Helping newly insured consumers understand the system

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, has been AHCJ’s topic leader on health reform and curated related material at Follow her on Facebook.

roadmapHealth reporters: Do you understand everything about your health insurance?

I didn’t think so.

Now imagine the struggles of newly insured people who don’t write about health care for a living – and who may not have had insurance for years and who may not speak English as a first language. Deductibles? Cost share? Copay? Narrow networks? Catastrophic caps?

The Center for Medicare and Medicaid Services just released the From Coverage to Care initiative, and the “Roadmap to Better Care and a Healthier You,” (also in Spanish) which is sort of the ACA equivalent of “Everything You’ve Always Wanted to Know About Health Insurance but Were Afraid to Ask.” It includes an eight-step guide:

  • Put your health first
  • Understand your insurance plan
  • Find a provider
  • Make an appointment
  • Be prepared for the first visit
  • Decide if you like the provider
  • Next steps after your appointment

It also includes resources, a glossary, videos, and materials for doctors and other health care providers to use to help explain insurance.

For a reporter, a few points emerge. First, who is using this guide? Community groups? Clinics? The organizations that did outreach and sponsored navigators during open enrollment?

Second, it’s a good reminder that there are a lot of people who really don’t understand how to navigate the system, even how to find a doctor or make an appointment. If people unwittingly go out of network and end up with big bills, health care isn’t affordable.

If they don’t get preventive care because they don’t realize it is free (for specified recommended services) health care isn’t much of a benefit. And, as always with health care, there are political implications. If people are paying for something – in some cases paying quite a bit – and not getting much back, they aren’t going to be happy, and they are likely to share that dissatisfaction, possibly discouraging friends and family from enrolling or staying enrolled next year.


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