Americans Confused by Health Insurance Laws But Happy with Their Plans

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Ignorance can be bliss for health insurance buyers. Most Americans say they enjoy health insurance, but that doesn’t mean they understand it.

A recent Forbes Advisor survey of 2,000 Americans with health insurance found that three-quarters don’t recognize the term “coinsurance” and nearly half report incorrect payments and deductibles. This is just the beginning of their confusion about health insurance in the US.

The study also found more opportunities related to open enrollment, Health Savings Accounts and medical billing.

Confusion About Health Insurance

More than three-thirds (77%) do not understand coinsurance

Coinsurance is part of the bill that a health plan member splits with the member’s insurer when it comes to their reimbursement. Coinsurance is usually 20%/80%. This means that the member pays 20% of the bill after reaching the deductible, and the health insurance company takes the other 80% until the member pays the premium.

The survey found that only 23% could identify the correct definition of coinsurance from multiple options—and nearly a third did not want to compare.

Young respondents (aged 18 to 25) were not well informed about coinsurance, with 41% saying they did not know. Only 20% of people in that age group answered correctly, which was slightly lower than other age groups.

Women were twice as likely as men (36% to 18%) to say they didn’t know, but men (24% to 7%) were more likely to confuse coinsurance and copayment.

Health insurance coinsurance is:

Almost half (46%) do not know what health insurance premiums are

Coinsurance was not the only time of confusion for respondents. More than half of respondents (54%) correctly identified health insurance coverage. A copay is a fee you pay each time you receive medical care. For example, this could be a $30 copay if you see a general practitioner, or $60 if you see a specialist.

Most of the respondents confused the payment with other health insurance, and 6% did not want to think.

Less than half of the young respondents (aged 18 to 25) answered the question correctly, while more than half of the other age groups answered correctly.

Coverage in health insurance is:

Almost half (45%) do not know what their health insurance deductible is

A similar number of people are more likely to understand health insurance. A deductible is what you pay for medical care before your health insurance plan starts paying for your care. If you have a $1,000 annual deductible, you must reach that amount before your insurance company starts paying.

Younger respondents were also less likely to earn less than other age groups. Only 40% of 18-25 year olds answered correctly.

Women chose the correct interpretation more than men (59% to 45%). More than a third of men confused discounts with premiums compared to just 11% of women.

Health insurance deductibles include:

Misunderstandings About Health Savings Accounts

A Health Savings Account (HSA) allows you to save for your health care tax-free. HSAs are available only if you have a high-cost health plan, and employers often contribute money to these accounts to help employees with their health expenses.

When asked what they know about HSAs, respondents can select multiple answers that they believe are most likely to apply. A little more than 40% correctly answered that the HSA allows you to set aside money on a pre-tax basis to pay qualified medical expenses or that the HSA can pay deductibles, coinsurance and copays.

Some respondents appeared to be confusing HSAs with flexible spending accounts (FSAs). They wrongly said that you can set up an HSA with any health plan, you lose HSA money if you do not work in a year and that you lose your HSA if you exchange work. This is true of both FSAs and not HSAs.

Which of the following is true about health savings accounts (HSAs)? (select all that apply)

44% Don’t Know About Children in Parental Health Plans

Many respondents also do not understand how long they can keep children in the health care system. The Affordable Care Act allows parents to keep their children on their health plans until they turn 26.

About a quarter of respondents incorrectly thought that the child had to stay at home to keep the parents’ health insurance until they turned 26.

Are children under the age of 26 generally covered as a dependent under the parents’ health insurance?

Many Don’t Know About Special Registration Events

You can usually get health insurance during open enrollment or if you qualify for a special enrollment period.

The survey asked when you would change health insurance plans and found that the majority correctly said that the following would trigger a special enrollment period:

  • Changing jobs
  • Having a child
  • Getting married
  • Losing a job
  • Divorce

But almost 30% mistakenly believe that not liking the current insurance or being diagnosed with a new disease can make a person eligible to change insurance at any time. It is not.

About 20% think that moving will give you a change in health insurance. This may be correct, depending on where the person is going. If you move out of state, you are eligible to purchase a variety of health insurance policies. If you are moving around in the same area, you may not be able to change health plans.

Getting rich and buying a home were wrongly selected as valid registration events by 11% of respondents.

The following are valid reasons to purchase health insurance at any time of the year: (select all that apply)

Medical Expenses That Cause Confusion

Medical expenses have affected many of the respondents in this survey – both at the grassroots and in their banking experience. About 21% of respondents said they were confused about the medical bill they received. Men are more likely than women to report having been affected by medical expenses.

What do you do when you receive medical bills that you didn’t expect or don’t understand? One in five respondents said they did not pay for medical bills until they had reviewed it with the doctor’s office and insurance company. Younger respondents (ages 18 to 41) were more likely to say they had not paid until the review.

Surprise medical bills may be less likely this year after Congress passed the No Surprises Act, which is expected to deal with unexpected medical bills from the internet. This policy is for patients who receive unexpected medical expenses after an emergency visit to an out-of-network facility or after receiving treatment from an out-of-network provider on a social network.

While the No Surprises Act may help people who get windfalls from out-of-pocket payments, some Americans (19%) are struggling to pay some of their medical bills. More women than men said they did not pay for medical care because they could not afford it (23% to 9%).

Related: Medical Debt: Everything You Need to Know

Have you ever done the following after receiving a medical bill: (select all that apply)

Most People Are Happy With Health Insurance Plan

Although respondents are confused about medical expenses and many do not know enough about health insurance terms, most of the respondents said they are happy with their health plans.

This includes 91% of men who said they are very happy or satisfied with their health plan compared to 82% of women. Only two percent of men said they were unhappy with their plan.

How happy are you with your health insurance plan?

For those who are not happy with their health plan, the biggest complaint is money, both out-of-pocket and health insurance premiums. Some of the majority said that their unhappiness was rooted in uncertainty about what their plans entailed.

Why are you unhappy with your health insurance plan? (select all that apply)

Find the Best Health Insurance Companies in 2022

The way

The online survey of 2,000 Americans with health insurance was commissioned by Forbes Advisor and conducted by market research firm OnePoll, according to the Market Research Society. Data was collected June 29-July 1, 2022. The margin of error is +/- 2.2 points with 95% confidence. The survey was conducted by research group OnePoll, which is a member of MRS and has corporate membership with the American Association for Public Opinion Research (AAPOR). For a complete research proposal, including sample sizes and demographics, contact pr@forberadvisor.com.