Under-Insurance Survey: Preliminary Results

By Laura Remson Mitchell

This was a survey, not a formal scientific study with a statistically valid random sample. However, because it was first offered to subscribers to my disability and health-care e-mail lists, it tapped into a population that is more likely than the average to have had experience in the area on which I was seeking information. I believe that makes the results of this survey of particular interest and justifies additional research to examine some of the issues revealed here.

This page is just a preliminary report on the statistical results. I am still examining the many comments that were submitted in association with this survey, which also may provide valuable insight into what I believe is a growing problem that relatively few have acknowledged.

The survey was conducted between approximately May 23 and July 5, 2002. It was offered by e-mail, online via Zoomerang, and online from my own web site.

A total of 32 people responded, 30 of whom (93.75%) reported having health coverage of some kind. Following is a closer look at these responses.

COVERAGE SOURCES: Number (% of those with coverage)

(Numbers don't total 100% because some respondents had multiple coverage sources.)

Job: 11 (37%)
Individual/private: 3 (10%)
Medicare: 16 (53.3%)

[Note: 10 of Medicare recipients also have Medicaid.]

Medicaid: 12 (40%)

[Note: 10 of Medicaid recipients also have Medicare.]

TYPE OF COVERAGE: Number (% of those with coverage)

Traditional (fee-for-service): 10 (33.3%) [2 also have HMO coverage and are on both Medicare and Medicaid]
PPO: 5 (16.7%)
HMO: 12 (40%)

GAPS (OVERALL TOTALS)

Number insured=30
Number with coverage gaps=22 (73.3% of those covered)]

Prescription drugs: 15 (50.00%) of those with coverage; 68.2% of 22 with coverage gaps)
DME: 13 (43.3% of those with coverage; 59.1% of those with coverage gaps)
Rehab: 9 (30% of those with coverage; 40.9% of those with coverage gaps)
Orthotics/prosthetics: 9 (30% of those with coverage; 40.9% of those with coverage gaps)
Mental health: 6 (20% of those with coverage; 27.3% of those with coverage gaps)
Specialty care: 10 (33% of those with coverage; 45.5% of those with coverage gaps)
Other: 11 (36.7% of those with coverage; 50% of those with coverage gaps) Other gaps mentioned include hearing aids, dental care, chiropractic.

GAPS BY COVERAGE SOURCE

     1.   Private (job and/or individual) [Private total=14; 11 job-based, 3 individual]
               a.   Prescription drugs: 6/14 (42.9%)
               b.   Durable Medical Equipment: 5/14 (35.7%)
               c.   Rehabilitation: 6/14 (42.9%)
               d.   Orthotics/prosthetics: 4/14 (28.6%)
               e.   Mental Health: 3/14 (21.4%)
               f.   Specialty care: 3/14 (21.4%)
               g.   Other: 5/14 (35.7%)
               h.   NOTE: Those with individual coverage are more likely to have gaps than those with job-based coverage.

     2.   All Medicare [Medicare Total=16]
               a.   Prescription drugs: 7/16 (43.8%)
               b.   Durable Medical Equipment: 6/16 (37.5%)
               c.   Rehabilitation: 2/16 (12.5%)
               d.   Orthotics/prosthetics: 5/16 (31.25%)
               e.   Mental Health: 3/16 (18.75%)
               f.   Specialty care: 5/16 (31.25%)
               g.   Other: 4/16 (25%)

     3.   All Medicaid: [Medicaid total=12]
               a.   Prescription drugs: 5/12 (41.7%)
               b.   Durable Medical Equipment: 6/12 (50%)
               c.   Rehabilitation: 2/12 (16.67%)
               d.   Orthotics/prosthetics: 3/12 (25%)
               e.   Mental Health: 2/12 (16.67%)
               f.   Specialty care: 4/12 (33.33%)
               g.   Other: 4/12 (33.33%

    4.   Medicare and Medicaid (Total of those with both Medicare and
Medicaid = 10.)
               a.   Prescription drugs: 3/10 (30%)
               b.   Durable Medical Equipment: 4/10 (40%)
               c.   Rehabilitation: 1/10 (10%)
               d.   Orthotics/prosthetics: 3/10 (30%)
               e.   Mental Health: 2/10 (20.00%)
               f.   Specialty care: 3/10 (30.00%)
               g.   Other: 3/10 (30.00%

5. Medicare, Medicaid and Private Coverage (two with job-based coverage, one with individual coverage in addition to Medicare and Medicaid): In all categories of health coverage gaps, one person who had Medicare, Medicaid and individual
coverage reported a gap in coverage. No such gaps were reported by those with
Medicare, Medicaid and job-based coverage.

GAPS BY COVERAGE TYPE

     1.   Traditional ( fee-for-service ) [Total with traditional coverage=10]
               a.   Prescription drugs: 3/10 (30%)
               b.   Durable Medical Equipment: 5/10 (50%)
               c.   Rehabilitation: 1/10 (10%)
               d.   Orthotics/prosthetics: 1/10 (10%)
               e.   Mental Health: 1/10 (10%)
               f.   Specialty care: 2/10 (20%)
               g.   Other: 3/10 (30%)
     2.   Preferred Provider Organization (PPO) [Total with PPO coverage=5]
               a.   Prescription drugs: 2/5 (40%)
               b.   Durable Medical Equipment: 1/5 (20%)
               c.   Rehabilitation: 2/5 (40%)
               d.   Orthotics/prosthetics: 1/10 (10%)
               e.   Mental Health: 2/5 (40%)
               f.   Specialty care: 1/5 (20%)
               g.   Other: 2/5 (40%)
     3.   HMO [Total with HMO coverage=12]
               a.   Prescription drugs: 7/12 (58.3%)
               b.   Durable Medical Equipment: 4/12 (33.3%)
               c.   Rehabilitation: 4/12 (33.3%)
               d.   Orthotics/prosthetics: 1/12 (8.3%)
               e.   Mental Health: 3/12 (25.0%)
               f.   Specialty care: 1/5 (20%)
               g.   Other: 5/12 (41.7%)

GAPS BY COVERAGE SOURCE (comparison)

GAPS FOR THOSE WITH JOB-BASED HEALTH COVERAGE ONLY
(11 respondents)
     1.   Prescription drugs: 4 (36%)
     2.   DME: 3 (27%)
     3.   Rehabilitation: 4 (36%)
     4.   Orthotics/prosthetics: 2 (18%)
     5.   Mental Health: 2 (18%)
     6.   Specialty care: 2 (18%)
     7.   Other: 4 (36%)

GAPS BY MIXED SOURCE

The following, broken down by coverage sources, shows the number (percentage) of
respondents to my survey who indicated that they had coverage gaps in the specified
benefit areas. Paragraphs with headings in large, boldface italic type include job-
based coverage among the coverage sources. Note that in each case where job-based
coverage is combined with public coverage (i.e., Medicare and/or Medicaid), the
number of reported coverage gaps in all areas falls to 0.

     1.   Medicare + Job (2)
               a.   Prescription drugs: 0
               b.   DME: 0
               c.   Rehabilitation: 0
               d.   Orthotics/prosthetics: 0
               e.   Mental Health: 0
               f.   Specialty care: 0
               g.   Other: 0
     2.   Medicare + Individual (1)
               a.   Prescription drugs: 1 (100%)
               b.   DME: 1 (100%)
               c.   Rehabilitation: 1 (100%)
               d.   Orthotics/prosthetics: 1 (100%)
               e.   Mental Health: 1 (100%)
               f.   Specialty care: 1 (100%)
               g.   Other: 1 (100%)
     3.   Medicare only (6)
               a.   Prescription drugs: 4 (67%)
               b.   DME: 2 (33%)
               c.   Rehabilitation: 1 (17%)
               d.   Orthotics/prosthetics: 2 (33%)
               e.   Mental Health: 1 (17%)
               f.   Specialty care: 2 (33%)
               g.   Other: 1 (17%)
     4.   Medicaid +Job (2)
               a.   Prescription drugs: 0
               b.   DME: 0
               c.   Rehabilitation: 0
               d.   Orthotics/prosthetics: 0
               e.   Mental Health: 0
               f.   Specialty care: 0
               g.   Other: 0
     5.   Medicaid + Individual (1)
               a.   Prescription drugs: 1 (100%)
               b.   DME: 1 (100%)
               c.   Rehabilitation: 1 (100%)
               d.   Orthotics/prosthetics: 1 (100%)
               e.   Mental Health: 1 (100%)
               f.   Specialty care: 1 (100%)
               g.   Other: 1 (100%)
     6.   Medicaid Only (2)
               a.   Prescription drugs: 2 (100%)
               b.   DME: 2 (100%)
               c.   Rehabilitation: 1 (50%)
               d.   Orthotics/prosthetics: 0
               e.   Mental Health: 0
               f.   Specialty care: 1 (50%)
               g.   Other: 1 (50%)
     7.   Medicare+Medicaid+Job (2)
               a.   Prescription drugs: 0
               b.   DME: 0
               c.   Rehabilitation: 0
               d.   Orthotics/prosthetics: 0
               e.   Mental Health: 0
               f.   Specialty care: 0
               g.   Other: 0
     8.   Medicare+Medicaid (10)
               a.   Prescription drugs: 3 (30%)
               b.   DME: 4 (40%)
               c.   Rehabilitation: 1 (10%)
               d.   Orthotics/prosthetics: 3 (30%)
               e.   Mental Health: 2 (20%)
               f.   Specialty care: 3 (30%)
               g.   Other: 3 (30%)

I will continue to review both the statistical results of this survey and the comments that were submitted. The survey certainly shows that having health insurance (whether traditional or managed care) is no guarantee of having coverage for needed health-care items and services.

This page content was last revised Aug. 3, 2002.

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