Employee Cost Sharing
In addition to their premium contributions, most workers make payments when they use health care services. Fifty-six percent of covered workers are in a health plan that requires that a deductible be met for single coverage before most plan benefits are provided. In PPOs, the most common plan type, the average deductible for in-network services is $323 for single coverage and $679 for family coverage. Across all plan types, average deductibles for single coverage in small firms (3–199 workers) are substantially higher than average deductibles in large firms (200 or more workers). |
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| More than half of covered workers face separate cost sharing when they are admitted to a hospital. Thirty-six percent of covered workers face a separate deductible or copayment for each hospital admission, with an average payment of $241. Ten percent of workers face separate coinsurance when they are hospitalized, with an average coinsurance rate of 16%. An additional 3% of workers face both a deductible or copayment and coinsurance when hospitalized. |
The vast majority of covered workers face copayments when they go to the doctor or fill a prescription. Copayments for physician office visits changed little in 2005. Forty-four percent of covered workers are in a plan with a $20 or $25 copayment. For workers covered by multi-tier drug plans, the average copayments are $10 for generic drugs, $22 for preferred drugs, and $35 for nonpreferred drugs. A small percentage of plans have added a fourth tier of prescription drug cost sharing, with an average copayment in that tier of $74.
Availability of Employer Based Coverage
While the percentage of firms offering health benefits is statistically unchanged from last year, it has declined over the last few years. Annual changes have been small, but the cumulative result is a statistically significant decline in the percentage of firms offering health benefits, from 69% in 2000 to 60% in 2005. This drop is driven largely by a significant decline in the percentage of small firms (3–199 workers) offering coverage, which has fallen from 68% to 59% over the same period.
Even when a firm offers health insurance, not all workers get covered. Some workers are not eligible to enroll as a result of waiting periods or minimum work-hour rules, and others choose not to enroll because they must pay a share of the premium or can get coverage through a spouse. Within offering firms, 80% of workers are eligible for coverage, and 83% of those eligible elect to enroll.
Next Page (Enrollment, Utilization Management and Disease Management, and High-Deductible Health Plans)
