Another View of Medical Plan Design Trends in 2014

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.