Healthcare Costs Up 7.8% for PPO Plans; Miami, New York City Most Expensive

Cheryl Clark, for HealthLeaders Media , May 13, 2010

Of the $18,074 total average cost for a family of four, the employer paid about 59% while the employee paid 24% in employee contributions and 17% in out-of-pocket costs such as co-pays, deductibles, and other time-of service charges.

For employers, the report explains, "Healthcare costs continue to increase at rates exceeding most other costs of doing business .... For the near term, the underlying drivers of increasing healthcare costs are not expected to immediately change."

Also, the report says, "For now, the onus of control remains with insurers, who will attempt to put pressure on providers to lower costs to a level that approved premium rates can support. There may be more extensive shifts in market dynamics in 2014, when the government takes on an even larger proportion of payment responsibility due to expansion in Medicaid, the creation of exchanges, and the availability of subsidies for certain lower-income individuals."

However, the report says, some immediate changes from healthcare reform, such as increasing dependent coverage up to age 26 and elimination of lifetime and annual benefit maximums, will cause a direct shift in costs from employees to employers.

Because specifics about new legislation have not yet been defined, the Milliman report says, "many employers are choosing to delay changes to their benefit plans for future annual benefit cycles, although it is very possible that these changes could be dramatic."

The Milliman's Group Health Insurance Survey is an 18-year-old effort that provides a way to measure rate levels and experience for a uniform population and benefit design for HMOs, PPOs, and consumer-driven health plans.

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