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Jonathan and Nikia Reynolds are still deciding on a new health plan for 2018, weighing the pros and cons of a high-deductible insurance plan to try to keep their monthly premium lower.
"How it's supposed to work, I kind of get all that stuff. ... In practice, it's usually less clear," said Jonathan, a 34-year old Atlanta-based freelance video photographer.
At least, that's how he felt after a late-night trip to the emergency room a couple of years ago resulted in months of confusing bills in the mail.
"I would get bills way after the fact, and it was never clear exactly what the bills were from, and how they related to what the insurance covered," he said.
As the first generation to come of age under Obamacare, millennials are finding the new rules of consumer-driven health care tough to navigate.
More than half of millennials, 57 percent, say they have little to no understanding of how out-of pocket health costs such as co-pays, deductibles and co-insurance work, according to a new report from consumer credit firm TransUnion. By contrast, about 40 percent of baby boomers admit to limited knowledge about their benefits.
"Millennials came into the health-care market at a really volatile time, when cost-shifting was really happening … [and] deductibles have quadrupled," said Jonathan Wiik, principal at TransUnion's health-care unit.
For hospitals and other health providers, millennial patients — born from 1980 to 1994 — are proving to be a challenge when it comes to collecting payment for bills.
Nearly 3 in 4 millennials, 74 percent, failed to pay their medical expenses in full when first billed in 2016; that's up from 64 percent in 2014, TransUnion's survey said.
The vast majority cited limited savings for not paying, but nearly half of those surveyed say they'd be more apt to pay if they could get a cost estimate up front.
"They don't pay their bills on time because they don't understand them. That's pretty typical of that generation — they're not going to pay until somebody explains it to them," said Wiik, who consults with hospitals on bill collection.
He says hospitals are starting to change the way they have traditionally billed, by trying to prepare patients for what their out of pocket costs will be ahead of treatment, and working out flexible payment plans to allow patients to pay over time.
But the hospitals have a long way to go.
"I don't think any millennial pays their bills on paper," Wiik said. "That's how hospitals are billing right now. … It's a big gap that the industry's going to have to help fill."
Jonathan Reynolds is hoping not to see any hospital bills in the mail any time soon.
"I know health care is complicated," he said, but it's high time for real "simplification of how deductibles and co-pays are explained, and just the process of billing itself."