Underinsured – A Stealthy Problem

There is a small subsection of research that looks at the problem of the underinsured. Underinsurance is when a person has insurance, but the quality or extensiveness of the inusrance leaves them vulnerable to dramatic health care costs and limited access to care. Simply put, it is inadequate insurance coverage, and the estimated number is 16 million.  Underinsurance as a problem is rarely mentioned in health care debates and when it is it is a footnote.  It may not be of the importance of the bigger uninsurerd problem, but it is a stealthy problem nonetheless.

This subsection of research is hampered by the difficulty of defining what exactly makes a person qualify as being underinsured. In the research article that seems to be most often quoted (where 16 million comes from) the definition goes like this: “an underinsured person is one who has insurance all year but has inadequate financial protection, as indicated by one of three conditions: 1) annual out-of-pocket medical expenses amount to 10 percent or more of income; 2) among low-income adults (incomes under 200 percent of the federal poverty level), out-of-pocket medical expenses amount to 5 percent or more of income; or 3) health plan deductibles equal or exceed 5 percent of income.”

You can agree or disagree with that criteria, but the number of people who meet this requirement in 2003 was estimated to be about 16 million American adults between the ages of 19-64. This number does not include those who have Medicare and fall into one of the biggest areas of underinsurance – lack of long-term care coverage (for another post).

Besides financial concerns the underinsured face many of the same access and quality of health care issues that the uninsured face (54% of the underinsured go without needed care in a year – that is double the rate of the fully insured).

For those who like to put these issues into real-life personal stories check out Saturday’s New York Times. Bob Herbert tells a story of someone who was underinsured.

Or if you like the numbers and want to see them for yourself check out these two links. The Commonwealth Fund has a brief on the issue and the article is out of Health Affairs (unfortunately, you have to pay for it).

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2 responses to “Underinsured – A Stealthy Problem

  1. I’d be interested to crunch some numbers and see if we fall into one of these categories. I certainly feel like, with our required student insurance covering only half of the well-baby visits pediatricians recommend, we should count as being underinsured no matter what the numbers…

  2. JTB,

    It sounds like your doctor and insurer definitely need to get on the same page. I don’t know what the best practice is for well-baby visits, but your doctor and insurance seem to have different ideas of what is considered best practice. More is not always best. To know if you are technically underinsured you would have to look at the size of your deductible, co-insurance (if any), premiums, whether there are caps placed on your coverage, and other medical out of pocket expenses. Then compare that to your household income. Either way I know it is frustrating to have medical care that you think is covered and later find out that it is not.

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