“Only two things in life are certain – death and taxes.” I had a high school teacher who liked to pull out this famous quote from Benjamin Franklin every time he got an unanswerable question from some wisenheimer.
As I sat last week poring over hundreds of pages of health plan brochures trying to sort out the best option for my family, I’m reminded of this quote and can’t help but wonder if there is a third certainty in life that Mr. Franklin missed – health insurance is about as clear as dishwater.
I count myself lucky to work in a profession that has allowed me to become a relatively well-informed healthcare consumer. However, I can’t help but think of how confusing insurance can be for those who don’t work in healthcare. Heck, it can be confusing for some who work in healthcare but have limited engagement with insurance. Just think about the way we use industry jargon in presentations meant to explain insurance to people who don’t live and breathe this on a daily basis – premiums, in-network vs. out-of-network, PPO vs. HMO, coinsurance vs. copayments, out-of-pocket maximum, deductible, precertification, etc. These are terms most folks only hear or think about once a year during open enrollment or when they’re forced to utilize their coverage. When you layer on top of these terms the often disorienting complexity associated with the different requirements and benefits for medical, dental, vision, and pharmacy services – it’s my guess that many folks simply don’t retain much of what was presented.
Given the complexity of our health delivery system combined with the dense nature in which insurance is often presented, it’s no wonder that there is often outrage among Americans at the perceived lunacy they encounter when trying to decipher and navigate the delivery system.
The good news is that the healthcare industry has noticed this issue and is taking steps to address consumers’ “insurance literacy.” Citing recent reports that consumers lack a clear understanding of their health insurance plans, America’s Health Insurance Plans (AHIP) partnered with the National Consumers League (NCL) to launch MyHealthPlan.guide – a comprehensive online guide meant to better inform consumers as to how health insurance works. Health plans have also taken major steps in recent years to improve their websites so enrollees and potential enrollees may better search to see if their doctors are in network.
While the effort by health plans to increase transparency and further educate the public is commendable, it will take broader engagement to truly lift the veil of confusion associated with health insurance. Given that most Americans receive private insurance through their employer, the employer may be best positioned to successfully improve people’s knowledge and comfort levels regarding insurance.
While most employers make some effort to communicate employee options during open enrollment and may even make an effort to inform employees about terminology, this likely does little to substantially inform people in a manner that allows them to be an informed consumer. Open Enrollment presentations often cover the generalities of a health plan such as network structure, premium, and cost-sharing. Often the only dialogue is brought by those who are brave enough to pose a question.
The best presentations I’ve seen (also the rarest) have focused not on terminology but the impact of the health plan on patient’s care and expenses. These presentations have successfully engaged employees in learning by providing real-life examples of what enrollment in a specific plan may be like. For example, out-of-pocket expenses could be better explained by highlighting an episode of care and noting what expenses could be expected to be paid by the enrollee given the plan’s deductible, coinsurance, and other cost-sharing provisions. This approach may be especially helpful in describing a plan’s prescription drug benefit especially if the plan does not include an integrated premium.
Now, I’m not removing an individual’s responsibility to do their own due diligence to educate themselves before making a decision. Nor am I advocating that employers bear the responsibility to ensure their employees are informed. However, employers, especially those who are self-insured, have an incentive to encourage their employees to be savvy consumers of healthcare. In order to be savvy one must understand the basics of the product they seek to purchase.
So here’s to hoping that next year’s Open Enrollment season sees fewer education efforts focused on insurance terminology and a few more that are rooted in real-life, tangible examples that may just resonate into the New Year.
Read more on this topic:
- URAC VA Community Care Network Resources
- URAC Accreditation: Align with the VA Community Care Network Needs
- Politics and Network Adequacy – It’s All Local
- VA Program to Provide Quality Care to Veterans in Their Communities