Employee Health Benefits

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The content of this web page is arranged under the following headings:
1. Overview
2. 2015 Health Insurance Coverage of the Total U.S. Population
3. Average Annual Premiums 1999-2015
4. Average Annual Worker & Employer Premium Contributions 1999-2015
5. Average Annual Health Plan Deductibles 2006-2015

1. Overview

Almost half (49%) of the total of the total U.S. population in 2015 was covered by group health insurance provided by an employer, either through their own job or as a dependent in the same household. Sixty-three percent (63%) of covered workers were in a self-funded health plan offered mostly by larger employers that can spread the risk of costly claims over a large number of employees and dependents. The remainder of covered workers were in a fully-insured plan where the employer contracts with a health insurance company that assumes financial responsibility for the costs of enrollees’ medical claims. Employers sponsoring self-funded plans typically contracted with a third-party administrator or insurer to provide administrative services, and often bought stop-loss coverage from a health insurance company to protect against very large claims.

Almost all employer-sponsored group health insurance is administered as one of the following plan types: (1) health maintenance organization (HMO), (2) preferred provider organization (PPO), (3) point-of-service plan (POS), and (4) high-deductible health plan with a savings option such as a health reimbursement arrangement or a health savings account (HDHP/SO). All of these plan types typically include a worker contribution in the form of a partial premium payment, deductible that must be paid before most services are covered, copayments (fixed dollar amounts), coinsurance (a percentage of the charge for services), and/or prescription drug cost sharing.

Average worker copayment amounts and coinsurance percentages have not changed a great deal the past few years. The dollar amount of worker cost sharing within prescription drug tiers has increased somewhat the last 15 years. For the past several years, workers enrolled in single coverage have paid an average of 18% of the total cost of group health insurance premiums – and workers enrolled in family coverage have paid an average of 29% of the total premiums cost. However, the total cost of group health insurance premiums AND deductible amounts have increased significantly. Some particularly useful conclusions result from a detailed analysis of ongoing worker increases in premium payments and deductibles.

A. 1999 to 2015 Employer-Sponsored Group Health Insurance Worker Premiums. The Single Coverage Average Annual Premium Increase for workers was 237% from $318 in 1999 to $1,071 in 2015. The Family Coverage Average Annual Premium Increase for workers was 221% from $1,543 in 1999 to $4,955 in 2015. These worker premium increases were 1.87 to 2.01 times more than the National Health Expenditures Per Capita Increase of 118%.

B. 1999 to 2015 Employer-Sponsored Group Health Insurance Employer Premiums. The Single Coverage Average Annual Premium Increase for employers was 176% from $1,878 in 1999 to $5,179 in 2015. The Family Coverage Average Annual Premium Increase for employers was 196% from $4,247 in 1999 to $12,591 in 2015. These employer premium increases were 1.49 to 1.66 times more than the National Health Expenditures Per Capita Increase of 118%.

C. 2004 to 2015 Employer-Sponsored Group Health Insurance Worker Premiums. The Single Coverage Average Annual Premium Increase for workers was 92% from $558 in 2004 to $1,071 in 2015. The Family Coverage Average Annual Premium Increase for workers was 86% from $2,661 in 2004 to $4,955 in 2015. These worker premium increases were 1.59 to 1.70 times more than the National Health Expenditures Per Capita Increase of 54%.

D. 2004 to 2015 Employer-Sponsored Group Health Insurance Employer Premiums. The Single Coverage Average Annual Premium Increase for employers was 65% from $3,136 in 2004 to $5,179 in 2015. The Family Coverage Average Annual Premium Increase for employers was 73% from $7,289 in 2004 to $12,591 in 2015. These employer premium increases were 1.20 to 1.35 times more than the National Health Expenditures Per Capita Increase of 54%.

E. 2009 to 2015 Employer-Sponsored Group Health Insurance Worker Premiums. The Single Coverage Average Annual Premium Increase for workers was 37% from $779 in 2009 to $1,071 in 2015. The Family Coverage Average Annual Premium Increase for workers was 41% from $3,515 in 2004 to $4,955 in 2015. These worker premium increases were 1.61 to 1.78 times more than the National Health Expenditures Per Capita Increase of 23%.

F. 2009 to 2015 Employer-Sponsored Group Health Insurance Employer Premiums. The Single Coverage Average Annual Premium Increase for employers was 28% from $4,045 in 2009 to $5,179 in 2015. The Family Coverage Average Annual Premium Increase for employers was 28% from $9,860 in 2009 to $12,591 in 2015. These employer premium increases were 1.22 times more than the National Health Expenditures Per Capita Increase of 23%.

G. 2006 to 2015 Employer-Sponsored Group Health Insurance Worker Deductibles. The Single Coverage All Plans Average Deductible Increase for workers was 126% from $584 in 2006 to $1,318 in 2015. The Estimated Family Coverage All Plans Average Deductible Increase for workers was 133% from $1,232 in 2006 to $2,870 in 2015. These worker deductible increases were 3.32 to 3.50 times more than the National Health Expenditures Per Capita Increase of 38%.

The preceding A-G analysis findings listed above lead to the conclusions listed next.

CONCLUSION #1. The supposed competition and choice in the healthcare marketplace does a poor job of controlling the costs of workers covered by employer-sponsored group health insurance plans. Worker premiums and deductibles have increased considerably more than National Health Expenditures Per Capita – this would not be the case if the healthcare marketplace were efficient and cost-effective.

CONCLUSION #2. The Affordable Care Act (ACA) is NOT responsible for the significant increases of worker premiums and deductibles in employer-sponsored group health insurance plans. Worker cost increases from 2004 are about the same as worker cost increases after the ACA was enacted March 2010.

CONCLUSION #3. Employers have shifted a disproportionate share of the cost increases in their group health insurance plans to their workers.

CONCLUSION #4. The Affordable Care Act (ACA) is a step in the right direction for those who believe that every U.S. resident should receive affordable and comprehensive health coverage irrespective of their social status, income, age, gender, race, pre-existing condition, or wealth. The ACA prohibits lifetime and annual limits on essential health benefits, extends dependent coverage to age 26, prohibits coverage exclusions for pre-existing health conditions, and provides the following essential health benefits: (a) ambulatory patient services (outpatient care); (b) emergency services; (c) hospitalization (inpatient care); (d) maternity and newborn care; (e) mental health and substance use disorder services, including behavioral health treatment; (f) prescription drugs; (g) rehabilitative and habilitative services and devices; (h) laboratory services; (i) preventive and wellness services, including chronic disease management; and (j) pediatric services, including oral and vision care. Repealing the ACA and allowing healthcare marketplaces in the 50 states to resume their prior practices will result in reduced health care quality with no reduction in overall worker costs. A single-payer system modeled after Medicare is the only real solution to keeping worker health care costs in line with increases in National Health Expenditures Per Capita – and possibly reducing National Health Expenditures Per Capita increases.

2. 2015 Health Insurance Coverage of the Total U.S. Population

Source Document: Health Insurance Coverage of the Total Population at http://kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

The sources of health insurance coverage for the total Unites States population in 2015 is as follows:
Private Health Insurance = 65%
    49% Employer
      7% Non-Group
      9% Uninsured
Government Health Insurance = 36%
    20% Medicaid
    14% Medicare
      2% Other Public

Employer: Includes those covered by employer-sponsored coverage either through their own job or as a dependent in the same household.

Non-Group: Includes individuals and families that purchased or are covered as a dependent by non-group insurance.

Uninsured: Includes those without health insurance and those who have coverage under the Indian Health Service only.

Medicaid: Includes those covered by Medicaid, the Children’s Health Insurance Program (CHIP), and those who have both Medicaid and another type of coverage, such as dual eligibles who are also covered by Medicare.

Medicare: Includes those covered by Medicare, Medicare Advantage, and those who have Medicare and another type of non-Medicaid coverage where Medicare is the primary payer. Excludes those with Medicare Part A coverage only and those covered by Medicare and Medicaid (dual eligibles).

Other Public: Includes those covered under the military or Veterans Administration.

3. Average Annual Premiums 1999-2015

 

Average Annual Premiums
Employer Health Benefits
Single & Family Coverage
1999-2015
SOURCES:
A. Kaiser/HRET Survey of Employer-Sponsored Health Benefits
at http://files.kff.org/attachment/report-2015-employer-health-benefits-survey
B: National Health Expenditures Per Capita at http://www.finplaneducation.net/national_health_expenditures.htm
	1999	2004	2008	2009	2010	2011	2012	2013	2014	2015
Single Coverage Average Annual Premium	2,196	3,695	4,704	4,824	5,049	5,429	5,615	5,884	6,025	6,251
Single Coverage Percent Increase		68.26%	27.31%	2.55%	4.66%	7.53%	3.43%	4.79%	2.40%	3.75%
Family Coverage Average Annual Premium	5,791	9,950	12,680	13,375	13,770	15,073	15,745	16,351	16,834	17,545
Family Coverage Percent Increase		71.82%	27.44%	5.48%	2.95%	9.46%	4.46%	3.85%	2.95%	4.22%
National Health Expenditures (Billions)	1,278.3	1,896.3	2,399.1	2,494.7	2,596.4	2,687.9	2,795.4	2,877.6	3,029.3	3,205.6
U.S. Population (Millions)	279	293	304	306	309	311	314	316	318	321
National Health Expenditures Per Capita	4,576	6,481	7,897	8,141	8,404	8,638	8,915	9,110	9,515	9,990
Expenditures Per Capita Percent Increase		41.63%	21.85%	3.09%	3.23%	2.78%	3.21%	2.19%	4.45%	4.99%
CONCLUSIONS:
1. Single Coverage Average Annual Premium Increase was 184.65% from 1999 to 2015.
2. Family Coverage Average Annual Premium Increase was 202.97% from 1999 to 2015.
3. National Health Expenditures Per Capita Increase was 118.31% from 1999 to 2015.
4. Single Coverage Average Annual Premium Increase was 69.17% from 2004 to 2015.
5. Family Coverage Average Annual Premium Increase was 76.33% from 2004 to 2015.
6. National Health Expenditures Per Capita Increase was 54.14% from 2004 to 2015.
7. Single Coverage Average Annual Premium Increase was 29.58% from 2009 to 2015.
8. Family Coverage Average Annual Premium Increase was 31.18% from 2009 to 2015.
9. National Health Expenditures Per Capita Increase was 22.71% from 2009 to 2015.

4. Average Annual Worker & Employer Premium Contributions 1999-2015

 

Average Annual Worker & Employer Premium Contributions
Employer Health Benefits
Single & Family Coverage
1999-2015
SOURCES:
A. Kaiser/HRET Survey of Employer-Sponsored Health Benefits
at http://files.kff.org/attachment/report-2015-employer-health-benefits-survey
B: National Health Expenditures Per Capita at http://www.finplaneducation.net/national_health_expenditures.htm
	1999	2004	2008	2009	2010	2011	2012	2013	2014	2015
Single Coverage Average Annual Premium	2,196	3,695	4,704	4,824	5,049	5,429	5,615	5,884	6,025	6,251
Worker Contribution	318	558	721	779	899	921	951	999	1,081	1,071
Worker Contribution Percentage	14%	16%	16%	17%	19%	18%	18%	18%	18%	18%
Employer Contribution	1,878	3,136	3,983	4,045	4,150	4,508	4,664	4,885	4,994	5,179
Employer Contribution Percentage	86%	84%	84%	83%	81%	82%	82%	82%	82%	82%
Family Coverage Average Annual Premium	5,791	9,950	12,680	13,375	13,770	15,073	15,745	16,351	16,834	17,545
Worker Contribution	1,543	2,661	3,354	3,515	3,997	4,129	4,316	4,565	4,823	4,955
Worker Contribution Percentage	27%	28%	27%	27%	30%	28%	28%	29%	29%	29%
Employer Contribution	4,247	7,289	9,325	9,860	9,773	10,944	11,429	11,786	12,011	12,591
Employer Contribution Percentage	73%	72%	73%	73%	70%	72%	72%	71%	71%	71%

5. Average Annual Health Plan Deductibles 2006-2015

 

Average Annual Health Plan Deductibles
Employer Health Benefits
Single & Family Coverage
2006-2015
SOURCE: Kaiser/HRET Survey of Employer-Sponsored Health Benefits
at http://files.kff.org/attachment/report-2015-employer-health-benefits-survey
	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015
Worker Percentage WITH Deductible	55%	59%	59%	63%	70%	74%	72%	78%	80%	81%
Single Coverage ALL PLANS Average	$584	$616	$735	$826	$917	$991	$1,097	$1,135	$1,217	$1,318
HMO Average Annual Deductible	$352	$401	$503	$699	$601	$911	$691	$729	$1,032	$1,025
PPO Average Annual Deductible	$473	$461	$560	$634	$675	$675	$733	$799	$843	$958
POS Average Annual Deductible	$553	$621	$752	$1,061	$1,048	$928	$1,014	$1,314	$1,215	$1,230
HDHP/SO	$1,715	$1,729	$1,812	$1,838	$1,903	$1,908	$2,086	$2,003	$2,215	$2,099
Family Coverage ALL PLANS Avg. (estimate)	$1,232	$1,295	$1,584	$1,723	$1,925	$1,892	$2,227	$2,459	$2,585	$2,870
HMO Average Annual Deductible	$751	$759	$1,053	$1,524	$1,321	$1,487	$1,329	$1,743	$2,328	$2,758
PPO Average Annual Deductible	$1,034	$1,040	$1,344	$1,488	$1,518	$1,521	$1,770	$1,854	$1,947	$2,012
POS Average Annual Deductible	$1,227	$1,359	$1,860	$2,191	$2,253	$1,769	$2,163	$2,821	$2,470	$2,467
HDHP/SO	$3,511	$3,596	$3,559	$3,626	$3,780	$3,666	$3,924	$4,079	$4,522	$4,332
NOTES:
HMO = Health Maintenance Organization
PPO = Preferred Provider Organization
POS = Point-Of-Service Plan
HDHP/SO = High-Deductible Health Plan with a Savings Option such as an HRA or HAS

Watchdog Vigilance Home Page Health Care Policies American Health Care Act (Trumpcare #1) Advocacy Group Position Statements American Health Care Act (Trumpcare #1) Congressional Budget Office Cost Estimate Better Care Reconciliation Act (Trumpcare #2) Congressional Budget Office Cost Estimate Affordable Care Act Summary Pertinent Historical Data Medicare Expansion (ME)

This page was last updated on 07/29/17.