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Rural Health Information Hub

Improving Health Insurance and Financial Literacy

This model seeks to improve health insurance and financial literacy. Health insurance literacy is “a person's ability to seek, obtain, and understand health insurance plans — and once enrolled, use insurance to seek appropriate healthcare services.” Only one in three consumers say they understand the meaning of important health insurance terms. Health insurance literacy is low among many rural residents, and research shows a large gap between urban and rural residents' ability to evaluate health insurance plans.

Health insurance literacy programs bridge information gaps by helping people understand basic health insurance information. This can empower people to have more control and make better informed decisions about their healthcare. Improved understanding of health insurance terms can also increase health insurance enrollment rates, which improves access to care and, ultimately, health outcomes.

The Coverage to Care (C2C) initiative was developed by the Centers for Medicare & Medicaid Services to help people understand the importance of health insurance, how to enroll in the right plan, and how to use their coverage. Some C2C resources are focused on educating consumers, and others are focused on providing education and resources for community partners who help people enroll in health coverage. Resources are available in multiple languages.

Rural programs can use the C2C toolkit to help enroll community members in health plans and ensure that they understand their coverage. The toolkit explains the benefits of health coverage, outlines key questions that consumers should consider when choosing a plan, and defines important health insurance terms for consumers, such as:

  • Premiums
  • Copayment
  • Coinsurance
  • Deductible
  • Out-of-pocket limit

Similarly, approaches that focus on promoting financial and economic literacy can improve financial stability for individuals and their families. This can ultimately increase savings, help people understand and pay for healthcare costs, and increase quality of life. Knowledge about how families can pay for long-term services and supports such as nursing home care as people age is particularly limited in much of the U.S. In 2020, the U.S. Financial Literacy and Education Commission identified guidelines and best practices for improving financial literacy and education. These guidelines and best practices can be applied to rural communities. Rural communities can leverage existing assets, such as community social infrastructure, to facilitate and provide financial education.

For more information about individual asset-building approaches that can also help improve financial literacy in rural areas, see the Social Determinants of Health in Rural Communities Toolkit.

Examples of Programs Focused on Improving Financial and Health Insurance Literacy

  • The Florida Literacy Coalition (FLC) promotes, supports, and advocates for the effective delivery of quality adult and family literacy services in Florida. FLC partnered with Wells Fargo through the Florida Financial Literacy Initiative to establish a statewide program that provides financial education to students in the adult literacy program. Students learn about basic financial skills, such as credit, bank services, taxes, and managing money. They also gain access to online financial education resources, such as webinars and podcasts.
  • Economic Literacy Colorado is a program that teaches teachers and students in Colorado fundamental economic and financial decision-making skills important for everyday life. The program provides information, resources, and tools about personal financial literacy. The program is designed to allow teachers and students to learn through hands-on experiences.
  • The Health Insurance Literacy Initiative (HILI), through the University of Maryland Extension and University of Delaware Cooperative Extension, offers web-based modules about health insurance. The Smart Choice and Smart Use Health Insurance programs help residents learn about health insurance options as they age and provide tools to help estimate costs and coverage options. Resources are available in English and Spanish.
  • The goal of Cover Missouri Coalition is to reduce the number of uninsured in Missouri by improving health insurance literacy. The program shares resources for health insurance plan decision-making, overall financial help, and understanding insurance costs and benefits. Resources are available in both English and Spanish.
  • The ABC for Rural Health program serves Wisconsin's rural individuals and families. Fact sheets help individuals learn about how to change health insurance plans, eligibility for healthcare coverage programs, and information about open enrollment timelines.
  • University of New Mexico Health Sciences Center (UNMHSC) created the Health Extension Regional Offices (HEROs) program to help local communities build capacity and skills to understand and improve health needs. HERO agents live in the community they serve and connect residents by providing education on available health resources. HERO agents work with community members who need health insurance and provide information to young people on the importance and benefits of enrolling in health insurance. In other communities, HERO agents educate residents about other important healthcare topics to improve understanding.

Program Clearinghouse Examples

Implementation Considerations

Health insurance literacy programs may experience challenges helping community members select and enroll in health insurance plans due to limited internet availability in rural areas. Programs can seek to involve strong community leaders and trusted institutions to help spread messages and instill confidence and understanding of health insurance information. Community partnerships can help to address limited resources in the community and lack of infrastructure that can impede financial education initiatives. Programs that have successfully improved financial literacy have partnered with organizations and funders to access resources, such as education materials, that support program goals.

Rural residents must have the financial means to pay for health insurance, but the affordability of health insurance continues to be a challenge in rural areas. Rural communities also continue to be targeted by predatory lending, which diminishes personal wealth.

Resources to Learn More

Health Insurance Literacy: Resources for Farmers and Farm Families
Offers resources, videos, and information for farmers about health insurance and various health insurance options.
Organization(s): University of Maryland Extension

Health Insurance Literacy: Theory, Findings and Trends from an Emerging Field
Presentation Slides
Presentation about various programs that improve health insurance literacy among consumers.
Author(s): Brown, V.
Organization(s): University of Maryland Extension
Date: 6/2016

2020 Health Insurance Marketplace Plan Comparison Activity
Presents a framework of activities and terminology useful for insurance navigators when helping patients understand health insurance plans and compare the benefits of these plans.
Organization(s): Florida Literacy
Date: 2019

Let's Ask 4: Questions for Consumers and Providers About Health Insurance
Describes four questions for both healthcare providers and consumers that are useful when selecting and discussing health insurance.
Author(s): Wu, V. Y., Jacobson, K.L., Wong, W.F., et al.
Organization(s): Institute of Medicine
Date: 6/2013