Health Insurance Premiums, Out-of-Pocket Costs ‘Leap’ for Californians, Study Finds

Health insurance premiums rose 13% in California last year, and workers' out-of-pocket expenses for the year also increased because of rising health care costs and the slowing economy, according to a survey released Friday by the Kaiser Family Foundation and the Health Research and Educational Trust, the Sacramento Bee reports. The survey found that HMO membership increased 5% in 2002 to 54% of all Californians with health insurance, while membership in preferred provider organizations fell 9% (Rapaport, Sacramento Bee, 3/1). Nationally, insurance premiums rose 12.7%, and 26% of the nation's insured are enrolled in HMOs (Kaiser Family Foundation release, 2/28). "This rebound in popularity for HMOs reflects the growing difference in price between HMOs and other types of health plans, and it also tells us employers who buy insurance still see great value in managed care," Peter Lee, president of the Pacific Business Group on Health, said.

The survey also found that workers' share of the cost of insurance premiums in 2002 rose 30% to $342 a year for single coverage and $1,806 for family coverage. According to the survey, the number of workers who contributed $5 copayments for doctor visits dropped from 64% to 12%; in comparison, 75% of California managed care plan members paid $10 or $20 fees for visits in 2002. Tiered prescription drug benefits -- under which people pay a higher price for brand name drugs than for generic medications -- "gained ground" in California in 2002, with 74% of workers enrolled in some form of tiered drug plan, compared to 58% in 2000, the Bee reports. Copays for drugs not on an HMO preferred drug list rose to $20 in 2002 from $15 in 2001, the report found. "It's a trade-off between having high premiums, so sicker people don't pay too much out-of-pocket for care, or having low premiums by passing more costs to people who have many expensive medical needs," Gary Claxton, vice president of Kaiser's health care marketplace project, said (Sacramento Bee, 3/1).