National Indicators > Impact on Families

Out-of-Pocket Expenditures

Families are often required to pay out of their pockets for health care services not fully covered by their insurance plans. These services may include therapies, home health care, prescription drugs, mental health care, medical equipment, and dental services. Families of over half of CSHCN reported spending $250 or more on health care in the previous year for the care of their CSHCN. The families of 13 percent of CSHCN spent between $501 and $1,000, and the families of 20 percent of children spent more than $1,000.

Children in low-income families are less likely to have high levels of expenditures than are children from families with higher incomes: the families of only 6.2 percent of children in poverty paid more than $1,000 out of pocket for their children’s care, compared to the families of 29 percent of CSHCN with incomes of 400 percent of poverty level or more. This could be because children in low-income families are more likely to be covered by Medicaid and Children’s Health Insurance Program (CHIP), which limit the copays charged to families. In addition, these data only include the expenses that families actually paid; low-income families may be more likely to have unpaid bills that are not reported here. Alternatively, low-income families may be more likely to delay or forgo care if they feel they cannot afford the out-of-pocket costs.

The families of non-Hispanic White children are the most likely to pay more than $1,000 in health care expenses; 24 percent did so, compared to the families of 15 percent of Hispanic children and 8 percent of non-Hispanic Black children. Non-Hispanic White children are also the least likely to have families that pay less than $250 per year. This may be related to the insurance status of non-Hispanic White children.

The level of out-of-pocket costs borne by families of CSHCN also varies by their children’s insurance status. Thirty-two percent of uninsured children’s families pay more than $1,000 annually, compared to 27 percent of those with only private coverage and 5 percent of those with only public insurance. Similarly, 77 percent of children with only public coverage live in families that pay less than $250 per year out of pocket for their child’s health care, compared to 25 percent of those with only private insurance and 30 percent of uninsured children. This may be due to the limits on copayments within public insurance programs, because publicly-insured and uninsured families are not able to pay bills they receive, or because these families do not seek care if they cannot pay the required copayments.

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