Insights and Implications: What Consumers Ask (and Don’t Ask) During Enrollment

This article was written by Jenn Whinnem, digital media manager for the Connecticut Health Foundation.

Independent research funded by the Universal Health Care Foundation, the Donaghue Foundation, and CT Health, and conducted by Community Alliance for Research Engagement (CARE) of the Yale School of Public Health, found that in-person assistance stood out as most valuable to urban consumers of color who enrolled in health insurance during the first open enrollment period.

The executive summary of the “Evaluation of the Enrollment Experience in Connecticut: Raising up the Voices of Urban Consumers, Assisters and Navigators” can be found on Universal’s website.

Connecticut is in the process of determining the scale and structure of in-person assistance for the second round of open enrollment. But the research illuminated another consideration for Connecticut: what should in-person assistance and consumer education look like going forward?

When we look at the information needs of survey respondents, a troubling – but not surprising – pattern emerges that indicates low health insurance literacy for the newly insured:

AHCT evaluation findings AHCT evaluation findings 2

Even consumers who have had previous experience comparing and selecting plans struggle with health insurance literacy. Drew Altman, president and chief executive officer of the Kaiser Family Foundation pulled together startling research in his post, “A Perilous Gap in Health Insurance Literacy,” on the Wall Street Journal’s Washington Wire blog. He cites research, for example, that revealed approximately 60 percent of new enrollees were not confident in their understanding of all health insurance terms.

As Altman acknowledges:

People with lower incomes were even less likely to understand the key elements of insurance. That’s no surprise, but it means that people who need coverage the most understand it the least.

For consumers who have little to no experience with health insurance, the research suggests they may not know they need to ask about provider networks and prescription drug benefits. The implication is that, by extension, they also do not know they can end up with a denied claim and a big bill if they don’t follow the particulars of their plan.

Currently the onus of understanding complex plan benefit designs has fallen on the consumers themselves. That system does not favor consumers and their wallets, nor does it favor the success of the Affordable Care Act itself. If a consumer purchases something that they then perceive as not working, they are less likely to re-enroll. Do we really want to go back to a time where the emergency room becomes the primary – and costly – provider of care for so many of our residents?

What systems should be responsible for ensuring the health insurance literacy of consumers in a changing health care landscape?


For more insights from the survey and evaluation, see CARE’s presentation to the Access Health CT Board of Directors on August 21, 2014:

Evaluation of the Enrollment Experience in Connecticut: Raising up the Voices of Urban Consumers, Assisters and Navigators from cthealth