U.S. average coinsurance rate 20 percent

March 27, 2013 at 3:05 PM   |   Comments

SUNNYVALE, Calif., March 27 (UPI) -- U.S. family and individual health plan consumers pay, on average, 20 percent of the cost of relatively expensive services, a private industry survey found.

Kev Coleman, head of Research & Data at HealthPocket -- which compares health plans -- said coinsurance is a method of insurance plan cost-sharing for more expensive services, including hospitalization, surgery, child birth and hospital emergency room care.

The analysis showed the plans with the highest average coinsurance rate -- above 40 percent -- also had the highest average annual limit on out-of-pocket expenses for enrollees.

Almost 10,000 health insurance plans were examined and a quarter of the plans with coinsurance had rates higher than the national average, Coleman said.

The lowest range of up to a 10 percent coinsurance rate corresponded to an average out-of-pocket limit of $4,286 while the highest range of above 40 percent corresponded to an average limit of $8,825.

"This is definitely a situation of buyer beware, particularly if people assume that a plan with a low premium but high coinsurance translates into less money out of their pockets in a given year. A serious medical episode could completely change the financial impact of the health plan," Coleman said in a statement. "Starting in 2014, cost transparency will be even more critical given that health plans will be designed around what percentage of medical costs the consumer is expected to pay. Consumers will need not only to understand how much of their costs are covered by their health plan but what their healthcare providers charge for the services they use."

The findings are at http://www.healthpocket.com/healthcare-resources/high-coinsurance-health-plans-poor-protection-against-medical-expenses#.UVMx4ByG260.

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