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Med Care Res Rev. 2014 Feb;71(1):85-98. doi: 10.1177/1077558713505327. Epub 2013 Oct 24.

Knowledge of health insurance terminology and details among the uninsured.

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  • 11Washington University in St. Louis, St. Louis, MO, USA.


By 2014, uninsured adults will be eligible for health insurance through exchanges with multiple plan options. Choosing health insurance is challenging even for those who have engaged in the process previously. We examined 51 uninsured adults' health insurance knowledge and preferences through semistructured qualitative interviews. Our sample was predominantly low-income and African American. Most had little or no experience with health insurance terminology. Those with limited health literacy skills understood less than those with higher health literacy. Many confused related insurance concepts. Non-health contexts (e.g., car insurance) aided understanding. Premiums, fixed costs, and specific coverage were rated very important to insurance decisions. Our study was one of the first to examine uninsured individuals' health insurance knowledge and preferences. Uninsured individuals may have different information needs and preferences than those studied in previous research. Clear information and familiar non-health contexts can be important strategies when communicating about the exchanges.


decision making; health communication; health insurance; health literacy

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