Facilitating State Health Exchange Communication Through the Use of Health Literate Practices Workshop Summary (2012) / Chapter Skim
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3 State Insurance Exchanges' Impact on Consumers
3 State Insurance Exchanges' Impact on Consumers
Pages 27-48
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From page 27... ...
According to three studies conducted by Consumers Union, the image of a careful shopper who is capable of weighing the myriad costs and benefits associated with their health insurance options must be aban doned (Consumers Union and People Talk Research, 2010; Kleimann Group and Consumers Union, 2011a,b)
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And I think it's one of the hardest things to figure out what's covered" (Consumers Union and People Talk Research, 2010)
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However, figuring out the "value" of any given health plan is a challenge for consumers. One barrier to understanding value is confusion over cost-sharing terms.
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Use these is not covered, so you pay examples to see, in general, how 100%) much insurance protection you Sample Sample care costs: might get from different plans.
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viders: Amount owed to providers: Amount owed to providers: $98,000 $7,800 Plan pays $94,800 Plan pays $6,800 You pay $3,200 You pay $1,000 aternity pay Sample care costs: Sample care costs: Office visits and Office visits and $100 $4,000 $960 procedures procedures $300 Radiology $4,000 Laboratory tests $300 $200 Medical equipment Laboratory tests $2,400 $2,000 $40 and supplies Hospital charges $3,300 Pharmacy $6,500 Inpatient medical care $200 $4,100 Total $7,800 Outpatient surgery $3,400 Chemotherapy $64,000 $1,900 You pay: Radiation therapy $13,000 $1,000 Deductibles $300 Prostheses (wig) $500 $200 Co-pays $260 Pharmacy $2,000 Co-insurance $400 $200 Mental health $1,200 Limits or exclusions $40 Total $98,000 $10,000 Total $1,000 You pay: $0 Deductibles $2,500 $0 Co-pays $200 $0 Co-insurance $0 $10,000 Limits or exclusions $500 $10,000 Total $3,200
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allow consumers to see the relative value of their health plan choices. Another shortcut would be an understandable measure of network adequacy.
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Exchanges might want to partner with a trusted entity, preferably a local organization, to build trust in the health plan information provided. More importantly, the exchanges and the health plans operating inside of them have to merit consumer trust.
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Hablamos Juntos Understanding how language works is important to effective communication about health insurance options, Partida said. Language is a system of arbitrary signals.
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With the lack of formal training, heritage speakers can exhibit wide variations in their level of language compre hension. More important, independent language learning can result in poor English mastery, language adaptations, and language mixing.
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For Spanish, because of a high risk for poor first language mastery and rate of attrition, language development history is an important consideration in soliciting opinions about translated materials. For Chinese, there are five regional languages that are spoken (Cantonese and Mandarin are the most well known)
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Translators, the language professionals who take these jobs, vary in their language skills, Partida said. The highly specialized nature of health insurance language, often framed in contractual terms, represents sig nificant challenges, even for translators with advanced training.
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L.A. Care Health Plan and partner health plans expressed long-standing concerns over translation quality and with inconsistencies in translations among the translation vendors they contracted with.
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Care Health Plan. The glossary consists of the 237 health plan terms, their definitions, parts of speech, and a recommended translation standard.
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, BOX 3-1 Examples of Inconsistently Used Program Names in Health Plan Materials • tate Department of Health Services (SDHS) /California Department of Health S Care Services (CDHCS)
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. When a term is selected for use by a health plan, it is essential that the term be used consistently.
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Developing standards for translation of terms and concepts specific to the American health system can help (1) identify health content with significant differences between English, the source language, and target language and culture; (2)
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Quincy plans to actively disseminate the findings in the fall of 2011. Cindy Brach, roundtable member, asked if Consumers Union would consider rating health plans in terms of how intelligible their materials are, such as the coverage benefits information and membership materials.
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indicated that health plans viewed the prospect of simplification very positively. However, considerable work is needed to simplify health insurance language so consumers can understand the plan's terms, she said.
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Brach asked Partida if federal legislation exists, or is emerging, to regulate language threshold requirements for translation and interpretation services. Many state Medicaid programs must provide language assistance for speakers of languages other than English if the popula tion of speakers of that language exceeds a certain threshold within a community or market area.
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Linda Harris, roundtable member, asked Quincy what role Consum ers Union might play in helping consumers purchase health insurance through the state health insurance exchanges. Quincy stated that the pri mary and traditional role of Consumers Union is to be a trusted source of information.
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2010. Early consumer testing of new health insurance disclosure forms.
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Pow erPoint presentation at the Institute of Medicine workshop on Facilitating State Health Exchange Communication Through the Use of Health Literate Practices, Washington, DC.
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