Objective The purpose of the following study was to determine whether health insurance impacts the risk of suicidal ideation among patients with head and neck cancer (HNC). Study Design A retrospective cohort study was completed using the 2016 to 2018 National Inpatient Sample on adult patients (≥18 years) with HNC. The primary predictor was health insurance. The primary outcome was suicidal ideation. Multivariate logistic regression was employed to identify risk factors for the primary outcome variable. Results The final study sample consisted of 29 231 patients with HNC. Not controlling for confounders, being a Medicaid patient was a risk factor for suicidal ideation (odds ratio [OR] 2.44; P < .01). However, after controlling for confounders, Medicaid was no longer a risk factor or suicidal ideation (OR 1.52; P = .190). Patients with alcohol dependence/abuse (OR 2.94; P < .01) and depression (OR 8.30; P < .01) were each more likely to experience suicidal ideation. Conclusions Medicaid insurance was not a risk factor for suicidal ideation in our study. Depression and alcohol dependence/abuse were each risk factors for suicidal ideation. Oral cancer and oropharyngeal cancer each decreased the risk for suicidal ideations. The purpose of the following study was to determine whether health insurance impacts the risk of suicidal ideation among patients with head and neck cancer (HNC). A retrospective cohort study was completed using the 2016 to 2018 National Inpatient Sample on adult patients (≥18 years) with HNC. The primary predictor was health insurance. The primary outcome was suicidal ideation. Multivariate logistic regression was employed to identify risk factors for the primary outcome variable. The final study sample consisted of 29 231 patients with HNC. Not controlling for confounders, being a Medicaid patient was a risk factor for suicidal ideation (odds ratio [OR] 2.44; P < .01). However, after controlling for confounders, Medicaid was no longer a risk factor or suicidal ideation (OR 1.52; P = .190). Patients with alcohol dependence/abuse (OR 2.94; P < .01) and depression (OR 8.30; P < .01) were each more likely to experience suicidal ideation. Medicaid insurance was not a risk factor for suicidal ideation in our study. Depression and alcohol dependence/abuse were each risk factors for suicidal ideation. Oral cancer and oropharyngeal cancer each decreased the risk for suicidal ideations.