There is intense interest in how employment-based health plans are responding to all the effects of reform implementation, even though the employer mandate has not officially kicked-in. The Corporate Executive Board and HighRoads collaborated on a survey to compare features of 2014 plans with those in 2013 (HighRoads Paper) The focus of the report is on cost-sharing features. In 2014, according to this survey, plans with high deductibles grew by 2% to 25% of all plans, but interestingly, the number with a zero deductible rose more, by 9%, to 29%. Plans have been moving from copays to coinsurance for office visits; 42% will use coinsurance in 2014, compared to 35% in 2013. Out-of-pocket maximums are also rising, 66% of 2014 plans have maximums over $2500, while only 58% did in 2013. Emergency room copays have risen, to an average of $113 in 2014, but the rise has been relatively slow over the last few years, just slightly above inflation. Similarly, office visit copays for in-network providers have leveled off in the $20 to $22 range. The spread between these in-network office visit copays and urgent care copays, which are around $33, has also stayed stable. It is unclear whether the spread needs to be larger to create an incentive to avoid urgent care use, but perhaps plan sponsors aren’t seeing negative effects from urgent care use. Mental health service copays have become equivalent to physical condition copays, as required by the mental health parity law. The reform law required that services defined as preventive be provided without a copay and without being subject to the deductible. A number of plans, around 28%, are providing preventive coverage without cost-sharing even for out-of-network providers. Drug copays for both generics and brand-name prescriptions are pretty flat, at $9 for generics and $26 for brand-names in 2014. The overall picture is that cost-sharing is continuing to rise in most plans, including most importantly, the out-of-pocket maximums.
Another View of Medical Plan Design Trends in 2014
By Kevin RocheMay 5, 2014Commentary
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
Another example of over-priced companies trying to find some way to survive in the post-epidemic financial world. Transcarent, which does something, somehow to “access high quality, affordable care” is buying...
March 6, 2023
In an attempt to swiftly revive two floundering health care companies, a PE firm has announced the merger and recapitalization of Revive Health and SwiftMD. You know they are...
January 30, 2023
Investors have not yet learned their lesson, as Pearl Health gathers a new round of $75 million in capital for its business of supporting physicians who want to participate in...
January 30, 2023
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace
March 25, 2023
Coronamonomania Lives Forever, Part 201
Tired of March Madness? A boringly refreshing dip into some CV-19 research summaries is recommended.
March 24, 2023
The CDC Is a Font of Methodological and Statistical Error
Several times in the last three years I and others have pointed out serious flaws…
March 24, 2023
A Couple of Health Care Notes
A couple of pieces of health care research focus on high health care spending and…