Healthcare cost literacy in the united states: Cross-sectional estimates from a representative national sample.

Authors

Alexandra Guttentag, Smrithi Sukumar, Jeroen van Meijgaard, Khurram Nasir, Harlan Krumholz, Haider J Warraich

Published in

PloS one. Volume 21. Issue 8. Pages e0354341. Epub Aug 19, 2026.

Abstract

As healthcare costs and patient cost-sharing continue to rise in the United States, little is known about patients' understanding of healthcare pricing, insurance-related expenses, and cost-planning strategies.
To assess healthcare cost literacy (HCL) among U.S. adults and identify domains in which patients report the greatest and least confidence in understanding healthcare costs.
A total of 2,308 American adults were surveyed. A cross-sectional design was utilized, incorporating a 12-item survey that examined key dimensions of healthcare cost literacy (HCL), such as healthcare cost knowledge, health insurance cost knowledge, and proactive cost planning behaviors.
Participants reported knowing most about pharmacy-level price differences for prescription drugs (77%) and how to contest a hospital bill (56%); they reported knowing least about hospital chargemasters (33%). When asked to describe various healthcare terms, participants found it easiest to describe "deductible" (mean 2.85 [SD 0.83]) and hardest to describe "health insurance formulary" (mean 2.10 [SD 0.96]). Regarding preemptive cost planning, participants had the most difficulty with knowing the cost of an emergency room visit ahead of time (mean 2.19 [SD 0.98]) and found it easiest to know the out-of-pocket cost of a prescription drug ahead of time (mean 2.60 [SD 0.87]). Participants with high-HCL, defined as those with>median HCL score of 2.42, were more likely to be older, have greater health literacy, and be more confident in managing their healthcare (all p < .001). They were more likely to have visited a doctor in the last year and were more knowledgeable about cancer screening guidelines (both p < 0.001).
Levels of HCL are varied among the adult population, with wide knowledge gaps in understanding hospital bills and insurance-related costs. Efforts to bolster levels of HCL may help patients' ability to anticipate, manage, and navigate healthcare expenses.

PMID:
42616702
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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