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Health insurance literacy (HIL) may be briefly defined as the ability to comprehend insurance plans and make informed decisions. Low HIL is associated with delays in receiving care, larger medical debt, and reduced use of preventive services. Fourth year medical students (MS4) are the future attendings, department heads, and hospital administrators. Low HIL may limit their ability to make cost-effective decisions for, and with, their patients. The Health Insurance Literacy Measure (HILM) and Kaiser Family Foundation (KFF) Health Insurance Quiz were distributed to MS4s across the US. The HILM is a 21-question measure evaluating behavior and confidence with choosing or using health insurance plans. The KFF is a 10-question measure assessing knowledge of terms, health insurance use, and ability to calculate costs. Data was analyzed via SPSS 28. 81 MS4s responded to the survey. HILM questions are scored on a Likert scale, where 3.40 indicates adequate HIL. HIL scores ranged from 1.0 to 4.0 with a mean of 2.57. Scores on the behavior sections averaged 3.05 (Choosing-Insurance) and 2.96 (Using-Insurance). MS4s consistently scored lower on the confidence sections, the average score was 2.16 for Choosing-Insurance and 2.11 for Using-Insurance. 45 MS4s scored at least a 9/10 on the KFF quiz, but only 23 (28.4%) could correctly calculate out-of-pocket costs. MS4s have a poor understanding of health insurance, its relationship to healthcare delivery and this may impede their ability to counsel and care for their patients. Medical schools should address this knowledge gap by implementing health insurance concepts into the curriculum.