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Cost Sharing in State Health Plans (2001)

By Ginny Cady

The Department of Research and Collective Bargaining Services has surveyed cost-sharing provisions in state health plans in several collective bargaining states. The following tables show the results of the survey thus far. Please contact us if you can provide information on states not included in the tables.

Table 1 shows the premiums and cost sharing for the most popular Preferred Provider Option (PPO) plan in each surveyed state. In a few states, premiums are shown for an indemnity, Point of Service (POS) or HMO plan because they are clearly the most populated plan. In some cases, premiums vary significantly. Large cost differences may occur because benefit levels vary among surveyed plans and because health care costs tend to vary geographically. On average, surveyed employees contribute 7.8 percent of the single premium and 12.8 percent of the family premium.

Table 2 shows the deductibles, co-payments and out-of-pocket maximums in the surveyed plans. This table also lists the type of plan for which the cost-sharing provisions apply. All of the PPO and POS plans attempt to steer employees to in-network services through higher cost-sharing provisions for out-of-network services. Of the 12 surveyed states with PPO or POS plans, seven impose higher deductibles for out-of-network services. Employees must pay higher co-payments for out-of-network services in all of the POS and PPO plans except in Oregon. Seven of the surveyed plans have higher maximum out-of-pocket amounts for non-network service than for services obtained in-network.

Table 3 provides information on prescription drug co-payments. As with the premiums, these costs vary widely from plan to plan. Six of the surveyed states use formularies. In a few states, employee costs are capped at some point through separate prescription drug out-of-pocket maximums. Because prescription drug costs are rising sharply, this is where we are seeing the most significant increases in employee cost sharing.

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