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Collaboration is key to solving tough problems that make it hard for people to get the care they need.

A panel of Exchange Directors at the 2023 National Academy for State Health Policy (NASHP) Annual Conference discussed strategies to improve insurance literacy and address access challenges.

Discussions centered around how insurers, exchanges, and Medicaid agencies can work together to tackle complex problems for members and consumers.

Understanding Consumer Education Levels and Improving Health Literacy

Health insurance literacy isn’t directly tied to education level.

Mila Kofman, the Executive Director of DC Health Link, described her exchange’s enrollment demographics. Despite 56% of enrollees having more than an undergraduate degree and 30% having a college degree, there is still confusion about how to use their coverage. This reflects an area for stakeholders to work to improve health insurance literacy.

Most individuals also struggle at some level with health literacy, but there is no one size-fits-all solution. Different applicants and consumers can have distinct barriers to coverage and enrollment that require customized approaches.

Here are some strategies exchanges, government stakeholders, and health plans have taken to improve health literacy and access to coverage through improved enrollee engagement.

The Right Answers to Specific Questions

Panelists highlighted that some carriers are already playing a larger in educating members and partners about coverage.

Creating a robust database of plan information that consumers, call center staff, brokers, and community partners can access, enhances the accuracy of information given to members.

A Large Language Model (LLM) enables staff and members to ask questions to a chat bot and get a simple and accurate answered tailored to them.

Generative AI can rephrase and modify the answer based on the feedback from the user.

Health literacy is more than resolving coverage questions, it also includes providing guidance regarding care. Members benefit from understanding how to manage their high blood pressure, cholesterol, diabetes treatment, and other chronic conditions.

Collaboration with Community Touchpoints

Increased collaboration with community organizations allows carriers to reach members where they live and receive care. Panelists emphasized the role of brokers and navigators in improving health insurance access and literacy.

To make the most of these touchpoints, carriers should actively engage with and train community experts.

Panelists also emphasized that insurers can also play a valuable role in educating members about enrollment, accessing care, and addressing health conditions.

AI-Powered Consumer Engagement

In addition, health plans are proactively seeking automated tools for member engagement. Members are seeking a self-guided enrollment and plan management experience. Give members the tools they need to understand their coverage and care.

Improving health literacy is a complex task and the solution is specific to each member. Automating some forms of engagements allows for more resources to be used for one-on-one support.

Combating Affordability Issues in Post-Deductible Care

Variation in plan design is required to meet the needs of a diverse group of enrollees.

“If all your care is post-deductible, then it’s like being uninsured,” stated Kofman. This sentiment was echoed by others on the panel.

Many ACA enrollees and even consumers with employer plans have long struggled to access, afford, and use their coverage. Stakeholders are experimenting to see which barriers of coverage have the largest impact so they can refine mitigation efforts.

Jessica Altman, Executive Director of Covered California, announced plans to eliminate deductibles for over 600,000 of her enrollees in 2024, emphasizing the need to ease affordability burdens.

As discussed earlier, increasing the affordability of coverage is only one step towards a solution. Enrollees and members must also be informed about this elimination of deductibles and what that means for their coverage. A success would mean more utilization of care for those who could previously not afford it.

Identifying Provider Ghost Networks

In addition to increasing access to coverage, carriers can prioritize access to care.

Kevin Bagley, Nebraska’s Director of Medicaid and Long-Term Care, offered his perspective into provider ghost networks and the challenges surrounding them.

Ghost networks refer to insurance directories filled with providers who are not active or are not accepting new patients. Bagley and other panelists spoke of the difficulties faced by members when providers are not transparent about the status of their network.

While not the focus on this panel, ghost networks also cause issues for commercial employer-sponsored plans.

To address the ghost network issue, DC Health Link has partnered with an external vendor provider that obtains monthly feeds to identify providers actively taking patients within plans’ networks.

NASHP 2023 shed light on the multifaceted challenges in health insurance literacy, with insights into the disconnect between education levels and insurance understanding, dissatisfaction surrounding deductibles, and the harm of provider ghost networks.

The collaborative efforts between state officials, health plans, and consumer advocates reveal an industry actively working towards transparency, education, and accessibility.

If you have any questions or would like to discuss the topics covered at NASHP, feel free to reach out to the author of this recap, Josh Schultz, at