Primary care benefits may blunt impact of rising deductibles

Although patients with work-sponsored insurance plans are having to pay more out of pocket to see a doctor, experts say that might not indicate, as it did in the past, that they will try to avoid medical care for as long as possible.

Deductibles are going up, but a higher proportion of plans provide coverage of primary care office visits without patients having to meet those deductibles, according to a Nov. 12 brief from the Kaiser Family Foundation, which gathered data from 2,121 companies with three staffers or more. In addition, the Affordable Care Act requires many insurance plans to cover preventive services with no out-of-pocket cost to a patient. Many of these services are provided in the primary care setting.

“It’s a smart insurance design,” said Cathy Schoen, senior vice president of the Commonwealth Fund. “You want to encourage people to get preventive care, and primary care visits are not very expensive. You want patients to stay connected to primary care.”

Deductibles continue to grow because companies are trying to hold down premiums, according to the Kaiser brief. The average deductible for individual coverage went up from $991 in 2011 to $1,097 in 2012, a total that has nearly doubled since 2006. The percentage of workers in a individual-coverage plan with a general annual deductible of at least $1,000 for individual coverage grew from 31% in 2011 to 34% in 2012, a total that has more than tripled since 2006. The proportion with an annual general deductible for individual coverage of $2,000 or more went from 12% in 2011 to 14% in 2012, a total that has gone up almost five times the percentage of 2006.

However, having to meet a deductible during the past few years has become a less common issue in access to primary care services, both for prevention and illness care. The percentage of covered workers in an HMO plan with no deductible for those visits grew from 77% in 2008 to 84% in 2011, and up to 87% in 2012. PPO plan holders had seen their first-dollar preventive services coverage fall from 76% in 2008 to 70% in 2010, but that number increased to 78% in 2012.

Between the ACA and employers’ desire to get workers in for lower-cost primary care services, rather than letting them wait to see a doctor until they are really sick, the goal is for deductibles to reduce health care costs without blocking people from what they actually need. For instance, an analysis in the May issue of Health Affairs found that high-deductible plans could lower the cost of outpatient care by 18.2% but also cut cervical cancer screening by 4.7% and colorectal cancer testing by 2.8%.

Although deductibles are increasing, the percentage of workers with employer-sponsored, individual-coverage health insurance involving any general annual deductible dropped slightly to 72% in 2012 from 74% in 2011. The number had grown from 52% in 2006. Kaiser researchers say it is too soon to determine whether the slight decline from 2011 to 2012 is a plateau or an indication that general deductibles will become less common over the long term. Consultants believe the number of companies offering this type of insurance may have maxed out, along with the number of employees willing to sign on.

Most companies are expected to continue to offer health insurance to employees as health system reform rolls out. Eighty-eight percent said they had no plans to end health care plans for full-time workers, according to a survey of 440 companies with 6.6 million employees released on Aug. 27 by Towers Watson, a global human resources consulting firm, for the National Business Group on Health. This represented an increase from the 71% who said the same in 2011.

Consultants said these workplace insurance trends may accelerate the return of patients to primary care practices. Various surveys have found physician office visits slowly ticking upward after they fell in 2010 and 2011 as the economy recovered from the deep recession of December 2007 to June 2009.