Table 3.

Select references related to health literacy and health insurance literacy in low-income populations.

AUTHOR(S)	POPULATION	METHODS	MAJOR FINDINGS
Coughlin et al., 2008	1,848 newly enrolled Medicaid beneficiaries in Florida between November 2006 – March 2007	Telephone survey of participants, oversampled those receiving Supplemental Social Security (SSI)	30% unaware they were enrolled in Medicaid reform plan 30% unaware that different plans may have different benefits or new benefits Over half reported difficulty understanding/choosing plan
Greene et al., 2009	59 Florida Medicaid beneficiaries in June 2007, 122 Florida Medicaid beneficiaries in May 2007.	Mixed qualitative and quantitative design. 1) Focus groups on Medicaid reforms conducted 10 months after state reforms, 2) Convenience sample was tested for understanding of program changes	Participants generally endorsed plan choice as desirable Comprehension of plan comparisons generally poor; simplification improved this for some with higher numeracy
Kenney et al., 2014	639 uninsured adults with family incomes at or below 138% FPL from June to July 2013	Cross-sectional observational design using the Health Reform Monitoring Survey (HRMS), a nationally representative survey of ongoing ACA implementation	Most did not have prior experience with Medicaid Of those with experience, most said they were not currently enrolled because of actual or perceived ineligibility Most had both low confidence in their understanding of insurance terms and few sources of insurance information
Long et al., 2014	7,450 (1,233 uninsured) non-elderly adults of all incomes, including those with family incomes at or below 138% FPL in 2013	Cross-sectional observational design using the HRMS	Fewer than one-fourth of uninsured adults very or somewhat comfortable with all health insurance terms examined, including cost-sharing terms Except for “copay,” fewer than half of uninsured adults understood any one health insurance term
Politi et al., 2014	51 uninsured adults, mostly low-income and African American, in three locations (one urban, suburban, and rural) in Missouri	Semi-structured interviews	Only slightly more than half of participants had “adequate” health literacy For all key insurance terms except “premium,” fewer than half of participants demonstrated adequate understanding The least understood cost-sharing term was “coinsurance”
Sentell, 2012	35,033 adults age 18–64 in California	Used self-reported measures of health literacy from the California Health Interview Survey, a representative telephone survey in 2007, and compared with demographic variables	Those with low health literacy were more likely to be uninsured, sicker, and to meet criteria for coverage under Medicaid expansion
Walsh and Fitzgerald, 2012	1,073 Medicaid recipients in a mid-Atlantic state who chose between Medicaid Managed Care plans in 2008	Qualitative analyses of mail survey responses of a random sample of Medicaid enrollees	Over half of participants did not understand difference in plans Several chose plans based on misconceptions like perceived provider network differences (actually same for both plans)
Yin et al., 2009	6100 parents in the United States	Using the National Assessment of Adult Literacy, a nationally representative survey in 2003, assessed self-reported health literacy, measured health literacy by a number of tasks/exercises, and compared these with a number of demographic variables using regression models	Incomes below the poverty threshold predicted low health literacy, but not incomes 100–175% FPL Approximately 2/3 of the parents were unable to calculate the annual price of a health insurance policy Parents had higher health literacy than nonparents