BACKGROUND:
Although the Vaccines for Children Program provides free vaccines to uninsured children in the United States, insured children may face insurance-related barriers to vaccination, including deductibles, co-payments, and co-insurance, as well as availability of care. Because a tremendous number of health plans exist, an objective assessment of vaccine coverage benefits that accounts for these components would be useful.

OBJECTIVE:
We ranked health insurance plans based on out-of-pocket expenditures for immunization and well-child care, given monthly insurance premiums.

METHOD:
We obtained benefit plan data from 1337 (87%) of 1537 plans registered in Georgia between 2001—2003. Plans were ranked according to out-of-pocket expenses (including co-insurance and co-payment) for immunization and well-child coverage, given monthly plan premiums for a family of four. Out-of-pocket expenses included total patient payments, copayments and coinsurance, for vaccine and its administration and office visits.

RESULT:
Plans varied from full insurance coverage for vaccinations and well-child visits (i.e., zero co-insurance and zero co-payment) to a 90% co-insurance rate. Out-of-pocket expenses for all vaccinations from birth to 18 years ranged from $0 to $760. About 14% of plans had zero out-of-pocket expenses, while the 25th, 50th, and 75th cost percentiles were $70, $170, and $275, respectively, representing about $10, $24, and $40 per visit for each of seven visits needed to comply with the recommended immunization schedule. Median plan premium was $650 per month (range $150 – $6,000). Plan premiums, particularly among HMO and POS plans, exhibited a marked, step-like downward trend as out-of-pocket expenses increased (r=-0.21, pvalue=0.00).

CONCLUSION:
Plan designs were clearly skewed, towards low out-of-pocket expense for immunizations, which should support family compliance with the recommended immunization schedule for minors. Further research may help indicate whether this is the result of a priority placed by insurers and/or families on immunization delivery.

LEARNING OBJECTIVES: