? is that clear? do you understand? Have them tell you how the plan will work rather than you telling them. (Worst Pop Quiz Ever?)

42 + Not enough time? Partner with other non-navigator organizations who can help you teach consumers about health insurance Use tools! (Did I mention use tools?!) Tools save time and brain power. Advocate for better tools and more consumer-friendly website design be a part of a feedback loop (In the Loop!)We re on the ground, people! Let s speak up about these challenges!

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45 Framework Guiding Smart Choice RC + IC & IC = SC Reduce Confusion + Increase Capability & Increase Confidence = Smart Choice

46 Key Questions I Need to Answer Why? What? Why do I need health insurance? Why is it important? What do I need and want? What are my choices? How? How much can I afford? How much will it cost? My SMART CHOICE

47 Extension.umd.edu/insure

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49 Consumers are confident they 1. Understand health insurance terms 2. Know how to estimate costs for health care and what questions to ask 3. Can find information to choose a health plan

50 Consumers are likely to 1. Determine which doctors and hospitals are covered 2. Understand what they would have to pay for prescription drugs, emergency department visits, and specialist visits 3. Find out if they have to meet a deductible and if unexpected costs are covered

51 What DIDN T Have an Impact on Confidence? Age Education Income Having Health Insurance Meaning Everyone could benefit from Smart Choice Health Insurance

52 How Did Consumers and Educators Compare?

53 How Did Consumers and Educators Compare?

54 How confident are you that you can make a smart choice? There is a strong positive correlation between the pre-test and the post-test and it is statistically significant (r =.400, p <.01). 555 consumers from 6 states.

55 Smart Choice is robust enough to work!

56 Bonnie Braun, PhD University of Maryland Extension

57 Acknowledgements This educational program was developed with funding from the University of Maryland Extension, College of Agriculture and Natural Resources and extension Program Development Team: University of Maryland Extension: Bonnie Braun & Lynn Little, Co-Leaders; Virginia Brown, Christine Garcia, Amanda Ginter, Jinhee Kim, Lynn Little, Teresa McCoy, & Mia Russell University of Delaware Cooperative Extension: Maria Pippidis

58 DISCUSSION AND Q&A 2013 Enroll America and Get Covered America EnrollAmerica.org GetCoveredAmerica.org