The MEPS View of Employment-Based Insurance

The Agency for Healthcare Research & Quality runs the regular Medical Expenditures Panel Survey, a large population-based study that gathers data on many aspects of health and health care.  It recently released a chart book on findings related to the provision on health coverage by employers.   (MEPS Study)   This is an interesting companion study to the annual KFF survey we discussed last week.  The MEPS work comes from surveys during 2004 to 2017 of around 30,000 employers of all sizes.  According to the AHRQ work, about 84.5% of all workers at employed where at least one health plan is offered.  There has been no significant change in this percent in recent years, although there is a slight drop dating back to 2004, with all of the decline taking place in smaller firms.   Only about half of workers at companies with less than 50 employees have access to a health plan.  At firms with a health plan, 77% of employees were eligible to enroll and 56.5% did enroll.  The take-up rate has also experienced a slight decline in recent years.  72.4% of workers had a choice of at least two health plans in 2017, stable with very recent years and up slightly over the entire study period.  Only about 30% of small companies offer such a choice.  About 40% of firms offer a plan that is self-funded.

The average annual single premium in 2017, according to this work, was $6368, up 4.4% from the prior year, and the average family one was $18,687, up 5.5%.  The cumulative growth rate in these premiums since 2004 is around 80%.  Interestingly, premiums tend to be somewhat lower for medium-sized companies, 50-100 employees, than for either smaller or larger ones.  I suspect it is a combination of risk pooling issues for small firms, and richer benefit designs at larger ones.  The mean employee contribution to premiums in 2017 was 22% or $1415, and for family coverage it was 28% or $5218.  Since 2004 the percent born by employees is up 4% for single coverage and 3.5% for family coverage.  87.5% of workers were in a plan with a deductible for 2017, that has risen from around 60% in 2004.  The average annual deductible increased to $1808 for single coverage and $3396 for family coverage.  Deductibles tend to be higher in small and medium-sized companies than in small ones.  The report includes a lot of other information breaking down these statistics by geography, by average worker wage, by industry and other characteristics.  As with the KFF and other similar studies, the thing that always catches my eye is how much the average worker really is paying for health care coverage, both in premium sharing and out-of-pocket costs.