HMO enrollees are paying higher co-pays for office visits, drugs, and emergency room visits this year, and more hikes are expected next year as employers face another wave of double-digit premium increases, says a survey issued today by Hewitt Associates.
Typical co-pays for HMO enrollees at large employers are now $15 for office visits, $20 for brand-name formulary drugs, $30 or more for brand-name nonformulary drugs, $10 for generic drugs and $50 or more for ER visits, according to Hewitt, a human resources consulting firm based in Lincolnshire, Ill.
Meanwhile, Hewitt says large employers report that HMO premiums for 2004 will rise 17.7%, only somewhat lower than a 21% rise in 2003.
"Continued increases at these levels remain unaffordable for the majority of employers," says Ken Sperling, East market leader for Hewitt's Health Management Practice, in a release. "So we expect companies to continue making aggressive plan design and employee contribution changes for the future."
The company bases its report on the Hewitt Health Resource, a Web site that captures HMO rate information for nearly 140 large employers with more than 1 million employees and annual premiums of nearly $4 billion.
The report shows how large employers have been raising HMO co-pay amounts:
- Use of $15 co-pay for primary care office visits rose from 24% of companies in 2002 to 43% in 2003.
- Use of a $15 co-pay for specialty office visits rose from 25% in 2002 to 40% in 2003, with 12% of companies introducing a $20 co-pay.
- Use of a $20 co-pay for brand-name formulary drugs rose from 26% in 2002 to 32% in 2003.
- Use of a $30 co-pay for brand-name nonformulary drugs actually fell somewhat, from 22% in 2002 to 19% in 2003, but 24% of companies now use a co-pay of more than $30 in this category.
- Use of a $10 co-pay for generics rose from 40% in 2002 to 52% in 2003.
- Fifty-five percent of companies use a $50 co-pay for emergency room visits, while 16% use a co-pay of more than $50, doubling from just 7% in 2001.