What’s New for Navigating Health Insurance

By Monique Cuvelier

Health insurance is—if possible—even more important for Americans now than ever before. Everyone’s healthcare needs have been turned upside down, thanks to the coronavirus.

Some people are sicker, some are withholding their preventative care checkups, such as breast cancer screenings, until they feel comfortable visiting doctors, and others still have shifts—or gaps—in their coverage as their jobs change and as President Trump limits and threatens to overturn the Affordable Care Act (ACA).

→ Free Resource Guide: 10 Things To Fix in Women’s Health [Access Now]

It’s been more than 10 years since the ACA passed—and seven years after CHWTraining released the Navigating Health Insurance course–more Americans are insured. However, more people are under-insured. Plus, government funded education about the ACA has been either reduced or eliminated, which leaves many more people confused about coverage.

Avoiding Chronic Conditions

The simplest first step for anyone in navigating health insurance is to avoid the need for care. Preventive care, such as immunizations and cervical cancer screenings, can help individuals and their families stay healthy and reduce the risk of developing a chronic disease.

Lifestyle choices—exercising and eating healthfully—also contribute hugely to a person’s health and finances.

“1 in 3 US adults has pre-diabetes,” says Eric Hannah, the Chief Catalyst at Mode Health in East Lansing, MI. “That is an impending tsunami on the healthcare and insurance system.

“One point I preach is that health literacy needs to include how the insurance plan works, but also how [people can] care for themselves, for example avoid lifestyle-related chronic conditions, and navigate the healthcare system–when to go to the ER.”

Hannah refers to “food as medicine,” a technique of choosing the right foods to reduce or even avoid medication for conditions such as diabetes.

The impact of making smart lifestyle choices can save a great deal of money. Diabetes, for one, is expensive. The journal Diabetes Care revealed the cost for one single person with diabetes to be more than $13,000.

The average economic cost per person was projected to be $13,240 for diagnosed diabetes, $4,250 for undiagnosed diabetes, $500 for prediabetes, and $5,800 for gestational diabetes mellitus (GDM). –Diabetes Care, September 2019.

“When we empower people to be good health citizens and healthcare consumers, it can transform how and how much we pay for healthcare,” Hannah says.

CHWs and Health Insurance

Without the proper education about health insurance, patient populations will only decline if trends in insurance cover continue on the path they’re on.

This is why community health workers, promotores and other health promoters are so important in helping people become insured and also understand the basics of health insurance. CHWs can connect clients to professionals who can help them sign up for insurance, make payments and file claims.

That’s why we created Navigating Health Insurance and included it as part of our core competencies for CHWs learning track. As part of our latest updates to the course, we took a careful look at how things have changed in the last six years. The data reveal that confusion about health coverage in the U.S. has a strong impact on people’s overall health and well-being.

Trends in Navigating Health Insurance

According to the Commonwealth Fund, which conducts surveys of health insurance, today compared to 2010:

  • More people have insurance
  • More people are underinsured
  • People who are underinsured or uninsured have trouble getting care because of cost and paying medical bills

Here are some important highlights about health insurance we learned during our recent updates:

Low Health Insurance Literacy Stops People from Seeking Care

People who don’t understand how health insurance works are more likely to avoid care. People will skip treatment due to cost. This is a powerful case for health insurance literacy as well as general health literacy.

Noncitizens Are More Likely Than Citizens To Be Uninsured

Nearly a quarter of lawfully present immigrants and more than four in ten (45%) undocumented immigrants are uninsured compared to less than one in ten (9%) citizens.


The U.S. Spends More on Health Than Anywhere Else

On average, the U.S. spends twice as much as other wealthy countries per person on health., according to a KFF analysis of OECD and National Health Expenditure (NHE).


Many People Think They Don’t Need Travel Health Insurance

Serious problems when traveling in other countries are rare, many people do get hurt. People with chronic illnesses can also be at risk of a medical emergency. This decision can be an expensive mistake if they become sick or hurt while in other countries, and their main insurance doesn’t work. Request a copy of the Travel Health Insurance Toolkit to use with clients.   


Millions of People are Uninsured and Even More Are Underinsured

Around 25 million people don’t have health insurance at all, and for those who do, premiums on family policies have increased 54% in the last decade.


Not understanding health insurance is bad for people in the U.S. Government debates about ACA and Medicaid aren’t helping people know how their health is affected by coverage. Community health workers are more important than ever when it comes to navigating health insurance.

If you’re not including training about navigating health insurance in your CHW workforce, start now. If you’re interested in building a diabetes education program for your team with these or other courses, contact us to learn how to add certified training to your program. Our team will be in touch ASAP to schedule a time to chat.

Originally published Dec 15, 2019, updated July 24, 2020.