Open enrollment season has ended for most people with health insurance, and the benefit plan choices have been made. The sign-up process brings equal...

Open enrollment season has ended for most people with health insurance, and the benefit plan choices have been made.

The sign-up process brings equal parts anxiety and confusion. Many people are left with a less-than-confident feeling about decisions they made for this very important part of their lives.

Two recent national surveys have pointed to the general consumer confusion about health insurance. But there may be help on the way.

The bewilderment about benefits was demonstrated in a survey released by Aetna, the insurance giant. It showed that more than half of privately insured adults found some aspect of selecting a health plan difficult to understand.

According to the survey of more than 1,000 Americans adults, many had trouble understanding:

* The total cost of a health insurance plan — the premiums plus out-of-pocket expenses (32 percent);

* The differences between plan types such as PPOs and HMOs (30 percent);

* Which providers are “in network” (26 percent).

The problem was not limited to the poorly educated. When it came to levels of confusion, it basically made no difference whether the respondent had a college degree, said Aetna, which was promoting its Plan for Your Health website.

The findings don’t surprise Nancy Metcalf, a health insurance expert for Consumer Reports. She calls the typical enrollment process ‘‘a nightmare.’’

“It’s just really, really hard’’ for people to figure out how much they will pay out of pocket under different health scenarios, Metcalf says.

Some of the worst-written policies, she says, come from individual insurance. “I’ve seen policies that I swear were written to obscure how bad they were.’’

Reform law offers more transparency

The federal health reform law — if it withstands court challenges — will require standardized information about health plans to help consumers to compare coverages.

Private individual and group health plans will have to provide a uniform summary of benefits and coverage to all applicants and enrollees.

According to a Kaiser Family Foundation brief, the summary “must use words understandable to the average consumer and be presented in a culturally and linguistically appropriate manner. It cannot contain ‘fine print.’ ”

It would also illustrate complicated health plan provisions using hypothetical medical scenarios.

The public would appreciate the ‘‘understandable’’ feature, a recent Kaiser Foundation poll shows.

The poll found the most-liked element of the reform law is that health plans must provide consumers with a short, easy-to-understand description of their benefits and coverage.

Sixty percent gave this greater transparency requirement a very favorable rating. It was the only provision in the law to get such a rating from more than half the public.

A Consumers Union study found that consumers were able to use the forms to make hypothetical choices among health plans. The study, though, also found deep-seated confusion and lack of confidence with respect to health plan cost-sharing.

‘‘Anxiety about shopping for health insurance was especially prevalent in those of midlevel to low-level health insurance literacy and occurred in both the uninsured and individually insured groups,’’ said the study, written by Lynn Quincy.

(Consumers Union, the publisher of Consumer Reports, is looking for examples of consumer insurance confusion. Here’s a link to their request for consumers’ stories.)

Other reform provisions may help as well. Health insurance exchanges, if adopted by states, are expected to make health plans easy to compare.

Massachusetts’ exchange, created before the federal reform law was passed, ‘‘is quite easy to use,’’ Metcalf says, with Gold, Silver and Bronze denoting levels of coverage.

Calling out for help

Currently, consumer assistance phone lines provide a useful resource for people needing help.

A number of states took advantage of consumer assistance funding under the health reform law. Georgia, for example, received a $1 million grant and hired more people to answer consumer questions about health insurance. The money has helped the state insurance commissioner’s office handle more calls and more cases.

People can get help in finding coverage and assistance with claims or appeals of insurers’ decisions, said Greg Hawkins, director of consumer services for the state insurance commissioner’s office.

Open enrollment season, as usual, drew a lot of calls from Georgians, Hawkins says.

Medicare beneficiaries also experience confusion about choices. Today, Wednesday, marks the last day of open enrollment for the federal program.

Even well-educated people ‘‘are overwhelmed when they get into Medicare,’’ says Lisa Federico, coordinator of the Atlanta region’s Georgia Cares program, which assists people and their families with Medicare information.

State insurance assistance programs like the one in Georgia help many people around the nation sort through their choices. “We’re able to lay out all the different options and explain it in laymen’s terms,’’ Federico says.

 


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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