Cost-Sharing On the Rise Among Workers with Employer-Sponsored Health Insurance

Cost-sharing is growing among individuals with employer-sponsored health insurance. According to an article published by Peterson-Kaiser Health System Tracker, workers are spending more out-of-pocket on their healthcare than insurers are paying.

Researchers found that the average deductible increased from $303 to $1077 between the years 2006 and 2014.

In order to find what workers spent out-of-pocket for covered services, researchers analyzed claims from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database from 2004 to 2014.

Data was used from individuals enrolled for over 6 months. There were 785,000 individuals included in 2004 and ended with over 15.3 million in 2014.

Average health costs for covered benefits, average amount paid by healthcare plans, and average amount attributable to deductibles, copayments, and coinsurance were all analyzed.

Researchers found that during this time period, average copayments decreased while average deductible payments increased significantly.

In addition, patient cost-sharing increased much faster than payments for care by employer-sponsored plans.

According to the data, the average payments by enrollees towards deductibles increased 256% from $99 in 2004 to $353 in 2014.

Average coinsurance rose 107% from $117 to $242, whileaverage copays decreased 26% from $206 to $152.

Patient cost-sharing increased during this time by 77% from $422 to $747.

Average payments by healthcare plans increased 58% from $2748 to $4353.

Employer plans covered 86.7% of covered medical expenses in 2004 and the average decreased to 85.3% in 2014. Researchers described these results as a decline in the generosity of insurance.

Researchers also stated that an increase in payments towards deductible is clear.

In 2004, deductibles accounted for 24% of cost-sharing payments in 2004 and 47% in 2014. On the other hand, copays accounted for almost half of cost-sharing payments in 2004 and only 20% in 2014.

The increase in coinsurance is possibly due to plans that allow patients to create a health savings account, according to the article.

With these plans, patients are likely to have coinsurance for physician’s care rather than copayments. This makes patients more vulnerable to healthcare costs.

Researchers state that patients are showing an increased concern about out-of-pocket costs because deductibles are extremely visible. Even though health insurance pays a large portion of cost under the covered benefits, patients are still paying higher out-of-pocket expenses, the article concluded.