Analysis: Workers' out-of-pocket health costs growing faster than payments for care by health plans

Out-of-pocket healthcare costs including deductibles and coinsurance have risen significantly faster for workers covered by their employer's health plans, than costs paid by insurers for care, according to a new Kaiser Family Foundation analysis.

For the analysis, the Kaiser Family Foundation looked at a sample of claims obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database. They used a sample of between 785,000 and 15.3 million enrollees per year to analyze the change from 2004 to 2014 in average health costs for covered benefits overall, the average amount paid by health benefit plans, and the average amounts attributable to deductibles, copayments and coinsurance. 

Here are three findings from the analysis.

1. Overall, workers' out-of-pocket costs increased 77 percent, from an average of $422 in 2004 to $747 in 2014, while average payments by health plans increased 58 percent, from $2,748 to $4,354. This reflects a slight decline in the average generosity of health plans — large employer plans covered 86.7 percent of covered medical expenses on average in 2004, compared to 85.3 percent in 2014. Workers' wages increased by 32 percent from 2004 to 2014.

2. Between 2004 and 2014, the average deductible payment increased 256 percent, from $99 to $353, and the average coinsurance payment increased 107 percent, from $117 to $242, the analysis found. The average payments for copays fell by 26 percent, from $206 to $152. 

3. Deductibles accounted for 24 percent of cost-sharing payments in 2004, compared to 47 percent in 2014, the analysis found. Conversely, copayments accounted for almost 50 percent of cost sharing payments in 2004, compared to 20 percent in 2014.


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