KFF Employment-based Health Plan Survey Part I

By November 8, 2018 Commentary

Here we go with the fact-filled annual Kaiser Family Foundation survey of health plans offered by companies to their workers in 2018.   (KFF Survey)   This form of insurance covers over 150 million Americans.  The average single premium was $6896, up 3% from the prior year and the average family premium was $19616, up 5%.  For comparison wages rose about 2.6%.  Premiums for single coverage are similar for large (over 200 workers) and small companies, but family ones are lower at small firms, probably because there is more high-deductible plan use.  High-deductible plan premiums are lower, the average is $6459 for single coverage and $18602 for family.  On average, workers contribute about 18%, or around $1186, for the single coverage and 29%, or about $5547, for family coverage.  Employees in smaller firms tend to pay a larger share of the premium and, depressingly, staff at companies with a higher percentage of lower-wage workers tend to have higher employee premium sharing.  27% of workers at smaller companies have no premium for single coverage, while only 6% of employees at large firms have no premium, but for family coverage, at large companies 8% of staff pay more than 50% of the premium while 34% of those at small firms do so.  HMO coverage is slightly cheaper than PPO plans for both single and family, and a high-deductible plan has a slightly lower premium than the HMO design.  Total premiums and the employee share have grown at roughly the same pace for the past several years.  Both have risen much faster than personal income growth.  14% of workers were in an HMO design, 57% in a PPO plan, 9% in point-of-service and 20% in a high-deductible plan with a savings option.  Compared to 2013, PPO membership has risen and high-deductible declined.  61% of all workers and 81% of those in large companies are in self-funded plans.

On the all important cost-sharing front, 85% of workers are in plans with a deductible and among these the average deductible is $1573.  Deductibles tend to be higher in smaller firms, and 42% of employees at small firms have a deductible of at least $2000, compared to 20% of workers at large companies.  Deductibles have risen 53% over the last five years.  A significant number of people with deductibles also have a savings plan and these plans often reduce the actual deductible to less than $1000.  In addition to a deductible, almost all workers have point-of-service cost-sharing; with 66% having a fixed-dollar copay and 24% coinsurance for primary care and similar levels for specialty care.  The average copayment is $25 for primary care and $40 for specialty care, while coinsurance averages 18%.  Think about just those facts.  That is a lot of money for a low-wage worker or family to pay out-of-pocket just to show up at the doctor.  And almost everyone now has cost-sharing for a hospital stay, 68% have a plan with inpatient coinsurance and 11% with a copayment.  The average inpatient coinsurance is 19% and the average copay is $284.  99% of people do have an out-of-pocket maximum, but those tend to be pretty high and do little to lessen the financial burden.  More tomorrow.

Kevin Roche

Author Kevin Roche

The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry through Roche Consulting, LLC. Mr. Roche is available to assist health care companies through consulting arrangements and may be reached at khroche@healthy-skeptic.com.

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