Young, educated Philadelphians struggle to understand health coverage lingo

Confused by health insurance terms such as deductible and co-insurance?

Researchers at the University of Pennsylvania have found that even highly educated young adults aren’t familiar with those key concepts—and that could be a problem.

Getting healthy young people to join the ranks of the insured has been a top priority for the Obama administration and key to the success of the Affordable Care Act.

To figure out the challenges facing young adults, Penn pediatrician Dr. Charlene Wong tracked a few dozen Philadelphians, ages 19 to 30, in real time as they tried shopping for insurance on HealthCare.gov last year.

“A big barrier to making that choice was a lack of understanding of basic health insurance terms,” said Wong, who is also a Robert Wood Johnson clinical fellow and lead author of the study, which was published in the Journal of Adolescent Health.

Despite impressive academic training — nearly all the participants had bachelor’s degrees, and many had finished grad school — only about half knew what a deductible was. Fewer than one in five understood co-insurance or PPO. And no one correctly defined a cost-sharing reduction plan.

“I just wasn’t able to comprehend all of the things on HealthCare.gov. I got confused. I’m not a person to give up — not at all — but with the system, I just wanted to quit,” said one participant in a follow-up interview.

Wong said milennials expected the website to offer more guidance, perhaps in the form of pop-up definitions –- a fix that has since been implemented on some exchanges.

In addition to problems with lingo, price was a major concern identified in the study.

“We even had one participant who said, ‘I’ll just pay whatever the tax consequence is, $95 or something, right? Because $200 a month right now is way too much. I don’t know how my friends with student loans do it,'” said Wong.

The group of young Philadelphians said an affordable monthly premium would be under $100. But without tax credits, the cheapest plan in the area is nearly twice that.

In the end, about a quarter of the young adults signed up on HealthCare.gov, most opting for middle-of-the-road silver plans. Fifteen percent decided to remain uninsured.