Continuing with our examination of the results of the KFF survey of employer health plans. I would note that this is a survey-based analysis so to some extent subject to response levels, etc. but other evidence suggests that these KFF surveys are pretty accurate.
88% of people with single coverage have an annual deductible. Almost every service is covered by these deductibles; with the exception of preventive services like an annual physical. Deductible amounts have been increasing rapidly, as employers view them as a method to deter utilization. The average deductible was $1955. Workers in small companies generally have significantly higher deductibles than do those in large organizations. While some companies with deductibles have health savings accounts, the amount the employer contributes to those plans is almost always smaller than the deductible.
In addition to deductibles, most workers also have cost sharing relating to a specific service. Copayments are flat dollar amounts that the person pays and coinsurance is a percent of the cost of the service. The average copayment for a primary care visit is $27 and for a specialist is $46. About 20% of people have coinsurance for doctor visits. For hospital inpatient care, 60% of employees are in a plan with coinsurance, and 20% is the average. 11% have a copayment for hospital care and 10% have both coinsurance and a copayment.
The pain of these cost-sharing features is somewhat limited by out-of-pocket maximums, but 24% of workers are in plans with out-of-pocket limits of $6000 or more and only 14% in a plan with a limit of $2000 or less. Between premium contributions and out-of-pocket costs, the average working family is laying out thousands of dollars a year for health coverage. This, along with day care and other costs, explains why so many of these relatively high-income households feel so financially stressed and are hesitant to have children.
