Significant proportions of covered workers in PPOs (55%) and POS plans (46%) face coinsurance rates of 30% or more for services received from non-preferred providers. Such substantial cost sharing for out-of-network services may substantially diminish the value to enrollees of these broader choice options (Exhibit 7.8).
Large percentages of covered workers in HMO, PPO, and POS plans face some type of cost sharing for a hospital admission, either a deductible, copayment or coinsurance. Forty-four percent of covered workers have some type of cost sharing for a hospital admission (Exhibit 7.10).
Workers with deductibles or copays for hospital admissions pay $202, on average, per hospitalization for all plan types (Exhibit 7.11).
Last year the survey reported that just over half of workers with single coverage had a maximum out-of-pocket limit – the maximum total amount the plan will require beneficiaries to pay for services in a single year – of $2,000. This year, firms were asked if in 2003 they had excluded services and items that previously counted to-wards the limit (such as deductibles and copays for particular prescription drugs), effectively raising the out-of-pocket limit for employees. Twenty-one percent of firms (representing 15% of covered workers) said they had done so in the past year (Exhibit 7.13).
Tiered insurance plans, in which members must pay more to use certain physicians and hospitals based on their cost, remain uncommon (Exhibit 7.12). Six percent of workers in HMOs, PPOs, and POS plans are in such tiered plans, while an additional 19% are in firms that have considered adopting use of tiered networks in their HMO plans.
