Although the number of men with health insurance has increased, men are less likely to utilize health services than females, and experience difficulty in paying medical bills. Understanding the details of health insurance can be challenging and the lack of understanding can have financial consequences. This study, guided by Andersen's model of health-care utilization, assessed the relationship between confidence level in understanding health insurance terms and difficulty in paying medical bills among American men. Data were drawn from the Health Reform Monitoring Survey, 2015-2016. The study included 6,643 men aged between 18 and 64. Descriptive statistics examined participants' difficulty in paying medical bills by predisposing, enabling, and need characteristics, and by confidence in understanding health insurance terms. A modified Poisson regression analysis examined the association between difficulty in paying medical bills, confidence in understanding health insurance terms score, and predisposing, enabling, and need characteristics. An increase in confidence in understanding health insurance terms score was associated with significantly lower reported difficulty in paying medical bills (PR = .98; 95% CI = [.97-.99]; p = .002). Participants with a college degree or higher were less likely to report difficulty in paying their medical bills compared to participants with less than a high school degree (PR = .72; 95% CI = [.56-.92]; p = .009). A better understanding of health insurance might prevent men from experiencing difficulties in paying medical bills. Additional research should be performed to understand the relationship between the level of confidence in understanding health insurance, knowledge level of health insurance terms, use of health insurance, and their impact on difficulty in paying medical bills.
Keywords: confidence; health insurance; health insurance literacy; medical debt.