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July 05, 2006


Fact of the Day:

The "typical American family of four" will pay an average of $13,382 for medical services in 2006, up 9.6 percent from 2005, according to a study by the consulting firm Milliman. The study, part of the second annual Milliman Medical Index, examined average costs in five areas for a family covered by an employer-sponsored PPO. The five areas include inpatient services, outpatient services, physician care, pharmacy costs, and other services, such as ambulatory care, medical equipment, private nursing, and home health costs.

July 5, 2006 | Permalink


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Does that include 1) insurance premiums, and 2) the value of employer contributions to those premiums? In other words, if I don't go to the doctor at all this year, did I still spend $12k because my employer paid $1000/month in premiums to cover me? The answer sort of seems to be yes to both, but it's not entirely clear.

Posted by: SP | Jul 5, 2006 3:03:21 PM

If 20 families put their $13K together, they'd have $260,000. I think that amount would possibly purchase a MD and supporting hospital and drug services. A block party!

I tried multiplying $13K by 100 million on my HP calculator and got 1.3 X 10 to the 12th power. LOL.
I guess that's a lot of money. A GWOT-sized problem in search of a Halliburton solution. Outsourcing!

[apologies for two exclamation marks]

Posted by: JimPortlandOR | Jul 5, 2006 4:27:25 PM

If I'm reading it right, that figure seems to only include insurance premiums (both the employer's and the employee's share) as well as non-reimbursed medical costs, like copays and deductables (and possibly things like dentist visits if you don't have dental insurance, though it's not clear on this). It doesn't seem to be the actual cost of the medical care people receive, which is mostly paid by the insurance companies, assuming you have insurance. If so, that amount is surprisingly high--unless by "typical" they mean average, instead of median.

I'd like to see the actual study, so I can know what those numbers really mean. It's somewhat vague as it is.

Posted by: Matt F | Jul 5, 2006 5:10:59 PM

Aren't PPO's more expensive? And how widely used are they? I'm not sure I know even 1 person with on a PPO. Its all HMOs.

Posted by: Adrock | Jul 5, 2006 5:18:49 PM

I have a PPO! Hooray!

Posted by: SP | Jul 5, 2006 5:29:31 PM

I had a PPO when I was still on my parents insurance, but it was significantly subsidized by the company. I miss it--you just go to whatever doctor you want, no referrals, no real worrying about in/out of network, etc. It is quite a bit more expensive though.

Posted by: Matt F | Jul 5, 2006 5:37:30 PM

i have a ppo....and it is an excellent program. but one of my jobs goes to pay for it each month.

Posted by: jacqueline | Jul 5, 2006 6:06:10 PM

Officially, I have a PPO, but that really only seems to refer to the type of network, not the coverage itself. I have a high ($1K) annual deductible, but there's a cushion of $300 worth of routine office visits with my only contributing standard copays before I'm in deductible territory, then it's more like a traditional indemnity plan (with the usual PPO network restrictions) up to $5K in expenses and before 100% coverage kicks in, IIRC. It sucks, but I work for a tiny nonprofit and they do at least pay my entire premium, and my boss is a single mother who insisted on buying maternity coverage even though I'm the only female of childbearing age there.

Anyway, I'm not sure that the HMO/PPO/indemnity categories we spent most of the nineties trying to understand mean that much now.

Posted by: latts | Jul 5, 2006 7:21:41 PM

your are really fortunate to work for a place that pays your entire premium.
i pay for my own ppo premium and it is just at about seven hundred dollars each month, and that does not include the percentage i have to pay for my medical visits and prescriptions. in spite of that,i greatly value that i can choose my own doctors, and i can decide when i need to see them.
i am very grateful to have the plan, even though it is so costly. it gives me great peace of mind.
i would prefer to make other economic sacrifices, rather than sacrifice that plan.
and what a kind employer you have; who would arrange for maternity coverage under the circumstances you describe.

Posted by: jacqueline | Jul 5, 2006 7:47:49 PM


You do indeed have a good plan, a great place to work by the sound of it.

And you're very right, the distinctions that used to matter so much are almost pointless by now. Almost all health "insurance" is actually a healthcare delivery plan. The HMOs may not have been able to take over the whole market, but their model has.

Posted by: Stephen | Jul 5, 2006 9:17:41 PM

Yes, I'm very fond of my employer-- she was uninsured when she had her now 22-year-old son, and it took her almost a decade to finish paying the bills, so her position is that the company can pay a bit extra for her & the other employee to make sure I'm covered. The part I'm not crazy about is the high deductible, of course, and after years of pride in being able to assess & understand new insurance plans, this one finally stumped me enough to require multiple calls & emails before I could discuss a mammogram and/or ultrasound with my midwife. Beats hell out of being uninsured, though-- I've experienced it on a smaller scale myself and seen it close up among family members.

Oh, and regarding my boss, healthcare & stem-cell research-- her son's a type 1 diabetic-- seem to be the issues that drove her away from Republicans. That & Al Gore [g], who she knew as a young reporter & admires greatly as a person.

Posted by: latts | Jul 5, 2006 10:08:20 PM

Isn't maternity coverage required by law in many states? (That is, if you have health insurance, it must include maternity coverage.) If I remember correctly, this was one of the things Congress tried to override in the name of national "standards" pushed by the health insurance industry.

Posted by: SP | Jul 6, 2006 9:01:57 AM

SP, it's not required here (TN), or at least employers are not required to purchase maternity riders, although coverage has to be uniform within an organization. It may be required for larger employers; I don't know because it never came up as optional before I started working here.

When I worked for larger (usually meaning 40-100) employers, they always covered birth control, too, so I never realized that not all employer plans did until I started reading about it online.

Posted by: latts | Jul 6, 2006 10:27:51 AM

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