Clueless About Health Plans

Did it really take researchers to tell us that many people haven’t the foggiest notion about how their managed care plans work? Perhaps not. But a new study does help quantify the extent of our confusion. Only 30% of consumers could correctly identify even the most basic features of their health plans, such as whether they were required to choose doctors from an approved list, according to the Center for Studying Health System Change, a Washington, D.C.-based health policy organization.

Other basic features that confused lots of folks were whether the plan would pay for them to see a doctor outside an approved network, whether they needed to choose a primary care doctor, and whether they have to have a doctor’s approval to see a specialist. The results, the researchers concluded, “suggest many consumers lack a basic understanding of how managed care plans operate, leaving them ill-prepared to make informed health-care decisions.”

The study didn’t exactly blame the confusion on any group in particular, be it the health plans, employers that typically select the plans from which their workers choose or the patients themselves. Noting that more employers are asking workers to pay more of the bill for medical insurance and shoulder more responsibility for their own health, the researchers stressed the need for “a lot more work [to be] done to educate and engage” people.