Webinar slides from October 20, 2014. Here at Enroll America we want consumers to get covered, and stay covered, and research shows that the more consumers know about the Affordable Care Act and health insurance, the more likely they are to keep their coverage. We know that helping consumers understand their options, select a plan that meets their need and budget, and learn how to use their coverage once enrolled is crucial, but incredibly challenging. Join Enroll America and Consumers Union to learn about the critical connection between health insurance literacy and retention and how to talk about some of the key health insurance concepts consumers struggle with. We also shared some useful resources to keep in your back pocket as these issues continue to come up in the months ahead. This webinar is appropriate for enrollment stakeholders interested in addressing gaps in knowledge about health insurance among consumers to make sure they get covered, and stay covered! You can watch the recording here: http://www.enrollamerica.org/resources/webinars/ready4oe2-effective-strategies-second-open-enrollment-period/.

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Health Insurance Literacy:
Key Considerations for Enrollment
Stakeholders
Sophie Stern, Deputy Director, Best Practices Institute, Enroll
America
Lynn Quincy, Associate Director, Health Policy, Consumers Union
Ricky Gonzales, Deputy Director, Analytics, Enroll America

2. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 2 10-20-2014
Agenda
Introduction Sophie Stern (moderator), Deputy Director,
Best Practices Institute, Enroll America
Things to Consider When
Engaging Consumers Lynn Quincy, Associate Director,
Health Policy, Consumers Union
Testing Consumer Materials to
Improve Health Insurance
Literacy
Ricky Gonzales, Deputy Director,
Analytics, Enroll America
Sophie Stern, Deputy Director,
Best Practices Institute, Enroll America
Q&A Sophie Stern, Deputy Director,
Best Practices Institute, Enroll America

3. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 3 10-20-2014
Engage on Twitter
#HealthInsLit

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10-20-2014
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INTRODUCTION TO HEALTH INSURANCE LITERACY
Sophie Stern, Enroll America
Deputy Director of the Best Practices Institute
October 20, 2014

5. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 5 10-20-2014
Goals for Today
1. Why health
insurance literacy
(HIL) matters
2. Manage expectations
for OE2
3. Learn about
concepts consumers
are struggling with
and how to help

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Health Insurance Literacy
Source: Consumers Union, Measuring Health Insurance Literacy: A Call to Action,
February 2012. Can be found online at:
http://consumersunion.org/pub/Health_Insurance_Literacy_Roundtable_rpt.pdf
Financial
Literacy
Health
Literacy HIL

7. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 7 10-20-2014
HIL Levels are Very Low
• Americans are confident, but actual
understanding is very low
• Only 14 percent of all respondents accurately
understood deductible, copay, co-insurance and
out-of-pocket maximum
• 44 percent of consumer assistance programs had
seen people who did not understand how to use
insurance
Sources: Loewenstein, “Consumers’ misunderstanding of health insurance,” Journal of Health Economics, September 2013; Kaiser Family Foundation, Survey of Health
Insurance Marketplace Assister Programs, July 2014

8. © 2014 Enroll America and Get Covered America
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The Role of the
Enrollment Community
To Help Consumers
Get Covered and
Stay Covered

9. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 9 10-20-2014
HIL and Its Link to
Retention
Source: Enroll America, Knowledge is Power: Focusing on Health Insurance Literacy May Increase Health Coverage Retention, August 2014,
http://www.enrollamerica.org/blog/2014/08/health-insurance-literacy-coverage-retention/
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Feel like they have enough
information
Feel like they do not have
enough information Confidence in paying premium
Enrollees who have more information about the law
are more confident that they can pay their premium
86%
56%

10. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 10 10-20-2014
HIL and Its Link to
Retention
0%
10%
20%
30%
40%
50%
60%
70%
80%
Feel like they have enough
information
Feel like they do not have
enough information
73%
Enrollees who have more information about the law
are more likely to renew coverage
Plan to renew coverage
Source: Enroll America, Knowledge is Power: Focusing on Health Insurance Literacy May Increase Health Coverage Retention, August 2014,
http://www.enrollamerica.org/blog/2014/08/health-insurance-literacy-coverage-retention/
56%

11. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 11 10-20-2014
What Do Consumers
Need to Know?
Our Wish List
Why health insurance matters
When and how to get covered (and renew!)
Financial help (or low or no cost coverage) is available
How to find a plan that meets needs and budget
How to use health insurance
• Using a health insurance card
• Finding a doctor or hospital in-network and knowing what’s covered
• Understanding out of pocket costs
• Knowing how to appeal a coverage decision
How to keep coverage

12. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 12 10-20-2014
But the Bottom Line is…
Consumers
need to
Know
Where to
Get Help!
https://www.getcoveredamerica.org/locator/
Email connector@enrollamerica.org if interested in learning more

13. 13
Lynn Quincy Associate Director, Health Policy
October 20, 2014
Things to Consider When Engaging Consumers

14. 14
What DO Consumers Know?
Copays
Sometimes premium
Low health insurance literacy is ubiquitous:
All income levels
All education levels
Includes even those that have been insured most of their lives
Cost sharing terms are the hardest of all

15. Top Tips: Health Insurance Basics
Source: https://www.healthcare.gov/why-should-i-have-health-coverage/

16. Few of Us Can Pay for Health Care Out of Pocket
Source: Milliman, Benefit Designs for High Cost Medical Conditions. Note: 2010 costs inflated to 2014 using Medical CPI.
$350,322$193,012$137,228$112,683$83,676$80,329$68,056$0$50,000$100,000$150,000$200,000$250,000$300,000$350,000$400,000Respiratory Failure on VentilatorEnd-Stage Renal DiseaseCancer patients who receivesurgery or chemotherapy Premature baby with extremeproblemsCoronary Artery DiseaseHeart Attack including CardiacRevascularizationStroke

17. With Insurance…
 You pay a fixed premium each month…
 BUT the cost of most medical care is
shared between you and the insurance
company.
 You benefit because the insurer has
negotiated lower payment rates with
doctors.
 PLUS, the most you have to pay in a year
is capped. If you get an really expensive
illness, insurance will pay the majority of
those bills

18. Financial help: least understood
feature of ACA…
.. and a motivator to get
covered.
Financial help was the single greatest
motivator to get consumers to
explore options and get covered
during the initial open enrollment
period
1 in 5 Knew About
Financial Help
“I can’t afford
insurance.”
-Number one reason
respondents gave for not
enrolling
Source: PerryUndem Research and Enroll America, Voices from the Newly Enrolled and Still Uninsured: A survey about the Affordable Care Act’s First Open Enrollment Period, July
2014, http://www.enrollamerica.org/resources/public-education/voices-from-the-newly-enrolled-and-still-uninsured/

19. Top Tips: Picking the “Best” Plan
What’s covered?
Health plans you buy on your own now cover a standard set of benefits:
Doctor, hospital, maternity, prescription drugs, mental health and more.
But some things may not be covered:
Adult dental
Children’s dental
Certain drugs

20. Check the Drug Formulary
Tier 1: Generic $
Tier 2: Brand $$
Tier 3: Specialty Drugs $$$$
Some
drugs
aren’t
covered at
all
HOW? Use Marketplace website or ask the health plan for the link to the
formulary online (won’t be listed on the SBC)

21. Cost-sharing Terms are Very Difficult for Consumers
Deductible
Copay
Coinsurance
Benefit Limit
Out-of-Pocket Maximum
Balance Bill
Individual vs. Family
Aggregate vs. Embedded
Allowed Amount
Visits, days
In-vs. Out-of- Network
Separate deductibles for drugs or other services

22. Deductible is What You Pay First
22
Jan
Dec
Jul
Mar
Visit Doc for Flu:
$150
Todd pays: $150
Colonoscopy
$450
Todd pays: $0 (an exception to the deductible)
Broken arm (waterskiing)
$3,850
Todd pays: $850 (deductible) then coinsurance
Todd’s plan has a $1,000 deductible:
$150
$850
$450
$3,000
Todd pays:
Plan pays:
Todd & plan share the cost

23. Exceptions to Deductible
Free Preventive Health Services
including some vaccinations, mammograms and other cancer screenings, contraception, including birth control pills, and periodic physicals. But prevention services do not include treatment for anillness, such as the flu.
See: https://www.healthcare.gov/what-are-my-preventive- care-benefits/
Some plans offer 1-3 primary care visits before deductible –you have to look.
23
If the price for a doctor visit followed by the phrase "after the deductible is met" the consumer must pay the full deductible before getting doctor visits for indicated copayment or coinsurance amount.

24. © 2014 Enroll America and Get Covered AmericaEnrollAmerica.org | GetCoveredAmerica.org
10-20-2014
Summary of Benefits and Coverage
24

25. Individual vs. Family
Separate Medical and Prescription Drug vs. Combined
Types of Deductible

26. Types of Deductible
In-Network vs Out-of-Network

27. Coinsurance is Hard for Three
Reasons
1) WHO does the indicated
percentage apply to?
2) Low numeracy – can’t
calculate percentages.
3) Can’t get to a bottom
line - most times, you
don’t learn what the
allowed or contracted
amount is until you get
your bill.
80%
20%
Doctor visit costs $300
Health plan pays $240
You pay co-insurance of $60
Example

28. Keep paying your premiums
Find a primary care doctor – don’t use the emergency room for routine care
Report changes in income and family size to the Marketplace (if you are receiving a tax credit)
Congratulations! Got Coverage. Now What?

29. Explain the info on the Insurance Card
Adapted with permission from Texas Association of Community Health Centers presentation
For Example

30. For more information: http://www.ahrq.gov/apps/qb/
Adapted with permission from Texas Association of Community Health Centers presentation
Making the Most out of Doctors Appointments
During your appointment, ask:
Why do I need this treatment?
What is the test for?
Are there any alternatives?
What are the possible complications?
How many times have you done this procedure?
When will I get the results?
Does the medication have any side effects?
Will this medicine interact with medicines that I'm already taking?

31. You have options!
Start with health plan’s 1-800 number
Call number at the bottom of your “Explanation of Benefits”
If that doesn’t help, contact the Department of Insurance
Insurer didn’t pay for a service? Got a bill that seems too high?
http://www.naic.org/state_web_map.htm

32. 32
Action Steps
Continue to provide in- person help
Simplify health insurance information
Develop effective materials on HIL

33. © 2014 Enroll America and Get Covered AmericaEnrollAmerica.org | GetCoveredAmerica.org
10-20-2014
33
TESTING CONSUMER MATERIALS TO IMPROVE HEALTH INSURANCE LITERACY
Ricky Gonzales, Enroll America
Deputy Director of Analytics
October 20, 2014
Sophie Stern, Enroll America
Deputy Director of the
Best Practices Institute
October 20, 2014

34. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 34 10-20-2014
Designing Consumer
Lit for OE2

35. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 35 10-20-2014
Question of What to
Emphasize?
Information
• Financial help, in-person assistance, why insurance matters
(preventive care, no denials, prescriptions, etc.), fine
Tools
• Subsidy calculator, locator tool for in-person help, plan help
available on GetCoveredAmerica.org
Stories
• Highlight someone who got covered during OE1
Fine
• No mention of fine vs. mentioning fine vs. amount of fine

36. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 36 10-20-2014
Online Survey to Test
Different Messages
7,000
Respondents
120 Possible
Combinations
⁞
Source: Enroll America, Literature Test, 2014

37. © 2014 Enroll America and Get Covered America
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29% 48% 23%
Consumers Had a
Clear Cover Preference
Source: Enroll America, Literature Test, 2014

38. © 2014 Enroll America and Get Covered America
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Consumers Had a
Clear Cover Preference
29% 48% 23%
42% 58%
Source: Enroll America, Literature Test, 2014

39. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 39 10-20-2014
“Affordable Health
Insurance” Resonated More
42% 58%
Source: Enroll America, Literature Test, 2014

40. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 40 10-20-2014
Combining Multiple Types
of Content Performed Better
-2.0%
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
Likely to Get
Insurance
Has Enough
Information
Knows How
to Find Cost
Info
Knows How
to Set Appt
Knows
Financial
Help Exists
Knows Feb
2015
Deadline
Stories Tools Information Stories+Tools+Info
Source: Enroll America, Literature Test, 2014

41. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 41 10-20-2014
Consumers Underestimate
the Fine without More Info
No Fine Fine Nona Fine Amount
Knows Fine is
$300+
14% 14% 12% 72%
Has Enough
Information
41% 42% 46% 48%
Likely to Get
Insurance
36% 33% 36% 37%
Source: Enroll America, Literature Test, 2014

42. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 42 10-20-2014
Tools and Resources
for Partners
http://www.enrollamerica.org/hil/

43. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 43 10-20-2014
The Get Covered
Calculator was
created to help
consumers
understand the cost
of purchasing
coverage with
financial help:
https://www.getcov
eredamerica.org/cal
culator/
Get Covered America:
Premium Calculator

44. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 44 10-20-2014
The Plan Picker
was created to help
consumers
understand their
options across
metal levels:
https://www.getcov
eredamerica.org/pla
ns/
Get Covered America:
“Plan Picker”

45. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 45 10-20-2014
Beyond the Basics:
Assister Plan Compare Tool
http://www.healthreformbeyondthebasics.org/wp-content/
uploads/2014/03/CBPP-Marketplace-Plan-Comparison-
Worksheet-March-2014.pdf

46. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 46 10-20-2014
Consumer Reports:
‘Nutrition Facts Label’

47. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 47 10-20-2014
Families USA:
How to Keep Coverage
http://familiesusa.org/sites/default/files/product_documents/C
onsumer_HealthInsuranceBasics_FACTSHEET_KeepingHealt
hInsurance.pdf

48. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 48 10-20-2014
Consumers Union:
Tax Credit Brochure and Online Tool
Consumer-tested
paper brochure and
online tool
-customized for each
state
http://consumersunion.org/taxcredit/US_2014_EN.pdf

49. © 2014 Enroll America and Get Covered America
EnrollAmerica.org | GetCoveredAmerica.org 49 10-20-2014
CMS:
Coverage to Care in Spanish
http://marketplace.cms.gov/technical-assistance-resources/c2c.html

50. © 2014 Enroll America and Get Covered AmericaEnrollAmerica.org | GetCoveredAmerica.org
10-20-2014
50
QUESTIONS?
Lynn Quincy, Consumers Union, lquincy@consumer.org
Ricky Gonzales, Enroll America, rgonzales@enrollamerica.org
Sophie Stern, sstern@enrollamerica.org

51. © 2014 Enroll America and Get Covered America
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Engage on Twitter
#HealthInsLit

52. © 2014 Enroll America and Get Covered America
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#Ready4OE2 Series
#Ready4OE2 Webinar
and Blog Series During
October!
Subscribe to Enroll America’s newsletter for
updates: http://www.enrollamerica.org/

53. © 2014 Enroll America and Get Covered America
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