VISIT STATE HEALTH COMPARE
Blog & News
Employer-Sponsored Insurance, 2014-2018: Premiums Reach New Heights while Deductibles Hold Steady (Infographics)
August 14, 2019:More than 62 million private sector workers in the United States received health insurance benefits from their employer in 2018, and, according to SHADAC researchers, paid higher-than-ever premiums for their health plans last year. Using data from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC), a new analysis from SHADAC highlights the experiences of private sector workers with employer-sponsored insurance (ESI) from 2014 through 2018 at the national level and within the states.
Key Findings
Coverage
- Nationwide, the percentage of employers offering health insurance coverage remained steady, from 46.9 percent in 2017 to 46.8 percent in 2018.
- Employee eligibility for employer-sponsored insurance held steady as well, with a slight increase to 78.0 in 2018 from 76.8 in 2017.
- The percent of eligible U.S. employees receiving health coverage through ESI fell slightly in 2018 to 72.4 percent from 73.5 percent in 2017.
Premiums
- The average annual single-coverage premium nationwide rose $347, or 5.4 percent, to $6,715 in 2018, the largest single-year increase to date in the last five years.
- Premium increases for single coverage were also seen in 18 states and the District of Columbia, and no state saw a significant decrease in single coverage premiums.
- In 2018, the average annual family-coverage premium nationwide rose $847 to $19,565—a 4.7 percent increase from 2017.
- Family premiums for ESI also increased in 11 states, with no significant state-level decreases seen.
Deductibles
- The average annual single-coverage deductible held steady nationwide at $1,846 in 2018.
- The national average annual family-coverage deductible in 2018 also remained statistically unchanged from 2017 at $3,392.
- Among the states, eight saw increases in average deductibles for single coverage and only one (Utah) saw a significant decrease.
- In 2018, almost half of private-sector employees nationwide who had ESI (49.1 percent) were enrolled in a high-deductible health plan (HDHP), a rate that was unchanged from 2017 but that is 13.9 percentage points higher than in 2014 (35.2 percent).[1]
The Takeaway
As the majority of the United States population continues to receive health insurance coverage from their employer, it is important to remember that trends in ESI data such as rising premiums and continuing high enrollment in HDHPs affect a significant number of people. And while the 2018 plateau in deductible growth is heartening, it is too soon to say whether this leveling-off is actually part of a larger trend or if it’s merely a singular data point, as SHADAC’s State Health Compare estimates show average deductibles for employer-sponsored insurance more than doubling nationwide over the past 10 years.
Explore the Analysis
The following products present detailed findings from this analysis:
Interactive Map: Hover over a state on the map below to view the average annual single-coverage premium in 2018, or click a state to view and download its individual fact sheet.
| No Change in Average Annual Single-Coverage Premium in 2018 |
Significant Increase in Average Annual Single-Coverage Premium in 2018 |
|---|
Significant change between 2017 and 2018 at the 95% confidence level.
For more detailed information on ESI findings from SHADAC, see the following products:
- Report narrative highlighting key findings on levels of, and trends in: average ESI premiums and deductibles as well as employee access to and take-up of ESI coverage
- Two-page state profiles on ESI trends
- 50-state comparison data tables
About the Data
This analysis uses data from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC).
Related Resources
Now Available on State Health Compare: New and Updated Data on Measures of Availability, Cost, and Enrollment for Employer-sponsored Insurance (ESI)
SHADAC Blog
Employer-Sponsored Health Insurance at the State Level, 2013-2017: Chartbook and State Fact Sheets
SHADAC Report
Employer-Sponsored Insurance, 2013-2017: Premiums Grow Faster, Deductibles Continue to Increase
SHADAC Blog
[1] For the purposes of this analysis, high-deductible health plans are defined as plans that meet the minimum deductible amount required for Health Savings Account (HSA) eligibility ($1,350 for an individual and $2,700 for a family in 2018). This includes employees enrolled in single- and family-coverage plans.
Publication
State-level Trends in Employer-sponsored Health Insurance (ESI), 2014-2018
| RESOURCES |
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State Profiles 50-State Comparison Tables
Interactive Map |
Introduction
Health reform continues to be an ever-changing landscape, with numerous states in various stages and forms of Medicaid expansion, the fate of the Affordable Care Act as yet unknown, and politicians putting forward proposals to create new public coverage options or replace private coverage entirely. Though the future of health care may be unclear, it is important to understand the current state of affordability and access in our existing system, which, in the United States, is predominated by employment-based health insurance coverage, with more than 62 million private-sector employees enrolled in Employer-Sponsored Insurance (ESI) coverage in 2018.
To this end, SHADAC presents four related products analyzing the experiences of private-sector employees who had employer-sponsored insurance (ESI), from 2014–2018: a series of individual state profiles highlighting ESI trends, 50-state comparison data tables, a national-level infographic with an accompanying blog, and a 50-state interactive map showing levels of, and changes in, average annual premiums for single coverage in 2018. These analyses use estimates from the Medical Expenditure Panel Survey–Insurance Component (MEPS–IC), recently produced by the Agency for Healthcare Research and Quality (AHRQ).
This post provides an overview of the trends in affordability of ESI coverage and employees’ access to ESI. As in previous years, ESI premiums are high and have continued their sizeable increase—the average premium for family coverage was nearly $20,000 per year in 2018. In addition, employees with ESI face substantial cost-sharing, with average annual deductibles of more than $1,800 for single coverage and nearly $3,400 for family coverage in 2018. Additionally, almost half (49.1 percent) of employees receiving ESI nationwide were enrolled in a high-deductible health plan (HDHP).[1]
Premiums rose nationally and in 22 states in 2018
Among private sector workers who receive ESI, average annual premiums increased nationally and in 22 states (including D.C.) between 2017 and 2018. No states experienced decreases in average premiums over that period. Georgia had the largest increase in single premiums at 16.2 percent ($950) to $6,799 in 2018 from $5,849 in 2017, and Kentucky had the largest increase in family premiums at 13.7 percent ($2,329) to $19,277 in 2018 from $16,948 in 2017. The chart below shows trends in single and family premiums for the states with the largest significant increases in single or family premiums between 2017 and 2018.
States with the Largest Increases in Average Family Premiums, 2017-2018
States with the Largest Increases in Average Single Premiums, 2017-2018
(Grey lines in the charts above allow you to compare across the 5 states with the largest increases in premiums)
Premiums also ranged significantly across the states in 2018, from $5,971 in Tennessee to $8,432 in Alaska for single coverage and from $17,337 in North Dakota to $22,294 in New Jersey for family coverage.
Deductibles were stable in 2018 but remained high
Employees with coverage through their employer continued to face large deductibles in 2018. Nationally, the average deductible reached $1,846 for individuals and $3,392 for families. Eight states saw increases in individual deductibles, and just four states saw increases in family deductibles. Average individual deductibles fell in one state (Utah), and family deductibles fell in two states (Utah and Nebraska).
Average Individual and Family Deductibles, 2014–2018
There was a great deal of variation across states in the size of deductibles, ranging from $1,308 in Hawaii and D.C. to $2,447 in Maine for individual deductibles and from $2,362 in D.C. to $4,644 in New Hampshire for family deductibles.
Overall, individual and family deductibles were stable from 2017 to 2018 at the national level—a change from previous years, which saw large year-over-year growth in deductibles. Nevertheless, it is likely too soon to say if 2018 data represents a break in the long-running growth in ESI deductibles or just a temporary pause.
The percent of employees enrolled in a high-deductible health plan (HDHP) also held steady in 2018 at 49.1 percent nationwide. HDHP enrollment increased in four states and decreased in the District of Columbia from 2017 to 2018. A majority of employees were enrolled in a HDHP in nine states.
Employees’ access to ESI coverage largely unchanged in 2018
Employee access to ESI has three components:
- Employee Offer: An employee must work in an establishment that offers coverage.
- Employee Eligibility: An employee must meet the criteria established by the employer to be eligible for coverage that is offered. (For example, the employee might have to work a minimum number of hours per pay period or complete a minimum length of service with the employer in order to be eligible.)
- Employee Take-Up: The employee must decide to enroll in—or “take up”—the offer of ESI coverage.
Less than half (46.8 percent) of private-sector establishments offered coverage to their employees in 2018, statistically unchanged from 2017.
Nationally, 85.6 percent of employees worked at an establishment that offered ESI in 2018, also statistically unchanged from 2017. This trend in employee offer rates was reflected across the states, with only no states seeing an increase, and only two states seeing a decrease (Montana and South Carolina). However, substantial variation across the states remained, with employee offer rates ranging from 64.5 percent in Montana to 95.8 percent in Hawaii.
Among employees working at an offering establishment, 78.0 percent were eligible for ESI coverage in 2018, rising a small but statistically significant amount from 76.8 percent in 2017. In 2018, three states (Alabama, Pennsylvania, and Texas) and the District of Columbia saw increases in the eligibility rate, while just one state (South Dakota) saw a decrease.
Among employees eligible for coverage, 72.4 percent enrolled in ESI in 2018, a small decrease from 73.5 percent in 2017. However, the enrollment rate was largely stable across the country from 2017 to 2018, with one state (Utah) experiencing an increase, and three states (Michigan, Oklahoma, and Pennsylvania) experiencing a decrease.
“While employers continue to offer insurance benefits to their workers, fewer are taking up that coverage and those that do are facing ever-higher premiums and steep out-of-pocket costs,” said Elizabeth Lukanen, Deputy Director of SHADAC. “Medical bills can accrue quickly and for individuals with a high deductible and little or no savings, a health crisis or chronic illness can result in major medical debt.”
Overall, while it is heartening to see stability in ESI offer from establishments as well as a potential leveling-off for deductibles, our analysis saw concerning trends in fewer employees taking up offered ESI coverage and those that do are facing ever-higher premiums and steep out-of-pocket costs.
Interactive Map
Hover over a state on the map below to view the average annual single-coverage premium in 2018, or click a state to view and download its individual fact sheet.
| No Change in Average Annual Single-Coverage Premium in 2018 |
SIgnificant Increase in Average Annual Single-Coverage Premium in 2018 |
|---|
Significant change between 2017 and 2018 at the 95% confidence level.
For more detailed information on ESI findings from SHADAC, see the following products:
- Blog post highlighting key findings at the national level regarding ESI coverage affordability and access
- Two-page state profiles on ESI trends
- 50-state comparison tables
- Download a printable version of this report narrative
Notes and Sources
Notes. All changes and differences described in this report are statistically significant at the 95 percent confidence level unless otherwise specified. This analysis and linked products only pertain to employers, establishments, and employees in the private sector. Average premium prices have not been adjusted to account for variation in actuarial value.
Sources. Data are from the 2012–2018 Medical Expenditure Panel Survey–Insurance Component (MEPS-IC), produced by the Agency for Healthcare Research and Quality (AHRQ) and are available on SHADAC’s State Health Compare web tool at statehealthcompare.shadac.org.
Additional Resources
Employer-Sponsored Health Insurance at the State Level, 2013-2017: Chartbook and State Fact Sheets
Employer-Sponsored Insurance, 2013-2017: Premiums Grow Faster, Deductibles Continue to Increase
50-State Comparison Tables: Employer-Sponsored Insurance, 2016-2017
[1] Defined as plans that qualify for a tax-advantaged health savings account. In 2018, qualifying plans had to have an annual deductible of at least $1,350 for individual coverage or at least $2,700 for family coverage.
Blog & News
Now Available on State Health Compare: New and Updated Data on Measures of Availability, Cost, and Enrollment for Employer-sponsored Insurance (ESI)
August 08, 2019:SHADAC has updated four measures and added one new measure regarding employer-sponsored insurance (ESI) on our State Health Compare website to include the latest available data for calendar year 2018. The following measures have been updated:
Available for all states from 2003 to 2018, this measure reports the percent of workers whose employer offers health insurance coverage to employees, and can be broken down by firm size. Partial data is also available for 2002.
This measure reports the average annual premium for private-sector workers who get health insurance through their employer. The measure is available for all states from 2003 to 2018 and can be broken down by plan type (family or single). Partial data is available for 2002.
This new measure reports the average annual deductible for private-sector workers who receive a health insurance plan through their employer that has a deductible. The measure is available for all states from 2003 to 2018 and can be broken down by plan type (family or single). Partial data is available for 2002.
This measure reports the percent of annual premiums contributed by private-sector workers who get health insurance through their employer. The measure is available for all states from 2003 to 2018 and can be broken down by plan type (family or single). Partial data is available for 2002.
This measure reports the percent of private-sector employees enrolled in high-deductible health insurance plans. High-deductible health plans are defined as plans that meet the minimum deductible amount required for Health Savings Account (HSA) eligibility (e.g., $1,350 for an individual and $2,700 for a family in 2018). The measure is available for all states from 2012 to 2018 and can be broken down by firm size.
Explore these new and updated estimates on State Health Compare.
SHADAC will shortly be releasing its annual ESI report using these measures to highlight the experiences of private-sector employees with employer-sponsored coverage for 2014-2018, as well as examining trends from 2017 to 2018. For an example of last year’s report, visit our 2017 ESI homepage.
Sources
Each of these State Health Compare estimates comes from the Medical Expenditure Panel Survey - Insurance Component (MEPS-IC), Agency for Healthcare Research and Quality (AHRQ), and the Center for Financing, Access and Cost Trends (CFACT).
Publication
Assessing the Accuracy of Survey Reports of Health Insurance Coverage Using Enrollment Data
U.S. Census Bureau researcher Joanne Pascale, University of Minnesota researcher Angela Fertig, and SHADAC researcher Kathleen T. Call recently published a new article in the Health Services Research journal that details their efforts to measure the accuracy of responses to health insurance coverage surveys - such as the U.S. Census Bureau's Current Population Survey (CPS) - in reporting health insurance coverage and features of coverage for the civilian noninstitutionalized population. A reverse record check using a stratified random sample of enrollment records from households known to have health insurance through one large regional insurer and were cross-examined with data from the 2015 CPS survey in order to determine whether source/type of health insurance coverage were accurately self-reported by respondents of the survey.
Additionally, the Census Bureau redesigned the CPS in 2015 in order to make the survey more user-friendly, changing questions regarding individual features of insurance coverage from seeking "yes or no" answers to more open-ended and detailed toward the source of coverage that is reported by the respondent in order to capture more detailed information. The article thus additionally examines the accuracy of these individual questions, using comparable data from the Medical Expenditure Panel Survey (MEPS), the National Health Interview Survey (NHIS), and the Health Reform Monitoring Survey.
Blog & News
New SHADAC Brief Explores National and State Estimates of Gains in Equitable Coverage for Mental Health and Substance Use Disorder under the ACA
July 09, 2019:
A new brief from SHADAC, supported by the California Health Care Foundation (CHCF), examines gains in equitable coverage (i.e., “parity”) for mental health and substance use disorder (MH/SUD) treatment for people in the individual and small-group markets as well as those covered under Medicaid expansion after the passage of the Affordable Care Act (ACA). National and state-level estimates of parity gains for both types of treatment are provided within the brief, and estimates are broken down for the individual market, the small-group market, and the Medicaid expansion population.[1] These estimates provide important context for policymakers and others engaged in the ongoing debate about repealing, modifying, or replacing the ACA.
Background
Before the ACA, national legislation regarding equitable coverage for MH/SUD treatments applied only to large-group (i.e., employer-sponsored) health plans, as a result of the Mental Health Parity Act of 1996 (MHPA) and the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The ACA extended these MH/SUD parity protections beyond the large-group market to the individual and small-group markets and to Medicaid expansion beneficiaries by making MH/SUD treatments an essential health benefit (EHB). Before this change, coverage and parity for MH/ SUD treatment in these markets were addressed unevenly across states through a patchwork of state laws.
Expanding Equitable Coverage of Mental Health and Substance Use Disorder Treatment under the ACA: Key Provisions
Findings
Mental Health
In total, an estimated 39 million individuals nationwide had health insurance that was subject to the ACA’s expanded MH parity requirements as of 2017. Of these, 12.1 million were enrolled in individual plans, 14.4 million were enrolled in small-group plans, and almost 13 million were newly eligible Medicaid expansion enrollees.
At the state level, California saw the greatest number of individuals affected at approximately 8.6 million. Other states that had high estimates of affected populations included New York with 2.1 million, Florida with 2.08 million*, Texas with 1.9 million*, and Pennsylvania with 1.87 million.
Vermont, which had pre-ACA parity in both the individual and small-group market and had expanded Medicaid in advance of the ACA, was the only state that saw no effect. Other states such as Wyoming*, Alaska, and Delaware, all had affected populations of less than 100,000 (44,000; 67,000; and 80,000, respectively).
Substance Use Disorder
In total, an estimated 36.4 million individuals nationwide had health insurance that was subject to the ACA’s expanded SUD parity requirements as of 2017. Of these, 9.8 million were enrolled in individual plans, 14 million were enrolled in small-group plans, and almost 12 million were newly eligible Medicaid expansion enrollees.
At the state level, California saw the greatest number of individuals affected at approximately 8.26 million, followed by New York (2.09 million), Florida* (1.79 million), Pennsylvania (1.79 million) and Texas* (1.7 million).
Massachusetts, which had pre-ACA parity in both the individual and small-group market and had expanded Medicaid in advance of the ACA, was the only state that saw no effect. Other states such as Delaware, Wyoming*, Maine*, and Alaska all had affected populations of less than 100,000 (12,000; 39,000; 52,000; and 64,000, respectively).
Discussion
Though the ACA mandated access to health insurance coverage with parity for treatment of mental health and substance use disorders for new groups, it is important to note that the expansion of coverage parity legislation does not guarantee access to equitable MH/SUD services unless the legislation is enforced. Responsibility for parity enforcement falls primarily to states, and the nature and extent of enforcement is consequently inconsistent across the country, with many parity violations continuing to occur as state regulators face limitations in their enforcement capacities.
Further Reading
Access and Cost Barriers to Mental Health Care, by Insurance Status, 1999-2010
Kathleen Rowan, Donna McAlpine, and Lynn Blewett
Section 1115 Waivers and ACA Medicaid Expansions: A Review of Policies and Evidence from Five States: May 2016
SHADAC Special Issue Brief
Medicaid Expansion: Comparing State Choices in Alternative Benefit Plan Design
Colin Planalp
To learn more about mental health and state-level estimates for the affected population who report mentally unhealthy days, see our recent blog post, and visit State Health Compare to learn more about the measure and its data sources.
[1] National estimates do not include a Medicaid expansion breakdown because expansion has only occurred at the state level.
* No Medicaid expansion
