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Most Americans still focus solely on the most basic costs of their health insurance  — monthly premium and co-pays. But those who participate in a plan that requires them to engage in the management of plan costs are much savvier about the true cost of health coverage.

A study by Alegeus, based upon input from 5,000 adults, reports a disturbing lack of interest on the part of most plan participants in the details of coverage.

“Only 50 percent of consumers profess to want to play an active role in their health care,” Alegeus says. ”Less than half regularly do things like researching treatment options, quality ratings and success rates, seeking second opinions, consulting with peers, or comparing costs. A third never do any of those things.”

But when information was gathered from those in a consumer-driven plan, engagement and cost knowledge increased sharply.

“Consumer directed health care participants — those enrolled in high deductible health plans and account-based programs (such as HSAs, FSAs and HRAs) — scored universally higher than those enrolled in traditional health care plans in virtually all aspects of engagement — including being nearly 50 reported more likely to research and compare costs for health care purchases. They are also a third more likely to engage with their benefit service providers, considerably more fluent with health care coverage and medical billing, and twice as likely to participate in organized wellness activities,” Alegeus reported.

Part of the problem may lie in the degree of interaction plan participants have with plan administrators, Alegeus said.

“When asked about their interactions with health insurance carriers, benefit administrators and health care providers, less than a third of consumers have interacted in meaningful ways — such as visiting online portals, calling customer service lines, subscribing to updates, downloading mobile applications — and 43 percent have done none of these things.”

The survey revealed that nearly half of respondents said they didn’t know what their plan coverage, nor did they have any idea what their health care costs for the year would be. But two-thirds said they feared they may not be paying the right amount for service when they pay a bill, and more than half said they only learn the cost of a service when they pay for it. Only 32 percent said they compare prices on medical services.

“The health care industry is shifting towards individual responsibility for health care costs. Consumers will require substantial support to manage their ever-growing financial responsibilities — as they learn how to become savvy healthcare consumers,” said Steve Auerbach, Alegeus CEO. “These survey results highlight the fact that the industry still has a long way to go, but offers hope that account-based consumer directed health care programs — coupled with smart consumer engagement strategies – have great potential to positively influence consumer behavior, increase accountability, and drive more responsible health care consumption.”