Chartbook Section 4
Individual & Small Group
Health Insurance Markets
1
Section 4: Individual and Small Group
Health Insurance Markets


Individual market trends
 Enrollment
 Premiums
 Health plan market shares
 Benefits
Small group market trends
 Enrollment
 Premiums
 Health plan market shares
 Benefits
A summary of the charts and graphs contained within is provided on the MDH website. Direct links are
listed on each page. Please contact the Health Economics Program at 651-201-3550 or
[email protected] if additional assistance is needed for accessing this information.
2
INDIVIDUAL (NON-GROUP)
MARKET
A health insurance market where individuals purchase health insurance coverage
directly; plans can cover one person (single coverage) or dependents (family
coverage). Referred to as the individual or non-group market, because plans are
purchased by an individual rather than as part of a group.
Enrollment Trends in Minnesota’s Individual Market,
2002 to 2016
350,000
237,711
296,665
294,206
247,911
247,315
249,380
251,798
250,589
246,190
244,040
234,804
221,620
150,000
192,942
200,000
204,376
250,000
248,633
300,000
100,000
50,000
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Source: MDH Health Economics Program; Health Plan Financial and Statistical Report and National Association for Insurance Commissions (2016 only).
Summary of Graph
4
Premium Increases in Minnesota’s Individual Market,
2002 to 2016
23.7%
25%
20%
19.5%
17.2%
15%
11.2%
10%
8.6%
7.0%
6.1%
5%
3.4%
1.0%
4.9% 5.2% 5.2%
2.2%
3.3%
0%
-1.1%
-5%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Source: MDH Health Economics Program; Health Plan Financial and Statistical Report and National Association for Insurance Commissioners (2016
only). Based on total per-member-per-month premiums collected.
Summary of Graph
5
Health Plan Market Shares:
Individual Market, 2013 to 2016
$1,200
0.9%
Total Premiums ($ millions)
$1,000
$800
$600
1.3%
14.6%
9.8%
27.1%
6.0%
2.8%
0.6%
4.1%
0.2%
65.5%
0.0%
3.2%
16.7%
6.0%
6.9%
76.3%
$400
$200
5.6%
10.8%
2.8%
1.8%
2.1%
0.0%
0.2%
17.6%
62.1%
54.8%
$-
2013
Premium Volume:
$705 million
Blue Cross Blue Shield of MN
2014
Premium Volume:
$980 million
HealthPartners
Medica
2015
Premium Volume:
$1,074 million
PreferredOne
UCare
2016
Premium Volume:
$1,128 million
Assurant
Other
Note: Companies with common ownership have been combined for purposes of this analysis.
Source: MDH Health Economics Program; Health Plan Financial and Statistical Report and National Association of Insurance Commissioners (2016
only). Market share is based on percent of total premiums collected.
Summary of Graph
6
Individual Market Enrollment by Metal Level On and
Off Exchange, 2014
Off Exchange
On Exchange (MNsure)
0.6%
2.0%
12.9%
22.5%
28.0%
26.8%
30.8%
12.3%
36.6%
27.6%
Platinum
Gold
Silver
Bronze
Catastrophic
Note: All plans have an actuarial value (AV), which estimate the percent of health care costs the plan will coverage for an average consumer. As of
2014, metal levels were assigned based off the plan AV. Platinum represents an AV of 90%, Gold 80%, Silver 70%, Bronze 60%, and Catastrophic
<60%. Enrollment by metal level excludes grandfathered plans. Plans could be purchased from the state’s health insurance exchange, MNsure, or
directly from a health plan or broker (off-exchange).
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
7
Grandfathered Status Product Enrollment in the
Individual Market, 2011 to 2014
(by total share of enrollment)
80%
65.1%
60%
43.7%
40%
20%
0%
12.4%
2011
2013
Note: With the exception of slide 7, all slides contain grandfathered plans.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2014
8
Distribution of Per Person Annual Deductibles in
the Individual Market, 2002 to 2014
(by share of total enrollment)
100%
75%
50%
25%
0%
$6,350+
$4,001 to $6,350
$2,501 to $4,000
$1,251 to $2,500
$501 to $1,250
$1 to $500
No Deductible
2002
1.2%
6.6%
1.1%
29.9%
31.0%
27.9%
2.4%
2005
2.2%
8.8%
8.1%
39.7%
24.7%
15.4%
1.2%
2007
4.0%
16.2%
25.7%
32.9%
14.5%
6.4%
0.4%
2009
9.9%
25.6%
26.5%
22.6%
11.9%
3.5%
0.1%
2011
9.8%
21.4%
37.1%
21.7%
6.1%
1.8%
2.3%
2013
14.5%
23.2%
39.2%
17.4%
4.3%
1.4%
0.1%
2014
1.2%
28.8%
24.0%
25.7%
12.2%
4.1%
4.1%
Note: Category distribution excludes those in plans that are only available as family-only coverage and those in plans with a “per sickness” deductible,
as deductibles in these plans cover more than one person, or are not based on a calendar year.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
9
Average and Range for Per Person Annual Deductibles
in the Individual Market, 2002 to 2014
(by share of total enrollment)
30,000
25,000
20,000
15,000
10,000
5,000
-
2002
2005
Maximum & minimum
deductibles
2007
2009
75% of all deductibles
2011
2013
2014
Average deductible
Note: Category distribution excludes those in plans that are only available as family-only coverage and those in plans with a “per sickness” deductible,
as deductibles in these plans cover more than one person, or are not based on a calendar year.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
10
Family Level Annual Deductibles in the
Individual Market, 2002 to 2014
100%
75%
50%
25%
0%
$12,700+
$10,001 to $12,700
$6,351 to $10,000
$4,001 to $6,350
$2,501 to $4,000
$1,251 to $2,500
$501 to $1,250
$1 to $500
No Deductible
2002
7.2%
0.0%
1.6%
26.0%
17.2%
28.3%
13.6%
3.7%
2.4%
2005
9.8%
0.1%
4.6%
33.0%
27.1%
17.6%
4.5%
1.0%
2.4%
2007
12.7%
0.7%
9.6%
50.6%
17.1%
7.6%
1.2%
0.0%
0.5%
2009
8.9%
10.2%
12.8%
48.7%
16.9%
2.0%
0.4%
0.1%
0.1%
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2011
15.7%
9.8%
31.2%
28.3%
12.1%
2.5%
0.4%
0.1%
0.0%
2013
20.0%
11.0%
31.4%
27.6%
7.7%
1.8%
0.2%
0.1%
0.2%
2014
3.0%
23.8%
17.1%
17.8%
19.9%
10.3%
0.1%
3.8%
4.3%
11
Distribution of Family Level Deductibles in the
Individual Market, 2002 to 2014
50,000
40,000
30,000
20,000
10,000
-
2002
2005
Maximum & minimum
deductibles
2007
2009
75% of all deductibles
For 2011, the maximum family deductible was $150,000.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2011
2013
2014
Average deductible
12
Individual Market Enrollment in High Deductible
Health Plans with Health Savings Account Eligibility,
2005 to 2014
60%
40%
20%
37.7%
40.8%
25.4%
18.7%
0%
2005
45.6%
40.2%
2007
2009
2011
2013
2014
Note: This is the percent of plans that are Qualified High Deductible Health Plans, as determined by the Internal Revenue Service (for 2014 the
minimum deductible is $1,250), and have the option to be paired with a Health Savings Account (HSA). The proportion of people with and HAS is
unknown. In the 2009 survey firms did not reliably report on HSA pairing, therefore the portion of HDHP plans was determined using only the IRS
minimum deductible guideline. In 2011, the plans identified whether it was a HDHP plan. This difference in reporting methodology may be reflected
in the 2011 total.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
13
Office Visit Cost-Sharing Requirements in the
Individual Market, 2002 to 2014
(by share of total enrollment)
2002
2005
2007
2009
2011
2013
2014
No Cost Sharing
25.8%
36.4%
46.8%
60.1%
56.4%
50.0%
56.5%
Copayment
5.5%
0.9%
1.7%
0.0%
7.7%
11.0%
15.8%
Coinsurance
68.3%
62.7%
50.2%
39.8%
30.5%
21.7%
13.9%
Copayment & Coinsurance
0.5%
0.0%
1.3%
0.2%
5.5%
17.3%
13.8%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
Total
Note: Plans with only a deductible and no copayment or coinsurance are included in No Cost Sharing.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
14
Cost-Sharing Requirements for Hospitalization in
the Individual Market, 2002 to 2014
(by share of total enrollment)
2002
2005
2007
2009
2011
2013
2014
10% Coinsurance
33.0%
41.1%
48.9%
0.0%
0.4%
0.0%
0.9%
20% Coinsurance
64.6%
58.1%
45.7%
35.1%
31.4%
26.1%
14.6%
Greater than 20% Coinsurance
0.8%
0.8%
3.8%
3.2%
3.6%
12.5%
8.2%
Copayment
1.6%
0.0%
0.0%
4.0%
1.2%
0.0%
1.4%
Copayment & Coinsurance
0.0%
0.0%
0.3%
1.6%
0.6%
0.4%
4.0%
No Cost Sharing
0.0%
0.0%
1.3%
56.1%
62.9%
61.0%
71.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
Total
Note: Plans with only a deductible and no copayment or coinsurance are included in No Cost Sharing.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
15
Deductible Levels and Cost-Sharing for Office Visits in
the Individual Market
2013
2014
50%
0%
23.8%
37.5%
20.3%
16.1%
10%
8.7%
20%
27.6%
27.7%
30%
19.1%
15.9%
16.4%
15.1%
1.6%
0%
0.2%
10%
2.9%
20%
37.9%
30%
Cost Sharing
40%
28.2%
35.1%
Cost Sharing
No Cost Sharing
5.8%
40%
46.7%
No Cost Sharing
13.4%
50%
Under
$1,000
$1,000 to $2,000 to $3,000 to $4,000 or
$1,999
$2,999
$3,999
more
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
16
Under
$1,000
$1,000 to $2,000 to $3,000 to $4,000 or
$1,999
$2,999
$3,999
more
Per Person Out-of-Pocket Limits in the
Individual Market, 2002 to 2014
(by share of total enrollment)
100%
80%
60%
40%
20%
0%
Over $6,350
$4,501 to $6,350
$2,501 to $4,500
$1,201 to $2,500
Less than $1,200
2002
1.3%
8.0%
26.6%
54.7%
9.5%
2005
3.8%
8.9%
27.6%
56.8%
2.9%
2007
6.2%
16.6%
35.7%
40.6%
1.0%
2009
14.1%
25.6%
35.3%
24.5%
0.6%
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2011
16.3%
22.9%
41.3%
18.0%
1.6%
2013
20.2%
18.9%
46.4%
14.4%
0.1%
2014
2.8%
40.1%
24.7%
22.1%
10.3%
17
Family Level Out-of-Pocket Limits in the
Individual Market, 2002 to 2014
(by share of total enrollment)
100%
80%
60%
40%
20%
0%
Over $12,700
$9,001 to $12,700
$6,001 to $9,000
$2,501 to $6,000
Less than $2,500
2002
7.4%
0.7%
6.2%
68.1%
17.6%
2005
11.9%
4.6%
27.0%
54.5%
2.1%
2007
13.8%
11.0%
19.8%
55.4%
0.1%
2009
11.9%
18.4%
12.1%
57.2%
0.5%
2013
24.8%
19.1%
33.3%
22.7%
0.2%
2014
5.0%
40.9%
17.0%
27.2%
9.8%
Note: Family out of pocket maximums were not gathered in the 2011 Small Group and Individual Market Survey. Includes Grandfathered plans.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
18
Number of Tiers for Prescription Drug Benefits in the
Individual Market, 2002 to 2014
(by share of total enrollment)
100%
80%
25.4%
23.4%
8.3%
6.7%
16.6%
14.7%
38.9%
28.4%
51.5%
60%
40%
74.6%
76.7%
85.0%
68.8%
47.9%
65.4%
43.2%
20%
0%
13.3%
2002
2005
2007
One Tier
Two Tiers
2009
2011
6.2%
5.4%
2013
2014
Three (or more) Tiers
Note: Due to changes in regulations, all individual market plans offered prescription drug coverage as of 2013. Prior to 2013, over 95%
of people were enrolled in plans with some prescription drug coverage.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
19
Individual Market Enrollees with a Separate
Prescription Drug Deductible, 2002 to 2014
100%
75%
50%
79.4%
88.5%
90.1%
93.5%
94.7%
2005
2007
2009
2011
89.8%
81.3%
25%
0%
2002
Note: Separate Prescription Drug Deductible may be $0.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2013
2014
20
Out-of-Pocket Limits for Prescription Drugs in the
Individual Market, 2002 to 2014
(by share of total enrollment)
2002
2005
2007
2009
2011
2013
2014
No Separate Prescription Drug Outof-Pocket Limit
96.9%
100.0%
96.1%
96.0%
97.6%
98.5%
99.2%
Separate Prescription Drug Out-ofPocket Limit1
3.1%
0.0%
3.9%
4.0%
2.4%
1.5%
0.8%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
Total
1 General
health plan out-of-pocket limits apply.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
21
Lifetime Limit on Benefits in the Individual
Market, 2002 to 2014
(by share of total enrollment)
100%
80%
60%
40%
20%
0%
Less than or equal to $2 million
$2 million to $4 million
$4 million to $6 million
$6 million or greater
Unlimited
2002
7.7%
59.3%
21.1%
0.0%
12.0%
2005
8.9%
73.0%
18.1%
0.0%
0.0%
2007
11.3%
1.7%
83.7%
0.0%
3.3%
2009
6.9%
2.1%
88.5%
0.4%
2.2%
2011
7.0%
0.0%
6.6%
0.0%
86.3%
Note: This data was not collected with the most recent survey due to health reform’s removal of lifetime and annual benefit limits.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2014
0.0%
0.0%
0.0%
0.0%
100.0%
22
Loss Ratio Experience in the Individual Market,
2000 to 2015
200%
180%
160%
140%
120%
100%
80%
60%
40%
20%
0%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Total Market
BCBSM
Assurant
HealthPartners
PreferredOne
Medica
Statutory Minimum
Note: Companies with common ownership have been combined for purposes of this analysis. Data was not available in 2015 for PreferredOne.
Source: Minnesota Department of Commerce, "Report of 2015 Loss Ratio Experience for Health Plan Companies" October, 2016. Loss Ratios and
statutory minimums presented are State Loss Ratios.
Summary of Graph
23
SMALL GROUP MARKET
Health insurance coverage purchased for employees by employers with 2 to 50
employees.
Enrollment Trends in Minnesota’s Small Group Health
Insurance, 2000 to 2015
261,032
322,671
327,683
341,479
359,775
294,803
200,000
383,194
300,000
408,535
424,660
437,493
446,856
449,890
451,862
469,474
491,079
400,000
483,665
500,000
100,000
-
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Fully Insured market only.
Source: MDH Health Economics Program; Health Plan Financial and Statistical Report.
Summary of Graph
25
Percent Change in Premiums Per Member in
Minnesota’s Small Group Market, 2000 to 2015
20% 19.6%
16.5%
15%
14.0%
11.2%
10%
7.0%
5%
0%
5.0%
5.7% 5.6%
5.2%
5.3% 5.5%
3.7%
2.7%
0.4%
0.9% 0.8%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Fully Insured market only.
Source: MDH Health Economics Program; Health Plan Financial and Statistical Report. Based on total per-member-per-month premiums collected.
Summary of Graph
26
Health Plan Market Shares:
Small Group Market, 2013 to 2015
Total Premiums ($ millions)
$1,400
$1,200
$1,000
$800
2.6%
5.6%
3.0%
16.4%
2.6%
6.5%
7.2%
29.5%
33.5%
42.5%
39.8%
40.0%
41.2%
2013
Premium Volume:
$1.4 billion
2014
Premium Volume:
$1.3 billion
2015
Premium Volume:
$1.2 billion
7.0%
22.5%
$600
$400
$200
$-
Blue Cross Blue
Shield of MN
HealthPartners
Medica
PreferredOne
Other
Note: Companies with common ownership have been combined for purposes of this analysis.
Source: MDH Health Economics Program; Health Plan Financial and Statistical Report. Market share is based on percent of total premiums collected.
Summary of Graph
27
Distribution of Per Person Deductibles in the
Small Group Market, 2002 to 2014
100%
75%
50%
25%
0%
2002
2005
2007
2009
2011
2013
2014
Greater than $4,000
0.0%
0.1%
0.8%
1.2%
10.0%
5.8%
5.2%
$2,501 to $4,000
0.0%
0.6%
10.0%
14.1%
16.7%
15.4%
25.4%
$1,251 to $2,500
0.7%
6.2%
39.9%
29.7%
31.6%
37.8%
30.1%
$501 to $1,250
6.1%
10.4%
13.8%
18.3%
16.2%
16.9%
12.6%
$1 to $500
27.6%
29.1%
15.5%
18.3%
17.2%
14.3%
16.7%
No Deductible
65.6%
53.6%
20.1%
18.5%
8.3%
9.9%
9.9%
Note: In 2013 and 2014, less than 1% of enrollees had deductibles above $6,350, the maximum out of pocket under the Affordable Care Act (ACA)
compliant plans. Deductible levels are per person.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
28
Average and Range for Per Person Annual Deductibles
in the Small Group Market, 2002 to 2014
(by share of total enrollment)
$10,000
$8,000
$6,000
$4,000
$2,000
$0
2002
2005
Maximum & minimum
deductibles
2007
2009
75% of all deductibles
Note: Results exclude plans with a $0 deductible.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2011
2013
2014
Average deductible
29
Distribution of Family Level Deductibles in the Small
Group Market, 2002 to 2014
(by share of total enrollment)
100%
75%
50%
25%
0%
2002
2005
2007
2009
2011
2013
2014
Greater than $12,700
0.0%
0.0%
0.0%
0.0%
6.5%
0.2%
3.3%
$6,351 to $12,700
0.0%
0.1%
0.5%
2.3%
9.1%
18.2%
10.7%
$4,001 to $6,350
0.2%
2.3%
13.0%
27.4%
29.1%
24.3%
25.4%
$2,501 to $4,000
1.2%
4.6%
16.5%
18.1%
19.6%
23.7%
27.2%
$1,251 to $2,500
7.6%
10.5%
16.8%
19.4%
16.9%
17.6%
17.5%
$501 to $1,250
24.5%
27.3%
21.3%
14.3%
10.4%
8.5%
6.1%
$1 to $500
0.9%
1.7%
0.1%
0.1%
0.0%
0.0%
0.0%
No Deductible
65.6%
53.6%
31.9%
18.5%
8.3%
7.6%
9.9%
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
30
Distribution of Family Level Annual Deductibles in the
Small Group Market, 2002 to 2014
(by share of total enrollment)
$30,000
$25,000
$20,000
$15,000
$10,000
$5,000
$0
2002
2005
Maximum & minimum
deductibles
2007
2009
75% of all deductibles
Note: Results exclude plans with a $0 deductible.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2011
2013
2014
Average deductible
31
Distribution of Deductibles in the Small Group Market,
2014 by share of total enrollment
FAMILY
INDIVIDUAL
0.0%
4.7%
3.3%
0.5%
9.9%
9.9%
10.7%
25.4%
0.0%
6.1%
16.7%
17.5%
25.4%
12.6%
30.1%
27.2%
No Deductible
$2,501 to $4,000
$1 to $500
$4,001 to $6,350
$501 to $1,250
$6,351 to $12,700
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
$1,251 to $2,500
Greater than $12,700
32
Small Group Market Enrollment in High Deductible
Health Plans with Health Savings Account (HSA)
Eligibility, 2005 to 2014
(by share of total enrollment)
50%
40%
30%
20%
44.9%
2009
2011
41.2%
48.3%
25.5%
10%
0%
45.8%
2.1%
2005
2007
2013
2014
Note: This is the percent of plans that are Qualified High Deductible Health Plans, as determined by the Internal Revenue Service (for 2014 the
minimum deductible is $1,250), and have the option to be paired with a Health Savings Account (HSA). The proportion of people with and HAS is
unknown. Prior to 2006, HSAs and similar options were rare.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
33
Comparison of Individual Out-of-Pocket Maximums between
Those in High Deductible Health Plans (HDHP) & Those in
Non-HDHP in the Small Group Market, 2009-2014
$15,000
$10,000
$5,000
$-
2009
2011
2013
2014
2009
HDHP
Maximum & minimum
Out-of-Pocket Maximums
2011
2013
2014
Non-HDHP
75% of all Out-of-Pocket
Maximums
Average Out-of-Pocket
Maximums
HDHPs include plans with individual deductibles over $1,250, but they do not necessarily have a Health Savings Account (HSA) option.
Cost Sharing data as displayed in the 2009 Chartbook was not collected in 2011.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
34
Distribution of Individual Out-of-Pocket Maximums
between Those in High Deductible Health Plans
(HDHP) & Those in Non-HDHP in the Small Group
Market
2011
2013
2014
Non-HDHP
HDHP
Non-HDHP
HDHP
Non-HDHP
HDHP
Less than $2,000
24.9%
16.2%
6.2%
20.3%
1.3%
14.7%
$2,000 to $2,999
34.4%
32.1%
29.7%
26.1%
13.7%
27.8%
$3,000 to $3,999
30.2%
32.1%
26.8%
24.9%
35.5%
34.3%
Over $4,000
10.5%
19.6%
37.3%
28.8%
49.6%
23.2%
Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
35
Portion of Small Group Enrollees with Deductibles
over $1,250 in 2014
Less than $1,250
38.9%
Over $1,250
61.1%
Note: The minimum deductible in the IRS definition of High Deductible Health Plan (HDHP) was $1,250 in 2014 for an individual plan.
Not all plans with deductibles over this amount are classified HDHP by the IRS because they do not meet other requirements for the HDHP
designation. This slide shows all enrollees with a deductible burden that meets the IRS minimum requirement regardless of whether or not they
meet other HDHP criteria.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
36
Office Visit Cost Sharing Requirements in the
Small Group Market, 2002 to 2014
(by share of total enrollment)
2002
2005
2007
2009
2011
2013
2014
No Cost Sharing
0.0%
0.0%
20.8%
36.8%
35.9%
33.4%
36.0%
Copayment
70.3%
86.9%
66.2%
36.3%
8.4%
6.8%
0.3%
Coinsurance
27.9%
10.8%
8.9%
12.7%
13.2%
18.9%
20.9%
Copayment &
Coinsurance
1.8%
2.4%
4.2%
14.2%
42.5%
40.9%
42.8%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
Total
Note: If plan had tiered cost sharing, the lowest cost sharing was used in this analysis.
Plans with only a deductible and no copayment or coinsurance are included in No Cost Sharing.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
37
Distribution of Office Visit Copayments in the Small
Group Market, 2002 to 2014
(by share of enrollment)
100%
75%
50%
25%
0%
2002
2005
2007
2009
2011
2013
2014
$30+
1.9%
8.8%
19.0%
28.3%
58.1%
68.0%
64.5%
$25
4.1%
11.6%
40.0%
53.3%
39.5%
30.4%
35.1%
$20
11.3%
12.9%
14.9%
4.3%
0.5%
0.8%
0.0%
$15
74.3%
50.3%
26.1%
14.0%
1.9%
0.7%
0.5%
$10
8.4%
16.5%
0.0%
0.0%
0.0%
0.0%
0.0%
Note: Includes only enrollees who have an office visit copayment.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
38
Deductibles and Cost-Sharing for Office Visits in the
Small Group Market, 2014
60%
42.8%
40%
35.3%
34.4%
26.4%
19.4%
20%
16.7%
8.0%
4.2%
0%
Under
$1,000
$1,000 to
$1,999
$2,000 to
$2,999
No Cost Sharing
$3,000 to
$3,999
6.7%
6.1%
$4,000
or more
Cost Sharing
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
39
Cost Sharing Requirements for Hospitalizations in
the Small Group Market, 2002 to 2014
(by share of total enrollment)
2002
2005
2007
2009
2011
2013
2014
≤10% Coinsurance
3.7%
4.2%
1.2%
0.1%
0.2%
0.6%
0.4%
11-20% Coinsurance
85.0%
92.9%
59.5%
25.5%
11.4%
24.0%
21.2%
Greater than 20% Coinsurance
2.3%
2.2%
1.2%
28.0%
44.1%
35.2%
34.1%
Copayment & Coinsurance
9.1%
0.8%
0.1%
0.0%
0.0%
0.0%
8.1%
No Cost Sharing
0.0%
0.0%
38.0%
46.4%
44.4%
40.2%
36.3%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
Total
Note: Plans with only a deductible and no copayment or coinsurance are included in No Cost Sharing.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
40
Per Person Out-of-Pocket Limits in the Small
Group Market, 2002 to 2014
(by share of total enrollment)
100%
75%
50%
25%
0%
$3,000 +
$2,000 to $2,999
$1,500 to $1,999
Less than $1,500
2002
2005
2007
2009
2011
2013
2014
4.1%
31.1%
36.7%
28.2%
12.1%
28.7%
11.9%
47.4%
13.5%
38.0%
37.1%
11.4%
29.9%
34.8%
26.7%
8.6%
45.6%
33.4%
18.4%
2.6%
59.7%
28.2%
11.1%
1.0%
71.8%
20.5%
7.3%
0.5%
Note: Out-of-pocket limit applies to covered services only.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
41
Family Level Out-of-Pocket Limits in the Small
Group Market, 2002 to 2014
(by share of total enrollment)
100%
75%
50%
25%
0%
$10,000 +
$7,500 to $10,000
$5,000 to $7,500
$2,500 to $5,000
Less than $2,500
2002
16.3%
0.4%
36.2%
44.6%
2.6%
2005
9.5%
8.3%
57.6%
23.8%
0.7%
2007
0.8%
2.8%
68.3%
20.4%
7.8%
Note: Out-of-pocket limit applies to covered services only. This data was not collected in 2011.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2009
6.0%
4.7%
60.8%
20.8%
7.8%
2013
10.0%
23.4%
48.7%
17.0%
0.9%
2014
26.6%
24.8%
35.1%
13.1%
0.4%
42
Number of Tiers for Prescription Drug
Copayments or Coinsurance in the Small Group
Market, 2011-2014
(by share of total enrollment)
100%
75%
50%
25%
0%
4 Tiers
3 Tiers
2 Tiers
1 Tier
2011
52.8%
29.5%
2.0%
15.7%
2013
56.6%
32.7%
0.0%
10.7%
Note: Number of tiers for prescription drugs was not collected before 2011.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2014
78.6%
21.4%
0.0%
0.0%
43
Prescription Drug Out-of-Pocket Limits in the Small
Group Market, 2002 to 2014
(by share of total enrollment)
2002
2005
2007
2009
2011
2013
2014
No Separate Prescription Drug Outof-Pocket Limit
40.7%
62.5%
70.0%
72.3%
79.6%
74.1%
100.0%
Separate Prescription Drug Out-ofPocket Limit1
59.3%
37.5%
30.0%
27.7%
20.4%
25.9%
0.0%
Total
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
100.0%
1 General
health plan out-of-pocket limits apply.
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
44
Lifetime Limit on Benefits in the Small Group
Market, 2002 to 2011
100%
8.0%
25.2%
75%
51.2%
50%
1.9%
59.3%
83.3%
0.4%
25%
0%
40.8%
6.2%
2002
100.0%
70.7%
39.3%
0.9%
2005
Less than $2 million
5.6%
3.2%
3.9%
0.2%
2007
$2 to $4 million
2009
$4 to $6 million
Source: MDH Health Economics Program analysis of Small Group and Individual Market Survey.
Summary of Graph
2011
Unlimited
45
Loss Ratio Experience in the Small Group Market,
2002 to 2015
100%
80%
60%
40%
20%
0%
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Total Market
BCBSM
HealthPartners
PreferredOne
Medica
Statutory Minimum
Note: Companies with common ownership have been combined for purposes of this analysis.
Source: Minnesota Department of Commerce, "Report of 2015 Loss Ratio Experience for Health Plan Companies" October, 2016. Loss Ratios and
statutory minimums presented are State Loss Ratios.
Summary of Graph
46
Additional Information from the Health Economics
Program Available Online
• Health Economics Program Home Page
• http://www.health.state.mn.us/healtheconomics
• Health Economics Program Publications
• http://www.health.state.mn.us/divs/hpsc/hep/publications/index.html
• Health Care Market Statistics (Chartbook Updates)
• http://www.health.state.mn.us/divs/hpsc/hep/chartbook/index.html
A summary of the charts and graphs contained within is provided at Chartbook
Summaries - Section 4. Direct links are listed on each page. Please contact the Health
Economics Program at 651-201-3550 or [email protected] if additional
assistance is needed for accessing this information.
47