SECTION7. EMPLOYEECOSTSHARING COSTSHARINGFORPHYSICIANOFFICEVISITS • Themajorityofcoveredworkersareenrolledinhealthplansthatrequirecostsharingforanin-networkphysicianoffice 2 visit, in addition to any general annual deductible. – Themostcommonformofphysicianofficevisitcostsharingforin-networkservicesiscopayments. Seventy-one percentofcoveredworkershaveacopaymentforaprimarycarephysicianofficevisitand22%havecoinsurance. Forofficevisitswithaspecialtyphysician,67%ofcoveredworkershavecopaymentsand26%havecoinsurance [Figure 7.36]. – Overthelastfiveyears,thepercentageofcoveredworkerswithcoinsuranceforofficevisitswithaspecialisthas risen from19%to26%. – CoveredworkersinHMOs,PPOs,andPOSplansaremuchmorelikelytohavecopaymentsforbothprimarycare andspecialtycarephysicianofficevisitsthanworkersinHDHP/SOs. Forprimarycarephysicianofficevisits,62% of coveredworkersinHDHP/SOshavecoinsurance,18%havenocostsharingafterthegeneralannualplan deductibleismet,and18%havecopayments[Figure7.36]. – Amongcoveredworkerswithacopaymentforin-networkphysicianofficevisits,theaveragecopaymentis$25for primarycareand$38forspecialtyphysicianofficevisits[Figure7.37],similartotheamountslastyear. – Amongcoveredworkerswithcoinsuranceforin-networkphysicianofficevisits,theaveragecoinsuranceratesare 19%foravisitwithaprimarycarephysicianand19%foravisitwithaspecialist[Figure7.37],similartotherates 2 Starting in 2010, the survey asked about the prevalence and cost of physician office visits separately for primary care and specialty care. Prior to the 2010 survey, if the respondent indicated the plan had a copaymentforofficevisits,weassumedtheplanhadacopaymentforbothprimaryandspecialtycarevisits. Thesurveydidnotallowforarespondenttoreportthataplanhadacopaymentforprimarycarevisitsandcoinsuranceforvisitswithaspecialistphysician. Thechangesmadein2010allowforvariationsinthetypeofcostsharingforprimarycareandspecialtycarevisits. Thesurveyincludescostsharingfor in-networkservicesonly. The Kaiser Family Foundation and Health Research & Educational Trust / Page 123