Chartbook #25: Medical Expenditure Panel Survey Insurance Component Chartbook 2020
 
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Chartbook #25: MEPS Insurance Component 2020 Chartbook


Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857
www.ahrq.gov

Acknowledgments

This chartbook was prepared by G. Edward Miller, Patricia Keenan, Thomas A. Hegland and Asako S. Moriya of the Division of Research and Modeling, Center for Financing, Access, and Cost Trends (CFACT) in the Agency for Healthcare Research and Quality (AHRQ).

The authors appreciate the efforts of Alon Evron, Jillian Botkin, Lauren Kestner, Sara Bernate Angulo, and Andy Elkins of IMPAQ, Karen Turner of the University of Minnesota, Abigail Smith and Damon Harris of Insignia, and Embrey Young of Visual Connections in creating the exhibits in the chartbook, compiling the chartbook, and preparing the chartbook for production; the data production work of Brandon Flanders of the U.S. Census Bureau; and the production assistance of Doreen Bonnett and Nicole Shulman, AHRQ.

Reviewers of this publication were Joel W. Cohen, Director of CFACT, and Steven C. Hill (Senior Economist), Julie Hudson (Senior Economist), Salam Abdus (Senior Economist), Paul D. Jacobs (Senior Service Fellow), and Samuel H. Zuvekas (Senior Research Adviser) of the Division of Research and Modeling in CFACT.


Table of Contents

Introduction
Background
Data Presentation
References
Executive Summary
Section 1: Health Insurance Offer Rates
Section 2: Employee Eligibility and Enrollment
Section 3: Health Insurance Premiums
Section 4: Employee and Employer Premium Contributions
Section 5: Employee Cost Sharing

The data used in this report are from the Insurance Component of the Medical Expenditure Panel Survey. Information about this survey, including sample design, data collection, sample sizes, and response rates, can be found at https://meps.ahrq.gov/survey_comp/Insurance.jsp.

This product is in the public domain and may be used and reprinted without permission in the United States for noncommercial purposes, unless materials are clearly noted as copyrighted in the document. No one may reproduce copyrighted materials without the permission of the copyright holders. Users outside the United States must get permission from AHRQ to reprint or translate this product. Anyone wanting to reproduce this product for sale must contact AHRQ for permission.


Suggested Citation

Medical Expenditure Panel Survey Insurance Component 2020 Chartbook. Rockville, MD: Agency for Healthcare Research and Quality; December 2021. AHRQ Publication No. 22-0002. https://meps.ahrq.gov/mepsweb/data_files/publications/cb25/cb25.shtml.


Introduction

The Medical Expenditure Panel Survey Insurance Component (MEPS-IC) is an annual survey of private employers and State and local governments. The MEPS-IC produces national and Statelevel estimates of employer-sponsored insurance, including offered plans, costs, employee eligibility, and number of enrollees. The MEPS-IC is sponsored by the Agency for Healthcare Research and Quality and is fielded by the U.S. Census Bureau.

This chartbook provides both single-year and multiyear trend analyses using private-sector MEPS-IC data from 2008 to 2020. To best convey key information from the MEPS-IC, the report is presented in five sections: Health Insurance Offer Rates; Employee Eligibility and Enrollment; Health Insurance Premiums; Employee and Employer Premium Contributions; and Employee Cost Sharing. Each section provides charts and discussion with links to MEPS-IC data tables that contain the estimates and standard errors for each exhibit.

Many of the estimates in this publication are categorized by firm sizes that are relevant to national healthcare policy. The firm-size categories used in the charts and tables are based on actual employment counts rather than full-time equivalent (FTE) counts, because the MEPS-IC does not collect FTE employment figures.

Each section discusses the estimates to highlight trends and differences by employer and workforce characteristics. If a comparison of estimates is presented in the discussion, any differences are statistically significant at the 0.05 level. In some cases, differences noted in the text, in estimates as well as statistical significance of comparisons, may vary slightly from calculations performed using data in the exhibits, MEPS-IC data available on the MEPS website, or MEPS-IC Statistical Briefs due to rounding. All dollar estimates are nominal (not adjusted for inflation).

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Background

The IC is one of three annual component surveys that make up MEPS. The other two components are the Household Component (HC) and the Medical Provider Component (MPC). The HC is a nationally representative survey of the U.S. civilian noninstitutionalized population that collects data at both the person and household levels. The MPC collects information from a sample of physicians, hospitals, home health agencies, and pharmacies that provided services to HC respondents.

The MEPS-IC uses two independent samples: the private sector and the public sector. The private-sector sample is composed of approximately 42,000 business establishments from more than 7 million establishments found on the Business Register at the U.S. Census Bureau, with 4.2 percent of the sample determined during the data collection process to be out of scope. In 2020, the response rate for the private sector was 56.1 percent of the remaining in-scope sample units.

An establishment is a single business entity or location. Firms (also often referred to as companies) can include one or more establishments. An example of a multi-establishment firm is a chain of grocery stores, where the establishments of the firm are the sites of the individual grocery stores. The charts and tables in this publication report characteristics within firm-based size categories.

The public-sector sample of the MEPS-IC selects almost 3,000 State and local government agencies. However, this report focuses only on the private sector. Additional information on MEPS-IC sampling can be found in Sample Design of the 2020 Medical Expenditure Panel Survey Insurance Component (Davis, 2021; PDF).

The unprecedented pandemic and economic disruption in 2020 have caused uncertainty in some of the private-sector employment estimates, particularly with respect to the distribution of employment across firm sizes.

The issue is a concern because offers of health insurance are strongly correlated with firm size. Consequently, changes in employment may have affected differences in the estimated percentages of employees offered, and covered by, employer-sponsored health insurance between 2019 and 2020. They also affect estimates of totals by firm size (e.g., totals of establishments and employees). However, our initial investigations suggest that the vast majority of means and proportions estimated in the MEPS-IC data are not affected by this issue.

AHRQ is currently investigating several factors that may have influenced the 2020 MEPS-IC data. These factors include: (1) when firms of different sizes respond to the survey; (2) openings and closures of establishments during the survey period; and (3) the role of openings and closures in multi-establishment firms.


Data Presentation

For purposes of the analyses presented in this chartbook, the District of Columbia is treated as a State. In addition, exhibits are organized by category (e.g., premium type, firm size), so references to exhibits in the text may not be in numeric order (e.g., Exhibits 3.1, 3.3, and 3.5 instead of 3.1, 3.2, and 3.3).

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References

Davis K. Sample Design of the 2020 Medical Expenditure Panel Survey Insurance Component. Methodology Report #34. Rockville, MD: Agency for Healthcare Research and Quality; August 2021. https://meps.ahrq.gov/data_files/publications/mr34/mr34.shtml. Accessed September 29, 2021.

Kearney A, Sommers J. Switching from retrospective to current-year data collection in the Medical Expenditure Panel Survey - Insurance Component. ICES-III: Third International Conference on Establishment Surveys, Conference Proceedings, Montréal, Québec, Canada; June 2007.

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Executive Summary

Overview

Employer-sponsored insurance (ESI) is the primary source of health insurance coverage for individuals under age 65. This chartbook uses data for private-sector establishments in the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to describe trends in employer coverage, premiums, and benefits from 2008 to 2020.

The MEPS-IC is an annual survey of private employers and State and local governments and is designed to be representative of all 50 States and the District of Columbia. The large sample size (about 42,000 private-sector establishments), combined with a response rate of 56.1 percent in 2020, permits analyses of variations in ESI by firm size and across States that are not readily available from other sources.

Examining trends by firm size and across States is important due to variation in insurance markets along these dimensions. Historically, insurance markets have differed by firm size due to smaller firms' more limited ability to pool risk and their higher administrative costs compared with larger firms. State variation in ESI markets may reflect differences in employment patterns, healthcare prices, and utilization, as well as differences in State approaches to regulating private insurance and administering Medicaid.

This chartbook describes trends and patterns in ESI overall, by firm size, and by State from 2008 to 2020. All differences noted are at the 0.05 significance level. All dollar estimates are nominal (not adjusted for inflation).

Summary of Findings

Employee Enrollment in Health Insurance

Between 2019 and 2020, there was a significant increase, from 47.6 percent to 49.5 percent, in the overall percentage of private-sector employees covered by a health insurance plan offered by their employers (the "enrollment rate"). There were no significant changes, however, in the enrollment rate within any of the three firm size groups examined in this study.

Compared with 2019, the increase in the overall 2020 enrollment rate reflects a large reduction in employment among small employers (fewer than 50 employees) and a subsequent increase in the proportion of employees in medium (50 to 99 employees) and large firms (100 or more employees). Since these firms have higher enrollment rates than small firms, the overall 2020 enrollment rate increased even though enrollment rates within firm sizes did not change.*

The enrollment rate reflects the combination of employers' decisions about offering health insurance and employee eligibility for such coverage, as well as employees' decisions to take up coverage if eligible. Offer rates, eligibility rates, and take-up rates, as well as coverage rates among employees offered insurance, are described further below.

Availability of Coverage: Offer Rates

Overall, the percentage of private-sector employees working at establishments that offered insurance ("the offer rate") increased from 85.3 percent in 2019 to 86.9 percent in 2020 (Exhibit ES.1). Offer rates at small (50.5 percent), medium (88.5 percent), and large firms (98.8 percent) were unchanged from their 2019 values.

The change in the overall offer rate was driven by the large decline in employment among small employers. Compared with 2019, the increase in the overall 2020 offer rate reflects an increase in the proportion of employees in medium and large firms. Since these firms have higher offer rates than small firms, the overall 2020 offer rate increased even though offer rates within firm sizes did not change.*

* These findings may be affected by measurement issues related to the 2020 MEPS-IC employment and related estimates. For a discussion of these issues, see the MEPS IC 2020 user note.

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ALTER EXBES.1



Exhibit ES.1 Percentage (standard error) of private-sector employees in establishments that offer health insurance, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 87.7% 87.6% 86.5%* 85.3%* 84.7% 84.9% 83.2%* 83.8% 84.3% 84.5% 84.6% 85.3%* 86.9%*
(Standard Error) (0.3%) (0.2%) (0.2%) (0.2%) (0.3%) (0.3%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%)
<50 61.6% 59.6%* 57.8%* 54.7%* 52.9%* 53.1% 49.8%* 47.6%* 47.7% 48.3% 47.3% 50.7%* 50.5%^
(Standard Error) (0.5%) (0.5%) (0.5%) (0.4%) (0.6%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%)
50-99 90.7% 89.6% 87.3% 85.6% 84.1% 87.0% 83.0%* 85.3% 88.6%* 86.3% 88.0% 88.0% 88.5%^
(Standard Error) (0.9%) (1.3%) (0.9%) (1.0%) (1.4%) (1.0%) (1.3%) (1.2%) (1.0%) (1.2%) (1.1%) (1.1%) (1.2%)
100+ 98.2% 98.8% 98.5% 98.1% 98.2% 98.0% 97.3%* 98.8%* 98.9% 98.9% 99.0% 99.0% 98.8%
(Standard Error) (0.3%) (0.1%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%) (0.1%) (0.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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Since almost all large firms offer health insurance coverage, offer rates among small firms are an important factor contributing to overall State ESI offer rates, along with the distribution of employers by firm size in the State. Overall, the average annual offer rate for 2018-2020 was 49.5 percent for small firms, but there was substantial variation across the United States. Among small firms, 15 States were significantly below the national average, with average annual offer rates ranging from 35.5 to 44.4 percent. Another 15 States, with average annual offer rates ranging from 53.7 to 90.2 percent, were significantly above the national average for small firms (Exhibit ES.2).



ALTER EXBES.2



Exhibit ES.2 Percentage (standard error) of private-sector employees in establishments that offer health insurance, by State, firm size <50 employees, 3-year average, 2018-2020

Alabama 54.9%* Kentucky 49.4% North Dakota 56.3%*
(Standard Error) (2.3%) (Standard Error) (2.6%) (Standard Error) (2.1%)
Alaska 35.5%* Louisiana 50.2% Ohio 50.0%
(Standard Error) (2.3%) (Standard Error) (2.5%) (Standard Error) (2.4%)
Arizona 45.5% Maine 45.0% Oklahoma 50.2%
(Standard Error) (2.7%) (Standard Error) (2.4%) (Standard Error) (2.3%)
Arkansas 40.4%* Maryland 56.8%* Oregon 48.2%
(Standard Error) (2.5%) (Standard Error) (2.4%) (Standard Error) (2.1%)
California 50.2% Massachusetts 62.5%* Pennsylvania 55.6%*
(Standard Error) (1.4%) (Standard Error) (2.5%) (Standard Error) (1.9%)
Colorado 46.1% Michigan 50.5% Rhode Island 56.1%*
(Standard Error) (2.4%) (Standard Error) (2.3%) (Standard Error) (2.5%)
Connecticut 57.8%* Minnesota 49.2% South Carolina 40.8%*
(Standard Error) (2.3%) (Standard Error) (2.4%) (Standard Error) (2.4%)
Delaware 50.5% Mississippi 45.6% South Dakota 50.1%
(Standard Error) (2.9%) (Standard Error) (2.6%) (Standard Error) (2.1%)
District of Columbia 70.4%* Missouri 49.2% Tennessee 48.3%
(Standard Error) (2.6%) (Standard Error) (2.4%) (Standard Error) (2.5%)
Florida 41.7%* Montana 37.6%* Texas 47.4%
(Standard Error) (2.1%) (Standard Error) (2.1%) (Standard Error) (1.7%)
Georgia 41.1%* Nebraska 41.2%* Utah 38.1%*
(Standard Error) (2.5%) (Standard Error) (2.3%) (Standard Error) (2.5%)
Hawaii 90.2%* Nevada 51.3% Vermont 46.1%
(Standard Error) (1.3%) (Standard Error) (2.9%) (Standard Error) (2.0%)
Idaho 39.9%* New Hampshire 55.3%* Virginia 50.8%
(Standard Error) (2.3%) (Standard Error) (2.3%) (Standard Error) (2.3%)
Illinois 53.7%* New Jersey 57.1%* Washington 50.1%
(Standard Error) (2.0%) (Standard Error) (2.3%) (Standard Error) (2.2%)
Indiana 43.9%* New Mexico 40.9%* West Virginia 44.1%*
(Standard Error) (2.4%) (Standard Error) (2.3%) (Standard Error) (2.6%)
Iowa 54.2%* New York 55.7%* Wisconsin 44.4%*
(Standard Error) (2.2%) (Standard Error) (1.6%) (Standard Error) (2.3%)
Kansas 54.7%* North Carolina 38.5%* Wyoming 38.0%*
(Standard Error) (2.3%) (Standard Error) (2.2%) (Standard Error) (2.1%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * Statistically different from the national average of 49.5 percent at p < 0.05. Note that the standard error on the national estimate of 49.5 percent is 0.4 percent.

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Employee Coverage, Eligibility, and Take-Up Rates

Among establishments that offered insurance, 57.0 percent of employees were enrolled in coverage through their employer (the "coverage rate") and 80.5 percent were eligible for health insurance (the "eligibility rate"). Among eligible employees, 70.8 percent were enrolled in their employers health insurance (the "take-up rate") (Exhibits ES.3, ES.4, and ES.5).

chart and data



Exhibit ES.3: Coverage Rate Percentage (standard error) of private-sector employees who are enrolled in health insurance at establishments that offer health insurance, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 61.4% 61.1% 59.8%* 59.4% 58.9% 58.2% 57.8% 57.0% 56.0% 56.5% 56.5% 55.8% 57.0%
(Standard Error) (0.4%) (0.4%) (0.5%) (0.2%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%)
<50 59.7% 59.6% 59.2% 58.6% 57.7% 57.1% 56.8% 57.0% 55.5% 55.4% 56.2% 53.9%* 55.1%^
(Standard Error) (0.2%) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%)
50-99 56.3% 60.1%* 55.9%* 54.9% 55.4% 54.7% 54.5% 55.8% 51.2%* 52.2% 50.3% 53.8%* 53.4%^
(Standard Error) (1.0%) (1.0%) (0.8%) (1.0%) (1.2%) (0.8%) (1.3%) (1.2%) (1.2%) (1.2%) (1.2%) (1.2%) (1.3%)
100+ 62.4% 61.6% 60.4% 60.0% 59.5% 58.8% 58.3% 57.1% 56.6% 57.1% 57.1% 56.4% 57.7%
(Standard Error) (0.5%) (0.6%) (0.6%) (0.3%) (0.4%) (0.3%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.          
Denominator: Within each category, all employees in establishments that offer health insurance.            
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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From 2019 to 2020, there was no significant change in the coverage rate overall, and no significant change in the coverage rate within small, medium, or large firms (Exhibit ES.3).

The overall eligibility rate for employees at private-sector establishments that offered insurance increased from 77.7 percent in 2019 to 80.5 percent in 2020. The eligibility rate for small employers increased from 78.1 percent to 80.2 percent, and the eligibility rate for large firms increased from 77.5 percent to 80.8 percent (Exhibit ES.4).



chart and data



Exhibit ES.4: Eligibility Rate Percentage (standard error) of private-sector employees eligible for health insurance at establishments that offer health insurance, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 78.1% 79.5%* 78.2%* 78.0% 77.8% 77.8% 75.4%* 76.0% 76.5% 76.8% 78.0%* 77.7% 80.5%*
(Standard Error) (0.4%) (0.3%) (0.5%) (0.4%) (0.3%) (0.2%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%)
<50 78.5% 79.3% 78.6% 78.7% 77.9% 78.0% 77.7% 79.1% 78.7% 78.3% 79.1% 78.1% 80.2%*
(Standard Error) (0.4%) (0.5%) (0.5%) (0.6%) (0.5%) (0.4%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%)
50-99 75.3% 79.2%* 74.5%* 73.6% 76.4% 76.2% 74.1% 77.8%* 76.2% 75.5% 75.6% 78.1% 77.6%^
(Standard Error) (1.3%) (0.8%) (0.6%) (1.0%) (1.2%) (0.8%) (1.4%) (1.2%) (1.2%) (1.2%) (1.2%) (1.2%) (1.4%)
100+ 78.3% 79.6%* 78.5% 78.3% 77.9% 77.9% 75.0%* 75.2% 76.0% 76.6% 78.0% 77.5% 80.8%*
(Standard Error) (0.4%) (0.5%) (0.6%) (0.4%) (0.3%) (0.3%) (0.5%) (0.5%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.          
Denominator: Within each category, all employees in establishments that offer health insurance.            
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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Among large employers (100 or more employees), take-up rates fell from 72.7 percent to 71.4 percent (Exhibit ES.5). Despite the decline, the take-up rate among large firms (71.4 percent) remained higher than in medium (68.8 percent) and small firms (68.7 percent), as has been true in almost every year from 2008 through 2020.



chart and data



Exhibit ES.5: Take-Up Rate Percentage (standard error) of eligible private-sector employees who are enrolled in health insurance at establishments that offer health insurance, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 78.7% 76.9%* 76.5% 76.1% 75.8% 74.8%* 76.7%* 75.0%* 73.3%* 73.5% 72.4%* 71.9% 70.8%*
(Standard Error) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%)
<50 76.0% 75.2%* 75.3% 74.4% 74.1% 73.1% 73.0% 72.1% 70.4%* 70.7% 71.0% 69.0%* 68.7%^
(Standard Error) (0.3%) (0.3%) (0.6%) (0.4%) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%)
50-99 74.9% 75.9% 75.1% 74.5% 72.5% 71.8% 73.5% 71.7% 67.2%* 69.1% 66.6% 68.9% 68.8%^
(Standard Error) (0.5%) (0.9%) (0.7%) (0.6%) (0.8%) (1.0%) (1.0%) (1.1%) (1.2%) (1.1%) (1.1%) (1.0%) (1.0%)
100+ 79.7% 77.5%* 76.9% 76.7% 76.4% 75.5%* 77.8%* 76.0%* 74.4%* 74.5% 73.3%* 72.7% 71.4%*
(Standard Error) (0.4%) (0.5%) (0.3%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.          
Denominator: Within each category, all employees in establishments that offer health insurance.            
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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Choice of Plans

The overall share of employees at health insurance-offering firms who were offered a choice of two or more health plans fell from 75.8 percent in 2019 to 73.8 percent in 2020. This decline was driven by firms with 100 or more employees, where the share of employees offered a choice of plans fell from 84.5 percent in 2019 to 81.0 percent in 2020 (Exhibit ES.6).

In all years from 2008 to 2020, the likelihood that a worker at an offering establishment had a choice of plans increased with firm size. In 2020, the percentage of workers with a choice of plans was 39.9 percent in firms with fewer than 50 employees, 58.6 percent in firms with 50 to 99 employees, and 81.0 percent in firms with 100 or more workers.

ALTER EXBES.6



Exhibit ES.6 Percentage (standard error) of private-sector employees working in establishments that offer two or more health insurance plans, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 64.8% 66.5% 65.6% 65.5% 65.3% 66.0% 67.0% 70.2%* 71.7% 72.4% 75.7%* 75.8% 73.8%*
(Standard Error) (0.6%) (0.7%) (0.8%) (0.5%) (0.7%) (0.6%) (0.6%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%)
<50 26.8% 27.3% 26.7% 27.2% 29.3% 28.4% 29.6% 33.6%* 34.2% 34.9% 37.8%* 41.4%* 39.9%^
(Standard Error) (0.7%) (0.9%) (0.8%) (0.9%) (0.8%) (1.0%) (0.9%) (1.1%) (1.0%) (1.0%) (1.0%) (1.1%) (1.1%)
50-99 42.5% 42.8% 44.1% 46.8% 43.7% 46.6% 46.8% 50.2% 56.2%* 59.3% 56.4% 58.7% 58.6%^
(Standard Error) (1.7%) (2.0%) (1.9%) (2.2%) (1.7%) (2.2%) (2.1%) (2.2%) (2.0%) (1.9%) (1.9%) (2.0%) (2.1%)
100+ 76.9% 78.5% 77.3% 76.3% 75.7% 76.5% 77.0% 79.7%* 80.7% 81.0% 84.7%* 84.5% 81.0%*
(Standard Error) (0.7%) (0.7%) (1.0%) (0.7%) (0.7%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.5%) (0.6%) (0.6%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.          
Denominator: Within each category, all employees in establishments that offer health insurance.            
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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Self-Insured Plans

Between 2019 and 2020, the overall percentage of offering establishments that self-insured at least one plan increased from 39.4 percent to 41.9 percent. This increase occurred despite a decrease (from 83.1 percent to 77.8 percent) among establishments in firms with 1,000 or more employees (Exhibit ES.7).

ALTER EXBES.7



Exhibit ES.7 Percentage (standard error) of private-sector establishments that offer health insurance that self-insure at least one plan, overall and by detailed firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 34.2% 35.1% 35.8% 36.9% 37.2% 37.6% 37.2% 39.0%* 40.7%* 39.2% 38.7% 39.4% 41.9%*
(Standard Error) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%)
<10 14.0% 14.6% 13.1% 12.6% 14.9% 15.2% 14.4% 15.8% 19.3%* 17.7% 13.1%* 14.8% 17.6%^
(Standard Error) (0.8%) (0.7%) (0.5%) (0.8%) (0.9%) (0.4%) (0.8%) (1.0%) (1.4%) (1.4%) (1.1%) (1.3%) (1.7%)
10-24 11.1% 10.4% 11.6% 9.9% 10.7% 9.0% 12.0%* 10.6% 13.6%* 13.3% 13.8% 12.2% 13.1%^
(Standard Error) (0.9%) (0.4%) (0.8%) (0.7%) (0.7%) (0.7%) (1.0%) (1.0%) (1.1%) (1.2%) (1.2%) (1.1%) (1.2%)
25-99 12.6% 13.4% 14.3% 12.2%* 13.5% 12.4% 12.2% 13.7% 16.6%* 16.0% 12.9%* 17.2%* 16.3%^
(Standard Error) (0.8%) (0.7%) (0.7%) (0.7%) (0.7%) (0.7%) (0.8%) (0.9%) (0.9%) (0.9%) (0.8%) (0.9%) (0.9%)
100-999 32.7% 29.9% 30.9% 31.7% 30.1% 30.1% 32.5% 33.7% 34.4% 37.2% 35.1% 33.9% 35.8%^
(Standard Error) (1.3%) (0.7%) (0.9%) (1.1%) (0.8%) (1.0%) (1.2%) (1.2%) (1.2%) (1.3%) (1.2%) (1.1%) (1.2%)
1,000+ 86.5% 85.8% 86.6% 87.5% 87.1% 88.0% 84.2%* 83.8% 81.9% 78.6%* 81.6%* 83.1% 77.8%*
(Standard Error) (0.5%) (0.4%) (0.6%) (0.5%) (0.7%) (0.5%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <10, 10-24, 25-99, and 100-999 employees are statistically different from the estimate for firms with 1,000+ employees at p < 0.05. This test is conducted for 2020 only.

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Premiums

In 2020, average health insurance premiums were $7,149 for single coverage, $14,191 for employee-plus-one coverage, and $20,758 for family coverage (Exhibit ES.8).

ALTER EXBES.8



Exhibit ES.8 Average total premiums (standard error) per enrolled employee for single, employee-plus-one and family coverage, 2008-2020

Coverage 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Single $4,386 $4,669* $4,940* $5,222* $5,384* $5,571* $5,832* $5,963* $6,101* $6,368* $6,715* $6,972* $7,149*
(Standard Error) ($15) ($21) ($22) ($26) ($28) ($23) ($25) ($26) ($27) ($28) ($31) ($35) ($35)
Plus One $8,535 $9,053* $9,664* $10,329* $10,621* $10,990* $11,503* $11,800* $12,124* $12,789* $13,425* $13,989* $14,191
(Standard Error) ($43) ($34) ($60) ($105) ($56) ($54) ($60) ($58) ($60) ($70) ($70) ($83) ($93)
Family $12,298 $13,027* $13,871* $15,022* $15,473* $16,029* $16,655* $17,322* $17,710* $18,687* $19,565* $20,486* $20,758
(Standard Error) ($81) ($25) ($75) ($98) ($95) ($61) ($79) ($95) ($84) ($105) ($104) ($125) ($124)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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From 2019 to 2020, average single premiums increased by 2.5 percent (Exhibit ES.9). This 1-year percentage increase was significantly lower than the average annual growth rate (4.2 percent) for single premiums from 2008 to 2020 (data not shown). Average premiums for employee-plus-one coverage ($14,191) and family coverage ($20,758) were not significantly different from their 2019 levels. This was the first time in the 2008 to 2020 period that there was not a statistically significant increase in these premiums.



ALTER EXBES.9



Exhibit ES.9 Percentage change (standard error) in total premiums from previous year per enrolled employee for single, employee-plus-one, and family coverage, 2009-2020

Year Single Plus one Family
2009 6.5%* 6.1%* 5.9%*
(Standard Error) ($0.6%) ($0.7%) ($0.7%)
2010 5.8%* 6.7%* 6.5%*
(Standard Error) ($0.7%) ($0.8%) ($0.6%)
2011 5.7%* 6.9%* 8.3%*
(Standard Error) ($0.7%) ($1.3%) ($0.9%)
2012 3.1%* 2.8%* 3.0%*
(Standard Error) ($0.7%) ($1.2%) ($0.9%)
2013 3.5%* 3.5%* 3.6%*
(Standard Error) ($0.7%) ($0.7%) ($0.7%)
2014 4.7%* 4.7%* 3.9%*
(Standard Error) ($0.6%) ($0.7%) ($0.6%)
2015 2.2%* 2.6%* 4.0%*
(Standard Error) ($0.6%) ($0.7%) ($0.8%)
2016 2.3%* 2.7%* 2.2%*
(Standard Error) ($0.6%) ($0.7%) ($0.7%)
2017 4.4%* 5.5%* 5.5%*
(Standard Error) ($0.7%) ($0.8%) ($0.8%)
2018 5.4%* 5.0%* 4.7%*
(Standard Error) ($0.7%) ($0.8%) ($0.8%)
2019 3.8%* 4.2%* 4.7%*
(Standard Error) ($0.7%) ($0.8%) ($0.8%)
2020 2.5%* 1.4% 1.3%
(Standard Error) ($0.7%) ($0.9%) ($0.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from zero at p < 0.05.

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In 2020, average single premiums were lower in medium firms ($6,870) than in large firms ($7,197) (Exhibit ES.10).



ALTER EXBES.10



Exhibit ES.10 Average total single premium (standard error) per enrolled employee, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. $4,386 $4,669* $4,940* $5,222* $5,384* $5,571* $5,832* $5,963* $6,101* $6,368* $6,715* $6,972* $7,149*
(Standard Error) ($15) ($21) ($22) ($26) ($28) ($23) ($25) ($26) ($27) ($28) ($31) ($35) ($35)
<50 $4,501 $4,652* $4,956* $5,258* $5,460* $5,628* $5,886* $5,947 $6,070 $6,421* $6,667* $6,920* $7,045
(Standard Error) ($31) ($31) ($34) ($39) ($60) ($39) ($55) ($55) ($53) ($61) ($63) ($73) ($70)
50-99 $4,215 $4,614* $4,713 $4,861 $5,246* $5,314 $5,549* $5,642 $5,743 $6,163* $6,287 $6,629* $6,870^
(Standard Error) ($37) ($82) ($52) ($75) ($39) ($73) ($82) ($104) ($96) ($121) ($111) ($99) ($129)
100+ $4,370 $4,681* $4,959* $5,252* $5,378* $5,584* $5,851* $6,006* $6,146* $6,377* $6,770* $7,019* $7,197*
(Standard Error) ($26) ($38) ($23) ($31) ($28) ($29) ($30) ($31) ($32) ($33) ($37) ($42) ($41)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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In 2020, average total premiums for both types of dependent coverage (employee-plus-one and family) were higher in large firms ($14,304 and $20,990) than in small ($13,522 and $19,416)) and medium firms ($13,766 and $19,827) (Exhibits ES.11 and ES.12).



ALTER EXBES.11



Exhibit ES.11 Average total employee-plus-one premium (standard error) per enrolled employee, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. $8,535 $9,053* $9,664* $10,329* $10,621* $10,990* $11,503* $11,800* $12,124* $12,789* $13,425* $13,989* $14,191
(Standard Error) ($43) ($34) ($60) ($105) ($56) ($54) ($60) ($58) ($60) ($70) ($70) ($83) ($93)
<50 $8,631 $9,124* $9,850* $10,253* $10,524 $11,050* $11,386 $11,666 $11,833 $12,558* $13,044* $13,619 $13,522^
(Standard Error) ($110) ($119) ($80) ($104) ($121) ($92) ($163) ($158) ($156) ($170) ($176) ($248) ($212)
50-99 $8,421 $8,852* $9,166 $9,615* $10,178* $10,673 $10,845 $10,885 $11,389 $11,931 $12,593* $13,248 $13,766^
(Standard Error) ($88) ($148) ($124) ($192) ($185) ($330) ($187) ($198) ($227) ($232) ($236) ($321) ($246)
100+ $8,527 $9,058* $9,669* $10,394* $10,672* $11,006* $11,571* $11,892* $12,225* $12,878* $13,537* $14,105* $14,304
(Standard Error) ($60) ($34) ($62) ($113) ($70) ($59) ($68) ($66) ($68) ($79) ($79) ($92) ($106)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXBES.12



Exhibit ES.12 Average total family premium (standard error) per enrolled employee, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. $12,298 $13,027* $13,871* $15,022* $15,473* $16,029* $16,655* $17,322* $17,710* $18,687* $19,565* $20,486* $20,758
(Standard Error) ($81) ($25) ($75) ($98) ($95) ($61) ($79) ($95) ($84) ($105) ($104) ($125) ($124)
<50 $11,679 $12,041 $13,170* $14,086* $14,496 $14,787 $15,575* $15,919 $16,471 $17,649* $18,296* $19,417* $19,416^
(Standard Error) ($182) ($129) ($111) ($145) ($181) ($89) ($177) ($212) ($207) ($192) ($231) ($303) ($283)
50-99 $11,578 $12,431* $13,019* $14,151* $15,421* $15,376 $15,732 $16,336 $16,214 $17,735* $18,386 $19,893* $19,827^
(Standard Error) ($128) ($229) ($153) ($168) ($273) ($268) ($274) ($335) ($348) ($327) ($473) ($435) ($422)
100+ $12,468 $13,271* $14,074* $15,245* $15,641* $16,284* $16,903* $17,612* $18,000* $18,911* $19,824* $20,697* $20,990
(Standard Error) ($95) ($33) ($85) ($117) ($114) ($82) ($91) ($110) ($95) ($122) ($118) ($143) ($139)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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For the 3 years from 2018-2020, the overall average annual single premium was $6,944. Fifteen States, with average annual premiums ranging from $6,152 in Arkansas to $6,731 in Hawaii, were significantly below the national average. Twelve States, with average annual premiums ranging from $7,208 in Rhode Island to $8,672 in Alaska, were significantly above the national average (Exhibit ES.13).



ALTER EXBES.13



Exhibit ES.13 Average total single premium (standard error) per enrolled employee, by State, 3-year average, 2018-2020

Alabama $6,336* Kentucky $6,770 North Dakota $6,841
(Standard Error) ($102) (Standard Error) ($100) (Standard Error) ($75)
Alaska $8,672* Louisiana $6,666* Ohio $6,995
(Standard Error) ($206) (Standard Error) ($106) (Standard Error) ($98)
Arizona $6,453* Maine $7,261* Oklahoma $6,807
(Standard Error) ($88) (Standard Error) ($89) (Standard Error) ($103)
Arkansas $6,152* Maryland $7,048 Oregon $6,669*
(Standard Error) ($107) (Standard Error) ($116) (Standard Error) ($113)
California $6,884 Massachusetts $7,477* Pennsylvania $7,059
(Standard Error) ($72) (Standard Error) ($114) (Standard Error) ($87)
Colorado $6,662* Michigan $6,564* Rhode Island $7,208*
(Standard Error) ($94) (Standard Error) ($100) (Standard Error) ($81)
Connecticut $7,426* Minnesota $6,865 South Carolina $6,950
(Standard Error) ($104) (Standard Error) ($108) (Standard Error) ($95)
Delaware $7,427* Mississippi $6,256* South Dakota $7,058
(Standard Error) ($151) (Standard Error) ($91) (Standard Error) ($86)
District of Columbia $7,370* Missouri $6,875 Tennessee $6,358*
(Standard Error) ($95) (Standard Error) ($107) (Standard Error) ($79)
Florida $6,830 Montana $6,871 Texas $6,849
(Standard Error) ($113) (Standard Error) ($99) (Standard Error) ($77)
Georgia $6,848 Nebraska $7,007 Utah $6,315*
(Standard Error) ($131) (Standard Error) ($110) (Standard Error) ($93)
Hawaii $6,731* Nevada $6,365* Vermont $7,369*
(Standard Error) ($79) (Standard Error) ($110) (Standard Error) ($84)
Idaho $6,428* New Hampshire $7,544* Virginia $6,780
(Standard Error) ($104) (Standard Error) ($124) (Standard Error) ($86)
Illinois $7,217* New Jersey $7,554* Washington $6,996
(Standard Error) ($76) (Standard Error) ($115) (Standard Error) ($114)
Indiana $7,016 New Mexico $6,932 West Virginia $6,988
(Standard Error) ($102) (Standard Error) ($107) (Standard Error) ($132)
Iowa $6,791 New York $7,937* Wisconsin $7,021
(Standard Error) ($94) (Standard Error) ($105) (Standard Error) ($94)
Kansas $6,417* North Carolina $6,723* Wyoming $7,205
(Standard Error) ($93) (Standard Error) ($72) (Standard Error) ($133)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * Statistically different from national average of $6,944 at p < 0.05. Note that the standard error on the national estimate of $6,944 is $19.15.

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Employee Premium Contributions

In 2020, enrolled employees paid on average 21.4 percent of total premiums for single coverage, 28.4 percent for employee-plus-one coverage, and 28.8 percent for family coverage. In line with longer term trends, these shares were not significantly different from their 2019 levels (Exhibit ES.14).

From 2008 to 2020, the percentage of premiums contributed by employees increased by 1.3 percentage points, 1.4 percentage points, and 1.2 percentage points for single, employee-plus-one, and family coverage, respectively (Exhibit ES.14). There were few significant year-to-year increases, or decreases, in the employee share for any of the three types of coverage, indicating that employee and employer premium contributions typically increased at similar rates during this period.

ALTER EXBES.14



Exhibit ES.14 Average percentage (standard error) of premium contributed by employees for single, employee-plus-one, and family coverage, 2008-2020

Coverage 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Single 20.1% 20.5% 20.7% 20.9% 20.8% 21.0% 21.2% 21.1% 21.7%* 22.2% 21.3%* 21.4% 21.4%
(Standard Error) (0.2%) (0.3%) (0.2%) (0.2%) (0.3%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.3%) (0.2%)
Plus One 27.0% 26.1%* 25.8% 26.5% 26.6% 26.7% 26.9% 27.3% 27.8% 27.6% 27.1% 27.7% 28.4%
(Standard Error) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%)
Family 27.6% 26.7% 26.8% 26.4% 27.4%* 27.6% 27.1% 27.2% 28.0% 27.9% 27.8% 28.0% 28.8%
(Standard Error) (0.4%) (0.3%) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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In 2020, the average employee contribution was $1,532 for single coverage, which was not statistically different from the 2019 level (Exhibit ES.15). Average employee contributions for employee-plus-one coverage ($4,035) and family coverage ($5,978) were 4.0 percent and 4.4 percent, respectively, above their 2019 levels. These 1-year increases in contributions were in line with the average annual rate of increase (4.8 percent for both employee-plus-one and family coverage) from 2008 to 2020.



ALTER EXBES.15



Exhibit ES.15 Average annual employee contribution (in dollars) (standard error) for single, employee-plus-one, and family coverage, 2008-2020

Coverage 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Single $882 $957* $1,021* $1,090* $1,118 $1,170* $1,234* $1,255 $1,325* $1,415* $1,427 $1,489* $1,532
(Standard Error) ($6) ($13) ($14) ($9) ($14) ($16) ($13) ($14) ($13) ($15) ($14) ($18) ($16)
Plus One $2,303 $2,363 $2,498* $2,736* $2,824 $2,940* $3,097* $3,220* $3,376* $3,531* $3,634 $3,881* $4,035*
(Standard Error) ($22) ($27) ($42) ($36) ($46) ($23) ($40) ($35) ($36) ($39) ($39) ($54) ($52)
Family $3,394 $3,474 $3,721* $3,962* $4,236* $4,421* $4,518 $4,710* $4,956* $5,218* $5,431* $5,726* $5,978*
(Standard Error) ($54) ($44) ($53) ($42) ($69) ($50) ($48) ($56) ($56) ($64) ($63) ($82) ($76)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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Plan Benefits: Deductibles

From 2019 to 2020, the percentage of enrollees in a health insurance plan with a deductible increased overall (86.6 percent to 89.2 percent), among small employers (84.1 percent to 86.5 percent), and among large employers (87.1 percent to 89.7 percent) (Exhibit ES.16). In the last 12 years, the overall percentage of enrollees with a deductible increased by 18.5 percentage points (from 70.7 percent in 2008 to 89.2 percent in 2020), but there was no significant change in this percentage from 2017 to 2019.

From 2019 to 2020, there were no significant changes in average deductible levels for single coverage overall, or within any of the three firm sizes (Exhibit ES.17). Similarly, there was no significant change in overall average deductibles for family coverage, and there was a 7.9 percent decrease in deductibles ($5,067 to $4,666) among small employers (Section 5, Exhibit 5.3). In the 2008 to 2020 period, single and family coverage deductibles showed overall increases in every year except 2018 and 2020.

Average individual deductibles were higher in small ($2,376) and medium firms ($2,464) than in large firms ($1,814) in 2020 (Exhibit ES.17). Family deductibles were also higher in small ($4,666) and medium firms ($4,761) than in large firms ($3,540) in 2020 (Section 5, Exhibit 5.3).

chart and data



Exhibit ES.16 Percentage (standard error) of private-sector enrolled employees in a health insurance plan with a deductible, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 70.7% 73.8%* 77.5%* 77.8% 79.6%* 81.3% 83.9%* 85.4%* 84.5% 87.5%* 87.3% 86.6% 89.2%*
(Standard Error) (0.5%) (0.5%) (0.3%) (0.7%) (0.6%) (0.7%) (0.5%) (0.5%) (0.5%) (0.4%) (0.4%) (0.5%) (0.4%)
<50 70.9% 73.5%* 75.7%* 76.3% 79.5%* 79.5% 80.8% 82.1% 81.7% 82.3% 83.0% 84.1% 86.5%*^
(Standard Error) (0.7%) (0.7%) (0.7%) (0.4%) (1.0%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.9%) (0.8%)
50-99 70.3% 70.6% 78.2%* 79.6% 80.3% 78.0% 82.4%* 85.3% 82.5% 83.7% 85.1% 87.5% 89.0%
(Standard Error) (1.4%) (1.9%) (1.5%) (1.7%) (1.4%) (1.1%) (1.5%) (1.5%) (1.5%) (1.6%) (1.4%) (1.5%) (1.5%)
100+ 70.7% 74.2%* 77.8%* 77.9% 79.6% 81.9%* 84.6%* 86.1% 85.2% 88.8%* 88.3% 87.1% 89.7%*
(Standard Error) (0.6%) (0.6%) (0.3%) (1.0%) (0.7%) (0.7%) (0.6%) (0.6%) (0.6%) (0.4%) (0.5%) (0.5%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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chart and data



Exhibit ES.17 Average individual deductible (in dollars) (standard error) per employee enrolled with single coverage in a health insurance plan with a deductible, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. $869 $917* $1,025* $1,123* $1,167* $1,273* $1,353* $1,541* $1,696* $1,808* $1,846 $1,931* $1,945
(Standard Error) ($7) ($9) ($18) ($12) ($8) ($20) ($13) ($16) ($16) ($17) ($17) ($18) ($18)
<50 $1,177 $1,283* $1,447* $1,561* $1,628 $1,695 $1,777* $1,964* $2,105* $2,136 $2,327* $2,386 $2,376^
(Standard Error) ($13) ($24) ($21) ($26) ($25) ($24) ($28) ($35) ($34) ($35) ($36) ($35) ($39)
50-99 $1,149 $1,249 $1,522* $1,543 $1,622 $1,755 $1,744 $2,008* $2,173 $2,361 $2,369 $2,441 $2,464^
(Standard Error) ($62) ($46) ($57) ($49) ($64) ($49) ($59) ($62) ($64) ($85) ($65) ($67) ($67)
100+ $740 $774* $852* $951* $989* $1,106* $1,205* $1,383* $1,558* $1,681* $1,692 $1,778* $1,814
(Standard Error) ($8) ($7) ($20) ($14) ($10) ($19) ($14) ($18) ($18) ($20) ($19) ($21) ($20)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: In 2015, the methodology for calibrating the upper edit bound for the individual deductible amount changed, causing the average individual deductible per employee enrolled with single coverage in a heath insurance plan with a deductible to increase by about 5 percent at the national level in 2015 relative to the earlier methodology. * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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Conclusion

AHRQ produces this chartbook to make MEPS-IC data more readily usable by providing trends nationally and by firm size, by presenting national and State-level estimates in one document, and by providing additional firm-size cross-tabulations relevant to recent policy changes. More information is available at www.meps.ahrq.gov. AHRQ welcomes feedback on additional ways to make the data more usable.

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Section 1: Health Insurance Offer Rates

Health Insurance Offer Rates

This section presents estimates of the percentage of employees who worked where coverage was offered (the "offer rate"), by firm size, State, establishment characteristics (i.e., industry, ownership type, firm age, number of locations, percentage of workers who are full time, and percentage of workers with low wages). It also shows interactions of the percentage of workers with low wages and firm size and State. In addition, this section provides information on the prevalence of self-insured plans, availability of dependent coverage, and availability of retiree coverage by firm size. Finally, it shows the percentage of establishments that offer two or more plans, by firm size and establishment characteristics.

In the MEPS IC survey, respondents are asked whether their organization offers, or makes available, any health insurance plans to its active employees. Health insurance plans are defined as policies that provide hospital or physician coverage. The plan may provide this coverage for the employee only, or it may also provide coverage for the employee's dependents through employee-plus-one or family coverage.

Many organizations offer more than one plan. For example, an organization may offer both a high and standard option of a given plan, or it may offer coverage under a health maintenance organization (HMO) and a preferred provider organization (PPO) from the same or a different insurance company. A health plan is self-insured when the financial risk for the enrollee's medical claims is assumed partially or entirely by the organization offering the plan.

Employers' decisions about offering coverage depend on a range of characteristics associated with productivity, workforce demand for coverage, State policy, and other factors. Historically, firm size has been a key determinant of the offer rate, with smaller employers being less likely to offer health insurance coverage than larger employers for a number of reasons, including:

  • Smaller risk pools, which result in higher premium costs (holding benefits constant),
  • Higher administrative costs, and
  • Lack of dedicated staff to select and administer health benefits.

Highlights

  • The percentage of employees working at insurance-offering establishments increased from 85.3 percent in 2019 to 86.9 percent in 2020, even as the offer rate within small, medium, and large firms remained stable over the same period (Exhibit 1.1). These findings reflect a marked reduction in small-firm employment relative to medium- and large-firm employment, causing a compositional shift in employment from small firms with low offer rates to medium and large firms with high offer rates.*
  • The overall share of employees at health insurance-offering firms who were offered a choice of two or more health plans fell from 75.8 percent in 2019 to 73.8 percent in 2020. This decline was driven by 100+ employee firms, where the share of employees offered a choice of plans fell from 84.5 percent in 2019 to 81.0 percent in 2020 (Exhibit 1.10).
  • Overall, the average annual offer rate for 2018-2020 was 85.6 percent for all firms and 49.5 percent for small firms (fewer than 50 employees). Offer rates showed substantial variation across the United States for both groups of employers (Exhibits 1.2 and 1.3):
    • Among all firms, the average annual offer rate ranged from 69.7 percent in Montana to 96.4 percent in Hawaii.
    • Among small firms, 15 States, with average annual offer rates ranging from 35.5 to 44.4 percent, were significantly below the national average. Another 15 States, with average annual offer rates ranging from 53.7 to 90.2 percent, were significantly above the national average for small firms.

Key Trends

Beyond the key highlights presented above, many longstanding trends related to insurance coverage offers continued in 2020. Establishments in small firms continued to have a significantly lower offer rate relative to other firms. In addition, small-firm establishments that did offer insurance were less likely to self-insure their plans, less likely to offer dependent coverage, less likely to offer a choice of two or more plans, and less likely to offer retiree coverage.

Dependent coverage, as in prior years, was available at very high rates wherever health insurance was offered. Availability of retiree coverage of all kinds remained low and very rare outside of large firms.

* These findings may be affected by measurement issues related to the 2020 MEPS-IC employment and related estimates. For a discussion of these issues, see the MEPS IC 2020 user note.


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ALTER EXB1.1



Exhibit 1.1 Percentage (standard error) of private-sector employees in establishments that offer health insurance, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 87.7% 87.6% 86.5%* 85.3%* 84.7% 84.9% 83.2%* 83.8% 84.3% 84.5% 84.6% 85.3%* 86.9%*
(Standard Error) (0.3%) (0.2%) (0.2%) (0.2%) (0.3%) (0.3%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%)
<50 61.6% 59.6%* 57.8%* 54.7%* 52.9%* 53.1% 49.8%* 47.6%* 47.7% 48.3% 47.3% 50.7%* 50.5%^
(Standard Error) (0.5%) (0.5%) (0.5%) (0.4%) (0.6%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%)
50-99 90.7% 89.6% 87.3% 85.6% 84.1% 87.0% 83.0%* 85.3% 88.6%* 86.3% 88.0% 88.0% 88.5%^
(Standard Error) (0.9%) (1.3%) (0.9%) (1.0%) (1.4%) (1.0%) (1.3%) (1.2%) (1.0%) (1.2%) (1.1%) (1.1%) (1.2%)
100+ 98.2% 98.8% 98.5% 98.1% 98.2% 98.0% 97.3%* 98.8%* 98.9% 98.9% 99.0% 99.0% 98.8%
(Standard Error) (0.3%) (0.1%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%) (0.1%) (0.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB1.2



Exhibit 1.2 Percentage (standard error) of private-sector employees in establishments that offer, health insurance, by State, 3-year average, 2018-2020

Alabama 87.8%* Kentucky 86.8% North Dakota 84.6%
(Standard Error) (0.8%) (Standard Error) (0.8%) (Standard Error) (0.8%)
Alaska 76.1%* Louisiana 83.7% Ohio 86.8%
(Standard Error) (1.0%) (Standard Error) (1.1%) (Standard Error) (0.7%)
Arizona 86.7% Maine 80.4%* Oklahoma 84.7%
(Standard Error) (0.9%) (Standard Error) (1.1%) (Standard Error) (0.8%)
Arkansas 82.6%* Maryland 86.8% Oregon 82.1%*
(Standard Error) (0.9%) (Standard Error) (0.9%) (Standard Error) (0.9%)
California 85.8% Massachusetts 89.9%* Pennsylvania 88.5%*
(Standard Error) (0.5%) (Standard Error) (0.8%) (Standard Error) (0.6%)
Colorado 81.9%* Michigan 85.8% Rhode Island 85.7%
(Standard Error) (1.1%) (Standard Error) (0.8%) (Standard Error) (0.9%)
Connecticut 87.2%* Minnesota 85.1% South Carolina 84.0%
(Standard Error) (0.8%) (Standard Error) (0.9%) (Standard Error) (0.8%)
Delaware 85.8% Mississippi 84.5% South Dakota 81.5%*
(Standard Error) (1.1%) (Standard Error) (0.9%) (Standard Error) (1.1%)
District of Columbia 93.8%* Missouri 85.9% Tennessee 88.1%*
(Standard Error) (0.6%) (Standard Error) (0.8%) (Standard Error) (0.7%)
Florida 84.3% Montana 69.7%* Texas 84.4%
(Standard Error) (0.7%) (Standard Error) (1.2%) (Standard Error) (0.7%)
Georgia 85.8% Nebraska 81.9%* Utah 80.5%*
(Standard Error) (0.8%) (Standard Error) (1.0%) (Standard Error) (1.1%)
Hawaii 96.4%* Nevada 86.5% Vermont 79.3%*
(Standard Error) (0.7%) (Standard Error) (0.9%) (Standard Error) (0.9%)
Idaho 76.1%* New Hampshire 86.4% Virginia 86.7%
(Standard Error) (1.2%) (Standard Error) (0.8%) (Standard Error) (0.9%)
Illinois 87.3% New Jersey 86.8% Washington 84.6%
(Standard Error) (0.8%) (Standard Error) (0.8%) (Standard Error) (0.9%)
Indiana 85.5% New Mexico 78.8%* West Virginia 84.7%
(Standard Error) (0.7%) (Standard Error) (1.1%) (Standard Error) (0.8%)
Iowa 87.1%* New York 87.1%* Wisconsin 84.6%
(Standard Error) (0.7%) (Standard Error) (0.5%) (Standard Error) (0.8%)
Kansas 86.2% North Carolina 82.3%* Wyoming 72.1%*
(Standard Error) (0.8%) (Standard Error) (0.9%) (Standard Error) (1.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * Statistically different from the national average of 85.6 percent at p < 0.05. Note that the standard error on the national estimate of 85.6 percent is 0.1 percent.

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ALTER EXB1.3



Exhibit 1.3 Percentage (standard error) of private-sector employees in establishments that offer health insurance, by State, firm size <50 employees, by State, 3-year average, 2018-2020

Alabama 54.9%* Kentucky 49.4% North Dakota 56.3%*
(Standard Error) (2.3%) (Standard Error) (2.6%) (Standard Error) (2.1%)
Alaska 35.5%* Louisiana 50.2% Ohio 50.0%
(Standard Error) (2.3%) (Standard Error) (2.5%) (Standard Error) (2.4%)
Arizona 45.5% Maine 45.0% Oklahoma 50.2%
(Standard Error) (2.7%) (Standard Error) (2.4%) (Standard Error) (2.3%)
Arkansas 40.4%* Maryland 56.8%* Oregon 48.2%
(Standard Error) (2.5%) (Standard Error) (2.4%) (Standard Error) (2.1%)
California 50.2% Massachusetts 62.5%* Pennsylvania 55.6%*
(Standard Error) (1.4%) (Standard Error) (2.5%) (Standard Error) (1.9%)
Colorado 46.1% Michigan 50.5% Rhode Island 56.1%*
(Standard Error) (2.4%) (Standard Error) (2.3%) (Standard Error) (2.5%)
Connecticut 57.8%* Minnesota 49.2% South Carolina 40.8%*
(Standard Error) (2.3%) (Standard Error) (2.4%) (Standard Error) (2.4%)
Delaware 50.5% Mississippi 45.6% South Dakota 50.1%
(Standard Error) (2.9%) (Standard Error) (2.6%) (Standard Error) (2.1%)
District of Columbia 70.4%* Missouri 49.2% Tennessee 48.3%
(Standard Error) (2.6%) (Standard Error) (2.4%) (Standard Error) (2.5%)
Florida 41.7%* Montana 37.6%* Texas 47.4%
(Standard Error) (2.1%) (Standard Error) (2.1%) (Standard Error) (1.7%)
Georgia 41.1%* Nebraska 41.2%* Utah 38.1%*
(Standard Error) (2.5%) (Standard Error) (2.3%) (Standard Error) (2.5%)
Hawaii 90.2%* Nevada 51.3% Vermont 46.1%
(Standard Error) (1.3%) (Standard Error) (2.9%) (Standard Error) (2.0%)
Idaho 39.9%* New Hampshire 55.3%* Virginia 50.8%
(Standard Error) (2.3%) (Standard Error) (2.3%) (Standard Error) (2.3%)
Illinois 53.7%* New Jersey 57.1%* Washington 50.1%
(Standard Error) (2.0%) (Standard Error) (2.3%) (Standard Error) (2.2%)
Indiana 43.9%* New Mexico 40.9%* West Virginia 44.1%*
(Standard Error) (2.4%) (Standard Error) (2.3%) (Standard Error) (2.6%)
Iowa 54.2%* New York 55.7%* Wisconsin 44.4%*
(Standard Error) (2.2%) (Standard Error) (1.6%) (Standard Error) (2.3%)
Kansas 54.7%* North Carolina 38.5%* Wyoming 38.0%*
(Standard Error) (2.3%) (Standard Error) (2.2%) (Standard Error) (2.1%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * Statistically different from the national average of 49.5 percent at p < 0.05. Note that the standard error on the national estimate of 49.5 percent is 0.4 percent.

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ALTER EXB1.4



Exhibit 1.4 Percentage (standard error) of private-sector employees in establishments that offer health insurance, by the percentage of the establishment's workforce that is low wage and by firm size, 2008-2020

Low Wage 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
<50% Low-Wage Employees, Small Employers 73.2% 71.6%* 70.2%* 68.0%* 66.8%* 65.6%* 61.0%* 58.4%* 56.9% 57.6% 55.5%* 58.8%* 58.0%
(Standard Error) (0.5%) (0.5%) (0.5%) (0.4%) (0.3%) (0.6%) (0.7%) (0.7%) (0.7%) (0.7%) (0.7%) (0.8%) (0.8%)
50%+ Low-Wage Employees, Small Employers 36.8% 34.3% 34.1% 30.6%* 28.0%* 28.0% 26.6% 23.1%* 24.4% 24.2% 23.6% 25.4% 25.3%^
(Standard Error) (1.2%) (0.8%) (0.7%) (0.9%) (1.0%) (1.2%) (1.1%) (1.1%) (1.3%) (1.2%) (1.2%) (1.4%) (1.4%)
<50% Low-Wage Employees, Large Employers 98.4% 99.1% 98.9% 98.9% 98.6% 98.7% 98.2%* 98.9%* 98.9% 98.7% 98.9% 98.7% 98.7%
(Standard Error) (0.4%) (0.2%) (0.2%) (0.2%) (0.1%) (0.1%) (0.2%) (0.1%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%)
50%+ Low-Wage Employees, Large Employers 94.8% 94.7% 93.5% 91.4%* 92.2% 92.4% 89.6%* 92.7%* 94.5%* 94.0% 94.0% 95.2% 93.8%^
(Standard Error) (0.5%) (0.4%) (0.6%) (0.7%) (0.6%) (0.7%) (0.7%) (0.6%) (0.5%) (0.6%) (0.8%) (0.5%) (1.0%)
Key: Small employers = fewer than 50 employees. Large employers = 50 or more employees.
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: Wage levels in the MEPS-IC questionnaires have been adjusted to account for changing wages over time. In 2020, low-wage employees were defined as those earning less than $13.00 per hour. * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for small (large) employers with 50%%+ low wage employees are statistically different from the estimate for small (large) employers with < 50%% percent low wage employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB1.5



Exhibit 1.5 Percentage (standard error) of private-sector employees in establishments that offer health insurance, overall and by industry, 2020

Industry Percentage
United States 86.9%
(Standard Error) (0.2%)
Agriculture, fisheries, forestry 67.3%*
(Standard Error) (5.0%)
Mining and manufacturing 94.1%
(Standard Error) (0.6%)
Construction 80.8%*
(Standard Error) (1.4%)
Utilities and transportation 94.3%
(Standard Error) (0.8%)
Wholesale trade 90.7%*
(Standard Error) (1.0%)
Financial services and real estate 93.9%
(Standard Error) (0.5%)
Retail trade 86.4%*
(Standard Error) (0.8%)
Professional services 90.3%*
(Standard Error) (0.4%)
Other services 77.8%*
(Standard Error) (0.8%)
Source:  Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.                   
Note: * indicates that the estimate is statistically different from the estimate for firms in the financial services and real estate sector at p < 0.05.

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ALTER EXB1.6



Exhibit 1.6 Percentage (standard error) of private-sector employees in establishments that offer health insurance, overall and by selected characteristics, 2020

Employer Characteristics Percentage
United States 86.9%
(Standard Error) (0.2%)
Ownership: For Profit Inc. 87.2%*
(Standard Error) (0.3%)
Ownership: For Profit Uninc. 78.0%*
(Standard Error) (1.0%)
Ownership: Nonprofit 94.2%
(Standard Error) (0.4%)
Firm Age: 0-4 Years 48.8%*
(Standard Error) (2.1%)
Firm Age: 5-9 Years 57.2%*
(Standard Error) (1.8%)
Firm Age: 10-19 Years 73.1%*
(Standard Error) (1.2%)
Firm Age: 20+ Years 94.0%
(Standard Error) (0.2%)
# of Locations: 1 Location 66.0%*
(Standard Error) (0.7%)
# of Locations: 2+ Locations 98.6%
(Standard Error) (0.1%)
% Full Time: 0-24% 54.5%*
(Standard Error) (1.8%)
% Full Time: 25-49% 79.6%*
(Standard Error) (1.2%)
% Full Time: 50-74% 84.4%*
(Standard Error) (0.8%)
% Full Time: 75%+ 91.7%
(Standard Error) (0.3%)
% Low Wage: 50%+ 74.4%*
(Standard Error) (1.0%)
% Low Wage: <50% 89.7%
(Standard Error) (0.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2020. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.00 per hour in 2020. * indicates that the estimate is statistically different from the estimate for the reference category within each group at p < 0.05. Reference categories are: Nonprofit, Firm Age: 20+ Years, 2+ Locations, % Full Time 75%+, % Low Wage < 50%.

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ALTER EXB1.7



Exhibit 1.7 Percentage (standard error) of private-sector establishments that offer health insurance that self-insure at least one plan, overall and by detailed firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 34.2% 35.1% 35.8% 36.9% 37.2% 37.6% 37.2% 39.0%* 40.7%* 39.2% 38.7% 39.4% 41.9%*
(Standard Error) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%)
<10 14.0% 14.6% 13.1% 12.6% 14.9% 15.2% 14.4% 15.8% 19.3%* 17.7% 13.1%* 14.8% 17.6%^
(Standard Error) (0.8%) (0.7%) (0.5%) (0.8%) (0.9%) (0.4%) (0.8%) (1.0%) (1.4%) (1.4%) (1.1%) (1.3%) (1.7%)
10-24 11.1% 10.4% 11.6% 9.9% 10.7% 9.0% 12.0%* 10.6% 13.6%* 13.3% 13.8% 12.2% 13.1%^
(Standard Error) (0.9%) (0.4%) (0.8%) (0.7%) (0.7%) (0.7%) (1.0%) (1.0%) (1.1%) (1.2%) (1.2%) (1.1%) (1.2%)
25-99 12.6% 13.4% 14.3% 12.2%* 13.5% 12.4% 12.2% 13.7% 16.6%* 16.0% 12.9%* 17.2%* 16.3%^
(Standard Error) (0.8%) (0.7%) (0.7%) (0.7%) (0.7%) (0.7%) (0.8%) (0.9%) (0.9%) (0.9%) (0.8%) (0.9%) (0.9%)
100-999 32.7% 29.9% 30.9% 31.7% 30.1% 30.1% 32.5% 33.7% 34.4% 37.2% 35.1% 33.9% 35.8%^
(Standard Error) (1.3%) (0.7%) (0.9%) (1.1%) (0.8%) (1.0%) (1.2%) (1.2%) (1.2%) (1.3%) (1.2%) (1.1%) (1.2%)
1,000+ 86.5% 85.8% 86.6% 87.5% 87.1% 88.0% 84.2%* 83.8% 81.9% 78.6%* 81.6%* 83.1% 77.8%*
(Standard Error) (0.5%) (0.4%) (0.6%) (0.5%) (0.7%) (0.5%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <10, 10-24, 25-99, and 100-999 employees are statistically different from the estimate for firms with 1,000+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB1.8



Exhibit 1.8 Among establishments that offer insurance, percentage (standard error) of eligible employees in establishments that self-insure at least one plan, overall and by detailed firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 56.8% 57.2% 58.4% 59.6% 60.1% 58.1%* 59.2% 59.1% 57.3%* 58.2% 56.8% 58.0% 57.1%
(Standard Error) (0.5%) (0.7%) (0.7%) (0.6%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%)
<10 12.9% 12.3% 12.5% 11.5% 12.0% 13.2% 12.9% 13.5% 15.7% 15.6% 12.4% 12.5% 14.4%^
(Standard Error) (0.8%) (0.6%) (0.6%) (0.9%) (0.9%) (0.8%) (0.9%) (1.1%) (1.2%) (1.3%) (1.1%) (1.3%) (1.5%)
10-24 11.5% 9.8% 11.5% 10.1% 11.1% 9.1% 11.4% 10.5% 14.9%* 12.8% 12.9% 12.1% 12.0%^
(Standard Error) (1.3%) (0.5%) (1.0%) (0.8%) (1.0%) (0.9%) (1.2%) (1.1%) (1.3%) (1.2%) (1.1%) (1.3%) (1.2%)
25-99 12.8% 16.0%* 17.3% 13.5%* 15.5% 13.4% 14.0% 14.5% 17.1% 15.3% 14.0% 18.1%* 18.0%^
(Standard Error) (1.1%) (1.0%) (1.1%) (0.8%) (0.9%) (0.8%) (1.1%) (1.1%) (1.1%) (1.0%) (0.9%) (1.2%) (1.1%)
100-999 36.1% 31.7%* 35.7% 35.0% 35.7% 32.6% 39.5%* 39.5% 37.4% 42.0%* 34.7%* 37.8% 40.5%^
(Standard Error) (1.0%) (1.8%) (1.4%) (1.2%) (1.4%) (1.0%) (1.4%) (1.5%) (1.3%) (1.4%) (1.3%) (1.4%) (1.4%)
1,000+ 85.9% 85.8% 86.6% 89.0%* 89.0% 86.9%* 86.6% 86.4% 82.8%* 82.2% 82.2% 84.1% 77.3%*
(Standard Error) (0.7%) (0.7%) (0.6%) (0.4%) (0.5%) (0.4%) (0.7%) (0.7%) (0.8%) (0.7%) (0.9%) (0.8%) (1.0%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <10, 10-24, 25-99, and 100-999 employees are statistically different from the estimate for firms with 1,000+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB1.9



Exhibit 1.9 Percentage (standard error) of eligible private-sector employees in establishments that offer family coverage and employee-plus-one coverage among establishments that offer coverage, overall and by detailed firm size, 2020

Coverage United States <10 Employees 10-24 Employees 25-99 Employees 100-999 Employees 1,000+ Employees
Any Dependent Coverage 98.6% 82.8%* 93.1%* 97.7%* 99.4%* 99.9%
(Standard Error) (0.1%) (1.7%) (0.8%) (0.4%) (0.2%) (0.1%)
Any Family Coverage 97.8% 75.8%* 89.8%* 96.2%* 98.5%* 99.8%
(Standard Error) (0.1%) (1.9%) (1.0%) (0.5%) (0.3%) (0.1%)
Any Employee-Plus-One 94.5% 65.5%* 80.4%* 90.9%* 93.8%* 98.3%
(Standard Error) (0.2%) (2.2%) (1.4%) (0.8%) (0.7%) (0.2%)
Family and Employee-Plus-One 93.7% 58.5%* 77.1%* 89.5%* 92.9%* 98.2%
(Standard Error) (0.3%) (2.3%) (1.5%) (0.8%) (0.7%) (0.2%)
Family Coverage Only 4.1% 17.3%* 12.7%* 6.8%* 5.6%* 1.6%
(Standard Error) (0.2%) (1.7%) (1.2%) (0.7%) (0.6%) (0.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: This table does not include a row with estimates for "Employee-plus-one only." These estimates can be calculated by subtracting the estimates for "Family and Employee-Plus-One" from the estimates for "Any Employee-Plus-One." * indicates that the estimates for firms with <10, 10-24, 25-99 and 100-999 employees are statistically different from the estimate for firms with 1,000+ employees at p < 0.05.

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ALTER EXB1.10



Exhibit 1.10 Percentage (standard error) of private-sector employees working in establishments that offer two or more health insurance plans, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 64.8% 66.5% 65.6% 65.5% 65.3% 66.0% 67.0% 70.2%* 71.7% 72.4% 75.7%* 75.8% 73.8%*
(Standard Error) (0.6%) (0.7%) (0.8%) (0.5%) (0.7%) (0.6%) (0.6%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%)
<50 26.8% 27.3% 26.7% 27.2% 29.3% 28.4% 29.6% 33.6%* 34.2% 34.9% 37.8%* 41.4%* 39.9%^
(Standard Error) (0.7%) (0.9%) (0.8%) (0.9%) (0.8%) (1.0%) (0.9%) (1.1%) (1.0%) (1.0%) (1.0%) (1.1%) (1.1%)
50-99 42.5% 42.8% 44.1% 46.8% 43.7% 46.6% 46.8% 50.2% 56.2%* 59.3% 56.4% 58.7% 58.6%^
(Standard Error) (1.7%) (2.0%) (1.9%) (2.2%) (1.7%) (2.2%) (2.1%) (2.2%) (2.0%) (1.9%) (1.9%) (2.0%) (2.1%)
100+ 76.9% 78.5% 77.3% 76.3% 75.7% 76.5% 77.0% 79.7%* 80.7% 81.0% 84.7%* 84.5% 81.0%*
(Standard Error) (0.7%) (0.7%) (1.0%) (0.7%) (0.7%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.5%) (0.6%) (0.6%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.          
Denominator: Within each category, all employees in establishments that offer health insurance.            
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB1.11



Exhibit 1.11 Percentage (standard error) of private-sector employees in establishments that offer two or more health insurance plans,overall and by industry, 2020

Industry Percentage
United States 73.8%
(Standard Error) (0.6%)
Agriculture, fisheries, forestry 42.0%*
(Standard Error) (9.1%)
Mining and manufacturing 70.4%*
(Standard Error) (1.6%)
Construction 60.8%*
(Standard Error) (2.9%)
Utilities and transportation 70.3%*
(Standard Error) (3.8%)
Wholesale trade 67.2%*
(Standard Error) (2.4%)
Financial services and real estate 79.2%
(Standard Error) (1.7%)
Retail trade 75.8%
(Standard Error) (1.4%)
Professional services 76.3%
(Standard Error) (0.9%)
Other services 75.0%*
(Standard Error) (1.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.          
Denominator: Within each category, all employees in establishments that offer health insurance.            
Note: * indicates that the estimate is statistically different from the estimate for firms in the financial services and real estate sector at p < 0.05.

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ALTER EXB1.12



Exhibit 1.12 Percentage (standard error) of private-sector employees working in establishments that offer two or more health insurance plans, overall and by selected characteristics, 2020

Employer Characteristics Percentage
United States 73.8%
(Standard Error) (0.6%)
Ownership: For Profit Inc. 74.2%
(Standard Error) (0.7%)
Ownership: For Profit Uninc. 70.9%
(Standard Error) (1.5%)
Ownership: Nonprofit 74.5%
(Standard Error) (1.4%)
Firm Age: 0-4 Years 62.8%*
(Standard Error) (3.2%)
Firm Age: 5-9 Years 57.2%*
(Standard Error) (3.0%)
Firm Age: 10-19 Years 63.3%*
(Standard Error) (1.7%)
Firm Age: 20+ Years 76.4%
(Standard Error) (0.6%)
# of Locations: 1 Location 54.5%*
(Standard Error) (1.1%)
# of Locations: 2+ Locations 81.1%
(Standard Error) (0.6%)
% Full Time: 0-24% 72.8%
(Standard Error) (2.5%)
% Full Time: 25-49% 68.0%*
(Standard Error) (2.5%)
% Full Time: 50-74% 74.8%
(Standard Error) (1.5%)
% Full Time: 75%+ 74.3%
(Standard Error) (0.6%)
% Low Wage: 50%+ 70.1%*
(Standard Error) (1.6%)
% Low Wage: <50% 74.5%
(Standard Error) (0.6%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Denominator: Within each category, employees in establishments that offer health insurance.
Note: "% Full Time" refers to the percentage of the establishments workforce that worked full time in 2020. "% Low Wage" refers to the percentage of the establishments workforce that earned less than $13.00 per hour in 2020. * indicates that the estimate is statistically different from the estimate for the reference category within each group at p < 0.05. Reference categories are: Nonprofit, Firm Age: 20+ Years, 2+ Locations, % Full Time 75%+, % Low Wage < 50%.

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ALTER EXB1.13



Exhibit 1.13 Among establishments offering health insurance, percentage (standard error) offering coverage to retirees under age 65, overall and by detailed firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 11.2% 11.2% 11.6% 13.1%* 12.3% 11.9% 11.6% 11.6% 12.5% 10.8%* 11.1% 9.7%* 10.3%
(Standard Error) (0.3%) (0.3%) (0.4%) (0.3%) (0.3%) (0.5%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.5%)
<10 1.4% 1.2% 2.0%* 1.6% 1.8% 1.4% 1.4% 1.2% 2.3% 1.6% 2.3% 3.3% 1.6%†
(Standard Error) (0.2%) (0.2%) (0.2%) (0.3%) (0.2%) (0.2%) (0.3%) (0.3%) (0.6%) (0.4%) (0.5%) (0.7%) (0.6%)
10-24 1.6% 1.6% 1.4% 1.0% 1.2% 1.0%† 1.5% 1.3% 1.7% 2.1% 1.6% 1.8% 1.1%†
(Standard Error) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.4%) (0.4%) (0.3%) (0.4%) (0.5%) (0.4%) (0.5%) (0.3%)
25-99 2.4% 2.4% 3.0% 3.1% 2.4% 2.2% 2.4% 1.7% 2.3% 1.9% 2.3% 2.7% 1.9%^
(Standard Error) (0.4%) (0.4%) (0.4%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.3%)
100-999 8.0% 7.5% 6.9% 6.8% 7.4% 6.3% 6.6% 6.0% 6.2% 7.0% 6.8% 4.2%* 5.4%^
(Standard Error) (0.6%) (0.4%) (0.6%) (0.2%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%) (0.6%) (0.5%) (0.6%)
1,000+ 36.1% 34.5% 34.2% 37.7%* 35.3% 34.3% 32.5% 31.6% 32.4% 27.6%* 27.4% 23.7%* 23.5%
(Standard Error) (0.9%) (1.2%) (1.3%) (0.9%) (1.1%) (0.9%) (1.2%) (1.1%) (1.0%) (1.0%) (1.0%) (1.0%) (1.1%)
 † Estimate does not meet standard of reliability or precision.          
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.             
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <10, 10-24, 25-99, and 100-999 employees are statistically different from the estimate for firms with 1,000+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB1.14



Exhibit 1.14 Among establishments offering health insurance, percentage (standard error) offering coverage to retirees age 65 and over, overall and by detailed firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 10.5% 11.3% 10.8% 11.9%* 11.6% 10.5%* 10.3% 10.4% 10.5% 8.6%* 8.7% 8.6% 7.6%
(Standard Error) (0.4%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%)
<10 2.3% 2.6% 2.2% 2.5% 2.6% 2.1% 2.0% 2.2% 3.4% 2.3% 3.1% 2.6% 2.4%^
(Standard Error) (0.2%) (0.3%) (0.3%) (0.2%) (0.3%) (0.4%) (0.3%) (0.4%) (0.7%) (0.5%) (0.6%) (0.7%) (0.6%)
10-24 3.4% 2.7% 2.3% 2.3% 2.8% 2.2% 2.4% 2.4% 2.7% 2.7% 1.5% 3.3%* 1.3%*^
(Standard Error) (0.7%) (0.3%) (0.5%) (0.4%) (0.5%) (0.6%) (0.5%) (0.5%) (0.5%) (0.5%) (0.4%) (0.6%) (0.4%)
25-99 2.9% 3.4% 3.3% 3.7% 3.4% 3.4% 2.9% 3.1% 2.6% 2.9% 2.4% 2.0% 2.2%^
(Standard Error) (0.3%) (0.2%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.5%) (0.4%) (0.4%) (0.4%) (0.3%) (0.3%)
100-999 7.7% 8.6% 7.8% 6.5%* 7.5% 6.3% 7.1% 5.5% 5.9% 5.7% 6.0% 4.7% 4.2%^
(Standard Error) (0.7%) (0.4%) (0.4%) (0.4%) (0.8%) (0.7%) (0.6%) (0.6%) (0.7%) (0.6%) (0.6%) (0.5%) (0.5%)
1,000+ 31.1% 31.8% 29.9% 31.9% 31.1% 27.8%* 26.8% 26.1% 24.8% 20.3%* 19.7% 20.1% 16.1%*
(Standard Error) (1.0%) (1.0%) (1.1%) (0.9%) (1.4%) (0.7%) (1.2%) (1.1%) (1.0%) (0.9%) (0.9%) (1.0%) (0.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <10, 10-24, 25-99, and 100-999 employees are statistically different from the estimate for firms with 1,000+ employees at p < 0.05. This test is conducted for 2020 only.

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Section 2: Employee Eligibility and Enrollment

Employee Eligibility and Enrollment

The share of employees enrolled in a health plan through their employer is determined by the establishment offer rate (described in Section 1), the share of employees eligible for coverage at establishments that offer ("eligibility rate"), and the share of eligible employees who enroll in coverage (the "take-up rate"). Factors such as the share of workers who are part time or who are low wage, can affect eligibility and take-up rates.

This section presents estimates for 2008 to 2020 for private-sector employees for the:

  • Enrollment rate (percentage of all employees enrolled in their employer’s health insurance plan regardless of whether the establishment offered health insurance). Note that in this calculation the number of enrollees is equal to zero at employers that do not offer coverage;
  • Coverage rate (percentage of all employees enrolled in their employer’s health insurance plan at establishments that offered health insurance). The coverage rate is equal to the eligibility rate multiplied by the take-up rate;
  • Eligibility rate (percentage of employees eligible for health insurance through their employer at establishments offering health insurance); and
  • Take-up rate (percentage of eligible employees who enrolled in their employer’s health insurance).

This section also presents estimates for 2008 to 2020 for the percentage of enrollees in single, employee-plus-one, and family coverage and examines variation in coverage, eligibility, and take-up rates by firm size, industry, and other employer characteristics. It also presents coverage rates by the State in which the establishment was located.

Highlights

  • From 2019 to 2020, there were no statistically significant changes in enrollment rates for small (fewer than 50 employees), medium (50 to 99 employees), or large firms (100 or more employees). The overall enrollment rate increased from 47.6 percent in 2019 to 49.5 percent in 2020, while among small firms the total number enrolled decreased (Exhibits 2.1 and 2.2). These changes are due to a large reduction in total employment among small employers and a corresponding increase in the proportion of employees working in medium and large firms.*
  • The overall eligibility rate for employees at private-sector establishments that offered insurance increased from 77.7 percent in 2019 to 80.5 percent in 2020. The eligibility rate for small employers increased from 78.1 to 80.2 percent, and the eligibility rate for large firms increased from 77.5 to 80.8 percent (Exhibit 2.4).
  • Among large employers, take-up rates fell from 72.7 to 71.4 percent (Exhibit 2.5). Despite the decline, the take-up rate among large firms (71.4 percent) remained higher than in medium (68.8 percent) and small firms (68.7 percent), as has been true in almost every year from 2008 through 2020.
  • Across the nation, nine States (District of Columbia, Hawaii, Idaho, Kentucky, Missouri, North Carolina, Oregon, Texas, and Washington) had coverage rates above the national average of 56.4 percent, ranging from 59.2 percent in Texas to 64.3 percent in Washington. Nine States had coverage rates below the national average (Florida, Maryland, Massachusetts, New Hampshire, New Mexico, New York, Rhode Island, Vermont, and West Virginia), ranging from 51.0 percent in New York to 53.8 percent in Vermont and Rhode Island. All of these States except New Mexico are in the South Atlantic, Mid-Atlantic, and New England census divisions (Exhibit 2.9).

Key Trends

Enrollment rates are lower at small and medium firms, compared with large firms, reflecting lower offer rates (presented in Section 1). Coverage, eligibility, and take-up rates are lower among younger firms, firms with one location (versus multiple locations), with fewer full-time workers, and with a majority of workers who are low wage.

For firms with fewer than 50 workers and firms with 50 or more workers, coverage, eligibility, and take-up rates are substantially lower at firms with a majority (50 percent or more) of low-wage workers, compared with firms with less than 50 percent of workers who are low wage. Continuing a longstanding pattern, in 2020, a lower percentage of enrollees in large firms than in small and medium firms chose single coverage, while a higher percentage of large-firm enrollees chose employee-plus-one coverage and family coverage.

* These findings may be affected by measurement issues related to the 2020 MEPS-IC employment and related estimates. For a discussion of these issues, see the MEPS IC 2020 user note.

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ALTER EXB2.1: Enrollment Rate



Exhibit 2.1: Enrollment Rate Percentage (standard error) of all private-sector employees enrolled in health insurance offered by their employers, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 53.9% 53.5% 51.8%* 50.6% 49.9% 49.4% 48.1%* 47.8% 47.2% 47.7% 47.8% 47.6% 49.5%*
(Standard Error) (0.4%) (0.4%) (0.5%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%)
<50 36.8% 35.5%* 34.2% 32.0%* 30.5%* 30.3% 28.3%* 27.1% 26.5% 26.7% 26.6% 27.3% 27.8%^
(Standard Error) (0.3%) (0.4%) (0.6%) (0.4%) (0.3%) (0.4%) (0.4%) (0.5%) (0.4%) (0.4%) (0.4%) (0.5%) (0.5%)
50-99 51.1% 53.8% 48.8%* 46.9% 46.6% 47.6% 45.2% 47.0% 45.4% 45.0% 44.3% 47.4% 47.2%^
(Standard Error) (1.0%) (1.1%) (1.0%) (1.2%) (0.7%) (0.7%) (1.3%) (1.3%) (1.2%) (1.2%) (1.2%) (1.2%) (1.3%)
100+ 61.3% 60.9% 59.5% 58.9% 58.5% 57.7% 56.7% 56.4% 56.0% 56.5% 56.5% 55.8% 57.0%
(Standard Error) (0.6%) (0.6%) (0.6%) (0.4%) (0.4%) (0.3%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Denominator: Within each category, all employees in all establishments.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB2.2: Number Enrolled



Exhibit 2.2: Number Enrolled Total number (in millions) (standard error) of private-sector employees enrolled in health insurance offered by their employers, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 62.6 59.2* 56.1* 54.8 55.4 56.3 55.8 57.3 58.2 59.9 62.1* 62.5 60.8
(Standard Error) (0.6) (0.7) (0.8) (0.6) (0.6) (0.7) (0.6) (0.6) (0.6) (0.7) (0.7) (0.9) (0.7)
<50 11.5 10.6* 10.2 9.5* 9.3 9.5 8.9* 8.9 8.9 8.9 9.1 9.6* 7.9*^
(Standard Error) (0.1) (0.2) (0.2) (0.1) (0.1) (0.2) (0.1) (0.1) (0.1) (0.1) (0.1) (0.2) (0.1)
50-99 4.4 4.3 3.8* 3.7 3.8 4.0 4.1 4.0 4.0 4.1 4.2 4.2 4.0^
(Standard Error) (0.2) (0.1) (0.2) (0.1) (0.2) (0.2) (0.1) (0.2) (0.1) (0.2) (0.2) (0.2) (0.2)
100+ 46.7 44.3* 42.1* 41.6 42.3 42.9 42.8 44.4* 45.3 46.9 48.9* 48.7 48.8
(Standard Error) (0.6) (0.6) (0.8) (0.5) (0.6) (0.7) (0.6) (0.6) (0.6) (0.7) (0.7) (0.8) (0.7)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: The sum of estimates by firm size may differ from the U.S. total due to rounding. * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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chart and data



Exhibit 2.3: Coverage Rate Percentage (standard error) of private-sector employees who are enrolled in health insurance at establishments that offer health insurance, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 61.4% 61.1% 59.8%* 59.4% 58.9% 58.2% 57.8% 57.0% 56.0% 56.5% 56.5% 55.8% 57.0%
(Standard Error) (0.4%) (0.4%) (0.5%) (0.2%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%)
<50 59.7% 59.6% 59.2% 58.6% 57.7% 57.1% 56.8% 57.0% 55.5% 55.4% 56.2% 53.9%* 55.1%^
(Standard Error) (0.2%) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%)
50-99 56.3% 60.1%* 55.9%* 54.9% 55.4% 54.7% 54.5% 55.8% 51.2%* 52.2% 50.3% 53.8%* 53.4%^
(Standard Error) (1.0%) (1.0%) (0.8%) (1.0%) (1.2%) (0.8%) (1.3%) (1.2%) (1.2%) (1.2%) (1.2%) (1.2%) (1.3%)
100+ 62.4% 61.6% 60.4% 60.0% 59.5% 58.8% 58.3% 57.1% 56.6% 57.1% 57.1% 56.4% 57.7%
(Standard Error) (0.5%) (0.6%) (0.6%) (0.3%) (0.4%) (0.3%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.          
Denominator: Within each category, all employees in establishments that offer health insurance.            
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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chart and data



Exhibit 2.4: Eligibility Rate Percentage (standard error) of private-sector employees eligible for health insurance at establishments that offer health insurance, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 78.1% 79.5%* 78.2%* 78.0% 77.8% 77.8% 75.4%* 76.0% 76.5% 76.8% 78.0%* 77.7% 80.5%*
(Standard Error) (0.4%) (0.3%) (0.5%) (0.4%) (0.3%) (0.2%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%)
<50 78.5% 79.3% 78.6% 78.7% 77.9% 78.0% 77.7% 79.1% 78.7% 78.3% 79.1% 78.1% 80.2%*
(Standard Error) (0.4%) (0.5%) (0.5%) (0.6%) (0.5%) (0.4%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%)
50-99 75.3% 79.2%* 74.5%* 73.6% 76.4% 76.2% 74.1% 77.8%* 76.2% 75.5% 75.6% 78.1% 77.6%^
(Standard Error) (1.3%) (0.8%) (0.6%) (1.0%) (1.2%) (0.8%) (1.4%) (1.2%) (1.2%) (1.2%) (1.2%) (1.2%) (1.4%)
100+ 78.3% 79.6%* 78.5% 78.3% 77.9% 77.9% 75.0%* 75.2% 76.0% 76.6% 78.0% 77.5% 80.8%*
(Standard Error) (0.4%) (0.5%) (0.6%) (0.4%) (0.3%) (0.3%) (0.5%) (0.5%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.          
Denominator: Within each category, all employees in establishments that offer health insurance.            
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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chart and data



Exhibit 2.5: Take-Up Rate Percentage (standard error) of eligible private-sector employees who are enrolled in health insurance at establishments that offer health insurance, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 78.7% 76.9%* 76.5% 76.1% 75.8% 74.8%* 76.7%* 75.0%* 73.3%* 73.5% 72.4%* 71.9% 70.8%*
(Standard Error) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%)
<50 76.0% 75.2%* 75.3% 74.4% 74.1% 73.1% 73.0% 72.1% 70.4%* 70.7% 71.0% 69.0%* 68.7%^
(Standard Error) (0.3%) (0.3%) (0.6%) (0.4%) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%)
50-99 74.9% 75.9% 75.1% 74.5% 72.5% 71.8% 73.5% 71.7% 67.2%* 69.1% 66.6% 68.9% 68.8%^
(Standard Error) (0.5%) (0.9%) (0.7%) (0.6%) (0.8%) (1.0%) (1.0%) (1.1%) (1.2%) (1.1%) (1.1%) (1.0%) (1.0%)
100+ 79.7% 77.5%* 76.9% 76.7% 76.4% 75.5%* 77.8%* 76.0%* 74.4%* 74.5% 73.3%* 72.7% 71.4%*
(Standard Error) (0.4%) (0.5%) (0.3%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.          
Denominator: Within each category, all employees in establishments that offer health insurance.            
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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chart and data



Exhibit 2.6: Coverage Rate Percentage (standard error) of private-sector employees who are enrolled in health insurance, by the percentage of the establishment's workforce that is low wage and by firm size, 2008-2020

Low Wage 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
<50% Low-Wage Employees, Small Employers 65.1% 65.1% 64.7% 64.3% 62.9%* 62.1% 61.6% 61.7% 60.1%* 59.7% 59.6% 57.4%* 58.4%
(Standard Error) (0.3%) (0.4%) (0.6%) (0.4%) (0.5%) (0.4%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%)
50%+ Low-Wage Employees, Small Employers 36.4% 35.5% 37.2% 35.8% 35.5% 33.3% 33.5% 29.8% 28.2% 28.9% 32.6% 29.0% 29.1%^
(Standard Error) (1.0%) (0.7%) (0.8%) (0.6%) (0.6%) (1.2%) (1.5%) (1.4%) (1.3%) (1.3%) (1.5%) (1.6%) (1.6%)
<50% Low-Wage Employees, Large Employers 70.0% 70.0% 69.3% 68.8% 69.0% 67.5%* 67.8% 66.3%* 64.1%* 63.8% 63.0% 63.3% 62.5%
(Standard Error) (0.3%) (0.5%) (0.6%) (0.4%) (0.5%) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%)
50%+ Low-Wage Employees, Large Employers 38.7% 38.3% 34.8%* 33.3% 32.9% 33.2% 30.6%* 26.7%* 27.4% 29.5%* 30.3% 29.7% 31.6%^
(Standard Error) (0.6%) (0.8%) (0.9%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%) (0.7%) (0.7%) (0.9%) (0.9%) (0.9%)
Key: Small employer = fewer than 50 employees. Large employer = 50 or more employees.
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Denominator: Within each category, all employees in establishments that offer health insurance.
Note: Wage levels in the MEPS-IC questionnaires have been adjusted to account for changing wages over time. In 2020, low-wage employees were defined as those earning less than $13.00 per hour. * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for small (large) employers with 50%+ low wage employees are statistically different from the estimate for small (large) employers with < 50 percent low wage employees at p < 0.05. This test is conducted for 2020 only.

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chart and data



Exhibit 2.7: Eligibility Rate Percentage of private-sector employees eligible for health insurance at establishments that offer health insurance, by the percentage of the establishment's workforce that is low wage and by firm size, 2008-2020

Low Wage 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
<50% Low-Wage Employees, Small Employers 84.1% 84.3% 84.0% 84.3% 83.2% 83.3% 83.0% 83.8% 83.8% 83.0% 83.0% 81.8% 83.4%
(Standard Error) (0.2%) (0.3%) (0.5%) (0.4%) (0.6%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%)
50%+ Low-Wage Employees, Small Employers 54.3% 57.1%* 57.4% 56.4% 55.2% 52.9% 52.5% 51.9% 49.1% 49.6% 53.2% 51.5% 54.8%^
(Standard Error) (0.9%) (1.0%) (1.0%) (1.3%) (1.0%) (1.5%) (1.8%) (1.9%) (2.0%) (1.8%) (1.9%) (2.3%) (2.2%)
<50% Low-Wage Employees, Large Employers 84.6% 85.4% 85.0% 85.3% 85.4% 84.3%* 84.0% 83.8% 83.4% 83.0% 83.7% 83.5% 84.9%*
(Standard Error) (0.4%) (0.5%) (0.7%) (0.5%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%)
50%+ Low-Wage Employees, Large Employers 59.4% 63.3%* 59.6%* 56.9%* 57.4% 59.4%* 49.5%* 48.0% 49.7% 51.9% 53.7% 55.8% 58.7%^
(Standard Error) (0.8%) (0.9%) (0.8%) (1.0%) (0.5%) (0.6%) (0.9%) (0.9%) (0.9%) (0.9%) (1.1%) (1.1%) (1.1%)
Key: Small employer = fewer than 50 employees. Large employer = 50 or more employees.
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Denominator: Within each category, all employees in establishments that offer health insurance.
Note: Wage levels in the MEPS-IC questionnaires have been adjusted to account for changing wages over time. In 2020, low-wage employees were defined as those earning less than $13.00 per hour. * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for small (large) employers with 50%+ low wage employees are statistically different from the estimate for small (large) employers with < 50 percent low wage employees at p < 0.05. This test is conducted for 2020 only.

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chart and data



Exhibit 2.8: Take-Up Rate Percentage (standard error) of eligible private-sector employees who are enrolled in health insurance, by the percentage of the establishment's workforce that is low wage and by firm size, 2008-2020

Low Wage 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
<50% Low-Wage Employees, Small Employers 77.4% 77.2% 77.0% 76.3% 75.6% 74.5%* 74.2% 73.6% 71.7%* 71.9% 71.9% 70.1%* 70.0%
(Standard Error) (0.3%) (0.4%) (0.5%) (0.4%) (0.2%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%) (0.6%) (0.6%) (0.7%)
50%+ Low-Wage Employees, Small Employers 67.0% 62.1%* 64.9% 63.5% 64.3% 63.0% 63.9% 57.4%* 57.5% 58.3% 61.3% 56.4% 53.0%^
(Standard Error) (1.7%) (1.3%) (1.2%) (1.1%) (1.7%) (1.9%) (2.1%) (2.2%) (2.1%) (2.3%) (2.2%) (2.2%) (2.3%)
<50% Low-Wage Employees, Large Employers 82.8% 81.9%* 81.5% 80.7% 80.8% 80.0% 80.7% 79.1%* 76.9%* 76.9% 75.2%* 75.8% 73.6%*
(Standard Error) (0.2%) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%)
50%+ Low-Wage Employees, Large Employers 65.1% 60.5%* 58.4% 58.5% 57.3% 55.9% 61.9%* 55.6%* 55.2% 57.0% 56.5% 53.2% 53.9%^
(Standard Error) (0.9%) (0.9%) (1.0%) (0.8%) (1.1%) (0.5%) (0.8%) (1.0%) (1.0%) (1.0%) (1.2%) (1.2%) (1.2%)
Key: Small employer = fewer than 50 employees. Large employer = 50 or more employees.
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Denominator: Within each category, eligible employees in establishments that offer health insurance.
Note: Wage levels in the MEPS-IC questionnaires have been adjusted to account for changing wages over time. In 2020, low-wage employees were defined as those earning less than $13.00 per hour. * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for small (large) employers with 50%+ low wage employees are statistically different from the estimate for small (large) employers with < 50 percent low wage employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB2.9: Coverage Rate



Exhibit 2.9: Coverage Rate Percentage (standard error) of private-sector employees who are enrolled in health insurance at establishments that offer health insurance, by State, 3-year average, 2018-2020

Alabama 56.3% Kentucky 59.6%* North Dakota 58.4%
(Standard Error) (1.6%) (Standard Error) (1.2%) (Standard Error) (1.1%)
Alaska 56.9% Louisiana 54.0% Ohio 57.2%
(Standard Error) (1.4%) (Standard Error) (1.4%) (Standard Error) (1.3%)
Arizona 54.3% Maine 57.2% Oklahoma 57.1%
(Standard Error) (1.9%) (Standard Error) (1.2%) (Standard Error) (1.5%)
Arkansas 57.7% Maryland 52.8%* Oregon 63.8%*
(Standard Error) (1.4%) (Standard Error) (1.2%) (Standard Error) (1.4%)
California 57.2% Massachusetts 53.1%* Pennsylvania 57.6%
(Standard Error) (1.0%) (Standard Error) (1.4%) (Standard Error) (1.0%)
Colorado 58.2% Michigan 56.4% Rhode Island 53.8%*
(Standard Error) (1.3%) (Standard Error) (1.3%) (Standard Error) (1.1%)
Connecticut 55.3% Minnesota 59.0% South Carolina 57.2%
(Standard Error) (1.3%) (Standard Error) (1.3%) (Standard Error) (1.3%)
Delaware 56.5% Mississippi 57.3% South Dakota 56.9%
(Standard Error) (1.8%) (Standard Error) (1.5%) (Standard Error) (1.2%)
District of Columbia 60.1%* Missouri 59.9%* Tennessee 55.5%
(Standard Error) (1.4%) (Standard Error) (1.3%) (Standard Error) (1.4%)
Florida 52.9%* Montana 56.5% Texas 59.2%*
(Standard Error) (1.5%) (Standard Error) (1.2%) (Standard Error) (1.0%)
Georgia 55.0% Nebraska 57.7% Utah 56.7%
(Standard Error) (1.6%) (Standard Error) (1.2%) (Standard Error) (1.6%)
Hawaii 62.8%* Nevada 53.6% Vermont 53.8%*
(Standard Error) (1.4%) (Standard Error) (1.5%) (Standard Error) (1.1%)
Idaho 60.2%* New Hampshire 52.9%* Virginia 55.4%
(Standard Error) (1.6%) (Standard Error) (1.4%) (Standard Error) (1.6%)
Illinois 55.9% New Jersey 54.3% Washington 64.3%*
(Standard Error) (1.3%) (Standard Error) (1.4%) (Standard Error) (1.8%)
Indiana 56.8% New Mexico 51.3%* West Virginia 52.2%*
(Standard Error) (1.4%) (Standard Error) (1.3%) (Standard Error) (1.4%)
Iowa 56.4% New York 51.0%* Wisconsin 56.3%
(Standard Error) (1.1%) (Standard Error) (0.9%) (Standard Error) (1.3%)
Kansas 55.4% North Carolina 60.6%* Wyoming 54.5%
(Standard Error) (1.5%) (Standard Error) (1.3%) (Standard Error) (1.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Denominator: Within each state, all employees in establishments that offer health insurance.
Note: * Statistically different from national average of 57.0 percent at p < 0.05. Note that the standard error on the national estimate of 57.0 percent is 0.42.

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ALTER EXB2.10: Coverage Rate



Exhibit 2.10: Coverage Rate Percentage (standard error) of private-sector employees who are enrolled in health insurance at establishments that offer health insurance, overall and by industry, 2020

Industry Percentage
United States 57.0%
(Standard Error) (0.4%)
Agriculture, fisheries, forestry 50.6%*
(Standard Error) (7.3%)
Mining and manufacturing 74.2%*
(Standard Error) (0.7%)
Construction 57.5%*
(Standard Error) (1.8%)
Utilities and transportation 65.7%*
(Standard Error) (2.3%)
Wholesale trade 74.7%
(Standard Error) (1.4%)
Financial services and real estate 71.7%
(Standard Error) (1.0%)
Retail trade 45.7%*
(Standard Error) (1.1%)
Professional services 60.4%*
(Standard Error) (0.6%)
Other services 38.2%*
(Standard Error) (1.0%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Denominator: Within each category, all employees in establishments that offer health insurance.
Note: * indicates that the estimate is statistically different from the estimate for firms in the financial services and real estate sector at p < 0.05.

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ALTER EXB2.11: Eligibility Rate



Exhibit 2.11: Eligibility Rate Percentage (standard error) of private-sector employees eligible for health insurance at establishments that offer health insurance, overall and by industry, 2020

Industry Percentage
United States 80.5%
(Standard Error) (0.4%)
Agriculture, fisheries, forestry 78.9%*
(Standard Error) (4.2%)
Mining and manufacturing 94.7%
(Standard Error) (0.5%)
Construction 85.2%*
(Standard Error) (1.5%)
Utilities and transportation 89.4%
(Standard Error) (2.4%)
Wholesale trade 93.9%
(Standard Error) (0.7%)
Financial services and real estate 93.4%
(Standard Error) (0.7%)
Retail trade 68.9%*
(Standard Error) (1.1%)
Professional services 82.9%*
(Standard Error) (0.5%)
Other services 65.1%*
(Standard Error) (1.1%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Denominator: Within each category, all employees in establishments that offer health insurance.
Note: * indicates that the estimate is statistically different from the estimate for firms in the financial services and real estate sector at p < 0.05.

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ALTER EXB2.12: Take-Up Rate



Exhibit 2.12: Take-Up Rate Percentage (standard error) of eligible private-sector employees who are enrolled in health insurance at establishments that offer health insurance, overall and by industry, 2020

Industry Percentage
United States 70.8%
(Standard Error) (0.4%)
Agriculture, fisheries, forestry 64.1%
(Standard Error) (8.6%)
Mining and manufacturing 78.4%
(Standard Error) (0.7%)
Construction 67.5%*
(Standard Error) (1.7%)
Utilities and transportation 73.5%
(Standard Error) (1.8%)
Wholesale trade 79.5%
(Standard Error) (1.4%)
Financial services and real estate 76.7%
(Standard Error) (0.8%)
Retail trade 66.3%*
(Standard Error) (1.1%)
Professional services 72.9%*
(Standard Error) (0.6%)
Other services 58.7%*
(Standard Error) (1.1%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Denominator: Within each category, eligible employees in establishments that offer health insurance.
Note: * indicates that the estimate is statistically different from the estimate for firms in the financial services and real estate sector at p < 0.05.

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ALTER EXB2.13: Coverage Rate



Exhibit 2.13: Coverage Rate Percentage (standard error) of private-sector employees who are enrolled in health insurance at establishments that offer health insurance, overall and by selected characteristics, 2020

Employer Characteristics Percentage
United States 57.0%
(Standard Error) (0.4%)
Ownership: For Profit Inc. 57.1%*
(Standard Error) (0.5%)
Ownership: For Profit Uninc. 51.7%*
(Standard Error) (1.1%)
Ownership: Nonprofit 60.9%
(Standard Error) (0.7%)
Firm Age: 0-4 Years 49.7%*
(Standard Error) (2.0%)
Firm Age: 5-9 Years 46.1%*
(Standard Error) (1.9%)
Firm Age: 10-19 Years 54.2%*
(Standard Error) (1.2%)
Firm Age: 20+ Years 58.2%
(Standard Error) (0.5%)
# of Locations: 1 Location 52.5%*
(Standard Error) (0.7%)
# of Locations: 2+ Locations 58.7%
(Standard Error) (0.5%)
% Full Time: 0-24% 17.2%*
(Standard Error) (2.1%)
% Full Time: 25-49% 22.7%*
(Standard Error) (0.7%)
% Full Time: 50-74% 45.9%*
(Standard Error) (1.1%)
% Full Time: 75%+ 65.2%
(Standard Error) (0.5%)
% Low Wage: 50%+ 31.4%*
(Standard Error) (0.9%)
% Low Wage: <50% 61.9%
(Standard Error) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Denominator: Within each category, all employees in establishments that offer health insurance.
Note: "% Full Time" refers to the percentage of the establishments workforce that worked full time in 2020. "% Low Wage" refers to the percentage of the establishments workforce that earned less than $13.00 per hour in 2020. * indicates that the estimate is statistically different from the estimate for the reference category within each group at p < 0.05. Reference categories are: Nonprofit, Firm Age: 20+ Years, 2+ Locations, % Full Time 75%+, % Low Wage < 50%.

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ALTER EXB2.14: Eligibility Rate



Exhibit 2.14: Eligibility Rate Percentage (standard error) of private-sector employees eligible for health insurance at establishments that offer health insurance, overall and by selected characteristics, 2020

Employer Characteristics Percentage
United States 80.5%
(Standard Error) (0.4%)
Ownership: For Profit Inc. 81.6%*
(Standard Error) (0.5%)
Ownership: For Profit Uninc. 76.9%
(Standard Error) (1.0%)
Ownership: Nonprofit 79.1%
(Standard Error) (0.7%)
Firm Age: 0-4 Years 75.1%*
(Standard Error) (1.9%)
Firm Age: 5-9 Years 76.1%*
(Standard Error) (1.7%)
Firm Age: 10-19 Years 79.8%
(Standard Error) (1.0%)
Firm Age: 20+ Years 81.0%
(Standard Error) (0.4%)
# of Locations: 1 Location 77.1%*
(Standard Error) (0.7%)
# of Locations: 2+ Locations 81.8%
(Standard Error) (0.5%)
% Full Time: 0-24% 36.0%*
(Standard Error) (2.3%)
% Full Time: 25-49% 40.9%*
(Standard Error) (1.0%)
% Full Time: 50-74% 68.1%*
(Standard Error) (0.8%)
% Full Time: 75%+ 89.8%
(Standard Error) (0.4%)
% Low Wage: 50%+ 58.4%*
(Standard Error) (1.0%)
% Low Wage: <50% 84.7%
(Standard Error) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Denominator: Within each category, all employees in establishments that offer health insurance.
Note: "% Full Time" refers to the percentage of the establishments workforce that worked full time in 2020. "% Low Wage" refers to the percentage of the establishments workforce that earned less than $13.00 per hour in 2020. * indicates that the estimate is statistically different from the estimate for the reference category within each group at p < 0.05. Reference categories are: Nonprofit, Firm Age: 20+ Years, 2+ Locations, % Full Time 75%+, % Low Wage < 50%.

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ALTER EXB2.15: Take-Up Rate



Exhibit 2.15: Take-Up Rate Percentage (standard error) of eligible private-sector employees who are enrolled in health insurance at establishments that offer health insurance, overall and by selected characteristics, 2020

Employer Characteristics Percentage
United States 70.8%
(Standard Error) (0.4%)
Ownership: For Profit Inc. 70.1%*
(Standard Error) (0.5%)
Ownership: For Profit Uninc. 67.3%*
(Standard Error) (1.0%)
Ownership: Nonprofit 77.0%
(Standard Error) (0.6%)
Firm Age: 0-4 Years 66.1%*
(Standard Error) (1.9%)
Firm Age: 5-9 Years 60.6%*
(Standard Error) (2.0%)
Firm Age: 10-19 Years 67.9%*
(Standard Error) (1.1%)
Firm Age: 20+ Years 71.8%
(Standard Error) (0.4%)
# of Locations: 1 Location 68.1%*
(Standard Error) (0.6%)
# of Locations: 2+ Locations 71.8%
(Standard Error) (0.4%)
% Full Time: 0-24% 47.8%*
(Standard Error) (4.1%)
% Full Time: 25-49% 55.5%*
(Standard Error) (1.6%)
% Full Time: 50-74% 67.4%*
(Standard Error) (1.1%)
% Full Time: 75%+ 72.6%
(Standard Error) (0.4%)
% Low Wage: 50%+ 53.8%*
(Standard Error) (1.1%)
% Low Wage: <50% 73.1%
(Standard Error) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Denominator: Within each category, eligible employees in establishments that offer health insurance.
Note: "% Full Time" refers to the percentage of the establishments workforce that worked full time in 2020. "% Low Wage" refers to the percentage of the establishments workforce that earned less than $13.00 per hour in 2020. * indicates that the estimate is statistically different from the estimate for the reference category within each group at p < 0.05. Reference categories are: Nonprofit, Firm Age: 20+ Years, 2+ Locations, % Full Time 75%+, % Low Wage < 50%.

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chart and data



Exhibit 2.16 Percentage (standard error) of private-sector employees enrolled in a health insurance plan who take single coverage, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 50.2% 50.0% 51.3%* 50.2%* 51.3%* 51.3% 52.4%* 53.5%* 55.3%* 54.6% 55.2% 55.6% 55.8%
(Standard Error) (0.4%) (0.2%) (0.3%) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%)
<50 60.7% 58.8%* 60.3%* 60.8% 61.4% 62.5% 61.5% 63.5%* 62.8% 63.5% 63.2% 62.5% 63.3%^
(Standard Error) (0.5%) (0.5%) (0.6%) (0.7%) (0.5%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%)
50-99 58.5% 56.7% 57.6% 58.6% 58.1% 59.4% 60.8% 61.7% 63.3% 63.3% 64.6% 61.4%* 65.1%*^
(Standard Error) (0.6%) (1.1%) (1.2%) (0.9%) (0.6%) (0.8%) (1.0%) (1.0%) (1.0%) (1.0%) (0.9%) (1.2%) (1.2%)
100+ 46.9% 47.2% 48.6%* 47.1%* 48.5%* 48.1% 49.7%* 50.8%* 53.1%* 52.1%* 52.9% 53.7% 53.8%
(Standard Error) (0.4%) (0.2%) (0.3%) (0.4%) (0.3%) (0.2%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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chart and data



Exhibit 2.17 Percentage (standard error) of private-sector employees enrolled in a health insurance plan who take employee-plus-one coverage, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 18.0% 19.5%* 18.3%* 18.9% 18.1%* 18.9%* 18.3%* 18.4% 17.8%* 19.0%* 18.6% 18.6% 18.5%
(Standard Error) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%)
<50 13.3% 14.6%* 13.8% 14.3% 14.0% 13.4% 13.8% 13.7% 14.5% 13.9% 14.8% 15.7% 15.1%^
(Standard Error) (0.3%) (0.4%) (0.3%) (0.2%) (0.4%) (0.2%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%)
50-99 15.4% 17.7%* 15.9% 16.4% 16.7% 16.6% 15.8% 16.2% 16.3% 15.8% 16.1% 17.1% 15.3%*^
(Standard Error) (0.5%) (0.8%) (0.6%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.5%) (0.6%) (0.6%)
100+ 19.4% 20.9%* 19.6%* 20.1% 19.2%* 20.3%* 19.5%* 19.5% 18.6%* 20.2%* 19.6%* 19.3% 19.3%
(Standard Error) (0.2%) (0.2%) (0.3%) (0.3%) (0.2%) (0.1%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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chart and data



Exhibit 2.18 Percentage (standard error) of private-sector employees enrolled in a health insurance plan who take family coverage, overall and by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 31.8% 30.5%* 30.3% 30.9% 30.6% 29.8%* 29.3% 28.1%* 26.8%* 26.5% 26.2% 25.8% 25.7%
(Standard Error) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.2%) (0.3%) (0.2%) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%)
<50 26.0% 26.6% 25.8% 24.9% 24.6% 24.0% 24.7% 22.8%* 22.7% 22.6% 22.0% 21.8% 21.6%^
(Standard Error) (0.3%) (0.5%) (0.4%) (0.6%) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%) (0.6%) (0.6%)
50-99 26.1% 25.5% 26.5% 25.1% 25.2% 24.0% 23.4% 22.1% 20.4% 20.9% 19.3% 21.5% 19.6%^
(Standard Error) (0.7%) (0.7%) (0.9%) (1.0%) (0.7%) (0.5%) (0.8%) (0.9%) (0.9%) (0.9%) (0.8%) (0.9%) (1.1%)
100+ 33.7% 31.9%* 31.8% 32.8%* 32.4% 31.6%* 30.8%* 29.7%* 28.2%* 27.7% 27.5% 27.0% 26.9%
(Standard Error) (0.3%) (0.3%) (0.4%) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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Section 3: Health Insurance Premiums

Health Insurance Premiums

This section presents estimates of total health insurance premiums (i.e., the amount of premiums paid by employees plus the amount paid by employers on behalf of their employees) for single, employee-plus-one, and family coverage. The section includes recent premium growth rates and trends in growth rates from 2008 to 2020 overall and by firm size.

This section also presents information on variation in total premiums in 2020 by firm size, State where the employer is located, industry, and other employer characteristics (including ownership type, firm age, and single- versus multilocation status). It also presents variation in total premiums by workforce characteristics in each establishment (including percentage of full-time workers and percentage of low-wage workers). Finally, this section provides information on the distribution of premiums, overall and by firm size.

In the MEPS-IC, respondents are asked to report total premiums for fully insured plans and to report total premium equivalents for self-insured plans. If employee-plus-one premiums were different for employee-plus-child and employee-plus-spouse coverage, respondents were instructed to report for employee-plus-one child. If premiums for family coverage varied by family size, respondents were instructed to report for a family of four. If an employer's premiums varied across employees for other reasons, respondents were instructed to report for the "typical" employee.

In employer-sponsored health insurance plans, total premiums may vary for many reasons, including demographic and health characteristics of employers' workforces and employers' industry and firm size. In addition, premiums may vary due to differences in plan provider networks, covered services, and actuarial values (i.e., percentage of medical expenses paid by the plan, rather than out of pocket by a typical group of enrollees). State-level factors that may affect premiums include healthcare prices and utilization, as well as differences in State approaches to regulating private insurance.

Highlights

  • In 2020, the average total health insurance premium for single coverage was $7,149, representing a 2.5 percent increase over 2019 (Exhibits 3.1 and 3.2). This one-year percentage increase was significantly lower than the average annual growth rate (4.2 percent) for single premiums from 2008 to 2020.
  • Average total premiums for employee-plus-one coverage ($14,191) and family coverage ($20,758) were not significantly different from their 2019 levels (Exhibits 3.4 and 3.5). This was the first time in the 2008 to 2020 period that there was not a statistically significant increase in these premiums.
  • In 2020, average total premiums for both types of dependent coverage (employee-plus-one and family) were higher in large firms ($14,304 and $20,990) than in small ($13,522 and $19,416)) and medium firms ($13,766 and $19,827) (Exhibits 3.4 and 3.5).
  • Average annual total premiums for 2018-2020 showed strong regional variation that was fairly consistent for single, employee-plus-one, and family coverage (Exhibits 3.6, 3.7, and 3.8):
    • In the Northeast census region, six of nine States had average annual total premiums that were higher than the national average for all three types of coverage. In the other three census regions, only two States (Alaska and the District of Colombia) had higher than average premiums for all three types of coverage.
    • Twelve States had average annual total premiums that were lower than the national average for all three types of coverage. Six of these States are located in the Southern census region, five are in the West, and one is in the Midwest.

Key Trends

In addition to these highlights, variation in total premiums in 2020 followed a number of patterns that are in line with longer term trends. Average total premiums for single, employee-plus-one, and family coverage were consistently higher at nonprofit establishments, multilocation firms, and establishments where less than 50 percent of the workforce was low wage than at other establishments.

Average annual total premiums for 2018-2020 showed substantial variation across the United States. Average annual single premiums ranged from $6,152 in Arkansas to $8,672 in Alaska; average annual employee-plus-one premiums ranged from $12,115 in Idaho to $16,656 in Alaska; and average annual family premiums ranged from $17,627 in Arkansas to $22,716 in New York.

Finally, in 2020, overall total premium distributions for all three types of coverage showed substantial variation. The value of the premium at the 90th percentile was more than twice the value of the premium at the 10th percentile for single ($10,000 vs. $4,600), employee-plus-one ($19,000 vs. $9,100), and family coverage ($28,000 vs. $13,000).

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ALTER EXB3.1



Exhibit 3.1 Average total premiums (standard error) per enrolled employee for single, employee-plus-one and family coverage, 2008-2020

Coverage 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Single $4,386 $4,669* $4,940* $5,222* $5,384* $5,571* $5,832* $5,963* $6,101* $6,368* $6,715* $6,972* $7,149*
(Standard Error) ($15) ($21) ($22) ($26) ($28) ($23) ($25) ($26) ($27) ($28) ($31) ($35) ($35)
Plus One $8,535 $9,053* $9,664* $10,329* $10,621* $10,990* $11,503* $11,800* $12,124* $12,789* $13,425* $13,989* $14,191
(Standard Error) ($43) ($34) ($60) ($105) ($56) ($54) ($60) ($58) ($60) ($70) ($70) ($83) ($93)
Family $12,298 $13,027* $13,871* $15,022* $15,473* $16,029* $16,655* $17,322* $17,710* $18,687* $19,565* $20,486* $20,758
(Standard Error) ($81) ($25) ($75) ($98) ($95) ($61) ($79) ($95) ($84) ($105) ($104) ($125) ($124)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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ALTER EXB3.2



Exhibit 3.2 Percentage change (standard error) in total premiums from previous year per enrolled employee for single, employee-plus-one, and family coverage, 2009-2020

Year Single Plus one Family
2009 6.5%* 6.1%* 5.9%*
(Standard Error) ($0.6%) ($0.7%) ($0.7%)
2010 5.8%* 6.7%* 6.5%*
(Standard Error) ($0.7%) ($0.8%) ($0.6%)
2011 5.7%* 6.9%* 8.3%*
(Standard Error) ($0.7%) ($1.3%) ($0.9%)
2012 3.1%* 2.8%* 3.0%*
(Standard Error) ($0.7%) ($1.2%) ($0.9%)
2013 3.5%* 3.5%* 3.6%*
(Standard Error) ($0.7%) ($0.7%) ($0.7%)
2014 4.7%* 4.7%* 3.9%*
(Standard Error) ($0.6%) ($0.7%) ($0.6%)
2015 2.2%* 2.6%* 4.0%*
(Standard Error) ($0.6%) ($0.7%) ($0.8%)
2016 2.3%* 2.7%* 2.2%*
(Standard Error) ($0.6%) ($0.7%) ($0.7%)
2017 4.4%* 5.5%* 5.5%*
(Standard Error) ($0.7%) ($0.8%) ($0.8%)
2018 5.4%* 5.0%* 4.7%*
(Standard Error) ($0.7%) ($0.8%) ($0.8%)
2019 3.8%* 4.2%* 4.7%*
(Standard Error) ($0.7%) ($0.8%) ($0.8%)
2020 2.5%* 1.4% 1.3%
(Standard Error) ($0.7%) ($0.9%) ($0.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from zero at p < 0.05.

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ALTER EXB3.3



Exhibit 3.3 Average total single premium (standard error) per enrolled employee, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. $4,386 $4,669* $4,940* $5,222* $5,384* $5,571* $5,832* $5,963* $6,101* $6,368* $6,715* $6,972* $7,149*
(Standard Error) ($15) ($21) ($22) ($26) ($28) ($23) ($25) ($26) ($27) ($28) ($31) ($35) ($35)
<50 $4,501 $4,652* $4,956* $5,258* $5,460* $5,628* $5,886* $5,947 $6,070 $6,421* $6,667* $6,920* $7,045
(Standard Error) ($31) ($31) ($34) ($39) ($60) ($39) ($55) ($55) ($53) ($61) ($63) ($73) ($70)
50-99 $4,215 $4,614* $4,713 $4,861 $5,246* $5,314 $5,549* $5,642 $5,743 $6,163* $6,287 $6,629* $6,870^
(Standard Error) ($37) ($82) ($52) ($75) ($39) ($73) ($82) ($104) ($96) ($121) ($111) ($99) ($129)
100+ $4,370 $4,681* $4,959* $5,252* $5,378* $5,584* $5,851* $6,006* $6,146* $6,377* $6,770* $7,019* $7,197*
(Standard Error) ($26) ($38) ($23) ($31) ($28) ($29) ($30) ($31) ($32) ($33) ($37) ($42) ($41)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB3.4



Exhibit 3.4 Average total employee-plus-one premium (standard error) per enrolled employee, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. $8,535 $9,053* $9,664* $10,329* $10,621* $10,990* $11,503* $11,800* $12,124* $12,789* $13,425* $13,989* $14,191
(Standard Error) ($43) ($34) ($60) ($105) ($56) ($54) ($60) ($58) ($60) ($70) ($70) ($83) ($93)
<50 $8,631 $9,124* $9,850* $10,253* $10,524 $11,050* $11,386 $11,666 $11,833 $12,558* $13,044* $13,619 $13,522^
(Standard Error) ($110) ($119) ($80) ($104) ($121) ($92) ($163) ($158) ($156) ($170) ($176) ($248) ($212)
50-99 $8,421 $8,852* $9,166 $9,615* $10,178* $10,673 $10,845 $10,885 $11,389 $11,931 $12,593* $13,248 $13,766^
(Standard Error) ($88) ($148) ($124) ($192) ($185) ($330) ($187) ($198) ($227) ($232) ($236) ($321) ($246)
100+ $8,527 $9,058* $9,669* $10,394* $10,672* $11,006* $11,571* $11,892* $12,225* $12,878* $13,537* $14,105* $14,304
(Standard Error) ($60) ($34) ($62) ($113) ($70) ($59) ($68) ($66) ($68) ($79) ($79) ($92) ($106)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB3.5



Exhibit 3.5 Average total family premium (standard error) per enrolled employee, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. $12,298 $13,027* $13,871* $15,022* $15,473* $16,029* $16,655* $17,322* $17,710* $18,687* $19,565* $20,486* $20,758
(Standard Error) ($81) ($25) ($75) ($98) ($95) ($61) ($79) ($95) ($84) ($105) ($104) ($125) ($124)
<50 $11,679 $12,041 $13,170* $14,086* $14,496 $14,787 $15,575* $15,919 $16,471 $17,649* $18,296* $19,417* $19,416^
(Standard Error) ($182) ($129) ($111) ($145) ($181) ($89) ($177) ($212) ($207) ($192) ($231) ($303) ($283)
50-99 $11,578 $12,431* $13,019* $14,151* $15,421* $15,376 $15,732 $16,336 $16,214 $17,735* $18,386 $19,893* $19,827^
(Standard Error) ($128) ($229) ($153) ($168) ($273) ($268) ($274) ($335) ($348) ($327) ($473) ($435) ($422)
100+ $12,468 $13,271* $14,074* $15,245* $15,641* $16,284* $16,903* $17,612* $18,000* $18,911* $19,824* $20,697* $20,990
(Standard Error) ($95) ($33) ($85) ($117) ($114) ($82) ($91) ($110) ($95) ($122) ($118) ($143) ($139)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXBExhibit 3.6



Exhibit 3.6 Average total single premium (standard error) per enrolled employee, by State, 3-year average, 2018-2020

Alabama $6,336* Kentucky $6,770 North Dakota $6,841
(Standard Error) ($102) (Standard Error) ($100) (Standard Error) ($75)
Alaska $8,672* Louisiana $6,666* Ohio $6,995
(Standard Error) ($206) (Standard Error) ($106) (Standard Error) ($98)
Arizona $6,453* Maine $7,261* Oklahoma $6,807
(Standard Error) ($88) (Standard Error) ($89) (Standard Error) ($103)
Arkansas $6,152* Maryland $7,048 Oregon $6,669*
(Standard Error) ($107) (Standard Error) ($116) (Standard Error) ($113)
California $6,884 Massachusetts $7,477* Pennsylvania $7,059
(Standard Error) ($72) (Standard Error) ($114) (Standard Error) ($87)
Colorado $6,662* Michigan $6,564* Rhode Island $7,208*
(Standard Error) ($94) (Standard Error) ($100) (Standard Error) ($81)
Connecticut $7,426* Minnesota $6,865 South Carolina $6,950
(Standard Error) ($104) (Standard Error) ($108) (Standard Error) ($95)
Delaware $7,427* Mississippi $6,256* South Dakota $7,058
(Standard Error) ($151) (Standard Error) ($91) (Standard Error) ($86)
District of Columbia $7,370* Missouri $6,875 Tennessee $6,358*
(Standard Error) ($95) (Standard Error) ($107) (Standard Error) ($79)
Florida $6,830 Montana $6,871 Texas $6,849
(Standard Error) ($113) (Standard Error) ($99) (Standard Error) ($77)
Georgia $6,848 Nebraska $7,007 Utah $6,315*
(Standard Error) ($131) (Standard Error) ($110) (Standard Error) ($93)
Hawaii $6,731* Nevada $6,365* Vermont $7,369*
(Standard Error) ($79) (Standard Error) ($110) (Standard Error) ($84)
Idaho $6,428* New Hampshire $7,544* Virginia $6,780
(Standard Error) ($104) (Standard Error) ($124) (Standard Error) ($86)
Illinois $7,217* New Jersey $7,554* Washington $6,996
(Standard Error) ($76) (Standard Error) ($115) (Standard Error) ($114)
Indiana $7,016 New Mexico $6,932 West Virginia $6,988
(Standard Error) ($102) (Standard Error) ($107) (Standard Error) ($132)
Iowa $6,791 New York $7,937* Wisconsin $7,021
(Standard Error) ($94) (Standard Error) ($105) (Standard Error) ($94)
Kansas $6,417* North Carolina $6,723* Wyoming $7,205
(Standard Error) ($93) (Standard Error) ($72) (Standard Error) ($133)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * Statistically different from national average of $6,944 at p < 0.05. Note that the standard error on the national estimate of $6,944 is $19.15.

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ALTER EXB3.7



Exhibit 3.7 Average total employee-plus-one premium (standard error) per enrolled employee, by State, 3-year average, 2018-2020

Alabama $12,943* Kentucky $13,608 North Dakota $13,118*
(Standard Error) ($255) (Standard Error) ($188) (Standard Error) ($186)
Alaska $16,656* Louisiana $13,104* Ohio $13,703
(Standard Error) ($282) (Standard Error) ($215) (Standard Error) ($202)
Arizona $13,036* Maine $14,372* Oklahoma $13,353*
(Standard Error) ($224) (Standard Error) ($223) (Standard Error) ($247)
Arkansas $12,382* Maryland $14,074 Oregon $13,322*
(Standard Error) ($207) (Standard Error) ($251) (Standard Error) ($239)
California $13,898 Massachusetts $14,821* Pennsylvania $14,244
(Standard Error) ($215) (Standard Error) ($337) (Standard Error) ($200)
Colorado $13,727 Michigan $14,150 Rhode Island $14,407*
(Standard Error) ($254) (Standard Error) ($332) (Standard Error) ($193)
Connecticut $14,690* Minnesota $14,021 South Carolina $13,864
(Standard Error) ($373) (Standard Error) ($193) (Standard Error) ($226)
Delaware $13,789 Mississippi $12,502* South Dakota $13,714
(Standard Error) ($302) (Standard Error) ($312) (Standard Error) ($203)
District of Columbia $15,066* Missouri $13,431* Tennessee $12,782*
(Standard Error) ($226) (Standard Error) ($206) (Standard Error) ($182)
Florida $13,449 Montana $13,329* Texas $13,965
(Standard Error) ($222) (Standard Error) ($244) (Standard Error) ($156)
Georgia $13,515 Nebraska $13,820 Utah $12,898*
(Standard Error) ($269) (Standard Error) ($237) (Standard Error) ($204)
Hawaii $13,371 Nevada $12,475* Vermont $15,015*
(Standard Error) ($257) (Standard Error) ($265) (Standard Error) ($189)
Idaho $12,115* New Hampshire $15,097* Virginia $12,937*
(Standard Error) ($256) (Standard Error) ($241) (Standard Error) ($218)
Illinois $14,237 New Jersey $15,170* Washington $13,250*
(Standard Error) ($245) (Standard Error) ($238) (Standard Error) ($257)
Indiana $14,182 New Mexico $13,459 West Virginia $14,670*
(Standard Error) ($224) (Standard Error) ($255) (Standard Error) ($304)
Iowa $12,997* New York $15,633* Wisconsin $14,472*
(Standard Error) ($224) (Standard Error) ($240) (Standard Error) ($210)
Kansas $13,422* North Carolina $12,802* Wyoming $13,822
(Standard Error) ($203) (Standard Error) ($186) (Standard Error) ($287)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * Statistically different from national average of $13,865 at p < 0.05. Note that the standard error on the national estimate of $13,865 is $46.86.

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ALTER EXB3.8



Exhibit 3.8 Average total family premium (standard error) per enrolled employee, by State, 3-year average, 2018-2020

Alabama $17,674* Kentucky $20,107 North Dakota $18,490*
(Standard Error) ($316) (Standard Error) ($301) (Standard Error) ($208)
Alaska $22,170* Louisiana $19,102* Ohio $19,785
(Standard Error) ($420) (Standard Error) ($355) (Standard Error) ($330)
Arizona $19,530* Maine $20,317 Oklahoma $19,450*
(Standard Error) ($362) (Standard Error) ($216) (Standard Error) ($301)
Arkansas $17,627* Maryland $19,972 Oregon $19,539*
(Standard Error) ($333) (Standard Error) ($315) (Standard Error) ($277)
California $20,498 Massachusetts $21,740* Pennsylvania $20,270
(Standard Error) ($296) (Standard Error) ($484) (Standard Error) ($300)
Colorado $19,961 Michigan $19,514 Rhode Island $20,153
(Standard Error) ($289) (Standard Error) ($445) (Standard Error) ($262)
Connecticut $21,349* Minnesota $20,272 South Carolina $20,462
(Standard Error) ($302) (Standard Error) ($304) (Standard Error) ($460)
Delaware $20,756 Mississippi $18,093* South Dakota $20,106
(Standard Error) ($384) (Standard Error) ($376) (Standard Error) ($281)
District of Columbia $22,205* Missouri $20,070 Tennessee $18,315*
(Standard Error) ($305) (Standard Error) ($360) (Standard Error) ($237)
Florida $20,129 Montana $19,739 Texas $20,441
(Standard Error) ($354) (Standard Error) ($403) (Standard Error) ($267)
Georgia $19,395* Nebraska $19,636 Utah $18,707*
(Standard Error) ($352) (Standard Error) ($327) (Standard Error) ($258)
Hawaii $18,913* Nevada $18,848* Vermont $21,274*
(Standard Error) ($335) (Standard Error) ($368) (Standard Error) ($255)
Idaho $19,320* New Hampshire $21,281* Virginia $19,956
(Standard Error) ($399) (Standard Error) ($295) (Standard Error) ($307)
Illinois $20,933* New Jersey $22,433* Washington $19,436*
(Standard Error) ($281) (Standard Error) ($453) (Standard Error) ($380)
Indiana $20,283 New Mexico $18,687* West Virginia $21,095
(Standard Error) ($371) (Standard Error) ($411) (Standard Error) ($464)
Iowa $18,626* New York $22,716* Wisconsin $20,422
(Standard Error) ($283) (Standard Error) ($337) (Standard Error) ($271)
Kansas $19,292* North Carolina $19,507* Wyoming $20,245
(Standard Error) ($296) (Standard Error) ($216) (Standard Error) ($324)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * Statistically different from national average of $20,263 at p < 0.05. Note that the standard error on the national estimate of $20,263 is $67.52.

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ALTER EXB3.9



Exhibit 3.9 Average total single premium (standard error) per enrolled employee, overall and by industry, 2020

Industry Amount
United States $7,149
(Standard Error) ($35)
Agriculture, fisheries, forestry $5,716
(Standard Error) ($714)
Mining and manufacturing $7,026
(Standard Error) ($100)
Construction $6,656*
(Standard Error) ($129)
Utilities and transportation $7,181
(Standard Error) ($213)
Wholesale trade $7,110
(Standard Error) ($108)
Financial services and real estate $7,112
(Standard Error) ($84)
Retail trade $6,629*
(Standard Error) ($86)
Professional services $7,661*
(Standard Error) ($64)
Other services $6,916
(Standard Error) ($84)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * indicates that the estimate is statistically different from the estimate for firms in the financial services and real estate sector at p < 0.05.

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ALTER EXB3.10



Exhibit 3.10 Average total employee-plus-one premium (standard error) per enrolled employee, overall and by industry, 2020

Industry Amount
United States $14,191
(Standard Error) ($93)
Agriculture, fisheries, forestry $11,210
(Standard Error) ($1547)
Mining and manufacturing $14,019
(Standard Error) ($198)
Construction $13,388
(Standard Error) ($331)
Utilities and transportation $14,745
(Standard Error) ($890)
Wholesale trade $14,299
(Standard Error) ($227)
Financial services and real estate $14,082
(Standard Error) ($149)
Retail trade $12,952*
(Standard Error) ($217)
Professional services $14,965*
(Standard Error) ($141)
Other services $13,688
(Standard Error) ($228)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * indicates that the estimate is statistically different from the estimate for firms in the financial services and real estate sector at p < 0.05.

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ALTER EXB3.11



Exhibit 3.11 Average total family premium (standard error) per enrolled employee, overall and by industry, 2020

Industry Amount
United States $20,758
(Standard Error) ($124)
Agriculture, fisheries, forestry $19,409
(Standard Error) ($2066)
Mining and manufacturing $20,243*
(Standard Error) ($261)
Construction $19,400*
(Standard Error) ($446)
Utilities and transportation $21,924
(Standard Error) ($1036)
Wholesale trade $21,199
(Standard Error) ($321)
Financial services and real estate $21,139
(Standard Error) ($241)
Retail trade $19,676*
(Standard Error) ($486)
Professional services $21,402
(Standard Error) ($202)
Other services $19,778*
(Standard Error) ($245)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * indicates that the estimate is statistically different from the estimate for firms in the financial services and real estate sector at p < 0.05.

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ALTER EXB3.12



Exhibit 3.12 Average total single premium (standard error) per enrolled employee, overall and by selected characteristics, 2020

Employer Characteristics Amount
United States $7,149
(Standard Error) ($35)
Ownership: For Profit Inc. $6,952*
(Standard Error) ($42)
Ownership: For Profit Uninc. $6,873*
(Standard Error) ($81)
Ownership: Nonprofit $8,125
(Standard Error) ($84)
Firm Age: 0-4 Years $6,497*
(Standard Error) ($265)
Firm Age: 5-9 Years $6,549*
(Standard Error) ($203)
Firm Age: 10-19 Years $6,923*
(Standard Error) ($109)
Firm Age: 20+ Years $7,228
(Standard Error) ($38)
# of Locations: 1 Location $6,997*
(Standard Error) ($66)
# of Locations: 2+ Locations $7,209
(Standard Error) ($41)
% Full Time: 0-24% $6,603
(Standard Error) ($334)
% Full Time: 25-49% $6,817*
(Standard Error) ($107)
% Full Time: 50-74% $7,027
(Standard Error) ($93)
% Full Time: 75%+ $7,190
(Standard Error) ($39)
% Low Wage: 50%+ $6,661*
(Standard Error) ($105)
% Low Wage: <50% $7,207
(Standard Error) ($37)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2020. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.00 per hour in 2020. * indicates that the estimate is statistically different from the estimate for the reference category within each group at p < 0.05. Reference categories are: Nonprofit, Firm Age: 20+ Years, 2+ Locations, % Full Time 75%+, % Low Wage < 50%.

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ALTER EXB3.13



Exhibit 3.13 Average total employee-plus-one premium (standard error) per enrolled employee, overall and by selected characteristics, 2020

Employer Characteristics Amount
United States $14,191
(Standard Error) ($93)
Ownership: For Profit Inc. $13,945*
(Standard Error) ($119)
Ownership: For Profit Uninc. $13,598*
(Standard Error) ($181)
Ownership: Nonprofit $15,545
(Standard Error) ($188)
Firm Age: 0-4 Years $13,379
(Standard Error) ($589)
Firm Age: 5-9 Years $13,119*
(Standard Error) ($428)
Firm Age: 10-19 Years $13,685*
(Standard Error) ($258)
Firm Age: 20+ Years $14,297
(Standard Error) ($102)
# of Locations: 1 Location $13,763*
(Standard Error) ($171)
# of Locations: 2+ Locations $14,307
(Standard Error) ($109)
% Full Time: 0-24% $13,860
(Standard Error) ($540)
% Full Time: 25-49% $13,443*
(Standard Error) ($324)
% Full Time: 50-74% $13,937
(Standard Error) ($209)
% Full Time: 75%+ $14,248
(Standard Error) ($104)
% Low Wage: 50%+ $12,933*
(Standard Error) ($300)
% Low Wage: <50% $14,291
(Standard Error) ($96)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2020. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.00 per hour in 2020. * indicates that the estimate is statistically different from the estimate for the reference category within each group at p < 0.05. Reference categories are: Nonprofit, Firm Age: 20+ Years, 2+ Locations, % Full Time 75%+, % Low Wage < 50%.

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ALTER EXB3.14



Exhibit 3.14 Average total family premium (standard error) per enrolled employee, overall and by selected characteristics, 2020

Employer Characteristics Amount
United States $20,758
(Standard Error) ($124)
Ownership: For Profit Inc. $20,583*
(Standard Error) ($157)
Ownership: For Profit Uninc. $19,841*
(Standard Error) ($262)
Ownership: Nonprofit $22,107
(Standard Error) ($271)
Firm Age: 0-4 Years $17,994*
(Standard Error) ($662)
Firm Age: 5-9 Years $18,353*
(Standard Error) ($502)
Firm Age: 10-19 Years $20,056
(Standard Error) ($492)
Firm Age: 20+ Years $20,975
(Standard Error) ($131)
# of Locations: 1 Location $19,900*
(Standard Error) ($212)
# of Locations: 2+ Locations $20,989
(Standard Error) ($146)
% Full Time: 0-24% $19,411*
(Standard Error) ($630)
% Full Time: 25-49% $19,829*
(Standard Error) ($447)
% Full Time: 50-74% $20,156*
(Standard Error) ($276)
% Full Time: 75%+ $20,874
(Standard Error) ($137)
% Low Wage: 50%+ $18,654*
(Standard Error) ($451)
% Low Wage: <50% $20,885
(Standard Error) ($127)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2020. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.00 per hour in 2020. * indicates that the estimate is statistically different from the estimate for the reference category within each group at p < 0.05. Reference categories are: Nonprofit, Firm Age: 20+ Years, 2+ Locations, % Full Time 75%+, % Low Wage < 50%.

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Exhibit 3.15 Premium distributions (standard error) for employees enrolled in single, employee-plus-one, and family coverage, overall and by firm size, 2020

Coverage Estimate Total <50 employees 50-99
employees
100
or more employees
Single Average (mean) $7,149 $7,045 $6,870* $7,197
  (Standard Error) ($35) ($70) ($129) ($41)
  10 percentile $4,600 $4,100* $4,000* $4,800
  (Standard Error) ($48) ($75) ($231) ($52)
  25 percentile $5,700 $5,200* $5,200* $5,800
  (Standard Error) ($30) ($60) ($142) ($28)
  50 percentile (median) $6,900 $6,600* $6,600* $7,000
  (Standard Error) ($36) ($78) ($138) ($40)
  75 percentile $8,200 $8,400 $8,100 $8,200
  (Standard Error) ($51) ($93) ($152) ($46)
  90 percentile $10,000 $11,000* $10,000 $9,900
  (Standard Error) ($78) ($225) ($315) ($92)
Employee-plus-one Average (mean) $14,191 $13,522* $13,766* $14,304
  (Standard Error) ($93) ($212) ($246) ($106)
  10 percentile $9,100 $7,100* $7,900* $9,600
  (Standard Error) ($179) ($159) ($406) ($93)
  25 percentile $11,000 $9,600* $11,000* $12,000
  (Standard Error) ($104) ($245) ($318) ($115)
  50 percentile (median) $14,000 $13,000* $13,000* $14,000
  (Standard Error) ($86) ($288) ($178) ($98)
  75 percentile $16,000 $17,000* $16,000 $16,000
  (Standard Error) ($132) ($352) ($425) ($135)
  90 percentile $19,000 $21,000* $20,000 $19,000
  (Standard Error) ($263) ($512) ($799) ($259)
Family Average (mean) $20,758 $19,416* $19,827* $20,990
  (Standard Error) ($124) ($283) ($422) ($139)
  10 percentile $13,000 $11,000* $12,000* $14,000
  (Standard Error) ($214) ($459) ($674) ($217)
  25 percentile $17,000 $14,000* $15,000* $17,000
  (Standard Error) ($110) ($194) ($515) ($137)
  50 percentile (median) $21,000 $18,000* $20,000 $21,000
  (Standard Error) ($120) ($272) ($674) ($158)
  75 percentile $24,000 $24,000 $23,000* $24,000
  (Standard Error) ($138) ($318) ($341) ($139)
  90 percentile $28,000 $29,000 $29,000 $28,000
  (Standard Error) ($232) ($608) ($1333) ($233)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020.
Note: * indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05.

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Section 4: Employee and Employer Premium Contributions

Employee and Employer Premium Contributions

This section presents estimates of employee and employer premium contributions for single, employee-plus-one, and family coverage, both in nominal dollars and as a percentage of total annual premiums per enrolled employee. This section also presents trends from 2008 to 2020 and provides information on employee premium contributions by firm size, State where the enrolled employees' establishment was located, industry, and other employer characteristics. In addition, this section presents the distribution of employee contributions by firm size in 2020.

In the MEPS IC, respondents are asked to report the contributions employers and employees make to total health insurance premiums. If employee-plus-one total premiums were different for employee-plus-child and employee-plus-spouse coverage, respondents were instructed to report employer and employee contributions for employee-plus-one child coverage. If total premiums for family coverage varied by family size, respondents were instructed to report the information for a family of four. If an employer's premiums varied across employees for other reasons, respondents were instructed to report for the "typical" employee.

Employee and employer premium contributions (in nominal dollars) for employer-sponsored health insurance plans can vary due to (1) variation in total premiums and (2) variation in employee and employer shares of total premiums. Total premiums may vary for a number of reasons, including demographic and health characteristics of employers' workforces and employers' industry and firm size (as described in Section 3). The shares of total premiums paid by employees and employers can vary by firm size and other firm characteristics, as well as type of coverage. Employees typically pay a lower share of premiums for single coverage than for employee-plus-one and family coverage, which cover the employee and one or more dependents.

Highlights

  • In 2020, enrolled employees paid on average 21.4 percent of total premiums for single coverage, 28.4 percent for employee-plus-one coverage, and 28.8 percent for family coverage. In line with longer term trends, these shares were not significantly different from their 2019 levels (Exhibit 4.1).
  • In 2020, average employee and employer contributions for single coverage were $1,532 and $5,617, respectively, with the employer portion increasing by 2.4 percent over the 2019 level and the employee portion showing no significant change (Exhibit 4.3).
  • Average employee contributions in 2020 were $4,035 for employee-plus-one coverage and $5,978 for family coverage, representing increases of 4.0 percent and 4.4 percent, respectively, over 2019 levels. In a departure from long-term trends, average employer contributions in 2020 for both types of dependent coverage were not statistically different from their 2019 levels (Exhibits 4.4 and 4.5).
  • Average annual employee premium contributions, using pooled 2018-2020 data, vary widely by State, ranging from $777 in Hawaii to $1,750 in Massachusetts for single coverage; from $2,912 in Washington to $4,583 in Florida for employee-plus-one coverage; and from $4,250 in Michigan to $6,928 in South Carolina for family coverage (Exhibits 4.15, 4.16, and 4.17).
  • In 2020, the distribution of employee premium contributions showed substantial variation for all three coverage types, with enrolled employees at the 90th percentile of the distribution paying much larger amounts than those at the 10th percentile for single ($3,000 vs. $0), employee-plus-one ($7,600 vs. $780), and family coverage ($12,000 vs. $1,100) (Exhibit 4.27).

Key Trends

In addition to these highlights, variation in employee premium contributions in 2020 exhibited a number of patterns consistent with those seen in previous years.

First, in 2020, the employee share of premiums for employee-plus-one and family coverage was lower at nonprofit establishments, older firms, multilocation firms, and establishments where less than 50 percent of the workforce was low wage than at other employers.

Second, employee premium contributions showed substantial variation by firm size. The percentages of enrollees with no required premium contribution for single, employee-plus-one, and family coverage were highest at the smallest firms (fewer than 10 employees) and fell steadily as firm size increased. Still, employees enrolled in employee-plus-one and family coverage in small (fewer than 50 employees) and medium firms (50 to 99 employees) had higher average employee contributions, both in dollars and percentages, than those in large firms (100 or more employees). This situation occurs because employee contributions at the top end of the distribution tend to be higher in smaller firms. For example, at the 90th percentile, the employee contribution for family coverage was $16,000 at small firms, $14,000 at medium firms, and $11,000 at large firms.

Finally, average annual employee contributions for 2018-2020 showed regional variation that was not always consistent across coverage types. In the Northeast census region, seven of nine States had average annual employee contributions (in dollars) that were higher than the national average for single coverage, but no Northeastern State had higher than average employee contributions for dependent coverage. For all three types of coverage, average annual employee contributions (in dollars) tended to be higher than or not significantly different from the national average in the Southern census region and lower than or not significantly different from the national average in the West.

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ALTER EXB4.1



Exhibit 4.1 Average percentage (standard error) of premium contributed by employees for single, employee-plus-one, and family coverage, 2008-2020

Coverage 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Single 20.1% 20.5% 20.7% 20.9% 20.8% 21.0% 21.2% 21.1% 21.7%* 22.2% 21.3%* 21.4% 21.4%
(Standard Error) (0.2%) (0.3%) (0.2%) (0.2%) (0.3%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.3%) (0.2%)
Plus One 27.0% 26.1%* 25.8% 26.5% 26.6% 26.7% 26.9% 27.3% 27.8% 27.6% 27.1% 27.7% 28.4%
(Standard Error) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%)
Family 27.6% 26.7% 26.8% 26.4% 27.4%* 27.6% 27.1% 27.2% 28.0% 27.9% 27.8% 28.0% 28.8%
(Standard Error) (0.4%) (0.3%) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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ALTER EXB4.2



Exhibit 4.2 Average annual employee contribution (in dollars) (standard error) for single, employee-plus-one, and family coverage, 2008-2020

Coverage 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Single $882 $957* $1,021* $1,090* $1,118 $1,170* $1,234* $1,255 $1,325* $1,415* $1,427 $1,489* $1,532
(Standard Error) ($6) ($13) ($14) ($9) ($14) ($16) ($13) ($14) ($13) ($15) ($14) ($18) ($16)
Plus One $2,303 $2,363 $2,498* $2,736* $2,824 $2,940* $3,097* $3,220* $3,376* $3,531* $3,634 $3,881* $4,035*
(Standard Error) ($22) ($27) ($42) ($36) ($46) ($23) ($40) ($35) ($36) ($39) ($39) ($54) ($52)
Family $3,394 $3,474 $3,721* $3,962* $4,236* $4,421* $4,518 $4,710* $4,956* $5,218* $5,431* $5,726* $5,978*
(Standard Error) ($54) ($44) ($53) ($42) ($69) ($50) ($48) ($56) ($56) ($64) ($63) ($82) ($76)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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ALTER EXB4.3



Exhibit 4.3 Average annual employee contribution, employer contribution, and total premium (standard error) for single coverage, 2008-2020

Type of Premium 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Total Premium $4,386 $4,669 $4,940 $5,222 $5,384 $5,571 $5,832 $5,963 $6,101 $6,368 $6,715 $6,972 $7,149
(Standard Error) ($15) ($21) ($22) ($26) ($28) ($23) ($25) ($26) ($27) ($28) ($31) ($35) ($35)
Employer Contribution $3,505 $3,713 $3,918 $4,132 $4,267 $4,401 $4,598 $4,708 $4,776 $4,953 $5,288 $5,483 $5,617
(Standard Error) ($17) ($25) ($19) ($25) ($28) ($21) ($25) ($26) ($26) ($29) ($31) ($36) ($35)
Employee Contribution $882 $957 $1,021 $1,090 $1,118 $1,170 $1,234 $1,255 $1,325 $1,415 $1,427 $1,489 $1,532
(Standard Error) ($6) ($13) ($14) ($9) ($14) ($16) ($13) ($14) ($13) ($15) ($14) ($18) ($16)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: The sum of employee and employer contributions may not exactly equal the total premium due to rounding.

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ALTER EXB4.4



Exhibit 4.4 Average annual employee contribution, employer contribution, and total premium (standard error) for employee-plus-one coverage, 2008-2020

Type of Premium 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Total Premium $8,535 $9,053 $9,664 $10,329 $10,621 $10,990 $11,503 $11,800 $12,124 $12,789 $13,425 $13,989 $14,191
(Standard Error) ($43) ($34) ($60) ($105) ($56) ($54) ($60) ($58) ($60) ($70) ($70) ($83) ($93)
Employer Contribution $6,231 $6,690 $7,167 $7,593 $7,797 $8,050 $8,406 $8,579 $8,748 $9,258 $9,791 $10,108 $10,156
(Standard Error) ($43) ($44) ($40) ($95) ($45) ($55) ($65) ($57) ($61) ($75) ($70) ($93) ($99)
Employee Contribution $2,303 $2,363 $2,498 $2,736 $2,824 $2,940 $3,097 $3,220 $3,376 $3,531 $3,634 $3,881 $4,035
(Standard Error) ($22) ($27) ($42) ($36) ($46) ($23) ($40) ($35) ($36) ($39) ($39) ($54) ($52)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: The sum of employee and employer contributions may not exactly equal the total premium due to rounding.

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ALTER EXB4.5



Exhibit 4.5 Average annual employee contribution, employer contribution, and total premium (standard error) for family coverage, 2008-2020

Type of Premium 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Total Premium $12,298 $13,027 $13,871 $15,022 $15,473 $16,029 $16,655 $17,322 $17,710 $18,687 $19,565 $20,486 $20,758
(Standard Error) ($81) ($25) ($75) ($98) ($95) ($61) ($79) ($95) ($84) ($105) ($104) ($125) ($124)
Employer Contribution $8,904 $9,553 $10,150 $11,060 $11,238 $11,608 $12,137 $12,612 $12,754 $13,469 $14,134 $14,760 $14,781
(Standard Error) ($77) ($48) ($94) ($98) ($74) ($48) ($82) ($94) ($90) ($113) ($110) ($132) ($139)
Employee Contribution $3,394 $3,474 $3,721 $3,962 $4,236 $4,421 $4,518 $4,710 $4,956 $5,218 $5,431 $5,726 $5,978
(Standard Error) ($54) ($44) ($53) ($42) ($69) ($50) ($48) ($56) ($56) ($64) ($63) ($82) ($76)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: The sum of employee and employer contributions may not exactly equal the total premium due to rounding.

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ALTER EXB4.6



Exhibit 4.6 Average percentage (standard error) of premium contributed by employees for single coverage by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 20.1% 20.5% 20.7% 20.9% 20.8% 21.0% 21.2% 21.1% 21.7%* 22.2% 21.3%* 21.4% 21.4%
(Standard Error) (0.2%) (0.3%) (0.2%) (0.2%) (0.3%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.3%) (0.2%)
<50 17.6% 17.9% 18.3% 18.3% 17.9% 18.6% 17.6% 17.9% 20.0%* 20.0% 20.3% 21.0% 20.9%
(Standard Error) (0.5%) (0.3%) (0.6%) (0.4%) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%)
50-99 20.4% 19.4% 22.0% 22.7% 20.9% 21.5% 22.0% 21.8% 24.3% 21.9% 24.4%* 23.6% 22.9%
(Standard Error) (0.9%) (1.3%) (0.8%) (1.2%) (0.7%) (1.0%) (1.0%) (1.1%) (1.0%) (0.9%) (0.9%) (1.0%) (0.9%)
100+ 20.9% 21.4% 21.3% 21.5% 21.6% 21.7% 22.0% 21.8% 21.9% 22.8%* 21.2%* 21.2% 21.4%
(Standard Error) (0.2%) (0.4%) (0.4%) (0.2%) (0.3%) (0.2%) (0.2%) (0.3%) (0.2%) (0.3%) (0.2%) (0.3%) (0.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB4.7



Exhibit 4.7 Average annual employee contribution (in dollars) (standard error) for single coverage, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. $882 $957* $1,021* $1,090* $1,118 $1,170* $1,234* $1,255 $1,325* $1,415* $1,427 $1,489* $1,532
(Standard Error) ($6) ($13) ($14) ($9) ($14) ($16) ($13) ($14) ($13) ($15) ($14) ($18) ($16)
<50 $794 $834 $907* $960 $979 $1,045 $1,035 $1,065 $1,216* $1,287 $1,351 $1,454 $1,469
(Standard Error) ($22) ($12) ($29) ($22) ($20) ($27) ($30) ($29) ($32) ($34) ($39) ($43) ($43)
50-99 $861 $896 $1,035* $1,101 $1,096 $1,145 $1,220 $1,230 $1,393 $1,349 $1,534* $1,561 $1,571
(Standard Error) ($36) ($57) ($34) ($64) ($37) ($59) ($57) ($65) ($60) ($50) ($51) ($69) ($60)
100+ $912 $1,000* $1,054* $1,127* $1,159 $1,209* $1,287* $1,307 $1,343 $1,451* $1,433 $1,490* $1,540
(Standard Error) ($11) ($16) ($20) ($9) ($16) ($13) ($15) ($17) ($15) ($18) ($16) ($21) ($18)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB4.8



Exhibit 4.8 Average percentage (standard error) of premium contributed by employees for employee-plus-one coverage, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 27.0% 26.1%* 25.8% 26.5% 26.6% 26.7% 26.9% 27.3% 27.8% 27.6% 27.1% 27.7% 28.4%
(Standard Error) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%)
<50 28.3% 29.0% 28.8% 28.7% 28.5% 28.2% 28.8% 29.6% 29.4% 29.9% 30.8% 31.2% 32.5%^
(Standard Error) (0.8%) (1.0%) (0.8%) (0.8%) (0.9%) (1.0%) (0.8%) (0.9%) (0.9%) (1.0%) (0.9%) (1.2%) (1.2%)
50-99 34.4% 32.8% 33.3% 33.2% 33.3% 34.0% 33.4% 34.6% 35.8% 36.5% 37.6% 39.0% 38.8%^
(Standard Error) (1.1%) (0.9%) (1.5%) (0.7%) (0.8%) (1.0%) (1.4%) (1.5%) (1.3%) (1.3%) (1.3%) (2.2%) (1.3%)
100+ 26.2% 25.1%* 24.8% 25.7% 25.8% 26.0% 26.2% 26.4% 27.0% 26.7% 25.9% 26.4% 27.3%
(Standard Error) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB4.9



Exhibit 4.9 Average annual employee contribution (in dollars) (standard error) for employee-plus-one coverage, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. $2,303 $2,363 $2,498* $2,736* $2,824 $2,940* $3,097* $3,220* $3,376* $3,531* $3,634 $3,881* $4,035*
(Standard Error) ($22) ($27) ($42) ($36) ($46) ($23) ($40) ($35) ($36) ($39) ($39) ($54) ($52)
<50 $2,442 $2,648 $2,836 $2,942 $3,004 $3,117 $3,275 $3,454 $3,479 $3,760 $4,017 $4,244 $4,398^
(Standard Error) ($67) ($114) ($84) ($84) ($87) ($107) ($95) ($101) ($101) ($130) ($120) ($149) ($171)
50-99 $2,894 $2,901 $3,056 $3,189 $3,389 $3,630* $3,619 $3,765 $4,077 $4,358 $4,732 $5,163 $5,337^
(Standard Error) ($101) ($55) ($121) ($68) ($87) ($86) ($140) ($174) ($131) ($176) ($161) ($353) ($196)
100+ $2,235 $2,270 $2,398* $2,670* $2,751 $2,862 $3,031* $3,144 $3,307* $3,445* $3,504 $3,723* $3,903*
(Standard Error) ($33) ($35) ($46) ($48) ($49) ($30) ($46) ($37) ($40) ($41) ($43) ($55) ($56)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB4.10



Exhibit 4.10 Average percentage of premium contributed (standard error) by employees for family coverage, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 27.6% 26.7% 26.8% 26.4% 27.4%* 27.6% 27.1% 27.2% 28.0% 27.9% 27.8% 28.0% 28.8%
(Standard Error) (0.4%) (0.3%) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%)
<50 29.6% 30.1% 31.3% 29.4% 30.1% 28.6% 28.4% 28.8% 27.4% 30.7%* 32.0% 32.7% 34.6%^
(Standard Error) (0.9%) (0.6%) (0.4%) (0.9%) (0.9%) (1.0%) (0.8%) (1.0%) (0.9%) (1.1%) (1.1%) (1.1%) (1.3%)
50-99 33.3% 33.0% 34.2% 33.0% 31.6% 34.9%* 33.1% 33.7% 35.9% 32.4% 37.9%* 38.3% 36.6%^
(Standard Error) (1.4%) (1.0%) (1.7%) (1.3%) (0.8%) (1.3%) (1.3%) (1.6%) (1.8%) (1.7%) (1.9%) (1.8%) (2.6%)
100+ 26.9% 25.6%* 25.5% 25.5% 26.7%* 26.9% 26.5% 26.5% 27.6%* 27.3% 26.6% 26.6% 27.6%
(Standard Error) (0.5%) (0.4%) (0.5%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB4.11



Exhibit 4.11 Average annual employee contribution (in dollars) (standard error) for family coverage, by firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. $3,394 $3,474 $3,721* $3,962* $4,236* $4,421* $4,518 $4,710* $4,956* $5,218* $5,431* $5,726* $5,978*
(Standard Error) ($54) ($44) ($53) ($42) ($69) ($50) ($48) ($56) ($56) ($64) ($63) ($82) ($76)
<50 $3,458 $3,630 $4,117* $4,144 $4,366 $4,228 $4,426 $4,587 $4,510 $5,413* $5,854 $6,341 $6,714^
(Standard Error) ($79) ($60) ($63) ($148) ($135) ($155) ($122) ($156) ($146) ($188) ($188) ($209) ($271)
50-99 $3,852 $4,102 $4,455 $4,669 $4,866 $5,360* $5,206 $5,502 $5,821 $5,738 $6,973* $7,623 $7,261^
(Standard Error) ($168) ($128) ($196) ($143) ($150) ($201) ($220) ($255) ($330) ($317) ($336) ($354) ($477)
100+ $3,348 $3,393 $3,588* $3,882* $4,169* $4,387* $4,483 $4,671* $4,971* $5,154* $5,277 $5,497 $5,804*
(Standard Error) ($63) ($58) ($60) ($62) ($77) ($53) ($54) ($62) ($62) ($70) ($68) ($91) ($79)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <50 and 50-99 employees are statistically different from the estimate for firms with 100+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB4.12



Exhibit 4.12 Percentage (standard error) of single-coverage enrollees with no employee premium contribution, overall and by detailed firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 22.0% 20.6%* 18.3%* 17.3% 17.1% 16.6% 15.6% 15.8% 13.5%* 13.4% 13.2% 13.5% 12.5%
(Standard Error) (0.4%) (0.5%) (0.7%) (0.6%) (0.6%) (0.6%) (0.4%) (0.5%) (0.5%) (0.4%) (0.4%) (0.6%) (0.4%)
<10 63.0% 61.4% 58.8% 58.6% 60.0% 59.9% 60.6% 60.5% 57.9% 52.3%* 51.8% 52.0% 51.8%^
(Standard Error) (1.4%) (1.2%) (1.6%) (1.1%) (1.6%) (2.0%) (1.6%) (1.8%) (1.9%) (2.0%) (2.0%) (2.4%) (2.8%)
10-24 46.0% 45.4% 43.3% 38.9% 43.5%* 41.2% 43.5% 44.2% 36.9%* 38.2% 39.2% 31.7%* 37.5%*^
(Standard Error) (1.6%) (1.4%) (1.8%) (1.5%) (1.4%) (1.3%) (1.9%) (1.9%) (1.8%) (2.1%) (2.0%) (2.0%) (2.0%)
25-99 34.0% 33.1% 29.2% 30.6% 27.7% 27.6% 27.2% 27.5% 22.9%* 23.1% 20.8% 22.8% 23.2%^
(Standard Error) (1.1%) (1.6%) (1.8%) (1.7%) (1.4%) (1.3%) (1.4%) (1.6%) (1.2%) (1.3%) (1.2%) (1.3%) (1.4%)
100-999 21.4% 17.7%* 16.7% 15.2% 16.5% 14.4% 14.9% 13.9% 13.4% 14.3% 12.6% 13.0%† 12.1%^
(Standard Error) (1.1%) (1.0%) (1.3%) (1.4%) (1.0%) (0.8%) (1.2%) (1.1%) (1.3%) (1.2%) (1.0%) (1.2%) (1.0%)
1,000+ 8.3% 8.9% 6.5%* 5.7% 5.3% 5.2% 3.7% 4.9%* 4.1% 3.9% 4.9% 5.7% 4.9%
(Standard Error) (0.4%) (0.7%) (0.8%) (0.7%) (0.4%) (0.8%) (0.4%) (0.4%) (0.5%) (0.4%) (0.4%) (1.0%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <10, 10-24, 25-99, and 100-999 employees are statistically different from the estimate for firms with 1,000+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB4.13



Exhibit 4.13 Percentage (standard error) of employee-plus-one coverage enrollees with no employee premium contribution, overall and by detailed firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 9.4% 10.3% 9.8% 7.9% 7.7% 6.9% 7.8% 7.6% 7.4% 7.3% 7.1% 8.5%* 7.2%
(Standard Error) (0.3%) (0.7%) (0.9%) (0.5%) (0.3%) (0.4%) (0.4%) (0.5%) (0.5%) (0.4%) (0.4%) (0.6%) (0.4%)
<10 52.1% 47.9% 50.1% 46.6% 54.7%* 49.0% 48.3% 48.3% 48.2% 49.7% 49.9% 48.2% 42.4%^
(Standard Error) (2.8%) (1.7%) (2.0%) (2.3%) (2.1%) (3.3%) (2.7%) (3.1%) (3.2%) (3.4%) (3.3%) (3.9%) (4.1%)
10-24 29.0% 28.8% 25.3% 29.1% 24.0% 24.5% 24.3% 23.1% 21.8% 22.4% 18.9% 19.1% 23.6%^
(Standard Error) (2.0%) (1.4%) (2.4%) (1.9%) (2.8%) (3.0%) (2.2%) (2.3%) (2.1%) (2.6%) (2.1%) (2.7%) (2.6%)
25-99 13.8% 12.3% 12.4% 12.8% 10.9% 10.0% 12.1% 13.9% 10.1%* 11.2% 9.8% 7.5% 9.9%^
(Standard Error) (1.4%) (1.5%) (1.3%) (1.0%) (0.7%) (0.7%) (1.5%) (1.5%) (1.1%) (1.5%) (1.2%) (1.0%) (1.2%)
100-999 7.1% 8.3% 6.8% 5.9% 5.0% 5.6% 5.8% 4.9% 5.0% 5.5% 5.4% 6.0% 6.1%
(Standard Error) (0.8%) (1.5%) (0.9%) (1.0%) (1.0%) (0.6%) (1.1%) (0.7%) (1.0%) (0.8%) (0.8%) (1.1%) (1.1%)
1,000+ 4.8% 6.6% 6.2% 3.7% 3.7% 3.3% 4.4% 4.3% 4.6% 4.3% 4.2% 6.2%* 4.7%
(Standard Error) (0.4%) (0.9%) (1.2%) (0.7%) (0.5%) (0.4%) (0.5%) (0.6%) (0.7%) (0.5%) (0.4%) (0.7%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2008-2020.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05. ^ indicates that the estimates for firms with <10, 10-24, 25-99, and 100-999 employees are statistically different from the estimate for firms with 1,000+ employees at p < 0.05. This test is conducted for 2020 only.

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ALTER EXB4.14



Exhibit 4.14 Percentage (standard error) of family-coverage enrollees with no employee premium contribution, overall and by detailed firm size, 2008-2020

Number of Employees 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. 10.7% 11.4% 10.4% 9.7% 8.1%* 7.9% 9.2% 8.9% 8.3% 8.8% 7.7% 7.7% 7.0%
(Standard Error) (0.4%) (0.7%) (0.5%) (0.5%) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%) (0.7%) (0.6%)
<10 57.3% 54.2% 51.4% 53.2% 50.9% 53.0% 53.6% 54.4% 52.9% 52.0% 50.2% 48.7% 47.5%^
(Standard Error) (2.3%) (1.4%) (0.9%) (1.3%) (2.7%) (3.5%) (2.2%) (2.6%) (2.7%) (2.8%) (3.2%) (3.4%) (4.1%)
10-24 29.5% 31.0% 29.2% 29.8% 29.6% 28.2% 27.4% 29.5% 35.8% 27.3%* 26.4% 22.1% 25.8%^
(Standard Error) (2.8%) (1.5%) (1.6%) (1.4%) (2.8%) (2.6%) (2.2%) (2.6%) (2.9%) (2.6%) (2.5%) (2.4%) (2.6%)
25-99 17.4% 15.1% 15.3% 16.9% 13.4% 17.0% 17.7% 17.9% 18.6% 19.5% 13.9%* 10.0% 16.2%*^
(Standard Error) (2.1%) (1.9%) (1.9%) (1.8%) (1.0%) (1.7%) (2.0%) (2.0%)