Workers face many different forms of cost sharing. As reported in Section 6, more than three-in-four workers (77%) 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, copayments and/or coinsurance for physician office visits, hospital care, and prescription drugs.
This year we have revised and expanded reporting on enrollee cost sharing in several areas. The survey contains additional information on plan deductibles and plan out-of-pocket maximum amounts, and new information about cost sharing related to outpatient surgery. The changes are described in more detail below. In some cases, the revised information shown this year cannot be compared directly to published information from prior years; notes are included in the text below and in the exhibits in this section to alert readers of comparability issues.
Plan Deductibles
There are quite a few changes this year in the reporting of plan deductibles.1 For single and family coverage, there are now exhibits that show the percentages of enrollees in plans with no general annual deductible as well as the percentage of enrollees in plans with no general annual deductible that face per-episode cost sharing when they are hospitalized or have outpatient surgery. For single coverage, we have added exhibits that show the average deductible amounts for enrollees in plans with a deductible, and information about whether the deductible applies to certain type of services (such as office visits). For family coverage, we now separately identify amounts for plans that have a general annual deductible that is an aggregate deductible (i.e., all covered expenses from family members count toward meeting an identified deductible amount) and for plans that require each family member to meet a separate deductible amount before the plan covers expenses for that member.2 Generally, plans with separate, per-person family deductibles also limit the number of family members that are required to meet their deductible; for example, a plan may not require a third person in the family to meet a deductible before the plan will pay expenses for the person if two people in the family have already satisfied their deductible amounts. The survey reports the distribution of the number of family members subject to the deductible requirement for policies with separate family deductibles. The survey also shows, as we have in previous years, the distribution of enrollees with different deductible amounts.
Health plan deductibles for PPO, POS, and HDHP/SO plans are for in-network services.
2
Less than two percent of firms with a deductible for family coverage do not have values imputed for whether the deductible is an aggregate or a separate per person deductible. Consequently, these firms are not included in the average separate and aggregate family deductible estimates.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Substantial percentages of covered workers are in health plans with no general annual deductible, including most workers in HMO and POS plans and almost one-third of workers in PPO plans (Exhibit 7.1)
Many workers in plans with no general annual plan deductible face copayments or other charges when they are hospitalized or have outpatient surgery. For example, among workers with no general annual deductible who have single coverage, 60% of workers in HMOs, and 55% of workers in PPOs and POS plans face per-episode (or per diem) cost sharing when they are admitted to a hospital (Exhibit 7.2).
For covered workers in plans with a general annual plan deductible, the average plan deductible amounts for single coverage are $352 in HMOs, $473 in PPOs, $553 in POS plans, and $1,715 in HDHP/SOs. Within each plan type, covered workers in plans sponsored by small firms (3-199 workers) generally have higher deductibles for single coverage than covered workers employed in larger firms (Exhibit 7.3).
Even when workers are subject to general annual plan deductibles, the deductibles may not apply to all covered services. Among covered workers in HMOs and PPOs with general plan deductibles, just over one-half are in plans where the general plan deductible does not apply to prescription drugs, and just under one-half are in plans that do not apply the deductible to preventive procedures (Exhibit 7.11).
For covered workers in health plans that have an aggregate deductible for family coverage, the average plan deductible amounts are $751 in HMOs, $1,034 in PPOs, $1,227 in POS plans, and $3,511 in HDHP/SOs (Exhibit 7.8).
For covered workers in health plans that have separate per-person deductible amounts for family coverage, the average plan deductible amounts are $710 in PPOs, and $992 in POS plans (Exhibit 7.8).3 The majority of covered workers in plans with separate deductible amounts for family coverage are in plans that limit the number of family members that must satisfy the deductible amount to three (Exhibit 7.9).
The vast majority of covered workers (82%) face a fixed dollar copayment rather than a percentage coinsurance (11%) when they visit a physician (Exhibit 7.14). Covered workers in HDHP/SOs, however, are more likely to be in a plan with coinsurance than a copayment for physician office visits (42% vs. 13%, respectively) (Exhibit 7.14).
About three quarters of covered workers in plans with copayments for primary care physician office visits are in plans that require copayments between $15 and $25 per visit for in-network services (Exhibit 7.15).
Hospital Cost Sharing
When admitted to a hospital, the majority of covered workers (51%) face cost sharing in various forms, such as a copayment, coinsurance, or a per diem charge (charge per day) (Exhibit 7.12). This separate hospital cost sharing is in addition to any general annual plan deductible, and the 51% estimate includes covered workers in plans that have general deductibles and in plans that do not. Among the types of cost sharing, fixed dollar amounts (deductibles or copayments) and coinsurance are about equally prevalent (Exhibit 7.12). On average across all plans, covered workers with deductibles or copayments for inpatient hospital admissions pay $231 per hospital admission (Exhibit 7.13). Covered workers in plans with coinsurance for each hospital admission pay an average coinsurance rate of 17% (Exhibit 7.13). Two percent of covered workers face a per diem charge when admitted to a hospital (Exhibit 7.12).
Forty-six percent of covered workers are in plans that have cost sharing for outpatient surgery (Exhibit 7.12). This separate cost sharing for outpatient surgery is in addition to any general annual plan deductible, and the estimate includes covered workers in plans that have general deductibles and in plans that do not. Among the types of cost sharing, fixed dollar amounts (deductibles or copayments) and coinsurance are about equally prevalent (Exhibit 7.12). The average fixed dollar amount (deductible or copayment) is $133 and the average coinsurance rate is 17% (Exhibit 7.13).
Most covered workers are in a plan that partially or totally limits the cost sharing that a plan enrollee must pay in a year (Exhibit 7.18). These limits are generally referred to as out-of-pocket maximum amounts.
This year the survey contains more information on out-of-pocket maximum plan provisions than it has in previous years.4 One addition is information on the types of out-of-pocket expenses that plans count when determining whether an enrollee has met the out-of-pocket maximum. For example, some plans count amounts that enrollees spend meeting the plan deductible, while others do not, effectively increasing the amount of cost sharing that enrollees need to pay before the plan pays all of the costs for covered services. Additionally, some plans do not count cost sharing for certain services, such as prescription drugs, in determining whether an enrollee has met the out-of-pocket maximum. Another change to the survey is the delineation of different types of out-of-pocket maximum provisions for family coverage plans. Similar to deductibles, some plans have an aggregate out-of-pocket maximum amount that applies to cost sharing for all family members, while others apply a per-family member out-of-pocket maximum that limits the amount of cost sharing that the family must pay on behalf of each family member.
Twenty-one percent of covered workers with single coverage are enrolled in a plan that does not limit the amount of cost sharing that plan enrollees may have to pay (Exhibit 7.18). Workers in HMOs are more likely than workers in PPOs and HDHP/SOs to be in a plan without an out-of-pocket maximum. It should be noted, however, that many workers covered by HMOs are in plans with no general annual plan deductible and may not face significant cost sharing exposure under their plan.
Fifty-four percent of covered workers in plans that have an out-of-pocket maximum are enrolled in plans that have an out-of-pocket maximum limit for single coverage of less than $2,000 (Exhibit 7.20). As noted above, these reported limits may not apply to all required cost sharing under the plan, including plan deductibles.
Exhibit 7.19 shows the percentage of covered workers in plans with out-of-pocket maximum limits that do not count specified cost sharing in determining whether an enrollee has met the out-of-pocket limit. For example, among covered workers in PPO plans that have an out-of-pocket maximum limit, almost 40% are in a plan that does not count amounts that the enrollee spends in meeting the overall plan deductible and over 80% are a plan that does not count cost sharing for prescription drug expenses when determining whether an enrollee has reached the out-of-pocket maximum.
Looking at covered workers in plans that have an aggregate out-of-pocket maximum amount for family coverage, 55% are in plans that have an out-of-pocket maximum limit of less than $4,000 (Exhibit 7.22).
Looking at covered workers in plans that have a separate, per person out-of-pocket maximum amount for family coverage, 48% are enrolled in plans that have an out-of-pocket maximum of less than $3,000 (Exhibit 7.23). Plans with this structure usually have a limit on the number of family members that need to reach their separate out-of-pocket limit, after which the plan will consider the entire family as having met the out-of-pocket maximum under the plan. Exhibit 7.24 shows the percentage of covered workers in such plans based on the maximum number of family members that might have to meet their separate out-of-pocket maximum.
Out-of-pocket maximum amounts is a topic that the survey addresses periodically. We previously reported on this topic in 2005 and prior to that in 2003.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Exhibit 7.1: Percentage of Covered Workers With No General Annual Health Plan Deductible for Single and Family Coverage, by Plan Type and Firm Size, 2006
Single Coverage
Family Coverage
HMO
200-999 Workers
88%
87%
1,000-4,999 Workers
87
84
5,000 or More Workers
93*
93*
All Small Firms (3-199 Workers)
83%
86%
All Large Firms (200 or More Workers)
90%
89%
ALL FIRM SIZES
88%
88%
PPO
200-999 Workers
27%
27%
1,000-4,999 Workers
34
33
5,000 or More Workers
31
31
All Small Firms (3-199 Workers)
31%
29%
All Large Firms (200 or More Workers)
31%
30%
ALL FIRM SIZES
31%
30%
POS
200-999 Workers
60%
62%
1,000-4,999 Workers
55
60
5,000 or More Workers
85*
83*
All Small Firms (3-199 Workers)
65%
66%
All Large Firms (200 or More Workers)
72%
73%
ALL FIRM SIZES
68%
69%
*
Estimate is statistically different within plan type from estimate for all other firms not in the indicated size category at p<.05.
Note: HDHP/SOs are not shown because all covered workers in these plans face a minimum deductible. In HDHP/HRA plans, as defined by the survey, the minimum deductible is $1,000 for single coverage and $2,000 for family coverage. In HSA qualified HDHPs, the legal minimum deductible is $1,050 for single coverage and $2,100 for family coverage.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.2: Among Covered Workers with No General Annual Plan Deductible for Single and Family Coverage, Percentage Who Have Hospital Cost Sharing, by Plan Type, 2006‡
Single Coverage
Family Coverage
Separate Cost Sharing for Each Hospital Admission
HMO
60%
59%
PPO
55
55
POS
55
55
Separate Cost Sharing for Each Outpatient Surgery Episode
HMO
50%
50%
PPO
42
43
POS
48
48
‡
Separate cost sharing for each hospital admission includes the following types: deductible or copayment only, coinsurance only, both copayment and coinsurance, either a copayment or coinsurance (whichever is greater), and a charge per day (per diem). Cost sharing for each outpatient surgery episode includes the following types: deductible or copayment only, coinsurance only, both copayment and coinsurance, and either a copayment or coinsurance, whichever is greater.
Note: HDHP/SOs are not shown because all covered workers in these plans face a minimum deductible. In HDHP/HRA plans, as defined by the survey, the minimum deductible is $1,000 for single coverage and $2,000 for family coverage. In HSA qualified HDHPs, the legal minimum deductible is $1,050 for single coverage and $2,100 for family coverage.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.3: Among Covered Workers with a General Annual Health Plan Deductible for Single Coverage, Average Deductible, by Plan Type and Firm Size, 2006
Single Coverage
HMO
All Small Firms (3-199 Workers)
NSD
All Large Firms (200 or More Workers)
268
ALL FIRM SIZES
$352
PPO
All Small Firms (3-199 Workers)
$673*
All Large Firms (200 or More Workers)
375*
ALL FIRM SIZES
$473
POS
All Small Firms (3-199 Workers)
$677*
All Large Firms (200 or More Workers)
372*
ALL FIRM SIZES
$553
HDHP/SO
All Small Firms (3-199 Workers)
$2,014*
All Large Firms (200 or More Workers)
1,441*
ALL FIRM SIZES
$1,715
*
Estimates are statistically different within plan type between All Small Firms and All Large Firms at p<.05.
Note: Average health plan deductibles for PPO, POS, and HDHP/SO plans are for in-network services.
NSD: Not Sufficient Data.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.4: Among Covered Workers with a General Annual Health Plan Deductible for Single Coverage, Average Deductible, by Plan Type and Region, 2006
Single Coverage
HMO
Northeast
NSD
Midwest
NSD
South
363
West
NSD
ALL REGIONS
$352
PPO
Northeast
$383
Midwest
412*
South
547*
West
487
ALL REGIONS
$473
POS
Northeast
NSD
Midwest
681
South
573
West
NSD
ALL REGIONS
$553
HDHP/SO
Northeast
$1,641
Midwest
1,593
South
1,776
West
NSD
ALL REGIONS
$1,715
*
Estimate is statistically different from estimate for all other firms not in the indicated region at p<.05.
Note: Average health plan deductibles for PPO, POS, and HDHP/SO plans are for in-network services.
NSD: Not Sufficient Data.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.5: Among Covered Workers With a General Annual Health Plan Deductible for Single PPO Coverage, Distribution of Deductibles, 2000-2006
$1 - $499
$500 - $999
$1,000 - $1,999
$2,000 or More
2000
86%
13%
1%
<1%
2001*
80
16
4
<1
2002*
77
16
5
2
2003*
69
20
9
2
2004
71
20
6
2
2005*
67
20
10
3
2006*
62
26
8
4
*
Distribution is statistically different from distribution for the previous year shown at p<.05.
Note: Deductibles for PPO plans are for in-network services.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.6: Among Covered Workers With a General Annual Deductible for Single POS Coverage, Distribution of Deductibles, 2000-2006
$1 - $499
$500 - $999
$1,000 - $1,999
$2,000 or More
2000
74%
20%
7%
0%
2001
77
14
7
2
2002*
79
20
1
0
2003*
73
17
10
0
2004*
54
23
10
13
2005*
58
24
17
1
2006*
38
44
16
1
*
Distribution is statistically different from distribution for the previous year shown at p<.05.
Note: Deductibles for POS plans are for in-network services.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.7: Among Covered Workers with a General Annual Health Plan Deductible, Distribution of Type of Deductible for Family Coverage, by Plan Type and Firm Size, 2006*‡
Aggregate Amount
Separate Amount per Person
HMO
All Small Firms (3-199 Workers)
63%
37%
All Large Firms (200 or More Workers)
80%
20%
ALL FIRM SIZES
74%
26%
PPO
All Small Firms (3-199 Workers)
71%
29%
All Large Firms (200 or More Workers)
72%
28%
ALL FIRM SIZES
71%
29%
POS
All Small Firms (3-199 Workers)
76%
24%
All Large Firms (200 or More Workers)
75%
25%
ALL FIRM SIZES
76%
24%
HDHP/SO
All Small Firms (3-199 Workers)
93%
7%
All Large Firms (200 or More Workers)
91%
9%
ALL FIRM SIZES
92%
8%
*
Tests found no statistical difference within plan type between distributions for All Small Firms and All Large Firms at p<.05.
‡
Less than two percent of firms who report having a deductible for family coverage do not have values imputed for whether the deductible is an aggregate or a separate per person deductible.
Note: For the first time this year, the survey distinguished between plans that have an aggregate deductible amount in which all family members’ out-of-pocket expenses count toward the deductible and plans that have a separate amount for each family member, typically with a limit on the number of family members required to reach that amount.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.8: Among Covered Workers with a General Annual Health Plan Deductible, Average Deductibles for Family Coverage by Deductible Type, Plan Type, and Firm Size, 2006
Aggregate Amount
Separate Amount per Person
HMO
All Small Firms (3-199 Workers)
NSD
NSD
All Large Firms (200 or More Workers)
666
NSD
ALL FIRM SIZES
$751
NSD
PPO
All Small Firms (3-199 Workers)
$1,439*
$912
All Large Firms (200 or More Workers)
838*
610
ALL FIRM SIZES
$1,034
$710
POS
All Small Firms (3-199 Workers)
$1,499*
NSD
All Large Firms (200 or More Workers)
838*
NSD
ALL FIRM SIZES
$1,227
$992
HDHP/SO
All Small Firms (3-199 Workers)
$4,104*
NSD
All Large Firms (200 or More Workers)
2,965*
NSD
ALL FIRM SIZES
$3,511
NSD
*
Estimates are statistically different within plan type between All Small Firms and All Large Firms at p<.05.
Note: Deductibles for PPO, POS, and HDHP/SO plans are for in-network services. For the first time this year, the survey distinguished between plans that have an aggregate deductible amount in which all family members’ out-of-pocket expenses count toward the deductible and plans that have a separate amount for each family member, typically with a limit on the number of family members required to reach that amount.
NSD: Not Sufficient Data.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.9: Among Covered Workers With a Separate per Person General Annual Health Plan Deductible for Family Coverage, Maximum Number of Family Members Required to Meet the Deductible, by Plan Type, 2006
(object placeholder)
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.10: Among Covered Workers with a General Annual Health Plan Deductible for Family Coverage, Distribution of Deductibles for PPO and POS Plans, by Deductible Type, 2006
(object placeholder)
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.11: Among Covered Workers with a General Annual Health Plan Deductible, Percentage Whose Deductible Does Not Apply to Various Services, by Plan Type, 2006
HMO
PPO
POS
HDHP/SO
Hospital Admissions
1%
4%
6%
^
Outpatient Hospital Procedures
5
5
3
^
Primary Care Visits
45
44
36
^
Specialty Care Visits
42
40
31
^
Preventive Procedures
48
47
27
88
Prescription Drugs
53
51
37
43§
^
HDHP/SOs were not asked these questions with two exceptions: HDHP/SOs were asked about preventive procedures and HDHP/HRAs were asked about prescription drugs. HDHP qualified HSAs are required by law to apply the plan deductible to nearly all services.
§
Percentage is for covered workers in HDHP/HRAs only.
Note: These questions refer to payments made for specific services that do not count toward a worker’s annual deductible. For example, if a worker has a deductible of $500, an office visit copayment of $15 would not be included in meeting the deductible. These questions are asked for single coverage only. We make the assumption that they apply to workers enrolled in family coverage as well. For PPO, POS, and HDHP/SO plans, we ask about deductibles for in-network services.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
Errata: The percentage of covered workers in HDHP/SOs whose deductible does not apply to preventive benefits is 88% rather than the 22% previously reported; similarly, the percentage of covered workers in HDHP/HRAs whose deductible does not apply to prescription drugs is 43% rather than the 57% previously indicated. (8/23/07)
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.12: Distribution of Covered Workers With the Following Types of Cost Sharing in Addition to Any General Annual Deductible, by Plan Type, 2006
Deductible or Copay Only
Coinsurance Only
Both Copay and Coinsurance‡
Charge Per Day
None
Separate Cost Sharing for Each Hospital Admission
HMO*
45%
7%
2%
4%
42%
PPO*
19
26
3
<1
52
POS*
32
17
4
2
45
HDHP/SO*
1
33
2
<1
64
ALL PLANS
25%
22%
3%
2%
49%
Separate Cost Sharing for Each Outpatient Surgery
HMO*
41%
7%
1%
NA
51%
PPO*
11
30
2
NA
56
POS*
27
16
4
NA
52
HDHP/SO*
4
30
2
NA
65
ALL PLANS
20%
24%
2%
NA
54%
*
Distribution is statistically different from All Plans distribution at p<.05.
‡
This includes enrollees who are required to pay the higher amount of either the copayment or coinsurance under the plan.
NA: Not applicable. The survey did not offer “Charge Per Day” (per Diem) as a response option for questions about separate cost sharing for each outpatient surgery episode.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.13: Among Covered Workers With Separate Cost Sharing for Each Hospital Admission or Each Outpatient Surgery, Average Cost Sharing, by Plan Type, 2006
Average Deductible/Copay
Average Coinsurance
Charge Per Day
Separate Cost Sharing for Each Hospital Admission
HMO
$233
15%
NSD
PPO
238
17
NSD
POS
269
19*
NSD
HDHP/SO
NSD
14
NSD
ALL PLANS
$231‡
17%
$170‡
Separate Cost Sharing for Each Outpatient Surgery
HMO
$118
15%
NA
PPO
144
17
NA
POS
191
18
NA
HDHP/SO
NSD
15
NA
ALL PLANS
$133‡
17%
NA
*
Estimate is statistically different from All Plans estimate at p<.05.
‡
The averages for ‘All Plans’ were calculated without data from HDHP/SO plans due to insufficient observations in that plan type.
NSD: Not Sufficient Data.
NA: Not applicable. The survey did not offer “Charge Per Day” (per Diem) as a response option for questions about separate cost sharing for each outpatient surgery episode.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.14: Percentage of Covered Workers With the Following Types of Cost Sharing for Physician Office Visits, 2006
Copay Only
Coinsurance Only
Both Copay and Coinsurance‡
Neither
HMO*
95%
1%
0%
4%
PPO*
78
15
1
6
POS*
94
1
1
5
HDHP/SO*
13
42
0
44
ALL PLANS
82%
11%
1%
7%
*
Distribution is statistically different from All Plans distribution at p<.05.
‡
This includes enrollees who are required to pay the higher amount of either the copayment or coinsurance under the plan.
Note: For PPO, POS, and HDHP/SO plans, the survey asked specifically about cost sharing for in-network providers.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.15: Among Covered Workers With Copayments for A Physician Office Visit with Primary Care Physician, Distribution of Copayments, by Plan Type, 2004-2006‡
$5 Per Visit
$10 Per Visit
$15 Per Visit
$20 per Visit
$25 Per Visit
$30 Per Visit
Other
HMO
2004
3%
28%
40%
22%
3%
3%
1%
2005*
5
23
34
27
6
4
1
2006
3
21
37
25
8
5
2
PPO
2004
1%
17%
35%
28%
11%
4%
3%
2005*
<1
16
25
34
15
5
4
2006
<1
12
25
35
17
7
3
POS
2004
3%
17%
34%
36%
8%
<1%
1%
2005*
2
16
35
30
11
6
1
2006*
2
22
26
27
16
6
<1
ALL PLANS
2004
1%
19%
37%
27%
9%
3%
3%
2005*
2
17
29
32
12
5
3
2006
2
15
28
32
15
6
3
*
Distribution is statistically different from distribution for the previous year shown at p<.05.
‡
HDHP/SOs are not shown since information was not obtained for HDHP/SOs prior to 2006. In 2006, there is insufficient data to report the results.
Note: Copayments for PPO, POS, and HDHP/SO plans are for in-network providers. The survey has asked specifically about copayments for primary care physicians since 2005.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2004-2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.16: Among Covered Workers in HMOs With A Copayment for A Physician Office Visit, Percentage with Various Copayments, 1999-2006
1999
2000
2001
2002
2003
2004
2005
2006
$5 Per Visit
23%
22%
15%*
7%*
4%
3%
5%
3%
$10 Per Visit
60
54
56
52
35*
28
23
21
$15 Per Visit
12
16
22*
27
37*
40
34
37
$20 per Visit
1
3
3
11*
12
22*
27
25
Other
3
6
4
3
12*
7
11
15
*
Estimate is statistically different from estimate for the previous year shown at p<.05.
Note: In 2005 and 2006, the survey asked about primary care physicians (if the copayments were different for specialist care). This distinction was not made prior to 2005.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
Error in element (see logs)
Exhibit 7.17: Among Covered Workers With Coinsurance for Physician Office Visits, Average Coinsurance Rates, by Plan Type, 2006
10% or 15%
20% or 25%
30% or 35%
40% or 45%
Other
COINSURANCE RATES
PPO In-Network Provider
28%
68%
4%
0%
0%
PPO Out-of-Network Provider
2
28
32
27
11
POS Out-of-Network Provider
2
34
29
26
8
HDHP/SO
60
34
6
0
0
Note: HMO and in-network POS coinsurance rates are not shown because fewer than 2% of covered workers in the former and 1% of covered workers in the latter face coinsurance for office visits. For PPOs and POS plans, the survey asked about coinsurance rates for both in-network and out-of-network providers. For HDHP/SO plans, the survey asked about rates for in-network providers. For HMOs, the distinction is not applicable.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2006.
For more information regarding survey methodology, click here to view the Survey Design and Methods section.
