Tough choices: Children with mental health needs, private health insurance and family out-of-pocket spending

Research Objective: There is evidence that families raising children with mental health needs value low co-pay health insurance plans. This is troubling since low deductible and co-payment plans are expensive, reduce resources and thereby constrain use of services that are subject to co-payments or uncovered. This study compares simulated family ratings and expenditures for a set of plans to highlight areas of misunderstanding.

Study Design: Two samples of children were examined: those with mental health needs (n=3,222) and those with autism (n=260) in the Medical Expenditure Panel Survey 2002-2012. Plans available on state health insurance exchanges with generous and restrictive benchmark plans illustrate variation in plans. Regressions estimate the association between plan rating, plan features and service use experiences. Simulations generate ratings, plan-covered and family out-of-pocket expenses for each family-plan pair. Finally, ratings are compared to expenditures.

Principal Findings:  A generous state offers 142 plans, 36% of which are ranked high quality. A more restrictive state offers 46 plans, of which 17% are ranked high quality. Families rate plans higher when the plans do not manage care and when they have low rather than high deductibles (≥$2,400). Analyses yield distributions of family ratings and expenditures for each of the 188 plans. Low correlations between the plan-paid proportion of expenditures, plan features and plan ratings identify areas where families need better information.

Conclusions: The proposed study develops firmer evidence about family insurance choice strategies needing improvement. This work is a stepping-stone to future intervention studies focused on improving family insurance choices.