Employer sponsored health plans are still the single largest source of coverage for medical care for Americans. Every fall the Kaiser Family Foundation puts out a report describing benefit trends for these health plans. This year’s report is based on survey responses from over 2000 employers of various sizes. (KFF Report) The headline, of course, is that the cost of providing health benefits continues to rise, for both the employers and the employees and dependents. The average single premium for the year is $7188, up 4% from 2018; and the average family premium is $20,576, up 5%. Over ten years, employees have borne an increasing share of the cost of health coverage. From 2009 to 2019 the total premium for family coverage rose 22% but the employee contribution to the total premium increased 25%. Workers tend to have a higher share of family coverage costs than for single coverage, with the average amount being over $6000 a year. Small companies tend to pay more of the cost for single coverage but less for family coverage than do large companies. For high-deductible type plans, the premium is somewhat lower, $6412 for single coverage and $18,980 for family, but the tradeoff, of course, is that there is higher cost-sharing for the worker when medical care is received. 82% of employees are in a plan with an annual deductible for single coverage and that deductible averages $1655. While most employers contribute to a savings account accompanying the deductible plan, rarely does that contribution equal or exceed the size of the deductible. The employee can make additional contributions in a tax-advantaged manner. Almost every employee also has cost-sharing on a per service basis, usually a flat dollar copayment, but coinsurance is becoming more common.
44% of workers are covered by a PPO type plan, 31% by a high-deductible with savings account plan, and 19% in an HMO design. 61% are in a plan that is self-funded. Almost every employer of any size is self-funding. 99% of large firms offer a health plan for employees, compared to only 56% of small ones. 99% of employees work at a company that offers at least one health plan. Due to various eligibility requirements, such as number of hours worked per week, only about 80% of workers are eligible for a plan. Of these, 76% actually enroll. Aside from cost reasons, employees may not enroll in available health coverage because they have another form of coverage, such as through a spouse or Medicaid. 41% of small firms and 65% of large ones have a health risk assessment available and 50% of the large companies offer an incentive for completion. 26% of small businesses and 52% of large ones offer biometric screenings. 50% of small companies and 84% of large ones offer at least one wellness program. Of employers with more than 50 workers, 69% cover telemedicine. Most employers have kept their provider networks relatively broad, largely out of employee satisfaction concerns. A small percentage of larger ones do have a narrow network option. Prescription drug costs and arrangements with PBMs continue to be an area of concern for most employers. You look at all these numbers and facts and it is sometimes hard to understand the reality for employees. Think about the cost to a person with a family of that average $6000 a year. That is a lot of money. Imagine you make $40,000 or $50,000 a year and that much is going just for the premium, and then you have a deductible and other cost-sharing on top of it. That is very, very stressful.