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Health Insurance Plans Varies among States

rs have greater market share in rural states, so employees and employers in those states end up paying higher adjusted premiums. Also, small employers are more predominant in rural states, and they have less clout than large employers in negotiating with insurers," said Commonwealth Fund President Karen Davis.

Massachusetts had the highest average actuarial value, with 88% of total medical expenses paid by employer plans, compared with a low of 73% in Montana. The study, "Generosity and Adjusted Premiums In Job-Based Insurance: Hawaii Is Up, Wyoming Is Down," is based on an analysis of simulated bill paying for health plan claims from a sample of approximately 30,000 employers' establishments from the 2002 Medical Expenditure Panel Survey-Insurance Component (MEPS-IC).

"Millions of Americans who have health care coverage are underinsured--meaning their coverage does not protect them against catastrophic costs, and they face cost barriers to needed care," said Davis. "The value of an insurance plan and the financial protection it provides are crucial for state and federal policymakers to consider when designing health care coverage strategies."

Health maintenance organization (HMO) plans have an actuarial value that is nearly 14 percentage points higher than conventional indemnity plans. Translated into dollars, an HMO in 2002 cost nearly $700 less per employee than a PPO and nearly $1,000 less per employee than an indemnity plan.

"Our research clearly tells us that HMO plans still have a strong position in the health insurance marketplace and can offer employers and employees a solid value for their money," said Gabel, lead author of the study. "The research also points to the disadvantages small employers face in purchasing health benefits due to high administrative costs."

According to the authors, between 1997 and 2002, the proportion of medical bills paid by insurance rose about 8 percentage points, from 75 to 83
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