Knowledge of health insurance coverage by adolescents and young adults attending a hospital-based clinic

Purpose: To describe adolescents’ and young adults’ knowledge about their health insurance, and to identify factors associated with correct knowledge of health insurance in this population. Methods: Data were analyzed from a confidential questionnaire administered to 830 patients at a hospital-based adolescent medicine clinic. The questionnaire contained items pertaining to insurance type, demographics, health status, and health-risk behaviors. Actual health insurance data and information regarding utilization of health services were obtained from the hospital billing database. Predictors of health insurance knowledge were determined through bivariate analyses followed by stepwise logistic regression. Results: A total of 50.7% of respondents correctly identified their type of health insurance. Those who correctly identified their insurance had a higher mean age. Only 48.5% of participants who were 11–18 years old could identify their insurance type, versus 53.1% of 19–21-year-olds and 64.7% of 22–24-year-olds ( p = 0.02). Sixty-five percent of Medicaid patients and 76.3% of hospital free care patients knew how their medical bills were paid, versus 17.9% of self-pay patients and 47.3% of patients with private insurance ( p < 0.01). Greater utilization of health services was associated with increased rates of insurance knowledge among 19–24-year-olds on bivariate analysis; however, this factor was not significant when controlling for other factors. Regression analysis revealed that older age and insurance type other than self-payment were independent predictors of health insurance knowledge in adolescents (11–18 years old), while female gender and insurance type other than self-payment were independent predictors of insurance knowledge in young adults (19–24 years old). Conclusions: Approximately half of adolescents and young adults do not know how their medical bills are paid. Validation of self-reported insurance data is, therefore, critical both in clinical practice and health services research.