Health

Many with health insurance for the first time don't know how to use it

Advocates say the next big step in the rollout of the Affordable Care Act is making sure people who are newly insured know how to use their coverage.
Advocates say the next big step in the rollout of the Affordable Care Act is making sure people who are newly insured know how to use their coverage.
Adrian Florido

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A number of people who have gotten private health insurance or qualified for Medi-Cal under the Affordable Care Act are getting coverage for the first time, and many do not know how to use it. Community groups and the state's health insurance marketplace are trying to figure out how to bridge that knowledge gap.

St. John’s Well Child and Family Center in south Los Angeles has seen a 40 percent surge in patient volume since the health law took effect, but many of those new clients have never had coverage before. The clinic's call center has been fielding thousands of calls from these newly insured, said CEO Jim Mangia. They are unsure what a premium is, where they can go for care, or even the kind of plan they’re enrolled in, he said. 

"The first step was getting folks enrolled," said Mangia. "And now the issue is: How do we make sure their health is improving as a result?"

This knowledge gap can have real consequences for patients, said Carolina Coleman of the Insure the Uninsured Project, a think tank. Not knowing how best to use their coverage "can run them a really big bill," she said.

The list of potential missteps is long. For example, patients may not know that their plan only covers doctors within a certain network.

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"If you don’t understand in-network versus out-of-network, you can end up going to a provider and getting hundreds or thousands of dollars worth of care that will not get paid by your insurance company," Coleman said.

Other people have plans with high deductibles, but the first few visits are free. If patients don’t know that, Coleman said, they might not go to the doctor when they need care. Newly insured people who have always gotten their care in an emergency room might not know they can now get preventive care.

And the lack of understanding is even more basic than that.  A recent study by USC researchers found that 68 percent of uninsured Americans did not know what a deductible is. It also found that young adults and low-income people are the least informed about how health coverage works.

Officials at Covered California, the state insurance marketplace, acknowledge that this is a big issue. A spokesman said addressing it will be a big part of what the agency does going forward.

At the St. John’s clinic in south L.A., the work has already begun.

Staff members call patients who the clinic knows to be on Medi-Cal, but who have yet to make their first visit to the doctor. On a recent morning, operator Stephanie Espinoza called a woman who was surprised to learn she had coverage.

Espinoza set her up with an appointment.

When the woman walks through the clinic's front door, she will be greeted by staff the clinic has hired to walk clients through the steps of getting care.

"That’s where people learn how to navigate the system," said Mangia. "They learn it by utilizing it. It’s not something you can teach like a history lesson."

He said educating his clinic’s thousands of new clients will be a challenge, because it has to be done one patient at a time.