July 29, 2011
New data on medical benefits show the similarities and differences between traditional fee-for-service health care plans and health maintenance organizations (HMOs) for a variety of benefits: physical therapy, durable medical equipment, prosthetics, organ and tissue transplantation, kidney dialysis, and diabetes care management.
In both fee-for-service plans and HMOs, more than two-thirds of participants in private employer-provided health care plans were offered benefits for physical therapy, defined as services to restore natural movement to the body, relieve pain, and prevent further injury. Similarly, in both types of plans, about two-thirds of participants were offered benefits for durable medical equipment, such as oxygen tents, wheelchairs, crutches, and glucose monitors.
Nearly half of the participants in fee-for-service plans were offered benefits for prosthetics and organ and tissue transplantation; among those in HMOs, 35 percent were offered benefits for prosthetics and 31 percent for organ and tissue transplants.
Among participants in fee-for-service plans, 30 percent were offered benefits for kidney dialysis and for diabetes care management, whereas the corresponding figures for HMO participants were 19 percent and 17 percent, respectively.
These data are from the National Compensation Survey. To learn more, see "Function First: Medical Benefits to Manage Chronic Disease or Aid Recovery" in the July 2011 issue of Compensation and Working Conditions Online. Data are for employer-provided medical benefits in private industry obtained from the health plan documents of the employers in the 2009 National Compensation Survey sample. The estimates include the incidence of coverage as well as plan limits and copayment amounts.