Small Groups Face Skyrocketing PPO Deductibles

April 30, 2004 at 08:00 PM
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NU Online News Service, April 30, 2004, 6:12 p.m. EDT – Health plan deductibles tend to be much higher at small employers than at large employers.[@@]

Researchers from the Health Research and Educational Trust, Washington, come to that conclusion in a new report published by The Commonwealth Fund, New York.

The researchers, Jon Gabel and Jeremy Pickreign, analyzed PPO plan data from other organizations and found that carriers are charging employers with 3 to 199 workers an average of $286 per month for single coverage and an average of $746 per month for family coverage.

The monthly premium charges are similar at employers with 200 or more workers. There, the average monthly cost is $280 for single workers and $761 for families.

Between 2002 and 2003, the average premium cost went up an average of 15.5% at the small employers. The average 13.2% cost increase at large employers was only slightly more bearable.

But the researchers found a huge difference in deductibles.

For in-network care, the average PPO deductible was $209 at large employers and $419 at large employers.

For out-of-network care, the average deductible was $458 at large employers and $783 at small employers.

The PPO deductible gap may be getting worse.

"During periods of rapid premium increases, small firms appear more subject to ?buy downs,'" the HRET researchers write.

The average PPO deductible for in-network care went up only 33% between 2000 and 2003 at large employers, but it went up 100% at small employers, according to the researchers' data.

The researchers also found that small employers tend to be more generous when it comes to paying for single workers' care and less generous when paying for family coverage.

At employers with 3 to 24 workers, 62% of the single workers pay no premiums at all, and only 18% pay more than 20% of the premium bill, the researchers report.

But at large employers, 33% of the single workers pay more than 20% of the cost of premiums.

When employers offer family coverage, the share of workers who pay more than 20% of the premium cost is 56% at large employers and 62.5% at small employers, the researchers report.

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