Exhibit 4.6: Distribution of Covered Workers with the Following Types of Cost Sharing for Physician Office Visits and Hospital Admissions, 2005

Trends and Indicators in the Changing Health Care Marketplace

Section 4: Health Insurance Benefits
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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^

	Deductible or Copay	Coinsurance Only	Both Copay and Coinsurance	Charge Per Day	Annual Deductible	None
HOSPITAL ADMISSIONS
Conventional Plans	25%	14%	1%	0%	6%	54%
HMO Plans	55	3	1	4	0	37
PPO Plans	26	13	3	1	1	55
POS Plans	46	6	4	4	0	40
ALL PLANS	36%	10%	1%	2%	1%	48%

*Distribution is significantly different from All Plans at p<.05.
‡This category includes less than 0.5% of covered workers who face either a copayment or a coinsurance – whichever is greater.
^Tests found no statistically different distributions from All Plans at p<.05.

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2005. From Exhibit 7.10, at http://www.kff.org/insurance/7315/sections/ehbs05-7-10.cfm, and Exhibit 7.11, at http://www.kff.org/insurance/7315/sections/ehbs05-7-11.cfm.

Section 4: Health Insurance Benefits
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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