Do You Speak Health Insurance? It’s Not Easy

December 29 01:00 2015 by ushadmin

Solicit opinions about health insurance and you’re almost guaranteed to find consensus: It’s mystifying and irritating.

“It just seems like a lot of the buzzwords are intended to just complicate the whole thing and make it more expensive,” says David Turgeon, 46, who’s sitting in a Minneapolis mall eating lunch.

Health care glossary

Enrollment season rolls on, and people shopping on HealthCare.gov and the other marketplaces have until Jan. 31 to decide on a plan.

But even people trying to pick from their employers’ options can find the process complicated and difficult to understand. The jargon can be overwhelming, and it can lead people to make costly mistakes or to avoid care altogether.

Ronen Ben-Simon, 28, also eating lunch in Minneapolis, says some basic health insurance terms are lost on him — even though he’s a nurse. “I don’t even know what coinsurance is, to be honest,” he says.

Seanne Thomas manages three health insurance plans for people in her family.i
Seanne Thomas manages three health insurance plans for people in her family.
Mark Zdechlik/MPR
Coinsurance, if your plan has it, kicks in after you’ve met your deductible and requires you to pay a set percentage of medical bills.

Over in St. Paul, Minn., Seanne Thomas, a 50-year-old real estate broker, says she has gotten good at figuring out how health insurance policies work. She’s had to, because her family members are covered under three different plans. “So I had to compare copays, I had to compare out-of-pocket, you know, deductible and maximum coverage.”

With all that grappling with insurance plans she’s done, Thomas is game for a quiz. Here’s a scenario, one of several, developed by American Institutes for Research:

A guy goes to the doctor to get a wart removed. The bill is $530. He has a copay of $30, a deductible of $100 and coinsurance of 20 percent. How much is he on the hook for?
Thomas nails the copay and deductible, but then runs aground.

“I don’t know what you mean by the term coinsurance,” she says. And without knowing that term, she’s out of luck.

Most people would be in the same position. A couple of years ago, American Institutes for Research, which is a social science research firm, asked hundreds of people and found that only 1 in 5 got the right answer, which is $210.

“People really struggle with understanding health insurance for a variety of reasons,” says Kathryn Paez, who researches health insurance literacy for the organization. “One is just the volume of information. There’s a lot to know. The other is because the language is unfamiliar to them, and they don’t really understand health insurance terms and concepts.”…