They know less than they think they know. That’s the finding of a recent study that evaluated people’s confidence about choosing and using health insurance compared with their actual knowledge and skills.

As people shop for health coverage this fall, the gap between perception and reality could lead them to choose plans that don’t meet their needs, the researchers suggest.

“There’s a concern that people who don’t have much experience with health insurance don’t protect themselves financially, and then something happens,” says Kathryn Paez, a principal researcher at the American Institutes for Research who co-authored the study. “So they’re learning through hard knocks.”

The nationally representative survey of 828 people aged 22 to 64 is part of a project to develop a standardized questionnaire that researchers, health plans and providers can use to assess people’s health insurance literacy.

The study found, for example, that while three-quarters of Americans say they’re confident they know how to use health insurance, only 20 percent could correctly calculate how much they would owe for a routine physician visit. Many people don’t understand commonly used terms such as “out-of-pocket costs,” “HMO” and “PPO,” according to the study.

The study also found that certain groups of people tended to have a tougher time using health insurance, including young people, minorities, those with lower income or educational levels and those who used health care services infrequently.

People who visit the doctor occasionally but have never been hospitalized or visited the emergency room may be overconfident they understand how health insurance works, says Paez. Likewise, people who belong to integrated health care systems where providers are generally on staff may not realize the potential complications of in-network and out-of-network coverage, among other things, she says.

More comprehensive education could help close the gap between what people think they know about health insurance and what they actually know. In the meantime, the issue brief about the study includes a consumer checklist to aid consumers in choosing a plan.

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