Do Most People Know Everything About Their Health Insurance Plans?

Health Insurance Consumer Knowledge

Do most people know everything about their health insurance plans?

The two plans investigated for this assignment are Blue Cross Blue Shield and Humana, two of the most widely used and recognized health insurance companies in the United States.

Do you think that in general most people know everything about their health insurance plans?

The healthcare reform act of 2009 sought to make the healthcare system in the United States more navigable for Americans and to prevent health insurance companies from taking advantage of their customers. It seems, however, that the dense amount of legal and financial information embedding in the policies published by most companies is beyond the comprehension of most Americans (Gabel et al. 1987). Most people probably are aware of their emergency and primary care coverage but might not know about other less publicized and critical elements of insurance coverage plans which may offer valuable benefits, such as health club reimbursements, mail order bulk pharmaceutical ordering, and discounts on smoking cessation aids and programs.

Furthermore, most people do not have an objective adviser who can assist them in making the most of their insurance coverage. Representatives within the insurance company will be more committed to the bottom line of the company and doctors are often not trained in the intricacies of health insurance coverage and medical billing. This indicates that people do not have health advocates at the institutional, insurance, care provider, or medical billing level to advise them of more lucrative options either within their own plan or in other available plans. The human resources director may assist in this task for employment-based insurance coverage, but they, too, often lack specialized training in health insurance navigations and counseling.

2. Do they know the type that they have and what it means to them as a patient?

It does seem that due to the tendency of health insurance companies to issue identification cards to those with coverage that most people are aware of what their specific plan is called. It seems that due to the euphemistic ways in which insurance companies name their policies that many people would not be aware of which tier of coverage they have unless they were given an option and a chart comparing the benefits of each program type. For example, in Connecticut, Blue Cross Blue Shield offers the following programs: "Century Preferred Direct, Blue Care Direct, Lumenos, and Tonik." There is no indication based on the names of these programs which offers the most or the least comprehensive coverage (Anthem 2011). The use of acronyms such as "PPO" and "HMO" -- standing for health maintenance organization and preferred provider organization, respectively, is not widely understood by the general public.

3. Do they understand the difference between deductibles and co pays and coinsurance and out of pocket expenses?

The ways in which terms such as "deductibles," "co-pays" and: out of pocket expenses" are communicated to the public via health insurance websites and the United States government's public health insurance clarification webpages, it seems clear that these are terms which are generally poorly understood by the American public. On the Humana website, these terms are explained broadly and repetitively, without any information about how these various forms of payment and coverage can impact a patient financially during a medical emergency. These terms are expressed innocuously: "If you want coverage that has features similar to those of an employer-sponsored plan, consider our plans that include office visit copayments. These health plans have copays for illness and injury doctor's office visits. (Humana 2011)." There is little information provided about how to navigate these options on a personal basis.

4. Do you think that when they are looking for a health plan that they look into the details of the plan or do they just look at the bottom line? (how much will monthly premiums cost them)

Based upon the emphasis placed upon the cost of plans rather than the benefits offered within each tier of coverage, it seems that most people are more concerned with cost than with understanding the precise variances within different levels of health insurance coverage. The upfront cost is stressed more than the potential long-term cost of selecting one system vs. another. Lower premiums usually indicate lesser coverage. During a health emergency, the out of pocket cost to the patient will be greater when there is less coverage, and thus, the broader context of financial impact must look at the long-term financial consequences of health insurance plan coverage selection (Anthem and Humana 2011).