A new health literacy study finds that just 20 percent of people with health insurance through their employers feel they understand their coverage, reports Alan Goforth for BenefitsPro. While the researchers did not look at older Americans’ understanding of their Medicare coverage, it seems fair to assume that only a tiny proportion of older Americans feel they understand their coverage. People who don’t understand their coverage are not likely to get the care they need, which could cost them a bundle financially, emotionally and physically.
The direct costs to people’s health from lack of understanding their insurance is tremendous. Not only can they be deprived of needed care, but they can suffer undue stress and worse health conditions. In Medicare Advantage, most people don’t appreciate the obstacles to their getting the care they need when they need it. Insurers take a narrow view of what care is covered, often second-guessing treating physicians, because that is how they maximize their profits. Many people do not know they easily can appeal an insurer denial and, instead, go without needed care.
Cigna Healthcare produced the health literacy report, with the apparent goal of getting employers to do a better job of educating their employees about their health insurance coverage. Lack of understanding costs employers billions of dollars in lost productivity, according to Cigna Healthcare. But, people generally don’t have much free time, and it is not likely that they are going to spend time trying to understand their health insurance until they need it.
The solution to low health literacy when it comes to health insurance is to create a simple system that is easy to understand, such as traditional Medicare, the government-administered health care coverage for older adults and people with disabilities. With traditional Medicare, access to care is far less burdensome a process–even for people with mental and physical impairments and low health literacy–than in a Medicare HMO.
Traditional Medicare has no prior authorization requirements for medical or hospital care, no provider networks and no need for patients to know anything about the administrative elements of their care. Physicians and hospitals submit the bills, you pay nothing upfront, and if you have supplemental coverage, you often have no out-of-pocket costs to think about. Moreover, if Medicare denies a service, you generally are not stuck with a bill. The provider eats the cost, unless the provider has given you written notice and you have agreed to pay privately.
Here’s more from Just Care:
- If your health plan denies payment, fight back and appeal
- Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Four things to think about when choosing a plan to fill gaps in Medicare, a “Medigap” or Medicare supplemental insurance plan
- Ten ways Medicare Advantage plans differ from traditional Medicare
- Would standardizing Medicare Advantage plans protect people from making a bad choice?
