What is covered? How much will it cost? Is the service affordable? These are questions registrars field daily. The answers can carry serious implications for both patients and hospitals.

“Concerns about not knowing how to use health insurance may lead people to delay or forgo healthcare,” says Kathleen Call, PhD, professor at the University of Minnesota School of Public Health.

Only about one-fourth of insured adults really understand their coverage, according to a recent study.1 “The health insurance system in the U.S. is complicated and continuously evolving. At the same time, costs are rising, and more is at stake if people do not understand how to use their insurance,” Call says.

Call and colleagues surveyed 5,378 insured adults to learn if health coverage literacy affects how people access care. “This understanding may reveal solutions to the disconnect between having insurance and feeling protected by insurance,” Call offers.

Researchers compared two different measures of health insurance literacy. The first asks how likely a person is to look to member services to find out what services are covered and whether a doctor is in network before seeking care. The second asks how confident a person is he or she can find a provider in network, figure out whether a service is covered and how much it will cost, and determine which healthcare costs count toward the plan’s deductible.

Only those reporting high likelihood or high confidence on all items were coded as highly literate about health insurance. Those with high literacy were more likely to maintain a relationship with a usual source of care and were more confident about seeking needed care.

Participants most at risk for low health insurance literacy were those of Hispanic ethnicity, people with less than a high school education, unmarried individuals, and those with poor mental health. Patient access staff can safely assume that almost everyone needs an explanation of their coverage. That starts with the basics of terms like “co-insurance,” “provider network,” and “deductible.”

“That said, we are skeptical that we can educate consumers out of this health insurance literacy predicament,” Call says.

Instead, Call suggests health insurance really just needs to be simplified. “Equitable access to care for all is needed, not just for those who understand their insurance, and not just those who can afford to make a mistake using their insurance,” Call says.


  1. Call KT, Conmy A, Alarcón G, et al. Health insurance literacy: How best to measure and does it matter to health care access and affordability? Res Social Adm Pharm 2020; Sep 8;S1551-7411(20)30719-1. doi: 10.1016/j.sapharm.2020.09.002. [Online ahead of print].