Health Insurance Literacy
for First-Time Enrollees
RESEARCH
2026 · 10 week timeline
CONTEXT
We studied how young adults choose and manage employer-sponsored health insurance the first time they enroll on their own. Using a mixed-methods study, one pattern held across all four methods: the problem isn’t access to information — it’s translation.
MY ROLE
UX Researcher on a team of four, contributing across:
Research Planning
Research Execution
Data Synthesis
Design Opportunities
COLLABORATORS
Natalia Avella · Kate Besel · Eaghan Wright · Carly Zuklin
Young adults understand the billing aspects of their plan, but the structure behind it stays opaque. Providing more material or more time to choose doesn’t improve young adults’ understanding of their insurance plan.
PROBLEM STATEMENT
Young adults selecting employer-sponsored health insurance for the first time encounter employer-provided resources that fail to establish meaningful insurance literacy. Because most enter enrollment feeling healthy and perceiving little immediate need for care, they move through it quickly and learn only the costs that bill them directly.
Without the resources to evaluate their options based on estimated annual cost, out-of-pocket costs, deductibles, and premiums become the primary factors in decision-making. Most anchor on the cheapest available option and move on quickly, without understanding what their plan covers or what they’ll actually spend across the year.
When they do need care, the portals and cost tools fail to provide the information needed, and coverage gaps surface, often resulting in unexpected bills and avoidance of future treatment.
USER GROUPS
PRIMARY
The First-Time Enrollee
Ages 22–28, typically a recent graduate within the last five years, enrolling in their own employer-sponsored plan for the first time. They are digitally fluent, cost-sensitive, and generally healthy, which makes thorough plan research feel low-priority.
CORE NEEDS
Guidance selecting a plan that actually fits their life and medical needs.
Findable, comprehensible, trustworthy resources for literacy, comparison, and enrollment.
A high-quality portal that serves as the reliable center of their insurance experience.
BEHAVIORS
Spends minimal time learning about enrollment and plan selection.
Leans on trusted adults, peers, and informal sources, plus AI and internet search, over formal materials.
Defaults to the cheapest base plan without fully understanding what it covers or how it applies to their life.
METHODOLOGY
GENERATIVE
SURVEY
103 qualified participants. Screened for age, employment status, and enrollment recency. Used to establish baseline literacy and decision-making patterns at scale.
n = 103 · quantitative
MODERATED INTERVIEWS
8 semi-structured interviews conducted live. Participants narrated their enrollment journey and completed tasks on their own insurance portal via contextual inquiry.
n = 8 · qualitative
AI-MODERATED INTERVIEWS
16 interviews conducted asynchronously via AI moderation, split into 8 structured and 8 unstructured sessions. The structured sessions used a consistent question set for cross-participant comparability. The unstructured sessions were open-ended and exploratory, allowing participants to speak in their own language. This split let us validate patterns from the moderated sessions at greater scale while preserving room for emergent themes.
n = 16 · 8 structured + 8 unstructured
EVALUATIVE
COST-ESTIMATION TOOL CONCEPT STUDY
Participants were asked to price a foot MRI using their own insurance on a public cost-estimation tool. This concept study tested whether the tools young adults encounter can deliver the information they need at the highest-stakes moment.
14 participants
6 abandoned insurance entirely
About 3 got an estimate they trusted
Others errored out, guessed, or switched to an AI chatbot
INSIGHTS
Who we’re designing for
CORE NEEDS
Guidance selecting a health insurance plan applicable to their life and medical needs.
Easily findable, comprehensible, and reliable resources that aid in health insurance literacy, plan comparison, and enrollment.
High-quality health insurance portals that are the centralized location for their health insurance experience.
BEHAVIORS
Spends minimal time learning about the health insurance enrollment process and how to select an adequate plan.
Leans on trusted adults, acquaintances, or informal resources for information regarding health insurance.
Selects the cheapest, base plan without fully understanding what they are selecting or how it affects their lives.
JOBS TO BE DONE
When young adults are enrolling in employer-based health insurance for the first time, they want to identify and fully understand the plan that works best for their personal life and needs, so they can feel confident in their coverage without needing to navigate confusing material and terminology.
People only learn the aspects of insurance that bill them.
Understanding of deductibles scored highest on the survey at 3.82 of 5 while telling plan types apart scored lowest at 2.71. More time spent and more sources consulted made no measurable difference to either.
Self-reported insurance literacy · average 1–5
Understand deductibles & out-of-pocket maximum
3.82
Confident in plan selection
3.63
Understand copays vs. coinsurance
3.48
Estimate annual health care costs
3.04
Understand HMO / PPO / HDHP differences
2.71
Empathy map
THINK & FEEL
Healthy young adults who don’t need expensive, complex plans.
Companies provide resources that don’t meet first-time enrollees’ needs.
Unconfident in plan selection that meets their needs and budget.
HEAR
Family members’, friends’, and coworkers’ personal advice.
Company materials that overwhelm and confuse.
Base-level understanding of plans without seeing application to their lives.
SEE
Complex, unclear insurance portals.
Resources providing surface-level understanding.
Online sources replacing company materials.
SAY & DO
Prioritize plans on out-of-pocket costs and deductibles.
Trust those with similar experience, not expertise.
Turn to informal resources when company materials fail.
PAIN
Frustration with materials that don’t bridge knowledge gaps.
Portals that are difficult to navigate.
Persistent uncertainty even after enrollment.
GAIN
Reassurance that their plan fits their life and needs.
Plain-language plan comparisons.
Confidence in coverage for their financial situation.
Cost is the lens, but the total is invisible.
Out-of-pocket costs, deductibles, and premiums are the top three selection factors, yet 62% can’t confidently estimate their own annual costs. People anchor on the fixed numbers because they can’t calculate the annual cost.
Decision factors · % of respondents who selected
Out-of-pocket costs
63%
Deductible amounts
60%
Premium cost
47%
Prescription coverage
35%
Employer contribution
30%
In-network doctors
26%
Plan type
23%
Time spent researching · % of respondents
Less than 1 hour
30%
1–6 hours
59%
7–12 hours
4%
13–24 hours
2%
More than 24 hours
8%
The tools meant to help fail at the highest-stakes moment.
Asked to price a foot MRI with their own insurance, 6 of 14 abandoned insurance entirely and only about 3 got an estimate they trusted. The rest errored out, guessed, or switched to an AI chatbot.
Where young adults go for information · % of respondents
Internet search
59%
Company HR
54%
Parents / guardians
47%
Peers
32%
AI
26%
Social media
7%
OPPORTUNITY
There’s an opportunity to move young adults from compliance to comprehension. Today’s materials, sources, and tools treat the problem as one of information volume, when it’s really one of translation and timing.
A solution that explains plans in terms of real consequences, gives people a trustworthy estimate of what they’ll actually spend, and shows up at the two moments they reach for help — choosing a plan and decoding a charge — would close the literacy gap current resources leave open.
HOW MIGHT WE
Translate abstract insurance concepts, plan types above all, into concrete decision-time consequences instead of producing more or longer materials?
Use the credibility employers already have to deliver a plain-language decision aid rather than a benefits PDF?
Give young adults a realistic total-cost estimate for their likely usage, so the choice isn’t anchored entirely on premium and deductible?
Make a confident plan choice possible in under an hour, instead of asking people to spend more time?
Treat post-enrollment support, plain-language EOBs and deductible tracking, as core design scope rather than a separate problem?
Build a cost-estimation tool that works on the first try, with insurance prefilled and deductible status built into the result?
DESIGN EXPLORATION
Plain-language plan translator
A decision-time layer that reframes plan types and coverage as lived consequences, such as “with this plan, seeing a specialist works like…”, rather than definitions. Targets the single best-supported literacy gap.
Personalized cost estimator
A tool that takes a young adult’s likely usage and returns a realistic annual cost, with insurance prefilled and deductible status folded into the result. One solution answers both cost opportunities: a real total and a tool that works on the first try.
Employer-delivered decision aid
A guided, plain-language alternative to the benefits packet, delivered through the channel young adults already trust and start with, and built to make a confident choice possible in under an hour rather than asking for more effort.
Post-enrollment support layer
Plain-language explanation of benefits, deductible tracking, and provider search built into the portal, designed for the two moments people actually log in: finding care and decoding a charge.