The parents of CSHCN with health insurance were asked three questions about their children’s coverage:
- Does the plan allow the child to see the health care providers that he/she needs?
- Does the plan offer benefits and cover services that meet their needs?
- Are the costs not covered by the plan reasonable?
If parents answered “usually” or “always” for all three of these questions, then the child’s coverage is considered to be adequate. All others are considered to have inadequate insurance coverage.
Overall, one-third of CSHCN were reported by their parents to have inadequate insurance coverage. Nine percent of CSHCN were reported to have coverage where the child was not allowed to see needed providers, almost 13 percent were reported to have a plan where the benefits do not meet the child’s needs, and 28 percent were reported to have a plan with charges that are unreasonable. These figures are not mutually exclusive and the parents of some CSHCN may have reported more than one of these problems with their child’s coverage.
Adequacy of insurance coverage among CSHCN varies by family income. CSHCN with family incomes below 100 percent of the poverty level are most likely to be reported to have inadequate insurance coverage (36 percent), while the parents of CSHCN with family incomes of 400 percent of poverty or more are least likely to report that their children have inadequate insurance (29 percent). The perceived adequacy of insurance coverage also varies by type of insurance. Children with public insurance alone are less likely to be reported to have inadequate coverage (31 percent) than children with private insurance alone or in combination with public coverage (34 percent).
Perceived adequacy of insurance coverage among CSHCN also varies noticeably by the impact of the child’s condition. Children who are reported by parents to have a condition that never affects their abilities are the least likely to have inadequate insurance (26 percent), followed by children who are sometimes affected by their condition (36 percent). Children who are affected usually, always, or a great deal by their condition are the most likely to have inadequate insurance; 41 percent of these children are reported to have a plan that does not usually or always meet all of their needs.