The concept of health insurance literacy, which can be defined as “the extent to which consumers can make informed purchase and use decisions” (Kim, Braun, & Williams, 2013, p. 3), has only recently become a focus of health literacy research. Though employees have been making health insurance decisions for many years, the Affordable Care Act has brought the issues of health insurance literacy to the spotlight. For the large number of adults with lower levels of health literacy, their ability to procure appropriate levels of health insurance coverage and interact with the health care system successfully may be limited. While a considerable amount of literature has focused on studying health literacy in general, the information seeking and decision-making process regarding health insurance has not been studied as thoroughly. If this process is studied in a sample group of users, their information needs and use might be better understood. This qualitative study explores how individuals understand health insurance concepts and make health insurance purchase decisions. This study used semi-structured interview questions supplemented with a demographic questionnaire and the Health Insurance Literacy Measurement (HILM) developed by Paez et al. (2014). The study was conducted with newly hired employees at a large university in the southeastern United States. The collected data formed the foundation for the construction of a model of the health insurance decision-making process. This study identified information tactics used by individuals when evaluating health insurance materials, such as comparing plans side-by-side, calculating costs, and eliminating irrelevant information. The findings also shed light on the personal reflection individuals undertake when making their health insurance choices, including past experience with health insurance and forecasting their needs for the next year. The participants in this study characterized their health insurance choice as a shared decision, consulting others during their decision-making. The HILM, coupled with discussions during the semi-structured interviews, identified demographic implications of individuals’ health insurance literacy skills. In addition, the information needs and preferred information sources identified in this study will be of interest to human resources officers and other information professionals providing assistance with health insurance enrollment.Doctor of Philosoph
