Increasing Health Insurance Literacy Through Education

Increasing Health Insurance Literacy in Marketplaces and the Communities They Serve
Page 1 Denise O. Smith
Denise O. Smith
dsmithcommunityhealth@gmail.com
HSM541
Health Services System
Keller Graduate School of Management
Professor Julie Dennis
June 18, 2016

Table of Contents
Background 3
Define the Problem 4
Literature Review 5
Problem Analysis 11
Possible Solutions 13
Solutions and Implementation 16
Justification 18
References 20

Background
Health insurance marketplaces established through the implementation of the Affordable
Care Act (ACA), have enrolled more than 12.7 million individual United States citizens since
October 2013 (U.S. Department of Health and Human Services, 2016) through annual and
special open enrollment periods. Across the U.S. hundreds of different insurance plans are
offered through the 16 state-based marketplaces and Healthcare.gov, the federal marketplace,
including Medicaid and CHIP, each with unique eligibility requirements, premiums, deductibles,
copays and coinsurance (National Public Radio, 2013).
“Enrolling in a health insurance plan is not a simple task” wrote Laurie Martin for the
Rand Corporation in the early days of the first open enrollment, “Ignoring this complexity and
failing to support people with low health literacy could create barriers” (Martin, 2013).
Enrollment into health insurance requires one to create accounts on an online website,
knowledge of insurance and other state eligibility rules, ability to calculate a Modified Adjusted
Gross Income (MAGI), analyze and compare insurance plan information, and a grasp of
insurance-specific jargon such as premium, subsidy, cost sharing, coinsurance, in-network and
other terms. Navigators and assisters were funded by states and the federal government to aid in
the completion of complicated enrollment processes (Paez, Development of the Health Insurance
Literacy Measure: Conceptualizing and Measuring Consumer Ability to Choose and Use Private
Health Insurance, 2014).

Lack of health insurance literacy has emerged as the overarching barrier for new
enrollees, and has continued impact on insurance engagement and access to health care post
enrollment resulting in poor system utilization, lack of engagement in prevention services and
“one in five enrollees experiencing gaps in coverage due to lack of premium payments” (Cohn,
2014).
Using reports and peer reviewed research, this paper explores, what issues surround
health insurance literacy and what upstream population level interventions exist to increase the
health insurance literacy of newly insured communities.
Define the Problem
While the ACA seeks to increase access, reduce cost and improve the quality of health
insurance and healthcare (Berwick, 2008), poor health literacy among U.S. adults remains a
formidable foe. Currently “more than 36% of U.S. adults limited health literacy; 22% have basic
and 14% have below basic health literacy. Only 12% of American adults are considered health
literate” (Glassman, 2013). Thus a review of the current approaches to improving health literacy
is key to solving this problem.
The traditional model in the United States is one of agency and asymmetric knowledge,
skills and resources, favoring health insurance brokers or medical practitioners who recommend
or provide services, resulting in consumers “delegating decision making” (Folland, 2010). Low
health literacy, the inability to “obtain, process and understand basic health information and
make appropriate health decisions” (Office of Disease Prevention and Health Promotion, 2008)
contributes to the prevalence and persistence of asymmetric information. This definition of
health literacy centers on the ability of the consumer to operate within a largely clinical or

medical setting and does not comprehensively address the interrelatedness of health and health
insurance literacy; the focus of this text and the source of enrollment, access and utilization
barriers. “Although health insurance literacy overlaps with health literacy, it is distinguished by
the need to understand how health insurance benefits are structured, and to understand and
estimate cost sharing responsibilities; health insurance literacy is a factor in whether consumer
delay or avoid seeking care due to cost” (Paez, Development of the Health Insurance Literacy
Measure: Conceptualizing and Measuring Consumer Ability to Choose and Use Private Health
Insurance, 2014). Health literacy was found as a contributing factor to low enrollment for youth,
LEP and people of color who are targeted by the ACA marketplaces (Long, 2014).
Early open enrollment consumer assistance programs coordinated by marketplaces and
staffed by navigators and assisters were seen as an acknowledgement of the complexities
inherent in insurance enrollment and reports indicated that “79% of consumers who enrolled
sought out in-person assistance to help demystify health insurance” (Gupta, 2016), however
funding for these consumer programs in the 16 state-based marketplaces was eliminated after the
first year of open enrollment and funding in the other 34 states remains unstable and
continuously debated in the federal legislature (Kern, 2014).
Simultaneous issues emerge in the context of the continued success of enrollment of the
uninsured through the marketplace; who will provide and coordinate health insurance literacy
interventions
Literature Review
Improving health literacy among newly insured adults is an important part of achieving
the triple aim in the Affordable Care Act (Berwick, 2008). In “Attributes of a Health Literate

Organization” (Brach, 2012), Brach et al explore the health literacy of organizations as indicative
of their ability to increase health literacy among the population they serve. They hypothesize that
there “is an imbalance between the skills of people and the demands of the healthcare system”
and in response to this deficiency, they propose ten attributes that can be used to evaluate the
capacity of organizations to effectively address this issue, including “leadership that makes
literacy an integral part of its mission, integrates health literacy into planning and quality
improvement, meets the needs of populations with a range of health literacy skills and
communicates clearly what health plans cover and what individuals have to pay for” (Brach,
2012). The authors believe their big tent approach to the adoption of these attributes in all
interconnected sectors, healthcare, public and private payers and among adults of diverse
backgrounds, is the most logical way to respond to the system, communication and access
barriers that low health literacy creates.
In “Health Literacy: A Challenge for Nearly Everyone” (Krause, 2008), the CT Health
Foundation (CHF) agrees that, “even those who are highly educated are challenged to understand
and use health information at some point” (Krause, 2008), yet their solution is focused on
providing health literacy through adult education sites, centers and programs. In their research,
six adult education centers received approximately $72,000 to implement health literacy
education study circles, around themes such as health care access and navigation, disease
prevention and screening and chronic disease management, with results after 15 months showing
“students were more comfortable asking questions of their health providers and more confident
managing their health after being exposed to the curriculum” (Krause, 2008).
Integrating health literacy education into adult education can also be found in the work of
Mooney et al in “Addressing the Health Literacy Needs of Adult Education Students” (Mooney,

2013). This guide deepens the discussion of health literacy, rejecting the limitations of traditional
definitions about an individual’s “capacity to obtain, process and understand” (Office of Disease
Prevention and Health Promotion, 2008) which “defines health literacy as a risk instead of an
asset, ignores social conditions that can limit access to healthcare and does not reflect the
dynamic social practice of health literacy always situated in specific sociocultural settings”
(Mooney, 2013).
This deep understanding of sociocultural impacts on health literacy is well expressed in
“America’s Health Literacy: Why We Need Accessible Health Information” (Office of Disease
Prevention and Health Promotion, 2008) which, although it adopts the traditional definition of
health literacy as the expression of a person’s ability to function in health systems, explores
significant barriers to this functioning in race, culture and income. Data presented in this report
indicate that while all people experience health literacy barriers, “below basic health literacy
measures disproportionately impact Blacks and Hispanics, adults with less education, the elderly
and those receiving insurance coverage through Medicaid” (Office of Disease Prevention and
Health Promotion, 2008).
This report also addresses health literacy as an organizational priority as does Brach, and
urges organizations to “change the way health information is designed and delivered, establish
policy guidelines about information access and design, address health literacy as part of a
disparities initiative and encourage insurers to model these improvements and innovations” in
their organizations (Office of Disease Prevention and Health Promotion, 2008).
Recommendations of the Office of Disease Prevention are supported by Mooney, Brach
et al: each acknowledges the importance of social orientation of health literacy in their work.
Mooney also echoes the CT Health Foundation’s (CHF) approach of health literacy in adult

education, citing that their research “dramatically affected the health literacy scores of their
students” (Mooney, 2013). Research found in Mooney, Krause et al points to a effectiveness in
group participatory initiatives, such as the CHF study circles based on the work of Harvard
School of Public Health Rima Rudd (Krause, 2008), as important in the exploration of a best
practice for disseminating information, but each report lacks content to address between health
and health insurance literacy barriers experienced newly enrolled adults.
Rudd’s work on “Health Literacy: The Intersection between Skills of Individuals and
Demands of Health Systems” (Rudd, 2008) begins is a valuable framework that will have future
application in health insurance literacy discussions. She presents a mismatch in the skills of a
significant number of American adults demanded from an increasingly complex health care
system, charges healthcare settings to become more literate friendly and advocates for significant
change in the delivery of health information” (Rudd, 2008). Future researchers will use this
mismatch framework to describe health insurance literacy challenges in marketplace enrollment.
Early innovations included transitioning organizations to become health literate which
researchers believed would impact the products and services they provided. “The Health Literacy
Universal Precautions Toolkit” (North Carolina Network Consortium, 2010) is one of the first
products that provides implementation guidance and tools for health serving organizations. It
eliminates assumptions about consumers’ knowledge and adopts universal protocols, policies to
improve written and oral communication, and consumer skills development (North Carolina
Network Consortium, 2010).
In 2014 health insurance literacy came into focus with the research of Paez who surveyed
adults knowledge of health insurance literacy in four domains: knowledge, information seeking,
document literacy and cognitive skills, and found that while “more than half of the people

surveyed were moderately or very confident in their ability to select a health insurance plan, their
actual knowledge was less” (Paez, A Little Knowledge is a Risky Thing: Wide Gap in What
People Think They Know About Health Insurance and What They Actually Know, 2014), as was
their grasp of calculating cost sharing, understanding how to use health insurance to access care
and knowing what services their insurance covers (Paez, A Little Knowledge is a Risky Thing:
Wide Gap in What People Think They Know About Health Insurance and What They Actually
Know, 2014). Parragh confirmed the findings of Paez in “Health Literacy and Health Insurance
Literacy: Do Consumers Know What They Are Buying?” (Parragh, 2015), stating that insurance
is “becoming more consumer driven, and often includes higher deductibles, shifts financial risk
to the patient, increases the stakes and requires an even more sophisticated understanding of
health insurance” (Parragh, 2015) which a majority of newly insured Americans do not possess.
She recounts data from 2013 in which “51% of Americans did not understand basic health
insurance terms such as premium, deductible and copay, and 47% of people receiving federal
subsidies to help pay their premium did not know what they were getting” (Parragh, 2015). The
report points to several initiatives, including the National Action Plan to Improve Health Literacy
(NPHL).
The NPHL is considered a landmark resource for medical and public health professionals
to inform initiatives nationwide. Released in 2010 just after the Affordable Care Act was signed
into law, this document includes seven goals, many of which align with previously mentioned
authors including “promote changes in healthcare organizations and systems, support and expand
health literacy in adult education, increase the development, implementation and evaluation of
practices and interventions to improve health literacy” (Office of Disease Prevention and Health
Promotion, 2010). For the authors of this important work, it is the responsibility of organizations,

policy makers and professionals to clearly communicate and increase the capacity of American
adults to take positive actions in their own health (Office of Disease Prevention and Health
Promotion, 2010).
Since open enrollment began, consumers have looked to the health insurance
marketplaces created by the Affordable Care Act to facilitate enrollment and understanding of
health insurance. While enrollment has largely been a success, consumers’ knowledge of how
health insurance works or how to use it to has not increased. A formal measure of health
insurance literacy was published in 2014 in the Journal of Health Communication: International
Perspectives, developed through an extensive literature review process of prior attempts to
measure this literacy were found to be limited and lacking validity and reliability (Paez,
Development of the Health Insurance Literacy Measure: Conceptualizing and Measuring
Consumer Ability to Choose and Use Private Health Insurance, 2014). Building on the earlier
work of Paez et al, these authors confirmed that the “tasks associated with selecting and using
health insurance are complex and require applying knowledge while performing skills that are
interconnected” and that without these skills, “consumers may hesitate to obtain a service
because of their concerns about out-of-pocket costs” (Paez, Development of the Health Insurance
Literacy Measure: Conceptualizing and Measuring Consumer Ability to Choose and Use Private
Health Insurance, 2014).
Theoretical health insurance literacy frameworks and organization-focused toolkits have
not been widely implemented in response to immediate marketplace and consumer enrollment
needs. Two more pragmatic approaches have emerged from Enroll America and the Centers for
Medicare and Medicaid that have been widely adopted by navigators and assisters an
increasingly by state-based marketplaces.

“A Framework on Health Insurance Literacy for the Outreach and Enrollment
Community” (Stern, 2015) is the culmination of three years’ experience engaging low income,
culturally and linguistically diverse uninsured Americans to understand the marketplace
insurance plans. Their findings that “substantial gaps in knowledge about health insurance
remain, which may result in buyer’s remorse, improper utilization of health care services, and/or
loss of coverage completely” (Stern, 2015). Their five point framework: “1) understand
persistent consumer knowledge gaps, define what information consumers value, identify the best
time and manner to educate consumers, discover what triggers consumers’ need for new
information and determine what messengers consumers want to hear from” (Stern, 2015) is
person-centered and adaptable for use by clinical providers, enrollment assisters, brokers and
marketplace staff.
“From Coverage to Care” responds to health insurance literacy gaps with “an initiative,
developed by the Centers for Medicare & Medicaid Services (CMS), to help you understand
your health coverage and connect to primary care and the preventive services that are right for
you, so you can live a long and healthy life” (Centers for Medicare and Medicaid, 2016). CMS
has developed an 8-step roadmap used to teach consumers why health insurance is important,
terminology and financial concepts and responsibilities, and improves healthcare navigation
skills.
Problem Analysis
Health insurance marketplaces, community-based navigators and assisters, medical
providers and payers have a stake in successful implementation of the Affordable Care Act.
Research above summarizes the following problems in marketplace approaches to health
insurance literacy programs and services 1) Ineffective assumptions about newly enrolled adults

and those who remain uninsured, 2) Lack of an evidence-based framework for program
development, 3) The need for organizations and their staff to become health literate.
Newly Insured Have Additional Sociocultural Barriers
Reports on ACA enrollment indicate that newly insured Americans are diverse in
language, ethnicity, income and literacy levels. Five in ten newly insured adults “were mostly
people of color and those who have a family income below 200% of the federal poverty level”
and people who have lived for longer periods “without having insurance” (Kaiser Family
Foundation, 2015). Research presented above shows that either many adults assume a better
understanding if health insurance concepts than they actually have or that they are avoiding
engagement in services to hide their lack of knowledge (Paez, Development of the Health
Insurance Literacy Measure: Conceptualizing and Measuring Consumer Ability to Choose and
Use Private Health Insurance, 2014). Poor health insurance literacy may be even more
pronounced among the elderly, low income and minority populations. Lack of a universally
accepted definition of health insurance literacy and framework for educating adults allows these
knowledge gaps to persist.
Lack of an Evidence-based Framework
Current health literacy focuses on a definition of the consumers’ ability to function in a
clinical or medical environment, an insufficient perspective that lacks integration of health
insurance concepts and consumer barriers. Traditional clinical framing care of health insurance
literacy perpetuates consumer knowledge gaps, providing few opportunities to increase their
knowledge. New frameworks based on research-based initiatives are effective tools to help
marketplaces evaluate current literacy engagement, products and services and address gaps.

Promote a Health Literate Organization
After three years of ACA enrollment in the United States, health insurance marketplaces
have not become initiated organizational transformation to become more health literate,
effectively addressed the complexity of health insurance products, or provided navigators and
assisters with simplified tools to educate consumers on insurance financial concepts, terminology
or how to navigate the integrated environments of health and health insurance literacy. Recent
reports indicate that without significant changes, newly enrollment adults may experience gaps
in coverage, misuse of their insurance and lack of access to needed health services.
Possible Solutions
Health insurance marketplaces do not presently implement a comprehensive approach to
helping consumers to understand their insurance plans and use their plans to access healthcare
and improve their lives. However research included above identifies best practices rom several
different perspectives.
Adopt the Health Literacy Conceptual Model
This conceptual model establishes a clear definition and scope of work for health
insurance marketplaces and organizations to assess and understand the range of skills,
terminology and concepts required of consumers to enroll and use their health insurance.

Based on an extensive literature review of previous health insurance literacy research, this model
was created with consumer and stakeholder input, and validated through data collection and
analysis.
Health Literacy Universal Precautions Toolkit
Health insurance marketplaces would benefit their consumers by adopting an
organizational-wide training in and implementation of the Universal Precautions Toolkit. This
toolkit empowers management to engage in continuous quality improvement across departments
by ensuring that all employees become health literate, integrate health literacy universal
precautions in their products and services and treat all consumers as if they require health
insurance literacy assistance. Organization-wide adoption of these strategies will create a more
equitable environment for elderly, low education and minority populations disproportionately
impacted by low health insurance literacy.

Implement From Coverage to Care
Coverage to Care was developed by the Centers for Medicare and Medicaid Office of
Minority Health. From Coverage to Care is an initiative to help people with new health care
coverage understand their benefits and connect to primary care and the preventive services that
are right for them, so they can live a long and healthy life (Centers for Medicare and Medicaid,
2016).
The tool presented above, created as a summary expression and orientation of the
Coverage to Care Initiative is the “Road Map to Better Care and A Healthier You (Centers for
Medicare and Medicaid, 2016). The roadmap includes 8 steps which communicates what it

means to have health insurance, when and where to seek health services, why prevention and
partnering with a provider is important for having the best health” (Centers for Medicare and
Medicaid, 2016). Information, terminology and skills are presented to help people “find and
schedule an appointment with a primary care provider, prepare for a primary care visit, and
determine if they have the right provider for their family” (Centers for Medicare and Medicaid,
2016).
Solution and Implementation
To achieve increased health insurance literacy among marketplace staff, enrollment
assisters and consumers, state-based marketplaces should implement From Coverage to Care.
Health insurance marketplace administrators, trainers and outreach coordinators can will impact
ACA health reform discussions, design and implementation of health insurance literacy
consumer engagement and education by incorporating the Paez health insurance literacy
framework (Paez, Development of the Health Insurance Literacy Measure: Conceptualizing and
Measuring Consumer Ability to Choose and Use Private Health Insurance, 2014) with From
Coverage to Care (C2C) initiative tools (Centers for Medicare and Medicaid, 2016).
Marketplaces should recruit and coordinate cross sector implementation teams including
private insurance payers, state-based Medicaid administrators, community-based navigators,
assisters and medical associations, doctors and other clinical providers in education and training
in the framework and C2C. Through this educational process, marketplaces will improve
stakeholders’ knowledge of consumer needs based on research – not assumptions – and explore
the intersection of health and health insurance literacy gaps expressed in the framework and
identified among American adults. During open enrollment, marketplaces can establish technical

assistance programs for engaged stakeholders to help them develop policies and procedures that
are aligned with the framework and programs that incorporate the tools and skills building
concepts of C2C.
Learning objectives of training will include (1) increased knowledge of framework
concepts; (2) Understanding of C2C tools, why they are important for consumers to understand
and how to help consumers use them; (3) Understand of consumer health insurance literacy
knowledge gaps; (4) Skills on using the framework to develop person-centered policies across
the organizations and (5) Learn innovations to increase consumer health and health insurance
literacy, enrollment and health system navigation. Marketplace administrators and staff can
establish technical assistance services to support implementation of the framework and C2C.
One to one organizational consultation, webinars and regional meetings with stakeholders should
be a part of the implementation and technical assistance process to resolve immediate and
ongoing needs of medical providers, navigators and assisters, build organizational capacity and
“push” the best practice framework.
Issues that will persist during early implementation will include the need for funding and
organizational capacity building of stakeholders to achieve implementation of C2C and the
framework. Clinical providers may experience time barriers to use C2C with clients, navigators
and assisters may need ongoing training, funding support and deeper engagement of their
management and supervisors to incorporate the framework knowledge and use of C2C into their
normal enrollment activities. New trainings may have to be developed to address low literacy
and diverse language needs of consumers.
Effective implementation of these resources should be developed through person-
centered evaluations, surveys and focus groups that can be used to promote continuous quality

improvement and organizational transformation in knowledge and skill to address health and
health insurance literacy gaps. C2C currently has not evaluation tools developed for its initiative,
however the framework developed by Paez et al was developed during research with consumers,
medical providers and enrollment assisters and can support evaluation tool development.
Long term process analysis should be established through the measurement of the
following lag and lead indicators:
 Number of organizations/administrative leaders engaged in framework training and
implementation
 Number of navigators, assisters and medical providers engaged in C2C training
 Stakeholder increased knowledge, understanding and implementation capacity
 Number of consumers touched by programs developed using C2C tools
 Consumer feedback on sociocultural relevance, content and effectiveness to improve
their health and health insurance literacy and healthcare navigation skills
Justification
Health insurance marketplaces are the primary resource for American adults to access public
and private health insurance and enrollment assistance. While millions of adults have enrolled in
the last three years, research indicates that many newly enrolled and the remaining uninsured do
not have sufficient health and health insurance knowledge that they think they do, resulting in
poor utilization of insurance and healthcare services, unforeseen and costly financial
responsibilities and gaps in coverage. Marketplaces must take the lead in transforming their own

organizational approaches and those of their stakeholders in understanding the real needs of
consumers and best practice frameworks and tools that address these complexities.
Increased health literacy among U.S. adult populations can be achieved through a person-
centered, population-level, health literacy education and skills building intervention. While
historical approaches to literacy are focused on a traditional clinical model and lack integration
of health and health insurance literacy, the framework develop by Paez et al is an evidence-based
approach that clearly identifies consumer knowledge gaps in insurance financial literacy,
navigation of health services and terminology used to maintain insurance and use it
appropriately.
Further, the framework helps to transition organizations to becoming health literate.
Organization-wide engagement in the framework as a quality improvement approach is a best
practice that engages managers, develops the enrollment assistance workforce and employees,
and “applies research-based tools which can result in better quality products and processes”
(Evans, 2012) in the marketplaces and among their stakeholder organizations. Successful ACA
implementation, enrollment of the uninsured and improved health insurance literacy among
American adults requires system-wide collaborative ownership (Centers for Medicare and
Medicaid, 2016). “The primary responsibility for improving health literacy lies with public
health professionals and the healthcare and public health systems. We must work together to
ensure that health information and services can be understood and used by all Americans. We
must engage in skill building with healthcare consumers and health professionals.” (Office of
Disease Prevention and Health Promotion, 2005)

References
Berwick, D. (2008). The Triple Aim: Care, Health and Cost. Health Affairs, 759-769.
Brach, C. (2012). Attributes of a Health Literate Organization. Washington, D.C.: Institute of
Medicine.
Centers for Medicare and Medicaid. (2016, May 6). From Coverage to Care. Retrieved from
CMS.org: https://www.cms.gov/About-CMS/Agency-Information/OMH/OMH-
Coverage2Care.html
Cohn, J. (2014, February 16). One in Five Obamacare Applicants Didn't Pay a Premium -
Shouldn't We Care? Retrieved from Newrepublic.com:
https://newrepublic.com/article/116639/one-five-obamacare-applicants-didnt-pay-
premium-should-we-care
Evans, J. (2012). Managing for Quality and Performance Excellence, 9th Edition. Boston:
South-Western Cengage Learning.
Folland, S. (2010). Economics of Health and Health Care, 6th Edition. In S. Folland, Economics
of Health and Health Care, 6th Edition (p. 231). Upper Saddle River: Pearson Learning
Solutions.
Glassman, P. (2013, June). nnlm.gov. Retrieved from U.S. National Library of Medicine:
http://nnlm.gov/outreach/consumer/hlthlit.html#Prevalence_of_Low_Health_Literacy
Gupta, A. (2016, June 14). Survey Highlights the Value of Assister Programs. Retrieved from
Enrollamerica.org: https://www.enrollamerica.org/blog/2016/06/survey-highlights-the-
value-of-assister-programs/

Healthcare.gov. (2015, December 11). Retrieved from Understanding the fee for not having
health insurance coverage in 2016: https://www.healthcare.gov/blog/the-fee-for-not-
having-health-insurance-2016/
Kern, C. (2014, April 16). Future of Navigator Grants. Retrieved from HealthITOutcomes.com:
http://www.healthitoutcomes.com/doc/future-of-navigator-grants-questioned-0001
Krause, E. (2008). Health Literacy: A Challenge for Nearly Everyone. Hartford: CT Health
Foundation.
Long, S. (2014, February 12). Low ACA Knowledge and Health Literacy Hinder Young Adult
Marketplace Enrollment. Retrieved from Health Affairs:
http://healthaffairs.org/blog/2014/02/12/low-aca-knowledge-and-health-literacy-hinder-
young-adult-marketplace-enrollment/
Martin, L. (2013, November 7). Quick Takes: Health Literacy and ACA Enrollment. Retrieved
from Rand.org: http://www.rand.org/blog/2013/11/quick-takes-health-literacy-and-aca-
enrollment.html
Mooney, A. (2013). Addressng the Health Literacy Needs of Adult Education Students.
University Park: Penn State College of Education Goodling Institute for Research in
Family Literacy.
National Public Radio. (2013, October 11). The Affordable Care Act Explained. Retrieved from
FAQ: All About Health Insurance Exchanges And How To Shop For Coverage:
http://www.npr.org/2013/10/11/230916150/faq-all-about-health-insurance-exchanges-
and-how-to-shop-for-coverage

North Carolina Network Consortium. (2010). Health Literacy Universal Precautions Toolkit.
Rockville: Agency for Health Care Research and Quality.
Office of Disease Prevention and Health Promotion. (2005). Quick Guide to Health Literacy.
Retrieved from health.gov:
http://health.gov/communication/literacy/quickguide/factsbasic.htm
Office of Disease Prevention and Health Promotion. (2008). America's Health Literacy: Why We
Need Accessible Health Information. Retrieved from U.S. Department of Health and
Human Services: http://health.gov/communication/literacy/issuebrief/
Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve
Health Literacy. Washington, D.C.: U.S. Department of Health and Human Services.
Paez, K. (2014). A Little Knowledge is a Risky Thing: Wide Gap in What People Think They
Know About Health Insurance and What They Actually Know. Missouri: American
Institutes for Research.
Paez, K. (2014). Development of the Health Insurance Literacy Measure: Conceptualizing and
Measuring Consumer Ability to Choose and Use Private Health Insurance. Journal of
Health Communication: International Perspectives, 225-239.
Parragh, Z. (2015). Health Literacy and Health Insurance Literacy: Do Consumers Know What
They are Buying? Washington, D.C.: Alliance for Health Reform.
Rudd, R. (2008). Health Literacy: The Intersection between Skills and Demands of Health
Systems. Washington, D.C.: American College of Physicians Foundation.

Stern, S. (2015). A Framework on Health Insurance Literacy for the Outreach and Enrollment
Community. Washington, D.C.: Enroll America.
U.S. Department of Health and Human Services. (2016, February 4). HHS.gov. Retrieved from
Success by Numbers: 2016 Open Enrollment:
http://www.hhs.gov/about/news/2016/02/04/fact-sheet-about-127-million-people-
nationwide-are-signed-coverage-during-open-enrollment.html
Wilson-Stronks, A. (2008). One Size Does Not Fit All: Meeting the Health Care Needs of
Diverse Populations. Oakbrook Terrace: The Joint Commission.

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