Table 2. Cost Sharing in PPOs, Competing Coordinated Care Plans (CCPs), and Medicare Fee-for-Service (FFS)¹ Typical (Median) Copayment (Dollar Amount), Coinsurance (Percent), or Deductible (Dollar Amount) for Selected Services: 2004.

Service	PPO		CCP	FFS
	In-Network	Out-of-Network
Primary Care Physician Visit
Copayment	$10	Rare	$10	—
Coinsurance (Percent)	—	20	—	20
Specialist Physician Visit
Copayment	$20	Rare	$20	—
Coinsurance (Percent)	—	20	—	20
Hospital Inpatient Stay
Copayment Per Day2	$100	Rare	$175	—
Copayment Per Stay3	$250	$750	$250	$876
Coinsurance (Percent)	Rare	20	Rare	—
No Cost Sharing (Percent of Plans)	13	0	19	—
Hospital Outpatient
Copayment Per Visit4	$50	Rare	$50–100	—
Coinsurance (Percent)	10	20	20	20
No Cost Sharing (Percent of Plans)	33	0	29	—
Global Deductible	Rare	$250	Rare	$110 (Part B)
Prescription Drugs5
Generic-Only Drug Tiers	$10	—	$10	—
Some or All Brand Drug Tiers	$37.50	—	$30	—

¹Includes Parts A and B plans only. Employer-only plans are excluded. PPO is PPO demonstration plans. Competing CCP plans are defined by those offered in at least one PPO service area county. FFS is original Medicare fee-for-service.

²Copayments per day are often limited to the first days of a stay, for example, the first 5 days. Copayments may vary for different days of a stay.

³For FFS, this refers to initial deductible per benefit period. Beyond day 60, additional cost sharing applies.

⁴Copayments vary across outpatient services. For CCPs, the median minimum copayment is $50 and the median maximum copayment is $100.

⁵Thirty-day supply at designated retail pharmacy.

NOTE: PPO is preferred provider organization.

SOURCE: RTI International analysis of Centers for Medicare & Medicaid Services Health Plan Management System, April 2004 file.