User Note - Private Insurance Definitions
Changes in the Definition of Private Insurance
The definition of private insurance, and the survey questions related to this form of insurance, changed over time to reflect changes in the availability of different types of private coverage and issues of interest. This note summarizes changes in the definition of private insurance; a complementary note addresses Changes in Insurance Data Collection.
1976 to 1992
The Field Representative's Manuals defined insurance as a comprehensive health insurance plan designed to pay all or part of the bills from a hospital, doctor, or surgeon (and, in 1986 and 1989, also dental bills). The plan had to have defined membership and benefits; Health Maintenance Organizations (HMOs) and Individual Practice Associations (IPAs) were considered private health insurance. Public programs, such as Medicaid, Medicare, public welfare, "Crippled Children's Program," care given to military personnel, and Veteran's benefits, were excluded. The Manuals also explicitly instructed interviewers that plans that pay for only one type of service, such as nursing home care or accidents, were not considered to be private insurance. Prior to 1990, single service plans were described as plans for "dread diseases" (e.g., cancer, polio), plans that pay only for accidents, and "income maintenance" plans paying a fixed amount both in and out of the hospital. Surveys prior to 1989 did not inquire about or distinguish single service plans as separate from other hospital, surgeon's or doctor's insurance plans. According to the 1989 Field Representative's Manual, single service plans were not common in earlier years. Beginning in 1989, questions about "specialty health care plans" (i.e., single service plans) were included in the survey. Interviewers began by asking whether the sample person (for persons 65 or over) was covered by the part of Medicare that pays for hospital bills (Part A) and about coverage through the part of Medicare that pays for doctor's bills (Part B). They then asked to see the Medicare card to verify coverage. The interviewer next asked whether anyone in the family was covered by private insurance, defined as insurance that paid any part of a hospital, doctor's or surgeon's bill (excluding plans that pay only for accidents). Respondents were first asked whether anyone in the family had hospital insurance, and then were asked about insurance for any part of a doctor's or surgeon's bill.
1976 to 1992
The survey questions on private insurance asked about coverage for hospital, surgeon or doctor's bills. As noted, the 1986 and 1989 survey questions also included coverage for dentists' bills. The 1986 Manual defined dental coverage as "Any insurance which pays all or part of a dentist's bill for any dental services other than oral surgery." Because the Manual in 1986 did not explicitly mention single service plans should be excluded, it is possible that those with single service plans for dental coverage were considered to have private insurance. For 1989 and 1992, the Manuals specified that dental coverage had to be part of a comprehensive plan and not a single service plan.
1976 to 1989
The Field Representative's Manuals also instructed interviewers that plans paying extra cash for hospital stays were considered to be private health insurance.
1992 to 1996
It is unclear whether plans that pay cash while hospitalized constitute insurance coverage; such plans are not mentioned in the Manuals or survey text.
1993 to 1996
The Manuals adopted a different approach. In these years, interviewers were told that single service plans were a form of private health insurance. The 1993 to 1996 Field Representative's Manuals defined private insurance as "Any type of health insurance (other than the public programs [already asked about in the survey] including coverage by a health maintenance organization (HMO) AND single service plans." Because of this change in the definition of private insurance in1993 to 1996, dental coverage in the form of single service plans may have been considered private insurance in these years. Survey questions for 1993 to 1996 also uniquely used insurance coverage during the previous month as the reference period, while all other years referred to coverage at the time of the survey.
1997 to 1999
Plans that only provide extra cash while hospitalized or pay for only one type of service were not considered to be private insurance plans. For 2000 forward, respondents could select single service plans from the choices listed on flashcard specifying types of coverage, but these single service plans are excluded from the recoded variable HIPRIVATEE, which indicates private insurance coverage.
The Field Representative's Manuals generally described private plans as any insurance other than public insurance (i.e., Medicare, Medicaid, Children's Health Insurance Program [CHIP], Military health care [TRICARE/VA/CHAMP-VA], Indian Health Service, state-sponsored health plans, and other government programs). Single service plans or plans that paid extra cash while hospitalized were not considered to be private insurance for 1997 forward.
The Manuals for the most recent period also instructed interviewers to count insurance coverage through COBRA and TCC as private insurance (categorized as "from employer or workplace"). The Manuals' discussion of COBRA and TCC was as follows:
"If a respondent indicates that he/she is covered by COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985) or by TTC (Temporary Consolidation of Coverage), this should be coded as a Private Health Insurance Plan from employer or workplace. COBRA provides a bridge between health plans for qualified workers, their spouses and their dependent children when their health insurance might otherwise be cut off. Under this act, if a person voluntarily resigns from a job or is terminated for any reason other than 'gross misconduct,' they are guaranteed the right to continue in their former employers group health insurance plan as an individual or family health care coverage for up to 18 months at one's own expense. In some cases, a spouse and dependent children are also eligible for COBRA coverage for as long as three years. The TCC program is similar to COBRA. This program is available to federal employees. If a person loses Federal Employees Health Benefit (FEHB) coverage because of separation from federal service, they may enroll under the TCC provision of FEHB law to continue coverage for up to 18 months at their own expense in a FEHB plan. Family members who lose coverage because they are no longer eligible may enroll under TCC to continue FEHB coverage for up to 36 months at their own expense."