The rise in the cost of employer-sponsored health insurance has ameliorated in the past year, continuing a flattening trend, but patients continue to be asked to pay a bigger share.
That’s the conclusion of the 13th annual survey of nonfederal private and public employers with three or more workers conducted by the Kaiser Family Foundation and the Health Research & Educational Trust, and published Aug. 20 in the journal Health Affairs (doi: 10.1377/hlthaff.2013.0644).
Kaiser and HRET estimate that in 2013, 149 million nonelderly people receive coverage through employer-sponsored insurance, with 57% of U.S. firms offering health benefits – a statistically insignificant change from 61% in 2012 and 60% in 2011. But smaller companies and those with many low-wage workers do not offer benefits as frequently.
In 2013, the average annual premiums for employer-sponsored health insurance rose 5% to $5,884 for single coverage and 4% to $16,351 for family coverage from 2012. This continues the pattern seen over the past few years, with relatively small premium increases.
Workers on average pay 18% of the premium for single coverage and 29% for family coverage, again, similar to the two previous years. "We are in a prolonged period of moderation in premiums, which should create some breathing room for the private sector to try to reduce costs without cutting back benefits for workers," said Kaiser President and CEO Drew Altman, in a statement.
But workers are still struggling to cover health costs. During the same period (2012-2013), wages increased 1.8% and inflation increased 1.1%. And since 2003, the average premium for family coverage has increased 80%, and the average worker contribution has risen 89%.
Employers continue to cost-shift. Seventy-eight percent of covered workers have a deductible, with the average for single coverage running about $1,100 (largely unchanged from 2012). But big deductibles are getting to be more common. Firms with less than 200 employees generally charged more than $1,000, and the number doing that rose from 49% of all such firms in 2012 to 58% in 2013.
Three-quarters of workers have a fixed copayment for office visits with primary care physicians and specialists. That copay averages $23 for primary care and $35 for specialty care for in-network physicians. Out-of-network amounts were not covered in the survey, but Kaiser assumes that patients bear a greater cost for those visits. About 20% of workers pay a percent of the visit (coinsurance) for primary care and the same amount for specialty care. They pay an average 18% of the visit.
The survey found that preferred provider organization (PPO) plans are the most common, enrolling 57% of covered workers in 2013. High-deductible health plans, also known as catastrophic plans, are the next most popular, with 20% of covered workers. Deductibles in those plans range from around $2,000 for single coverage to $4,000 for family coverage, with some much higher.
Only 14% of workers are enrolled in health maintenance organizations (HMOs), 9% in a point-of-service (POS) plan, and less than 1% in a conventional fee-for-service plan. High-deductible plans have grown exponentially since first coming on the scene – going from 8% in 2009 to 17% in 2011 – but have plateaued in the last few years, according to the report.
Also of interest to physicians:
• 23% of employers offering benefits have high performance or tiered networks in their largest health plan. The programs help steer patients to providers who have been identified as being more efficient or giving higher-quality care.
• 56% cover services provided by retail health clinics. Among firms covering services in these settings, 17% provide a financial incentive to receive services in a retail clinic instead of a physician’s office.
• Almost all employers with more than 200 workers and most smaller employers offer at least one wellness program. The majority offer at least one of the following in 2013: weight loss programs, gym membership discounts or on-site exercise facilities, biometric screening, smoking cessation, personal health coaching, health and nutrition education, web-based resources, flu shots or vaccinations, employee assistance programs (EAPs), or a wellness newsletter. Thirty-six percent of large firms and 8% of smaller firms offer employees a financial incentive to participate.
The growth in wellness programs "will be an important issue to watch next year, as employers will have more flexibility and could ask workers to pay more because of their lifestyles and health conditions," said Kaiser Vice President Gary Claxton, the study’s lead investigator and director of the Foundation’s Health Care Marketplace Project.
Mr. Claxton and his colleagues found that an increasing number of employees are likely to be subject to the Affordable Care Act’s various provisions. Thirty-six percent of covered workers are in "grandfathered" plans – that is, they are exempt from the law – down from 48% in 2012 and 56% in 2011.