Health Insurance Literacy Among Second-Generation Nigerian Americans

Health insurance literacy-the ability to locate, comprehend, and use information about health insurance-is a critical yet understudied dimension of health equity for second-generation Nigerian Americans. Despite health insurance's known role in reducing disparities in preventive care, this population faces unique barriers in navigating the U.S. health system. This qualitative study explores how second-generation Nigerian Americans develop health insurance literacy within familial, environmental, technological, and cultural contexts. Twenty participants aged 18 to 24 were purposively recruited from churches in Metro Atlanta. Thematic analysis of semi-structured interviews identified four major themes: (a) limited knowledge of the health insurance system, (b) confusion and complexity surrounding U.S. health insurance, (c) reliance on parental coverage and knowledge, and (d) the significant impact of health care and insurance costs on health information-seeking and care decisions. Participants reported minimal health insurance education, confusion about complex terminology and processes, and a reliance on their parents for coverage and guidance. Many also reported anxiety about the transition to independent coverage and described how high health care costs drive them to self-care or online information. These findings underscore the urgent need for culturally tailored, accessible educational interventions to build health insurance literacy and confidence among Nigerian American youth. Addressing both practical knowledge gaps and systemic barriers may improve health outcomes and reduce disparities. This study presents actionable implications for educators, health systems, and policymakers to promote health equity within immigrant communities.