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

This is the third of three posts on this subject

In our last post, we showed that the cost sharing for urgent care tends to be more generous than the cost sharing for emergency room visits. In this post, we investigate how that difference in cost sharing between emergency rooms and urgent care has changed over time.

The data science team at Vericred analyzed the benefit designs for health insurance plans on the individual and small group ACA markets from 2015 to 2018 to see the how the difference in the way the costs for emergency room and urgent care are split between individuals and their health insurance companies has changed over time. The results show that over the past few years, insurance companies have become increasingly more likely to share cost before the deductible for urgent care than for the emergency room. This difference in the cost sharing structure between emergency rooms and urgent care is increasing over time for both audiences and all metal levels.* Urgent care clinics have become increasingly common in the past few years, and insurance companies may be shifting increasing portions of the cost of emergency room visits onto consumers in order to restrain costs by encouraging a shift in usage away from emergency rooms and toward the lower cost urgent care clinics.

Consumers and policy makers should keep an eye out as the 2019 open enrollment period approaches to see how insurance companies continue to modify their benefits in this shifting dynamic between provider types.

* Platinum and catastrophic plans excluded. Catastrophic plans typically have a deductible equal to the out of pocket maximum, which removes cost-sharing variation. Platinum plans often have a $0 deductible, meaning there is no distinction between before and after the deductible.

 

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