iLoveBenefits: Industry News Blog

Use of copays do not reduce Medicaid members use of ERs

JAMA internal Medicine published a study conducted by Johns Hopkins Researchers showing that Medicaid copayments do not significantly reduce Medicaid recipients’ use of emergency rooms.  “Our study suggests they will need to look at other strategies besides requiring copayments. There was little evidence that cost-sharing would have any impact on the use of emergency rooms by poor people, who often have few other health care options,” said the lead author of the study.

When you have seen one Silver Plan, you’ve seen one Silver Plan

Robert Wood Johnson Foundation released a report entitled Take Two Aspirin: An Examination of Physician Visit Cost Sharing and Benefit Design in the New Health Insurance Marketplaces.  The report, based on Breakaway Policy Strategies data, examined the 1,208 silver plans in all 50 states and D.C. and found that cost-sharing for silver plans varies widely.  Co-payments for primary care physician visits can cost anywhere from $0 to $75 and from $10 to $150 for specialist visits.  Co-insurance rates for primary care visits can range from 0% to 50% and from 8% to 100% for specialist visits.

Health care costs continue to rise

According to a recent analysis:

  • The average health care cost per employee was $10,131 in 2012; $10,471 in 2013; and is projected to rise to $11,176 in 2014
  • The portion of the total health care premium that employees were asked to contribute was $2,200 in 2012; $2,303 in 2013; and is projected at $2,499 for 2014
  • Average employee out-of-pocket costs–including copayments, coinsurance and deductibles–averaged $1,984 in 2012; $2,239 in 2013; and are expected to rise to $2,470 in 2014
  • Employees’ share of health care costs—including employee contributions and out-of-pocket costs—will have risen from $2,011 in 2004 to $4,969 in 2014

Source: “Aon Hewitt Analysis Shows Lowest U.S. Health Care Cost Increases in More Than a Decade,” Aon Hewitt Press Release, October 17, 2013,

Average cost paid by an employee in 2012 for health care projected to be $4,581

The 2012 Average Health Care Premium Rate Increase will be Lower Than in 2011

Costs continue to rise for both employers and employees. The average healthcare premium is now projected to be $10,475. (That considers all family types – family, 2 party and single.) The employee contribution both to premium and to the costs paid by the patient at time of service is now on average $4,581.

According to Aon Hewitt’s analysis, the 2012 average health care premium rate increase will be 7.0 percent, which is slightly lower than the 7.5 percent mark in 2011, and on par with the 6.9 percent increase in 2010. However, the average total health care premium per employee for large companies is projected to be $10,475 in 2012, up from $9,792 in 2011, and $9,111 in 2010. The amount employees will be asked to contribute toward this premium cost in 2012 is $2,306, compared to $2,084 in 2011, and $1,952 in 2010 (or 21.4 percent of the total health care premium). Meanwhile, average employee out-of-pocket costs, such as copayments, coinsurance and deductibles, are expected to be $2,275 in 2012, compared to $2,007 in 2011, and $1,691 in 2010.

Source: Aon Corporation, October 3, 2011

Health care cost: Insurance premiums are only part of the story

Nationwide, private-sector employees with single coverage contributed 21 percent of the cost of their health insurance and employees with family coverage paid 27 percent.  Health insurance premiums nationwide averaged $4,940 for single coverage and $13,871 for family coverage in 2010.  [Source: Agency for Healthcare Research and Quality, MEPS, Statistical Brief #329: State Differences in the Cost of Job-Related Health Insurance, 2010.]

This translates into approximate cost for employees of $1,037 for single and $3,745 for family. However, that’s the premium contribution. What doesn’t appear to be counted is the costs paid by individuals through dedutibles, copayments or coinsurance when they receive care.


Office Copay Benchmarks

Office Visit Copay by Industry

A new research report published by HighRoads shows the average office visit copays for employees of fully insured employers by industry as follows:

  • 79% of transportation employees pay $25 or more in office visit copays
  • 69% of financial services employees pay $25 or more in office-visit copays
  • 97% of wholesale employees pay $20 or less in office-visit copays
  • 87% of services employees pay $20 or less in office-visit copays
  • 67% of manufacturing employees pay $20 or less in office visit copays
Source: High Roads, Company release. June 24, 2010.

Consumerism Begins to Have a Measurable Impact

Patients who understand health costs make good decisions
People who understood their health plan costs were more likely to see a physician and had fewer hospital emergency department visits, a study of Massachusetts workers found. The authors said that when people are aware of co-payments, premium payments and other health care costs they tend to use the health care system more efficiently. The Boston Globe/The Associated Press