Family health

The average worker paid $5,588 out of pocket for family health coverage this year

Workers with employer-sponsored health coverage paid 17% of the premiums for individual coverage this year, on average, and 27% of the cost of family coverage, according to a comparative study of nearly 1,800 small and large American employers.

Annual premiums for employer-sponsored family health coverage reached $21,342 this year, up 4% from last year, with workers paying an average of $5,588 for the cost of their coverage and employers paying the remaining $15,754, according to the Kaiser Family Foundation (KFF).
2020 Employer Health Benefits Surveyconducted from January to July.

Deductibles rose, then held steady

Higher deductibles have become much more common, and the percentage of workers covered with an annual deductible of $2,000 or more for individual coverage has risen from 19% to 26% over the past five years, according to the survey.

Eighty-three per cent of covered workers had a deductible in their plan this year, similar to last year and up from 70 per cent a decade ago. Deductible amounts varied by plan type. For example:

  • The average deductible for individual coverage is $1,204 for Preferred Provider Organization Plans (OPPs), virtually unchanged from $1,206 in 2019, but up sharply from $675 in 2010.
    For high deductible health plans (HDHP), the average deductible for single coverage is $2,303.

  • The average deductible for family plans is $2,716 for PPO plans, down slightly from $2,883 last year, but up from $1,518 a decade ago.

    For HDHPs, the average family coverage deductible is $4,552.

“The burden of healthcare costs on workers remains high, but is not worsening dramatically,” said KFF President and CEO Drew Altman. “Things may look different in the future as employers grapple with the economic and health upheaval caused by the pandemic.”

Cost Share Amounts

After paying the deductible, most covered workers face a fixed dollar copayment when seeing a doctor, and some workers face coinsurance requirements — a percentage of the covered amount. The KFF survey showed that this year:

  • The average user fees were $26 for network primary care and $42 for specialized care.

  • The average coinsurance rates were 18% for primary care and 19% for specialist care.

These amounts were similar to 2019. Out-of-network cost-sharing fees can be significantly higher.

Virtually all covered workers are in plans with an in-network cost-sharing limit, known as the maximum payout. These limits vary widely. For individual coverage, 11% of covered workers were in plans with maximums less than $2,000 and 18% of covered workers were in plans with maximums of at least $6,000.

Bonuses exceed earnings

For 2020, premiums for employer-sponsored health plans increased 4% from 2019, according to the survey:

  • Overall, employer plan premiums were on average $21,342 for family coverage and $7,470 for single coverage only.

  • For HDHPs, average annual premiums were somewhat lower— $20,359 for family coverage and $6,890 for individual coverage only.

The 4% increase in premiums in 2020 was only slightly higher than the year-over-year rise in worker incomes (3.4%) and inflation (2.1%). Since 2010, however, average family bonuses have increased by 55%, at least twice as fast as wages (27%) and inflation (19%), KFF reported.

Employer premiums and deductibles have grown much faster than wages since 2010

Deductibles are for single coverage among insured workers.

Note: Workers in Plans
without an annual deductible for network services were assigned a value of zero.

Source: Kaiser Family Foundation.

Although the KFF benchmarking survey did not ask about premium increases for 2021, other studies show that employers expect moderate increases in health plan costs next year, mainly around 4.4% to 5.3%, on average.

Close mental health networks

A large majority (83%) of employers were satisfied with the overall choice of doctors and hospitals available under their insurance plans, although far fewer (67%) said the same about their mental health networks. and drug addiction, KFF reported.

About 1 in 5 (19%) describe their mental health networks as somewhat or very tight, potentially leaving workers with limited options at a time when pandemic-related worry and stress affects many American workers.

“The coronavirus pandemic has increased the need for access to mental and behavioral health services, for which provider networks are often tighter than for other services,” said KFF senior vice president Gary Claxton. and lead author of the study. “Some plans may have increased access by supporting telehealth, although it’s unclear if these options will become a permanent feature.”

“The COVID-19 pandemic has created significant mental health issues for many people around the world,” also reported Milliman, a global consulting and actuarial firm. “Telehealth visits may be part of the new ‘normal’ to replace, or at least complement, office visit-based treatment for behavioral health issues.”

Related SHRM articles:

Moderate cost increases projected for health benefits in 2021,
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Employers Project Health Plan costs will increase by 5.3% for 2021,
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15 ways employers can cut non-cost-shared healthcare expenses
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