| Summary: | Background: In India, there exists public health insurance for government employees and poor people. However, the middle-income households (MIHs) remain neglected. Objectives: The study was conducted to find out the coverage of health insurance and its determinants among MIH. Methods: It was a community-based sequential exploratory mixed methods study. Group interview and key informant interview were conducted among various stakeholders related to insurance coverage. The quantitative survey was done among 400 randomly selected head of households (HoHs) in an urban area of Puducherry. Manual content analysis was done for qualitative data. Generalized linear model with Poisson distribution was used to calculate the adjusted prevalence ratio (aPR) using Stata software. Results: The coverage of health insurance among the MIH was 41% (95% confidence interval [CI]: 36.1–50). The major reasons reported for not having insurance were poor financial status (63.7%) and lack of felt needs (59.4%). The significant determinants for the lack of health insurance among MIH were unskilled occupation (aPR: 1.62, 95% CI: 1.13–2.34) and lower education status (aPR: 1.79, 95% CI: 1.22–2.64) of HoH and less monthly family income (aPR: 2.19, 95% CI: 1.18–4.08). Conclusion: The health insurance coverage of 41% among MIH is better despite the fact that there was no public insurance scheme available for them in Puducherry. The MIH with the identified determinants might be considered in future for including them under publicly sponsored health insurance scheme.
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