Why is Employee Demand for these Coverages Rising?
Soaring Out-of-Pocket Maximums
Most workers also face additional cost sharing for a hospital admission or outpatient surgery. After any general annual deductible is met, 68% of covered workers have coinsurance and 14% have a copayment for hospital admissions. The average coinsurance rate for a hospital admission is 20% and the average copayment is $326 per hospital admission. The cost-sharing provisions for outpatient surgery follow a similar pattern to those for hospital admissions. While almost all (99%) covered workers are in plans with a limit on in-network cost sharing (called an out-of-pocket maximum) for single coverage, there is considerable variation in the actual dollar limits. Twelve percent of covered workers in plans with an out-of-pocket maximum for single coverage have an out-of-pocket maximum of less than $2,000, while 20% have an out-of-pocket maximum of $6,000 or more.
- 6 in 10 Single Plans have a $3,000 Out-Of-Pocket Max
- 1 in 5 Single Plans have a $6,000 Out-Of-Pocket Max
- $4,065 is the Average Out-of-Pocket Max
Further evidence of the need for voluntary benefits:
The majority of Americans are worried about being able to afford surprise medical bills.
How worried, if at all, are you about being able to afford each of the following for you and your family?
On average, 18% of emergency visits result in at least one out-of-network charge, but the rate varies by state.
The percentages shown are among people with large employer coverage, the share of emergency visits with at least one out-of-network charge, 2017.