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Pie graph: Health Insurance Coverage Among Currently Insured Children with Conditions Pie graph: Health Insurance Coverage Among Currently Insured Children without Conditions Bar graph: Children Lacking Adequate Health Insurance Coverage Bar graph: Children with Conditions with Health Insurance Never or Sometimes Adequate

Adequacy of Health Insurance Coverage

Insurance coverage may not always be adequate to meet children’s needs. Parents whose children were currently insured were asked three questions regarding the services and costs associated with their child’s health insurance. Of insured children aged 2-17 years without emotional, behavioral, or developmental conditions, the parents of 18.8 percent reported that the out-of-pocket costs were never or sometimes reasonable; 7.0 percent were reported to have health insurance that never or sometimes offers benefits or covers services that meet their needs; and 4.8 percent were reported to have health insurance that never or sometimes allows them to see the health care providers they need (data not shown).

Children were considered to have adequate health insurance coverage if their parent answered “usually” or “always” to each of the three questions. Overall, 29.4 percent of children with emotional or behavioral problems lacked adequate insurance, compared to 23.8 percent of children without these conditions. Moreover, the more such conditions a child has, the lower the likelihood that his or her insurance is adequate. Among children with three or more emotional, developmental, or behavioral conditions who had insurance, 36.9 percent did not have adequate coverage.

Of the three criteria for adequacy, reasonable costs seem to present the most substantial barrier to families of children with emotional, behavioral, or developmental conditions. Of children with at least one condition, the parents of 21.1 percent reported that the out-of-pocket costs for their children’s care were never or sometimes reasonable; 12.0 percent reported that their child’s plan never or sometimes offered benefits and covered services that met their child’s needs; and 9.0 percent reported that their child’s insurance never or sometimes offered access to the providers they needed. These figures are not mutually exclusive and the parents of some children may have reported more than one of these problems with their child’s coverage.


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