title: Seeing Health Insurance and HealthCare.gov Through the Eyes of Young Adults.
abstract: OBJECTIVE
  We describe young adults' perspectives on health insurance and HealthCare.gov, including their attitudes toward health insurance, health insurance literacy, and benefit and plan preferences.
  
  
  METHODS
  We observed young adults aged 19-30 years in Philadelphia from January to March 2014 as they shopped for health insurance on HealthCare.gov. Participants were then interviewed to elicit their perceived advantages and disadvantages of insurance and factors considered important for plan selection. A 1-month follow-up interview assessed participants' plan enrollment decisions and intended use of health insurance. Data were analyzed using qualitative methodology, and salience scores were calculated for free-listing responses.
  
  
  RESULTS
  We enrolled 33 highly educated young adults; 27 completed the follow-up interview. The most salient advantages of health insurance for young adults were access to preventive or primary care (salience score .28) and peace of mind (.27). The most salient disadvantage was the financial strain of paying for health insurance (.72). Participants revealed poor health insurance literacy with 48% incorrectly defining deductible and 78% incorrectly defining coinsurance. The most salient factors reported to influence plan selection were deductible (.48) and premium (.45) amounts as well as preventive care (.21) coverage. The most common intended health insurance use was primary care. Eight participants enrolled in HealthCare.gov plans: six selected silver plans, and three qualified for tax credits.
  
  
  CONCLUSIONS
  Young adults' perspective on health insurance and enrollment via HealthCare.gov can inform strategies to design health insurance plans and communication about these plans in a way that engages and meets the needs of young adult populations.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: charwong@upenn.edu.
authors.forename: Charlene A
authors.initials: CA
authors.lastname: Wong
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania; The Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania.
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Cjloe M
authors.initials: CM
authors.lastname: Vinoya
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Ford
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; The University of Pennsylvania School of Law, Philadelphia, Pennsylvania.
authors.forename: Tom
authors.initials: T
authors.lastname: Baker
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert
authors.initials: R
authors.lastname: Town
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Raina M
authors.initials: RM
authors.lastname: Merchant
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003669:Deductibles and Coinsurance / Q000191:economics* / Q000592:standards; D005260:Female; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000191:economics*; D020407:Internet; D008297:Male; D015143:Philadelphia; D012307:Risk Factors; D055815:Young Adult
keywords: Affordable Care Act; Health insurance; Health insurance exchange; Health reform; Young adults