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Underinsurance for Recently Recommended Vaccines in Private Health Plans

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Abstract

Underinsurance for vaccines presents financial barriers to vaccination. Preventive services coverage is of interest in national healthcare reform. To assess vaccine benefits coverage in private health plans. Private health insurance carriers were surveyed December 2008–June 2009 on policies regarding vaccine coverage in fully insured plans. Carriers were identified as multi-state, state-specific Blue Cross or local-independent carriers. Plan types included HMO, PPO, POS and ‘other.’ Full benefits coverage was defined as having benefits without a copay or coinsurance for a recommended vaccine. Analyses were conducted to examine associations between carrier type, plan type, and full benefits coverage. Fifty-one carriers (response rate = 56 %) provided data for 78 unique plans, reflecting over 47 million private plan enrollees. Full benefits coverage was highest for combined tetanus/diphtheria/acellular pertussis (74 %) and lower for pneumococcal conjugate (72 %), rotavirus (72 %), human papillomavirus (71 %), hepatitis A (68 %), meningococcal conjugate (67 %), inactivated influenza (67 %), live attenuated influenza (63 %) and zoster (57 %) vaccines. Compared with plans offered by state-specific Blue Cross carriers, significantly higher proportions of multi-state carriers and local independent carriers had plans with full benefits coverage for vaccines (p < 0.05). Compared with PPO and “other” plans, significantly higher proportions of HMO and POS plans had full benefits coverage for vaccines (p < 0.05). In this national study, levels of underinsurance for immunization leave room for improvement. State-specific Blue Cross plans and indemnity or high-deductible plans are least likely to offer full coverage for recently recommended vaccines, and may face changes with incorporation of “essential health benefits” requirements.

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Acknowledgments

This study was supported by Cooperative Agreement Number U48 DP000055 from the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Conflict of interest

The authors have no conflicts of interest to report.

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Authors and Affiliations

  1. Division of General Pediatrics, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, 300 North Ingalls Building, 6C23, Ann Arbor, MI, 48109-5456, USA

    Dianne C. Singer, Matthew M. Davis, Achamyeleh Gebremariam & Sarah J. Clark

  2. Division of General Medicine, University of Michigan, Ann Arbor, Michigan

    Matthew M. Davis

  3. Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan

    Matthew M. Davis

Authors
  1. Dianne C. Singer
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  2. Matthew M. Davis
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  3. Achamyeleh Gebremariam
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  4. Sarah J. Clark
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Corresponding author

Correspondence to Dianne C. Singer.

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Singer, D.C., Davis, M.M., Gebremariam, A. et al. Underinsurance for Recently Recommended Vaccines in Private Health Plans. J Community Health 37, 1164–1167 (2012). https://doi.org/10.1007/s10900-012-9567-7

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  • DOI: https://doi.org/10.1007/s10900-012-9567-7

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