Big plans use more coinsurance

By Allison Bell

January 07, 2014 at 10:06 AM

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Big group health plans may be more generous than smaller plans in some ways but tougher in others.

Karen Davis, a researcher at the federal Agency for Healthcare Research and Quality, has published data hinting at that conclusion in a summary of results from the 2012 Medical Expenditure Survey (MEPS).

Davis used the data to look at "cost sharing arrangements" — deductibles, co-pays and coinsurance levels — at group health plans.

Observers say employers have been trying to give plan members "more skin in the game" to get them to be better health care shoppers.

Davis found that the national average deductible for a private-sector employee with single coverage and a deductible was $1,167.

About 66 percent of private-sector employees must pay a co-pay for typical in-network office visits, and 27 percent must pay a coinsurance amount for an office visit.

About 80 percent of workers in plans of all sizes must reach a deductible before the plan starts paying for most types of care.

Only 62 percent of the workers in plans that cover more than 1,000 employees have to pay a co-pay for an in-network office visit, but 35 percent have to pay a coinsurance amount.

The situation seems to be different for workers at smaller companies. About 72 percent to 74 percent have to pay a co-pay for an office visit, but only 15 percent to 19 percent pay coinsurance amounts for office visits, according to the MEPS data.

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