January 2, 2020
According to the 2019 Annual Henry J. Kaiser Family Foundation national employer benefits survey, the average annual premiums for employer-sponsored health insurance in 2019 are $7,188 for single coverage and $20,576 for family coverage. Per the survey, the average single premium increased 4% and the average family premium increased 5% over the past year. Meanwhile workers’ wages increased 3.4% and inflation increased 2%. The average premium for family coverage has increased 22% over the last five years and 54% over the last 10 years, significantly more than either workers’ wages or inflation (Exhibit 1). Key headlines from the survey include:
- Plan Types – Preferred provider organizations (PPOs) continue to be the most common plan type, enrolling 44% of covered workers in 2019. Thirty percent of covered workers are enrolled in a high-deductible plan with a savings option, 19% in a health maintenance organization, 7% in a point-of-service plan, and 1% in a conventional (also known as an indemnity plan).
- Deductibles – 82% of covered workers have a general annual deductible for single coverage that must be met before most services are paid for by a general annual deductible, the average deductible amount for single coverage is $1,655, similar to the average deductible last year. The average deductible for covered workers is higher in small firms than large firms ($2,271 vs. $1,412). The average annual deductible among covered workers with a deductible has increased 36% over the last five years and 100% over the last 10 years.
- Copayments – Most covered workers face a copayment (a fixed dollar amount) when they visit a doctor, although some workers face coinsurance requirements (a percentage of the covered amount). The average copayments are $25 for primary care and $40 for specialty care. The average coinsurance rates are 18% for primary care and 19% for specialty care. These amounts are similar to those in 2018.
- Other Cost Sharing – Most workers also face additional cost sharing for a hospital admission or outpatient surgery. 66% of covered workers have coinsurance and 14% have a copayment for hospital admissions. The average coinsurance rate for a hospital admission is 20% and the average copayment is $326 per hospital admission. The cost-sharing provisions for outpatient surgery follow a similar pattern to those for hospital admissions.
- Out of Pocket Maximums – Almost all (99%) covered workers are in plans with a limit on in-network cost sharing (called an out-of-pocket maximum) for single coverage, though the limits vary significantly. Among covered workers in plans with an out-of-pocket maximum for single coverage, 12% are in a plan with an out-of-pocket maximum of less than $2,000, while 20% are in a plan with an out-of-pocket maximum of $6,000 or more.
- Plan Offering – The likelihood of offering health benefits differs significantly by firm size; only 47% of firms with three to nine workers offer coverage, while virtually all firms with 1,000 or more workers offer coverage.
- Wellness – Among firms offering health benefits, 26% of small firms and 52% of large firms provide workers the opportunity to complete a biometric screening. Additionally, among large firms with biometric screening programs, 14% reward or penalize workers based on achieving specified biometric outcomes (such as meeting a target body mass index). Most firms offering health benefits offer programs to help workers identify and address health risks and unhealthy behaviors. 50% of small firms and 84% of large firms offer a program in at least one of these areas: smoking cessation, weight management, and behavioral or lifestyle coaching.
- Population Health – 69% of firms with 50 or more workers offering health benefits cover the provision of health care services through telemedicine in their largest health plan. 67% of large firms offering health benefits cover health care services received in retail clinics, such as those located in pharmacies, supermarkets and retail stores, in their largest health plan. 19% of large firms offering health benefits, including 36% of firms with 5,000 or more employees, have a health clinic for their employees at or near one or more of their major locations.
- Pharmacy – Among employers offering health benefits with 1,000 or more employees, 27% say that ‘most’ of the prescription drug rebate negotiated by their pharmacy benefit manager or health plan, 32% say that they receive ‘some’ of the negotiated rebate, 18% say that they receive ‘very little’ of the negotiated rebate, and 23% do not know. ‘little impact’ on plan costs, 9% say that they have ‘no impact’ on plans costs, while 17% do not know.
Kaiser surveyed 2,012 randomly selected non-federal public and private employers to secure the data noted. The Kaiser survey is considered among the most reliable in measuring group benefit plan information. The summary report is available online at www.kff.org/report-section/ehbs-2019-summary-of-findings/