Workers face many different forms of cost sharing. As reported in Section 6, more than three-in-four workers (79%) with single coverage and more than nine-in-ten workers (91%) with family coverage contribute to their monthly health insurance premium. In addition, many covered workers face cost sharing such as deductibles and copayments and/or coinsurance for physician office visits, hospital care, and prescription drugs. Research has demonstrated that higher cost sharing reduces spending on health care, but may also discourage use of needed services, particularly among lower income individuals.⁵

As in previous years, covered workers in small firms (3-199 workers) face higher average annual deductibles for single coverage than workers in large firms (200 or more workers) across all plan types. Copayments remain more common than coinsurance for physician office visits, and most covered workers (52%) face separate cost sharing when admitted to a hospital.

Plan Deductibles

• Average annual deductibles across all plan types have not increased significantly over the past year.
  
  
  • Seventy-one percent of covered workers in PPO plans, the plan type with the highest enrollment, face an annual deductible for both single and family coverage (Exhibit 7.6). The average annual deductible (including those with a zero deductible) is $323 for single coverage for in-network services and $679 for family coverage for in-network services. If covered workers without deductibles were excluded from the average, the PPO deductibles for in-network services would average $455 for single coverage and $952 for family coverage (Exhibits 7.2, 7.3).
    
    
  • Forty-four percent of covered workers in POS plans face a deductible for single coverage and 46% face a deductible for family coverage (Exhibit 7.7). The average annual deductible (including those with a zero deductible) for in-network services is $220 for single coverage and $494 for family coverage. If covered workers without deductibles were excluded from the average, the POS deductibles for in-network services would average $495 for single coverage and $1,065 for family coverage (Exhibits 7.2, 7.3).
    
    
  • Only a small percentage (13%) of covered workers in HMO plans face an annual deductible for both single and family coverage. The average deductible (including those with a zero deductible) for workers in HMO plans is $71 for single coverage and $141 for family coverage. If covered workers without deductibles were excluded from the average, the HMO deductibles for in-network services would average $568 for single coverage and $1,105 for family coverage (Exhibits 7.2, 7.3).
    
    
• Average annual deductibles are higher for covered workers with single coverage in small firms (3-199 workers) compared to large firms (200 or more workers), across all types of plans. For single coverage in PPO plans, average deductibles for preferred providers are $469 in small firms and $254 in large firms (Exhibit 7.4).
  
  
• Among covered workers in health plans with a deductible, 63% are in plans where the worker is reimbursed for preventive services without being required to meet the deductible.

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