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” to all three of these questions, then the child’s coverage is considered to be adequate. All others are considered to have inadequate insurance coverage.

Nearly two-thirds (65.7 percent) of CSHCN were reported by their parents to have adequate insurance coverage. Of the three items that make up the adequacy standard, the one most likely to be met is the providers that are included in the plan; the parents of 89.5 percent of insured CSHCN report that their insurance usually or always allows them to see the providers they need. Similarly, the parents of 86.8 percent of CSHCN report that their insurance benefits usually or always meet their child’s needs. However, the parents of only 71.3 percent report that the non-covered charges for their plan are reasonable.

Children insured exclusively through public programs were the most likely to have coverage that is reported to meet all of the criteria for adequacy. Of CSHCN with only public insurance, 69.4 percent were reported to have adequate insurance, compared to 64.3 percent of those with only private insurance and 64.1 percent of those with both public and private insurance.

Children whose conditions have a greater impact on their daily lives are less likely to have insurance that meets their needs. Of CSHCN whose daily activities are consistently affected by their conditions, 58.2 percent were reported to have adequate insurance, compared to 73.8 percent of children whose daily activities are never affected by their conditions.

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