Demystifying the Process of Choosing a Health Insurance Plan

When Michelle Weiss, a health counselor at the Community Service Society of New York, asked her audience if they thought choosing a health insurance plan was “confusing,” she got a resounding “yes.”

That confusion – which is hardly confined to the 10 people who met in a Brooklyn office space Wednesday night – was the reason Weiss was offering training in the mysteries of health insurance at an event organized by the Democratic Socialists of America. It was her second workshop session since the Nov. 1 opening of the current enrollment period, which ends on Jan. 31 in New York State but was shortened to Dec. 15 in the 39 states using the federal marketplace.

Only 4 percent of American people understand what four basic health insurance terms – “deductible,” “co-pay,” “coinsurance,” and “out-of-pocket maximum” – mean, according to a Policy Genius survey of more than 2,000 health insurance consumers released this year.

“Contracts are written in a very technical language,” said Angie Fagerlin, chair of Population Health Sciences at the University of Utah and author of several studies about health care, in a phone interview. “It doesn’t help in terms of people being able to make good decisions.”

In a 90-minute presentation, Weiss tried to demystify insurance terminology. Showing more than 60 slides, she also detailed and compared different health care plans, displayed samples of hospital bills and provided information to decode them.

The audience appeared to listen carefully and some took notes.

“I have no idea how my health insurance works; I don’t really use it a lot,” said Jennifer James, a 26-year-old costume designer who just got her insurance plan through her employer a few months ago. “I haven’t been to my primary care since I was a child. I haven’t been really sick. I’ve gone to my gynecologist every once a while and that’s about it.”

According to the most recent data released by the Henry Family Foundation State Health Facts, 49 percent of Americans  are covered by an employer-sponsored health insurance plan. Another 19 percent of the population receive Medicaid, a state and federal program that provides health coverage for low-income people and people with certain disabilities.

Hollie Zegman, a 33-year-old Queens woman who describes herself as a “starving actor,’’ is one of them. She has been attending training sessions about health insurance for several years but still had many questions on Wednesday. This time, Zegman was especially preoccupied because she’s had many problems since she tried to renew her Medicaid insurance in June.

“They lost my case,” she said.  “I got thrown off of my coverage and I had to go all over the renewal process all over again.”

Zegman tried to solve the problem over the phone but Medicaid employees gave her inaccurate information, she said. She had to go to the Medicaid office – one hour from her home — wait hours in line and come back several times with the right documents. Even after all that, she is not sure that Medicaid will approve her application.

“It’s incredibly frustrating, the lack of accountability,” she said. “Medicaid just drives me crazy. I have health conditions I am dealing with so I don’t feel like I can’t afford any gap in my coverage.” Zegman said she has hormone imbalances.

As of Dec. 2, more than 3.6 million people in 39 states had enrolled in a health insurance plan using the federal website, according to the site. Given the shortened enrollment period in most of the states, analysts predict that the number of sign-ups will for 2018 coverage will be much lower than 2017. Last year, two weeks before the enrollment ended on Jan. 14, more than 8.8 million people had enrolled through

In New York, however, numbers are encouraging.  As of Nov. 30, more than 4 million people – more than 1 in 5 New Yorkers – had enrolled through the New York State of Health, according to a press release by the state marketplace. That’s 13 percent higher than last year.

New York hasn’t been exposed to the risk of lacking health insurers for 2018 coverage, which threatened 45 counties in the country, according to an analysis released by the New York Times this summer. Even if New York health insurance prices are expensive, they didn’t increase as much as in other states in the last few years, according to  a study  from the Robert Wood Johnson Foundation and the Urban Institute.

“New York is running like a smoothly well-oiled machine,” Weiss said, “as much as it can, given the bureaucratic nature of what we do.”