Child lying in bed asleepShare on Pinterest
Experts say children whose families have private health coverage plans are more likely to be underinsured. Ольга Симонова/Getty Images
  • A new study reports that one-third of U.S. children do not have adequate health insurance.
  • Researchers say children whose family have private insurance are more likely to be underinsured.
  • They say families with private insurance sometimes face co-payments and other costs that might discourage them from going to the doctor for preventive healthcare.
  • Experts say families can help lower their medical costs by establishing health savings accounts, using telemedicine, and using mail-order prescription plans.

You might think that children with private health insurance are better off than those with public health insurance, such as Medicaid.

However, it appears the opposite may be true.

Children with private health insurance are three times more likely to be underinsured than those on public plans, according to research published today, Dec. 6, by the American Academy of Pediatrics.

Researchers arrived at this conclusion by analyzing data from the 2016–2019 National Survey of Children’s Health.

They reported that about two-thirds of children in the United States had adequate health insurance. That leaves one-third — about 23 million children — underinsured.

The numbers increased by 11 percent, or more than 2 million children, between 2016 and 2019.

Researchers said “underinsured” means that although a child has health insurance, it doesn’t adequately provide for their healthcare needs.

They may not have access to quality health professionals. In addition, some policies have high deductibles, co-payments, and annual out-of-pocket costs, causing their families to avoid or limit trips to the doctor or forego medical tests, care, or prescriptions.

Why is this happening?

“This is a relatively new problem,” according to Michael Botta, PhD, a former advisor to the White House Office of Management and Budget on healthcare, and the co-founder of Sesame, a direct-to-patient healthcare company.

He said with healthcare premiums rising, employers who provide health insurance are looking to lower their costs. They sometimes do that by offering plans with higher deductibles and out-of-pocket limits. The employee might also be responsible for paying for coverage of partners and children.

“Previously, if a child was commercially insured, they were thought to be ‘home free.’ But what it means to be insured has changed. Premiums and deductibles continue to increase, and it wouldn’t be unheard of for a family to have a $17,000 out-of-pocket limit. This is unaffordable for most families,” Botta told Healthline.

While routine care may be more affordable, specialized care may not be.

The Vaccines for Children Program provides all recommended vaccines for children under age 19 who qualify for Medicaid, do not have health insurance, cannot afford out-of-pocket insurance costs, or are Native American or Alaskan natives.

In addition, most insurance plans cover recommended vaccines at no charge. Public insurance plans almost always cover recommended vaccines.

“For families who purchase their health insurance on the health marketplace exchanges, subsidies can help with premiums, but they don’t lower deductibles,” explained Botta.

Families who are not eligible for subsidies might choose a plan with a high deductible and high out-of-pocket limit because the premiums are more affordable.

Botta suggests considering a high deductible plan and paying some expenses out of pocket, which has the potential to save you money.

“Doctors and healthcare facilities are often willing to negotiate a better price if you are paying cash,” he said. “By doing this, you could pay less than you would if you used your insurance. Shop around for doctors by requesting their rate cards and comparing costs.”

Other ways for families to save money include:

  • Do preventive care. Make sure to go to “well visits” or annual checkups, and get your vaccines, which reduces your chances of getting ill and needing specialized care.
  • Talk to your employer about setting up a health savings account (HSA) or a flexible spending account (FSA). These programs allow you to set aside pre-tax money for medical expenses. If your employer isn’t willing, go to your bank to find out about setting one up on your own.

“Families with private and employer-based insurance should try to choose a hospital with funding-gap programs,” says Gail Trauco, RN, BSN-OCN, a patient rights advocate based in Atlanta.

These programs provide money to cover the amount not covered by insurance.

“The Children’s Miracle Network has 170 hospitals nationwide. Children receiving treatment and care at one of these hospitals can apply to the programs. For children with cancer, St. Jude Children’s Hospital provides treatment, travel, housing, and food for patients and their families,” Trauco told Healthline.

She also noted that prescription services might lower the price you pay for your medicine. Mail-order prescriptions may reduce your costs even more.

“Most major pharmaceutical companies have patient assistance programs. Links to information on these programs, including eligibility and the application process, are on their websites,” said Trauco.

Telemedicine, which became mainstream during the COVID-19 pandemic, can reduce travel costs and the time parents must take off work, she added. The fee for the doctor’s visit for telemedicine might be lower as well.

“Co-pays add up quickly, and out-of-pocket costs may financially cripple a family,” Trauco said. “Organize, strategize, advocate. Know your policy limits. Prepare an action plan. Resources are available and families must ask for and take advantage of them. Use your voice.”