Forget the election: Americans have another important decision making event coming up that’s far more important—selecting their 2013 health benefits.

A survey from Aetna finds that Americans rank choosing health care benefits as the second most difficult major life decision behind saving for retirement.

Survey participants reported that choosing health care benefits is more difficult than purchasing a car, making decisions about medical tests or treatments, parenting, and selecting homeowners, renters or auto insurance. Consumers who found health care benefits decisions difficult cited these reasons: the available information is confusing and complicated (88 percent), there is conflicting information (84 percent) and it is difficult to know which plan is right for them (83 percent).

Mark T. Bertolini, Aetna’s chairman, CEO and president, says that though consumers understand the importance of health benefits, they don’t feel they have the resources they need to make an educated decision.

“We need to make the process of choosing and using health benefits easier for consumers,” Bertolini says. “The survey results will help us continue to develop and enhance tools, programs and products to drive consumer engagement and empower people to live healthier lives.”

The survey finds that consumers often don’t do a good job of monitoring their own health—or their health care dollars.

Four in ten Americans (41 percent) have skipped a dose of prescription medication, stopped taking their medication or delayed a needed medical procedure. Consumers in fair or poor health (76 percent) and with chronic conditions (57 percent) are the most likely to skip, stop or delay prescription medication or a recommended medical procedure.

And while reducing health care costs continues to be a major political and social issue, many consumers don’t monitor their own costs closely. Four in 10 consumers (43 percent) rarely or never track how much they spend on out-of-pocket health care costs.

The survey finds consumers also remain in the dark about health reform.

More than three-quarters of consumers believe that all of the key elements of reform are important for their families or them. However, 41 percent of respondents said they need more information on health care reform to understand its impact.