VeriStat: Cost Sharing for Emergency Rooms Versus Urgent Care: Part II of III

This is the second of three posts on this subject

As we discussed in our previous post, emergency room visits are not only one of the most common interactions people have with our healthcare system, but they can be quite expensive for both individuals and their insurance companies. In recent years, urgent care clinics have emerged as a cheaper alternative to the emergency room for less severe conditions like the flu and injuries that occur outside traditional providers’ business hours and for folks without a regular doctor. In our analysis, we showed that insurance companies are more likely to share costs before the deductible for urgent care than for the emergency room. In this post, we take a deeper look at the structure of that cost sharing.

The data science team at Vericred analyzed the benefit designs for silver plans on the individual market to investigate how cost sharing between individuals and their health insurance companies is structured for emergency rooms versus urgent care. The results show that the most common type of cost sharing for emergency room visits is a coinsurance that applies only after the deductible has been met (median: 25%). This means that an individual would pay the full cost until her deductible is met, then a set percentage of the emergency room charges above that. In contrast, the most common type of cost sharing for urgent care is a copay that applies regardless of the deductible (median: $75). This means that an individual would pay a flat dollar amount regardless of the charges for the urgent care visit and whether or not she has met her deductible.

In advance of finding yourself footing a costly bill, it’s worth checking your insurance coverage to see the difference in the way emergency room and urgent care visits are covered. You may end up significantly reducing your healthcare expenses should you experience an urgent medical condition when the option to see your doctor is not available.

 

Part II_VeriStat - ER vs UrgentCare-2

*Updated on 10/17/2018

 

This is the second of three posts; in the next post, we will investigate how the difference in emergency room cost sharing has changed over time.