Not Sure About Patients' Copays? Ask them Where They Work

Cheryl Clark, for HealthLeaders Media , June 25, 2010

If your patients don't know what their co-pays should be when they show up for care, ask them what they do for a living. That is of course a grave oversimplification. But a new report from a Boston-based health consultant, HighRoads, suggests that employees in some industries accumulate a lot more annual share of cost with in-network co-pays than do others.

For example, the report, which only focuses on self-funded, or employer-based plans, says:

  • 79% of transportation industry and 69% of financial services employees pay $25 or more for office visits.
  • 97% of wholesale employees, 87% of service employees and 67% of manufacturing employees pay $20.

This variation "points to an increasing volatility in plan designs for those industries pushing a greater share of cost to their employees and families," says Josh Miley, principal of HighRoads.

HighRoads manages an employer benefits database with more than 9,000 health plans.

Across all fully insured plans, HighRoads says, 2010 monthly premiums average $380 for a single employee, $788 for an employee plus one, $726 for an employee plus children and $1,133 for a family.

Also across all fully insured plans, office visit co-pays have a median cost of $20, specialist office visits at $30, inpatient hospital co-pay is $250, an emergency room co-pay is $75 and infertility treatment requires cost-sharing of 50%.

The report shows that there is significant regional difference in co-pays paid by health plan enrollees. For example, in the Northeast, co-pays range from $10 to $30, with 66% paying $20. But in the Midwest, co-pays vary much ore, from $3 to $35, with 17% paying $10, 9% paying $15, 15% paying $20, 23% paying $25, 15% paying $30 and 11% paying $35. Variation for the South and West were not detailed.

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