Under the 2010 Affordable Care Act, millions of Americans gained health coverage in 2014 through Medicaid or subsidized private coverage in state and federal insurance marketplaces. Coverage is key to accessing affordable, high-quality care, but consumers who struggle to understand how health insurance works and how to estimate out-of-pocket costs are at risk of going without needed care even if they are covered.

While about three out of four Americans aged 22-64 believe they know how to use health insurance, only about one in five could correctly calculate how much they owed for a routine doctor visit, according to new findings from a 2013 national survey by AIR designed to measure health insurance literacy.

Generally, younger people, those who use fewer healthcare services, minorities, people with lower incomes and those with less education have more difficulties navigating health insurance. This brief outlines identifies what health insurance aspects pose the greatest problems for consumers, which groups need more assistance to enroll and use benefits, and what topics and skills consumer-counseling efforts should focus on.

The findings that older people and those who use more services have higher levels of health insurance literacy suggest that people learn about health insurance by doing, so creating tools that simulate real-life examples of how to use insurance are likely to be most effective.