Health insurance literacy (HIL) contributes to the lack of understanding basic health insurance (HI) terms, subsidies eligibility, health plan selection, and HI usage. The study is one of few to address the existing gap in the literature regarding the exploration of the relationship between HIL, individuals' HI enrollment, and individuals' satisfaction with their HI. The theoretical framework selected for this study was the prospect theory, which describes the behavior of individuals who make decisions. In this cross-sectional correlational study, secondary data set from the third Quarter 2015 Health Reform Monitoring Survey was used. Binary logistic regression models were used to test hypotheses of four predictive relationships between (a) HI enrollment and HIL with HI terms; (b) marketplace enrollment and HIL with HI terms; (c) satisfaction with HI and HIL with HI access to care; and (d) satisfaction with HI and HIL with HI cost of care. Results indicated that participants with high HIL with HI terms had 4.2 times higher odds that those with low HIL to be enrolled in HI and 81% higher odds than those with low HIL to be enrolled in marketplace HI. The most significant relationship indicated that participants with high HIL with HI activities had 12.8 times higher odds than those with low HIL to have high satisfaction with access to care and 8.8 times higher odds than those with low HIL participants to have high satisfaction with cost of care. The finding that low HIL is associated with lower enrollment and lower satisfaction with HI has implications for social change. Policymakers may have the opportunity to utilize this study to promote policies that promote higher HIL, which may lead to increased HI enrollment and improved satisfaction with HI selection.