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They have health insurance but may not understand it

WASHINGTON - Nine months after Americans began signing up for health insurance under the Affordable Care Act, a challenging new phase is emerging as confused enrollees clamor for help in understanding their coverage.

WASHINGTON - Nine months after Americans began signing up for health insurance under the Affordable Care Act, a challenging new phase is emerging as confused enrollees clamor for help in understanding their coverage.

Nonprofits across the country are being swamped by consumers with questions. Many are low income, have never had insurance, and have little knowledge of the health-care system. The rampant confusion poses a potential hurdle for the success of the health law:

If many Americans don't understand health insurance, that could hurt their ability to use their benefits - or to keep their coverage altogether.

A federal program to help consumers has also run out of money.

"We are hearing this in probably every state that we work in," said Christine Barber, a senior policy analyst with Community Catalyst, a Boston-based advocacy organization that works with community groups in more than 40 states.

" 'OK, I have my card, what do I do now?' "

Health insurance, with its jargon and complicated fee structure, has long been confusing for many consumers, but experts say the literacy gap poses an especially big problem now. Before the opening of the marketplaces, people buying coverage on their own tended to be individuals with higher incomes and more familiarity with how insurance works.

At a Silver Spring, Md., health clinic, Rebecca Wener spends most of her time helping clients figure out their new plans. Julio Herrera, 63, a construction worker, bought what he thought would be the most affordable plan when he enrolled through Maryland's new insurance exchange this spring.

But he doesn't understand why he is getting charged for hospital bills when he already pays the insurance company every month. And he did not grasp this thing - a deductible - that was $4,000.

"If there is one concept that people don't understand, it's the deductible," said Wener, a specially trained enrollment worker at Community Clinic, a nonprofit. "That's been a really huge thing. And the very cheapest plans have very big deductibles."

Organizations that helped people sign up for insurance are being swamped by consumers returning for help. It's "the boomerang effect," said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.

Demand for help from consumers has been so overwhelming at the Pennsylvania Health Access Network, a statewide coalition working to expand insurance coverage, that it is launching special seminars for consumers later this summer, said Antoinette Kraus, coalition director.

Language and cultural barriers are adding to the confusion. Many clients also struggle to read and write in their native language, predominantly Spanish, making for a steeper learning curve, said Elizabeth Colvin, director of Insure Central Texas, an Austin-based nonprofit working on enrollment. The majority of the 5,647 residents the group enrolled never had insurance before, she said.

Other residents often don't understand why they have to pay monthly for a service they may not use and then have to pay more when they use it. It's also hard for them to grasp the more abstract value of having insurance if they become seriously ill or have a major accident.

Efforts are underway around the country by government agencies, universities, and consumer groups to help people understand health insurance terms, what their plans cover, and how to use them. Online health insurance exchanges also have explainers and videos, as do the websites of insurance companies. Many services are offered in multiple languages, and interpreters are available.

CareFirst BlueCross BlueShield, the dominant carrier in the Washington region, anticipated that many people seeking individual coverage would be new to or have limited experience with insurance. In addition to printed materials with simple definitions and explanations, the company has developed a "quick guide" about coverage that it will distribute to all individual members in the next two months.

Wener, of Community Clinic in Maryland, often draws charts and diagrams on her notepad to explain terms to her clients. To explain what a hypothetical $1,000 deductible means, she draws a line into two segments. Anything up to the $1,000 mark means clients have to pay in full before health insurance begins to pay.

That means a hospital charge for $500 and a doctor's bill for $100 will come out of their pocket.

"That's when their faces are usually looking at me in horror," she said.