There is a growing need for understanding and addressing the issue of healthcare cost literacy (HCL) in the United States. We conducted a survey in partnership with YouGov targeting a representative sample of 1500 American adults (median age 47, 51.4% female, 62.8% white) to help develop a novel tool to assess the prevalence of HCL, and to estimate levels of HCL and health literacy across various sociodemographic and health-related variables. An exploratory factor analysis revealed that the HCL questions mapped to three factors: 1) knowledge on health insurance terminology/interpretation, 2) ability to estimate healthcare costs ahead of time, and 3) confidence in performing cost comparisons between healthcare plans and deductibles. An understanding of Americans' levels of HCL will help policymakers and various stakeholders in the healthcare system to develop targeted plans to educate consumers on financial planning and evaluation in the healthcare system.

The authors have declared no competing interest.

This study did not receive any external funding.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was determined exempt from IRB oversight by the Advarra IRB. Authors were provided access to de-identified survey responses by YouGov, who was responsible for collecting, storing and managing the survey responses. YouGov works with the Western IRB to ensure its research protocol and specific studies are consistent with Good Clinical Practices as defined under the U.S. Food and Drug Administration (FDA) regulations and the International Conference on Harmonisation (ICH) guidelines.

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All data produced in the present work are contained in the manuscript.