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People who have health insurance understand more terms than those who have never had it. But, even the insured confused the meaning of similar terms, such as urgent care and emergency care, or co-insurance and co-payment. (Credit: Daniela Vladimirova/Flickr)

health care

Confused by health insurance jargon?

Choosing the right healthcare policy—a daunting task for most people—can be even more difficult for those unfamiliar with insurance terminology, researchers say.

“Selecting the best health-insurance option can be confusing, even for people who have gone through the process for many years,” says Mary Politi, an assistant professor of surgery at Washington University School of Medicine in St. Louis and the study’s lead author. “We need to do a better job communicating information about health insurance to help people make the choices that work best for them.”


The study, one of the first to examine how well people who never have had health insurance understand key insurance terms and details, appears online in Medical Care Research and Review.

In October, US citizens began enrolling for healthcare coverage expanded under the Affordable Care Act. The plans take effect as early as Jan. 1; open enrollment continues until March 31.

Findings from the study suggest that healthcare navigators—workers hired under the federal law to help people sign up for health insurance—will play an important role. The navigators could simplify details, use visuals and provide context for unfamiliar terms to help people better understand their health insurance choices, the study’s authors says.

Researchers examined how well people who have been without health insurance understand such key terms as coinsurance, deductible, out-of-pocket maximum, prior authorization, and formulary. (The latter is a list of medications that are approved under a health insurance policy.) Those terms were among the most difficult for study participants, 51 uninsured Missourians from rural, urban, and suburban parts of the state.

The study also found that:

  • People who have been without health insurance but have had experience with auto insurance were more familiar with deductibles.
  • Those who have had health insurance understood more terms than those who have never had it.
  • Even individuals who have had previous experience with health insurance confused the meaning of similar terms, such as urgent care and emergency care or co-insurance and co-payment.

Based on their findings, the researchers are testing ways to improve communication about health insurance and the newly created state and federal health insurance exchanges. This effort is especially important for individuals with limited health literacy and math skills, given the complex information required to understand plan differences, Politi says.

Source: Washington University at St. Louis

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