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LEXINGTON, Ky. (Jan. 7, 2020) – When Jean Edward, Ph.D, assistant professor in the University of Kentucky College of Nursing, first started her research into disparities in health care access in the Hispanic and Latino population in Louisville, she was looking into not only how people accessed health care, but why some people had access while others didn’t. She found a number of contributing factors, but one stood out above the rest – how can people access health care if they don’t understand health insurance?

“People don’t understand health insurance,” said Edward. “And if they don’t understand health insurance, they’re less likely to use it to access the health care they need. And they’re less likely to adhere to their treatment plan, and that’s a problem for us as a health care system.”

Health insurance literacy is defined as an individual’s ability to understand, purchase and use health insurance to access timely and appropriate care. According to Edward’s research, 51% of Americans have inadequate knowledge of basic health insurance terms such as deductible, premium and copay. In addition, 48% have low confidence in using their insurance to access care. With the constant changes in health care reform policies and the complexities of Medicare and Medicaid systems, people don’t know what they are eligible for, how to sign up for a plan or how to use it once they do.

“There is an increased burden of understanding health insurance that is placed on the consumer,” said Edward. “You want people to be empowered to make their own health care decisions, but it isn’t fair or even reasonable to ask consumers to stay updated on a health system that is in constant flux and riddled with issues. So, either we fix these issues and simplify our health systems, or we provide access to resources, such as information intermediaries that can help consumers learn and adapt to these changes.”

In her research, Edward also found that more than 60% of Americans didn’t know their out of pocket health care costs and were unsure about their health insurance deductible amounts. If a person gets health insurance from their employer, they may not fully understand their options or what the plan would cover. More often than not, they will pick the least expensive option, prioritizing their financial situation over their health.

“Consumers usually think, ‘I’m healthy. I don’t know what this stuff means, so I’m going to sign up for the cheapest option’,” said Edward. “But there may be factors they don’t consider or don’t understand such as what exactly is covered, how much they have to pay out-of-pocket before their plan kicks in, or whether their provider is in their network. They assume because they are insured, they’re covered. And that’s when surprise billing hits and they get these unexpected bills.”

To help address consumer health insurance literacy, Edward and her colleagues launched the Kentucky Health Insurance Literacy Training (K-HILT), a training program for community health workers and other public health workers to learn the minutiae of different health insurance policies, and how to assist consumers with understanding and using their health insurance. The courses are offered through Kentucky TRAIN, a free education site dedicated to promoting and improving public health. After completing the training, health workers then take the information learned back to their communities to provide health insurance assistance. The focus has been on Appalachian communities, which have some of the highest levels of health disparities in the country.

“We have community health workers, social workers and patient navigators who serve as information intermediaries, or a type of liaison between the health care system and the consumer,” said Edward. “You can’t just walk into these communities, especially in rural Appalachian regions; you have to have strong, trusting relationships. If you’re an insider, like many of these outreach workers are, you will be welcomed. So we’re tapping into these individuals as resources and providing them with the skills and information necessary to assist their communities in accessing health insurance coverage and improving health outcomes. ”

The first K-HILT training session was conducted in-person and on a trial basis with 31 outreach workers. Before the session began, they were quizzed on their health insurance literacy, knowledge and behaviors related to assisting consumers, and awareness of health care reform policies. At the conclusion of the session, they were surveyed again, showing a substantial increase in knowledge and confidence in understanding federal and state health care reform policies. The K-HILT training was developed on Kentucky Train’s online platform in collaboration with and through the help of several organizations including the Kentucky Association of Community Health Workers, Kentucky Voices for Health, Family Health Centers and the University of Louisville School of Public Health. The online platform promotes accessibility for outreach workers in hard-to-reach and low-resource communities.

“For me, health insurance literacy is just very complicated because we have an uneducated population and it is very much something we deal with here,” said one community health care worker who serves four counties in the Appalachian region. “We’ve had a lot of changes [in state policies]. We’re still working with people who don’t know expanded Medicaid is an option. We’re still having to do education on that. There’s such an information deficit. As far as how to educate the public on these 'big picture' things, I think you need more people like us.”

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