Health Insurance Literacy in Action Throughout the Enrollment Cycle
October 20, 2025 | By Sara Hart and Elan Watson
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Health insurance literacy is a skill set that is presumed but takes time and real-world application to learn — the language of health insurance is a field of study on its own. For individuals across the country, knowing how and when to make enrollment decisions — which affect physical, mental, and financial health — has a direct impact on the ability to work, take care of others, and sustain communities.
Individuals and families need support to make these complex decisions about when to enroll and which health plans to choose.
Professional health insurance enrollment assisters, such as Navigators, work to not only support consumers in obtaining coverage, but also increase health insurance literacy to produce healthier outcomes.
What exactly is health insurance literacy?
How is it critical to our success as patients or consumers of health insurance that pays for our care? What can we do to ensure all community members that interact with health care spaces are learning these skills? We’ll walk through answers to these questions as we consider the example of Alex.
Starting the Journey Toward Health Insurance Literacy: Alex
Alex is a 27-year-old who works two-part time jobs. On December 6, Alex wakes up experiencing some pain in both legs after playing basketball with friends. Alex calls the doctor, who shares that Alex’s medical insurance is no longer active. Previously covered under Alex’s parents’ plan, Alex lost coverage at the end of the year after turning 26.
Still in a decent amount of pain, Alex decides to go to the emergency room, not knowing that emergency services without insurance coverage will leave Alex with a large bill.
DID YOU KNOW?
Health insurance literacy is how well an individual can evaluate health insurance options, enroll in a plan, and use the coverage.
According to the Centers for Disease Control and Prevention (CDC), improving health literacy — “an individual’s ability to find, understand, and use information and services to inform health-related decisions and actions” — could prevent nearly 1 million hospital visits and save over $25 billion a year. Health insurance literacy falls under the larger umbrella of health literacy and focuses specifically on obtaining and using health insurance.
Referral to a Health Insurance Navigator
At the hospital, Alex’s nurse sees that Alex is uninsured. The nurse remembers a resource that might help Alex.
A Navigator for the Health Insurance Marketplace conducted a presentation at the hospital recently for nurses, case managers, and the admissions department about the Open Enrollment Period. During the presentation, participants learned the benefits both hospitals and patients have from enrollment in health insurance, as well as eligibility guidelines and the process to refer patients to Navigators for assistance.
Using the quick and easy referral process, Alex schedules an appointment with the Navigator.
A few days later, meeting with the Navigator, they identify that neither of Alex’s two part-time jobs offer job-based coverage and Alex’s income is too high to qualify for Medicaid. Since Open Enrollment is currently taking place, the next step is to apply to the Health Insurance Marketplace, learn if Alex is eligible for financial assistance, and evaluate the plan options. As long as Alex chooses and enrolls in a plan by December 15, the coverage will start on January 1.
Learning Basic Concepts of Health Insurance
Throughout the conversation, Alex is starting to become overwhelmed by the plans available and the terminology, because this information is confusing and new. The Navigator take a step back and walks through the basic concepts and principles of health insurance, using these strategies:
- Share visual tools.
- Speak in short sentences and use familiar terms.
- Ask Alex to repeat back what was shared to confirm understanding. This is commonly called the “teach-back” method.
- Incorporate analogies to everyday life. For example, compare the insurance premium to a monthly subscription fee.
- Schedule follow-up appointments to make sure Alex understands how and when to use the coverage, when to submit additional paperwork or re-enroll, pay the monthly premium, and make other decisions that take place throughout the year to stay enrolled in coverage.
Key Health Insurance Literacy Terms Defined from HealthCare.gov:
Network: The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services
Copayment: A fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible
Medicaid: Insurance program that provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities.
Health Insurance Marketplace: A service that helps people shop and enroll in health insurance.
Enrolling in a Health Insurance Plan
Alex works with the Navigator to complete a Marketplace application on HealthCare.gov, and they find a plan that will maintain Alex’s current primary care doctor with a monthly premium that is within budget. Alex confirms the following:
- The amount of Alex’s monthly premium and how to pay it, especially the first payment (i.e., binder payment) to lock in coverage for the year
- The amount of the annual deductible (i.e., how much is spent on approved insurance claims before the insurance kicks in for that year)
- The types of services that would require a copay versus paying out of pocket toward the annual deductible
- How to find in-network providers and schedule appointments
Important Note: Primary care and specialty care doctor shortages are leading to waitlists for care. A critical health insurance literacy step is to look for the provider(s) in advance before choosing a plan to ensure that provider is in network and accepting new patients under that plan.
Alex keeps all the health coverage documents in a folder containing key information about the plan, and the Navigator sets up a follow-up phone appointment to check back in a month.
Coverage to Care: Health Insurance Literacy Throughout the Enrollment Cycle
Health insurance literacy education and the work of health insurance Navigators extend past enrollment. Obtaining coverage is one step toward building healthier communities, but ensuring that people maintain and use the coverage is the other half. The Centers for Medicare & Medicaid Services (CMS) outlines the journey from obtaining to using health coverage in their Coverage to Care resources.
The Journey Continues: Maximizing the Impact of Health Insurance Literacy
Over the coming months, the Navigator regularly checks in with Alex to find out if there are any recent life changes that may affect Alex’s eligibility for health insurance coverage and to assist with questions or concerns related to the plan or access to care.
With continued support by the Navigator, Alex’s knowledge about health insurance keeps growing, and as a result, Alex is accessing necessary and preventive care.
Advancing the Goals of Health Insurance Literacy
We need to continue to build on the work that has taken place under the banner of health insurance literacy, including:
- Gathering data on the most persistent information gaps that interrupt coverage and care among the uninsured and newly enrolled.
- Compiling data and analyzing what consumers value about having health insurance and how to use coverage.
- Determining the best times to expose consumers to information about health insurance to build a culture of awareness about when to make key decisions to enroll or review coverage to renew. This includes deepening our understanding of when consumers can adapt and change behavior to access care as a result of having coverage and how those health outcomes are driven by having health insurance know-how.
- Documenting and training on key phrases that invite consumers to take timely action at the community-level.
Supporting the Outreach and Enrollment Workforce
Transform Health provides policy, design, and implementation support for outreach and enrollment programming around the country:
- Policy analysis, research and design
- Program strategy and planning
- Partnership development and community engagement methodologies
- Communications strategy, marketing, and events
- Data strategy
- And more…
Contact Heather Bates, COO and Vice President, at heather@transformhc.com if you would like to work together, or book a free discovery call today.
Transform Health is an Inc. 5000-ranked national private health care consulting firm with a mission to drive systems change to build healthy communities.