U.S. Department of Health and Human Services, Health Resources and Services Administration

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Adequacy of Insurance

While most children have some type of health insurance, it may not always be adequate to meet their needs. The 2007 National Survey of Children’s Health asked parents of insured children three questions regarding the services and costs associated with their child’s health insurance. Insurance was considered adequate if parents answered that it “usually” or “always” met the following criteria: 1) out-of-pocket costs are reasonable; 2) the benefits that are included and the services that are covered meet the child’s needs; and 3) the family’s preferred providers are covered. Overall, 23.5 percent of insured children had insurance that did not meet at least one of these three criteria, and therefore were determined to have insurance that was not adequate.

The frequency with which parents reported problems with insurance adequacy differed for the three criteria. Problems with out-of-pocket costs were most commonly cited, with the parents of 18.3 percent of children reporting that out-of-pocket costs were not usually or always reasonable. The parents of 7.2 percent of children reported that insurance does not usually or always include benefits and services that meet the child’s needs, and the parents of 5.1 percent of children reported that insurance did not usually or always allow the child to see necessary providers. Older children were more likely than younger children to lack adequate coverage, with 26.3 percent of children aged 12–17 years and 25.1 percent of children aged 6–11 years lacking adequate coverage, compared to 19.2 percent of children aged 0–5 years.

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