Health insurance plans from NCI-designated public and private cancer centers versus federal health insurance plans.

24 Background: Understanding health insurance plans is crucial for making informed financial decisions and ensuring equitable access to healthcare. While physicians are directly involved in healthcare, the plans available to them are poorly understood. This study compared plans offered at NCI-designated cancer centers with federal plans to better understand and further investigate the differences in beneficiary costs. Methods: We collected data on health plans from 65 cancer centers and federal plans from 5 major insurers by reviewing their websites from 11/2023 - 03/2024. We included up to 3 plans (regardless of insurer) per cancer center and up to 6 federal plans per insurer. We abstracted cost data on premium, deductible, co-pay for physician visits, out-of-pocket (OOP) maximum, and coinsurance for hospitalizations. We compared HMO and PPO plans between public and private cancer centers, as well as with federal plans. Results: We obtained data of 153 plans from 39 public and 26 private cancer centers to compare with 18 federal plans. In the comparison of plans offered at public and private cancer centers, private cancer centers had significantly higher deductible ($597.6 vs $225.9, p=0.03), specialist visit co-pays ($36.1 vs $27.1, p=0.01), and inpatient stay co-insurance ($1281.0 vs $582.9, p=0.02) in HMO plans compared to public cancer centers. For PPO plans, private cancer centers had higher inpatient stay co-insurance ($2,100.5 vs $1,526.3, p=0.03). The premiums of private cancer centers are lower than those in public centers for both HMO plans ($113.5 vs $139.5, p=0.43) and PPO plans ($140.8 vs $190.2, p=0.33), although these differences were not statistically significant. Compared to federal plans, cancer centers plans had significantly higher HMO deductibles ($387.8 vs $100, p=0.02), lower PPO specialist visit co-pays ($30.4 vs $40.5, p=0.05), and lower OOP maximum ($3,823.8 vs $6,554.6, p<0.001) (Table). Conclusions: Our research reveals differences in beneficiary costs between health plans offered by cancer centers and federal plans, as well as among different types of cancer centers. Notably, private cancer centers had higher average costs for deductible, specialist visit, and inpatient stays compared to public cancer centers, likely as a tradeoff to offer a lower premium. These findings underscore the complexities within health plans offered to physicians, emphasizing the necessity for a more comprehensive understanding. Comparison of health plans. Average costs ($) Cancer centers HMO Federal HMO p Cancer Centers PPO Federal PPO p Premium 133.6 425.1 0.1 176.8 259.3 0.1 Deductible 387.8 100 0.02* 906.2 768.2 0.52 Co-pay of PCP visit 20 21.7 0.52 19.7 18.8 0.78 Co-pay of specialist visit 29.4 36.7 0.14 30.4 40.5 0.05* Co-insurance for inpatient stay 955.2 1231.6 0.53 1712 1957.9 0.48 OOP Maximum 3300.2 4416.7 0.24 3823.8 6554.6 <0.001* *p-value < 0.05.