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The Importance of Understanding Your Health Insurance

How well do you understand your health insurance plan? How well does your coworker, neighbor, family member or friend understand their health insurance plans? According to the American Institutes for Research Health Insurance Literacy Survey in June 2013, not very well.

The State of Health Insurance Literacy

Three out of four people surveyed were moderately confident in their abilities to utilize their health insurance plan. However, only 20% could accurately calculate an out-of-pocket cost from a doctor’s visit.

Knowing how to use your health insurance plan is important, but it takes more knowledge than that to be health insurance literate. Let’s start by breaking it down into the four main topics of health insurance literacy:

  • Understanding health insurance terms (e.g., deductible, copay, etc.), healthcare services, and enrollee rights
  • Having the skills to search and understand new health information (e.g., decision support tools, insurer telephone trees, carrier websites, etc.)
  • Understanding insurance documents (e.g., EOI forms, a summary of benefits, provider and drug tiers)
  • Utilization skills (e.g., calculating out-of-pocket costs, using preventative care, applying a health plan to personal health scenarios)

Why It Matters

A lack of understanding of your health plan can affect healthcare utilization and lead to negative health consequences. According to a study conducted by Kaiser Permanente, patients with congestive heart failure and low understanding of their health plans or their own personal health were three times as likely to die in a given year as patients with better health literacy skills.

How We Can Help

Public and private companies have created solutions that help engage consumers and give them opportunities to make better decisions. AccessBetterCoverage.org was created by Pharmaceutical Research and Manufacturers of America to help the public make informed decisions about healthcare and access comprehensive reports and fact sheets on coverage of prescription medicines.

Private companies like Hodges-Mace are offering one-to-one enrollment sessions with licensed Benefit Counselors and offer decision supports tools, like SmartBen Pathfinder to help employees who prefer to enroll on an individual basis.

One-to-One Enrollment Sessions

The American Institutes for Research suggest that for the least health insurance literate, face-to-face enrollments that focus on real-life scenarios help consumers make better decisions. Those better decisions result in better health plan utilization and increase overall Health Insurance Literacy.

Decision Support Tools

Shaller Consulting found that decision support tools increase consumer’s knowledge, satisfaction with the decision process, the probability of considering switching from a current plan, and choosing plans that best meet consumer’s needs and preferences.

Why Choose Hodges-Mace

Hodges-Mace knows how confusing benefits can be and is committed to enabling employees to realize the full value of their benefits. With Hodges-Mace custom enrollment services and innovative technologies, consumers have a greater understanding of their benefits and feel more empowered and are happier with their employer.


Hodges-Mace, an Alight company Main Office

5775-E Glenridge Drive, Suite 500 Atlanta, GA 30328

(404) 574-6110