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What Is the Average Out of Pocket Deductible in Health Insurance?

Considering the plethora of available health insurance plans, and the potentially dramatic cost differences from one region of the country to the next, determining the average out of pocket deductible for health insurance is a challenging task. Independent industry organizations regularly conduct anonymous surveys of both consumers and businesses, then compile the results into measurable, summarized reports.

  1. Fact Finding

    • Organizations such as Mercer and PricewaterhouseCoopers annually send comprehensive surveys to thousands of consumers and business owners across the nation. These surveys consist of basic multiple choice questions regarding health insurance, as well as fill-in-the-blank sections where respondents may provide additional details or clarify answers.

    Plans With Deductibles

    • Data provided by Mercer and PricewaterhouseCoopers regarding health insurance deductibles focuses entirely on PPO plans, as those policies remain the most common among employer-sponsored programs and have traditionally been the only type that contained a deductible. However, recent years have seen the development of, and an increasing shift toward, HMO and POS co-insurance plans, both of which contain deductibles. The data provided by the surveyors appears to relate only to members covered by PPO plans.

    Group Policies

    • Both Mercer and PriceWaterhouseCoopers report that health insurance deductibles are steadily rising with no indication of a reverse in the trend. These increases are expected to average between six and ten percent. However, discrepancies in the specific dollar amounts estimated varies sharply between the two organizations; Mercer reported that individual annual PPO deductibles average $1,200 while PricewaterhouseCoopers reported only $400. Further clouding the issue are reports on the federal government's HealthReform.gov website indicating that PPO deductibles range from $1,344 at larger employers and $2,367 for workers at smaller companies.

    Individual Policies

    • Neither Mercer nor PricewaterhouseCoopers provide data pertaining to individually purchased health insurance plans. HealthReform.gov, however, states that in the individual marketplace in 2007, the average annual PPO deductible was $2,753. No more current details seem to be available. But, considering the average annual cost increase across the industry of 6 to 12 percent, it's possible that in 2011 the average individual PPO deductible could approach or even exceed $4,000.

    Considerations

    • The accuracy of the data used to form these reports regarding health insurance cannot be guaranteed or verified. Since the information is not acquired in a controlled environment, the likelihood of errors, mistakes, lies, or other contamination of the facts remains statistically significant. Additionally, the number of respondents and the specific geographic regions returned surveys come from may also indicate potentially skewed results.

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