151 million Americans have health coverage through an employer. The Kaiser Family Foundation releases results from its 19th annual survey of employers with three or more workers regarding their health plans in 2017. (KFF Report) The average annual premium across the country for single coverage was $6690 and $18,764 for family coverage. The average single premium increased 4% and the average family one by 3%. For comparison, inflation was up 2.2% and wages 2.3%. Average premiums for family coverage are lower in small firms with 3 to 199 employees, $17,615; than in large ones, $19,235; but that likely reflects differences in plan benefits and cost-sharing amounts. Family coverage premiums have increased 19% in the last five years and 55% in the last ten. Among plan types, high-deductible plans with a savings option have the lowest average single premium, $6,024, and family premium, $17,581; while HMO has the highest single premium, $7,052, and PPO the highest family premium, $19,481. There is a fairly wide dispersal around the averages–17% of covered workers are in plans with premiums 20% or more than the average and 21% of employees are in plans with premiums 20% or more below the average.
Of great importance to employees is how much of the premium they have to contribute; and for single coverage it averages 18% and for family coverage, 31% or $5,714, which is a substantial burden. Employees in small firms contribute significantly more than do those in larger ones; and workers in relatively low-wage businesses, contribute more as well, which seems quite inappropriate. Since 2012, workers have seen a 32% increase in contributions for family coverage, while premiums have risen 19%, indicating that companies are shifting more of the increase to workers. And as with premiums, there is a wide range in contribution policies. For single coverage, 14% of employees have no contribution (can you say government employee), 60% in plans with a contribution that is 25% or less of the total premium and 2% are in plans that require contributions of 50% or more of the premium. The corresponding numbers for family coverage are 3%, 44% and 16%. Average actual dollars for single coverage premium contribution are $1,213 and $5714 for family. Small firms have lower contribution amounts, again likely due to plan type and design, although the percent is higher than that for large companies. High-deductible plans have smaller contributions. 16% of employees are in a plan that makes tobacco users pay more. (Why aren’t they all?)
PPOs are the most common plan, with 48% of covered employees, compared to 28% enrolled in a high-deductible plan, 14% in an HMO (or closed panel plan) and 10% in a point-of-service plan. In the last five years, however, PPO enrollment has fallen 8 percentage points while HDHP membership has increased 9 points. An increasing number of companies only offer HDHPs. 15% of workers at small employers are in a fully or partly self-funded plan, compared to 79% in larger employers. 81% of workers now have an annual general deductible attached to their single coverage, with the average amount of the deductible at $1505, up slightly from last year. The average deductible is much higher at small employers. 51% of small company workers and 48% of those at a large firm have a deductible of at least $1000. The only good news is that growing numbers of employees with a deductible also get savings account contributions which equal or exceed the deductible. In addition to deductibles, 71% of employees have a copayment for primary care, averaging $25, and 22% have coinsurance, averaging 19%; while 67% have a copayment for specialty care, averaging $38 and 26% have coinsurance, averaging 19%. Many also have special cost-sharing for ER use, hospital admissions or outpatient surgery.
53% of firms offer health benefits to at least some employees. (Almost all those that don’t are small companies.) But 89% of workers are at a company that offers health benefits. Offers of health coverage have declined slightly at small companies. For companies that offer coverage, 79% of workers at those firms are eligible for the benefits and 785 of those actually enroll, meaning that about 62% of all workers at companies with health benefits actually get coverage. (A lot of the people who don’t enroll are spouses who have coverage at their place of employment.) Almost all employers that do offer health benefits, offer family as well as single coverage. Basically no small companies provide retiree coverage, and only 25% of large employers do so. As you can see, it is a tough world for employee health benefits.