Trends and Indicators in the Changing Health Care Marketplace Section 4: Trends in Health Insurance Benefits
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Trends and Indicators in the Changing Health Care Marketplace
Exhibit 4.1: Percent of Covered Workers With Selected Benefits, by Firm Size, 2004
Today, most employer-sponsored health plans cover preventive services such as prenatal care and physicals, in addition to prescription drug and mental health coverage. Fewer plans cover acupuncture and chiropractic care.
All Small Firms (3-199 Workers)
All Large Firms (200 or More Workers)
All Firms
ALL PLANS
Adult Physicals
96%
94%
95%
Prescription Drugs
100
100
100
Outpatient Mental
95
99
98
Inpatient Mental
96
99
98
Annual OB/GYN Visit
99
98
98
Prenatal Care
97
100*
99
Oral Contraceptives
87
89
89
Well-Baby Care
95
98
97
Acupuncture
41
50
47
Chiropractic Care
79*
91*
87
Note: *Estimate is statistically different from All Firms at p<.05.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 02/02/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 4.2: Percentage of Covered Workers With Coverage of Well-Baby Care and Adult Physicals, by Type of Plan, 1988, 1996, 2003, and 2004
While HMOs have consistently covered preventive services, including well-baby care and adult physicals, PPO plans have not. However, PPOs have dramatically increased their coverage of well-baby care and adult physicals since 1988. In 2004, 97% of workers in PPOs had well-baby care (compared to 61% in 1988) and 94% had coverage for adult physicals (compared to 39% in 1988).
Source: Kaiser Family Foundation/Health Research and Educational Trust, Employer Health Benefits, 2004 Annual Survey, September 2004, Exhibit 8.3, p. 107, at http://www.kff.org/insurance/7148/sections/ehbs04-8-3.cfm, and unpublished data.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 02/02/05
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 4.3: Percentage of Covered Workers With the Following Types of Cost Sharing for Health Benefits, 2005
Most workers with employer-sponsored health coverage are required to share the costs of their health insurance premiums and benefits with their employers. In 2005, over three-quarters of workers contributed toward their monthly premiums (91% for family coverage, 79% for single coverage), and higher percentages of workers contributed to cost sharing for office visits (95%), and tiered cost sharing for prescription drugs (89%). Lower percentages faced plan deductibles (56%), separate hospital cost sharing (52%), and separate deductibles for prescription drugs (10%).
‡The percentage of covered workers with a plan deductible is calculated for workers with single coverage. For PPO and POS plans, deductibles are for in-network services.
§Covered workers with separate hospital cost sharing includes those with a hospital deductible or copay, coinsurance, both a coinsurance and a deductible or copay, a charge per day, or an annual deductible.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 04/26/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 4.4: Average Annual Deductibles for Covered Workers With Single Coverage, by Plan Type, 1988-2005
About half (56% in 2005) of covered workers with single coverage face annual deductibles that they must pay before insurance benefits begin (see Exhibit 4.3). In 2005, the average annual deductible for single coverage in PPO plans (the most common type of plan) was $323, up from $204 in 2001.
*Estimate is statistically different from the previous year shown at p<.05. No statistical tests were conducted for years prior to 1999.
^Information was not obtained for HMO single coverage prior to 2003, or for POS plans in 1988.
Note: Average deductibles for PPO and POS plans are for in-network services. Averages include covered workers who do not have a deductible. If covered workers who do not face a deductible are excluded from the analysis, the average deductibles are higher. The average deductibles for single coverage among covered workers who face a deductible are as follows: conventional - $671, HMO - $568, PPO - $455, POS - $495.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2005; KPMG Survey of Employer-Sponsored Health Benefits, 1996; The Health Insurance Association of America (HIAA), 1988. From Exhibit 7.2, at http://www.kff.org/insurance/7315/sections/ehbs05-7-2.cfm.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 04/26/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 4.5: Average Annual Deductibles for Covered Workers With Family Coverage, by Plan Type, 1988-2005
Covered workers enrolled in family coverage experience more expensive deductibles than those in single coverage plans. In 2005, the average annual deductible for family coverage in PPO plans (the most common type of plan) was $679. Covered workers in HMO plans had an average annual deductible of $141, up from $65 in 2003.
*Estimate is statistically different from the previous year shown at p<.05. No statistical tests were conducted for years prior to 1999.
^Information was not obtained for HMO family coverage prior to 2003, or for PPO and POS family coverage prior to 2005.
Note: Average deductibles for PPO and POS plans are for in-network services. Averages include covered workers who do not have a deductible. If covered workers who do not face a deductible are excluded from the analysis, the average deductibles are higher. The average deductibles for family coverage among covered workers who face a deductible are as follows: conventional - $1,405, HMO - $1,105, PPO - $952, POS - $1,065.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2005; KPMG Survey of Employer-Sponsored Health Benefits, 1996; The Health Insurance Association of America (HIAA), 1988. From Exhibit 7.3, at http://www.kff.org/insurance/7315/sections/ehbs05-7-3.cfm.
Trends and Indicators in the Changing Health Care Marketplace Information provided by the Health Care Marketplace Project. Publication Number:7031 Information Updated: 04/26/06
Trends and Indicators in the Changing Health Care Marketplace
Exhibit 4.6: Distribution of Covered Workers with the Following Types of Cost Sharing for Physician Office Visits and Hospital Admissions, 2005
When visiting a physician, most covered workers (95%) face some type of cost sharing, typically a fixed dollar copayment (see Exhibit 4.3). For hospital admissions, just over half (52%) of covered workers have some type of separate cost sharing, typically either a deductible or copayment.
Percentage of Covered Workers With the Following Types of Cost Sharing for Physician Office Visits, 2005
Copay Only
Coinsurance Only
Both Copay and Coinsurance‡
Neither
OFFICE VISITS
Conventional Plans
43%
32%
1%
24%
HMO Plans*
96
<1
1
3
PPO In-network Provider
78
13
2
7
POS In-network Provider
93
1
3
3
ALL PLANS
83%
10%
2%
5%
Percentage of Covered Workers With the Following Types of Cost Sharing for a Hospital Admission, 2005^
