Chartbook #26: Medical Expenditure Panel Survey Insurance Component 2021 Chartbook


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, Abby Woodroffe, Lauren Kestner, Sara Bernate Angulo, Alexis Rittweger, and Luis Martinez of the American Institutes for Research (AIR), Abigail Smith of Insignia, Sean Anderson of Pantheon, and Delia Tano 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, Nicole Shulman, and Michelle Roberts of AHRQ.

Reviewers of this publication were Joel W. Cohen, Director of CFACT, Steven C. Hill (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, and Karen Davis of the Division of Survey Operations.


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.

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

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Suggested Citation

Medical Expenditure Panel Survey Insurance Component 2021 Chartbook. Rockville, MD: Agency for Healthcare Research and Quality; October 2022. AHRQ Publication No. 22(23)-0056. https://meps.ahrq.gov/mepsweb/data_files/publications/cb26/cb26.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 State-level 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 2009 to 2021. 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 5.9 percent of the sample determined during the data collection process to be out of scope. In 2021, the response rate for the private sector was 56.9 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).

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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 August 30, 2022.

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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 2009 to 2021.

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 56.9 percent in 2021, permits analyses of variations in ESI by firm size and across States that are not readily available from other sources.

Examining variations 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 2009 to 2021. 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

The overall percentage of private-sector employees covered by a health insurance plan offered by their employers (the "enrollment rate") fell from 49.5 percent in 2020 to 48.0 percent in 2021. There were no significant changes, however, in the enrollment rate within any of the three firm size groups examined in this study.

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") decreased from 86.9 percent in 2020 to 85.7 percent in 2021, returning closer to the 2019 value of 85.3 percent (Exhibit ES.1). This overall change reflects a compositional shift in employment from medium- and large-firm employment toward small-firm employment, largely undoing a similar but directionally opposite compositional shift that occurred in 2020. Offer rates at small (50.4 percent), medium (90.3 percent), and large firms (98.9 percent) were not significantly different from their 2020 values.

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Percentage (standard error) of private-sector employees in establishments that offer health insurance, by firm size, 2009-2021
Exhibit ES.1: Percentage (standard error) of private-sector employees in establishments that offer health insurance, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 87.6% 86.5%* 85.3%* 84.7% 84.9% 83.2%* 83.8% 84.3% 84.5% 84.6% 85.3%* 86.9%* 85.7%*
(Standard Error) (0.2%) (0.2%) (0.2%) (0.3%) (0.3%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.3%)
<50 59.6% 57.8%* 54.7%* 52.9%* 53.1% 49.8%* 47.6%* 47.7% 48.3% 47.3% 50.7%* 50.5% 50.4%^
(Standard Error) (0.5%) (0.5%) (0.4%) (0.6%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%) (0.7%)
50-99 89.6% 87.3% 85.6% 84.1% 87.0% 83.0%* 85.3% 88.6%* 86.3% 88.0% 88.0% 88.5% 90.3%^
(Standard Error) (1.3%) (0.9%) (1.0%) (1.4%) (1.0%) (1.3%) (1.2%) (1.0%) (1.2%) (1.1%) (1.1%) (1.2%) (1.2%)
100+ 98.8% 98.5% 98.1% 98.2% 98.0% 97.3%* 98.8%* 98.9% 98.9% 99.0% 99.0% 98.8% 98.9%
(Standard Error) (0.1%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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Since almost all large firms offer health insurance coverage, offer rates among small firms (fewer than 50 employees) are an important factor contributing to overall differences in State ESI offer rates, along with the distribution of employers by firm size in the State. Overall, the average annual offer rate for 2019-2021 was 50.6 percent for small firms, but there was substantial variation across the United States. Among small firms, 13 States, with average annual offer rates ranging from 33.7 to 45.2 percent, were significantly below the national average. Another 11 States, with average annual offer rates ranging from 55.7 to 90.6 percent, were significantly above the national average for small firms (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, 2019-2021
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, 2019-2021
Alabama 56.5%* Kentucky 47.8% North Dakota 56.7%*
(Standard Error) (2.5%) (Standard Error) (2.8%) (Standard Error) (2.3%)
Alaska 33.7%* Louisiana 47.1% Ohio 51.5%
(Standard Error) (2.4%) (Standard Error) (2.9%) (Standard Error) (2.6%)
Arizona 45.4% Maine 47.1% Oklahoma 55.4%
(Standard Error) (2.9%) (Standard Error) (2.3%) (Standard Error) (2.4%)
Arkansas 40.3%* Maryland 55.6% Oregon 48.7%
(Standard Error) (2.7%) (Standard Error) (2.6%) (Standard Error) (2.2%)
California 52.4% Massachusetts 62.3%* Pennsylvania 57.2%*
(Standard Error) (1.6%) (Standard Error) (2.6%) (Standard Error) (2.1%)
Colorado 49.5% Michigan 49.8% Rhode Island 59.1%*
(Standard Error) (2.5%) (Standard Error) (2.4%) (Standard Error) (2.7%)
Connecticut 58.6%* Minnesota 48.7% South Carolina 41.7%*
(Standard Error) (2.5%) (Standard Error) (2.5%) (Standard Error) (2.7%)
Delaware 49.9% Mississippi 49.6% South Dakota 49.1%
(Standard Error) (2.9%) (Standard Error) (2.7%) (Standard Error) (2.2%)
District of Columbia 73.1%* Missouri 52.0% Tennessee 46.9%
(Standard Error) (2.6%) (Standard Error) (2.4%) (Standard Error) (2.6%)
Florida 41.4%* Montana 41.6%* Texas 47.6%
(Standard Error) (2.2%) (Standard Error) (2.2%) (Standard Error) (1.7%)
Georgia 42.9%* Nebraska 45.2%* Utah 42.6%*
(Standard Error) (2.8%) (Standard Error) (2.5%) (Standard Error) (2.5%)
Hawaii 90.6%* Nevada 51.4% Vermont 49.8%
(Standard Error) (1.3%) (Standard Error) (2.9%) (Standard Error) (2.1%)
Idaho 41.3%* New Hampshire 53.7% Virginia 53.1%
(Standard Error) (2.4%) (Standard Error) (2.6%) (Standard Error) (2.6%)
Illinois 57.1%* New Jersey 59.4%* Washington 50.6%
(Standard Error) (1.8%) (Standard Error) (2.5%) (Standard Error) (2.4%)
Indiana 42.7%* New Mexico 42.2%* West Virginia 46.1%
(Standard Error) (2.5%) (Standard Error) (2.5%) (Standard Error) (2.8%)
Iowa 52.3% New York 55.7%* Wisconsin 47.3%
(Standard Error) (2.3%) (Standard Error) (1.6%) (Standard Error) (2.4%)
Kansas 55.2% North Carolina 42.5%* Wyoming 38.6%*
(Standard Error) (2.4%) (Standard Error) (2.5%) (Standard Error) (2.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of 50.6 percent at p < 0.05. Note that the standard error on the national estimate of 50.6 percent is 0.4 percent.

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Employee Coverage, Eligibility, and Take-Up Rates

Among establishments that offered insurance in 2021, 56.0 percent of employees were enrolled in coverage through their employer (the "coverage rate") and 80.3 percent were eligible for health insurance (the "eligibility rate"). Among eligible employees, 69.8 percent were enrolled in their employer’s health insurance (the "take-up rate"). The overall coverage, eligibility, and take-up rates did not change significantly from 2020 (Exhibits ES.3, ES.4, and ES.5).

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, 2009-2021
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 61.1% 59.8%* 59.4% 58.9% 58.2% 57.8% 57.0% 56.0% 56.5% 56.5% 55.8% 57.0% 56.0%
(Standard Error) (0.4%) (0.5%) (0.2%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%) (0.4%)
<50 59.6% 59.2% 58.6% 57.7% 57.1% 56.8% 57.0% 55.5% 55.4% 56.2% 53.9%* 55.1% 53.8%^
(Standard Error) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%)
50-99 60.1% 55.9%* 54.9% 55.4% 54.7% 54.5% 55.8% 51.2%* 52.2% 50.3% 53.8%* 53.4% 51.3%^
(Standard Error) (1.0%) (0.8%) (1.0%) (1.2%) (0.8%) (1.3%) (1.2%) (1.2%) (1.2%) (1.2%) (1.2%) (1.3%) (1.3%)
100+ 61.6% 60.4% 60.0% 59.5% 58.8% 58.3% 57.1% 56.6% 57.1% 57.1% 56.4% 57.7% 56.9%
(Standard Error) (0.6%) (0.6%) (0.3%) (0.4%) (0.3%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.
Eligibility Rate Percentage (standard error) of private-sector employees eligible for health insurance at establishments that offer health insurance, overall and by firm size, 2009-2021
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 79.5% 78.2%* 78.0% 77.8% 77.8% 75.4%* 76.0% 76.5% 76.8% 78.0%* 77.7% 80.5%* 80.3%
(Standard Error) (0.3%) (0.5%) (0.4%) (0.3%) (0.2%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%)
<50 79.3% 78.6% 78.7% 77.9% 78.0% 77.7% 79.1% 78.7% 78.3% 79.1% 78.1% 80.2%* 79.7%
(Standard Error) (0.5%) (0.5%) (0.6%) (0.5%) (0.4%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%)
50-99 79.2% 74.5%* 73.6% 76.4% 76.2% 74.1% 77.8%* 76.2% 75.5% 75.6% 78.1% 77.6% 79.2%
(Standard Error) (0.8%) (0.6%) (1.0%) (1.2%) (0.8%) (1.4%) (1.2%) (1.2%) (1.2%) (1.2%) (1.2%) (1.4%) (1.3%)
100+ 79.6% 78.5% 78.3% 77.9% 77.9% 75.0%* 75.2% 76.0% 76.6% 78.0% 77.5% 80.8%* 80.5%
(Standard Error) (0.5%) (0.6%) (0.4%) (0.3%) (0.3%) (0.5%) (0.5%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.
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, 2009-2021
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 76.9% 76.5% 76.1% 75.8% 74.8%* 76.7%* 75.0%* 73.3%* 73.5% 72.4%* 71.9% 70.8%* 69.8%
(Standard Error) (0.3%) (0.2%) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%)
<50 75.2% 75.3% 74.4% 74.1% 73.1% 73.0% 72.1% 70.4%* 70.7% 71.0% 69.0%* 68.7% 67.5%^
(Standard Error) (0.3%) (0.6%) (0.4%) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%)
50-99 75.9% 75.1% 74.5% 72.5% 71.8% 73.5% 71.7% 67.2%* 69.1% 66.6% 68.9% 68.8% 64.7%*^
(Standard Error) (0.9%) (0.7%) (0.6%) (0.8%) (1.0%) (1.0%) (1.1%) (1.2%) (1.1%) (1.1%) (1.0%) (1.0%) (1.2%)
100+ 77.5% 76.9% 76.7% 76.4% 75.5%* 77.8%* 76.0%* 74.4%* 74.5% 73.3%* 72.7% 71.4%* 70.7%
(Standard Error) (0.5%) (0.3%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

Choice of Plans

The overall share of employees at health insurance-offering firms who were offered a choice of two or more health plans did not recover from its reduction in 2020, remaining at 73.9 percent in 2021 relative to the 2019 and 2020 values of 75.8 percent and 73.8 percent, respectively (Exhibit ES.6). In all years from 2009 to 2021, the likelihood that a worker at an offering establishment had a choice of plans increased with firm size.

Percentage (standard error) of private-sector employees working in establishments that offer two or more health insurance plans, overall and by firm size, 2009-2021
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 66.5% 65.6% 65.5% 65.3% 66.0% 67.0% 70.2%* 71.7% 72.4% 75.7%* 75.8% 73.8%* 73.9%
(Standard Error) (0.7%) (0.8%) (0.5%) (0.7%) (0.6%) (0.6%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%)
<50 27.3% 26.7% 27.2% 29.3% 28.4% 29.6% 33.6%* 34.2% 34.9% 37.8%* 41.4%* 39.9% 41.0%^
(Standard Error) (0.9%) (0.8%) (0.9%) (0.8%) (1.0%) (0.9%) (1.1%) (1.0%) (1.0%) (1.0%) (1.1%) (1.1%) (1.1%)
50-99 42.8% 44.1% 46.8% 43.7% 46.6% 46.8% 50.2% 56.2%* 59.3% 56.4% 58.7% 58.6% 60.8%^
(Standard Error) (2.0%) (1.9%) (2.2%) (1.7%) (2.2%) (2.1%) (2.2%) (2.0%) (1.9%) (1.9%) (2.0%) (2.1%) (2.2%)
100+ 78.5% 77.3% 76.3% 75.7% 76.5% 77.0% 79.7%* 80.7% 81.0% 84.7%* 84.5% 81.0%* 81.7%
(Standard Error) (0.7%) (1.0%) (0.7%) (0.7%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.5%) (0.6%) (0.6%) (0.6%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

Self-Insured Plans

In 2021, the percentage of offering establishments that self-insured at least one plan (40.1 percent) was not significantly changed from the 2020 percentage (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, 2009-2021
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 35.1% 35.8% 36.9% 37.2% 37.6% 37.2% 39.0%* 40.7%* 39.2% 38.7% 39.4% 41.9%* 40.1%
(Standard Error) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%)
<10 14.6% 13.1% 12.6% 14.9% 15.2% 14.4% 15.8% 19.3%* 17.7% 13.1%* 14.8% 17.6% 18.9%^
(Standard Error) (0.7%) (0.5%) (0.8%) (0.9%) (0.4%) (0.8%) (1.0%) (1.4%) (1.4%) (1.1%) (1.3%) (1.7%) (1.7%)
10-24 10.4% 11.6% 9.9% 10.7% 9.0% 12.0%* 10.6% 13.6%* 13.3% 13.8% 12.2% 13.1% 12.0%^
(Standard Error) (0.4%) (0.8%) (0.7%) (0.7%) (0.7%) (1.0%) (1.0%) (1.1%) (1.2%) (1.2%) (1.1%) (1.2%) (1.0%)
25-99 13.4% 14.3% 12.2%* 13.5% 12.4% 12.2% 13.7% 16.6%* 16.0% 12.9%* 17.2%* 16.3% 17.7%^
(Standard Error) (0.7%) (0.7%) (0.7%) (0.7%) (0.7%) (0.8%) (0.9%) (0.9%) (0.9%) (0.8%) (0.9%) (0.9%) (1.0%)
100-999 29.9% 30.9% 31.7% 30.1% 30.1% 32.5% 33.7% 34.4% 37.2% 35.1% 33.9% 35.8% 38.0%^
(Standard Error) (0.7%) (0.9%) (1.1%) (0.8%) (1.0%) (1.2%) (1.2%) (1.2%) (1.3%) (1.2%) (1.1%) (1.2%) (1.3%)
1,000+ 85.8% 86.6% 87.5% 87.1% 88.0% 84.2%* 83.8% 81.9% 78.6%* 81.6%* 83.1% 77.8%* 78.1%
(Standard Error) (0.4%) (0.6%) (0.5%) (0.7%) (0.5%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.9%) (0.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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Premiums

In 2021, average total health insurance premiums were $7,380 for single coverage, $14,634 for employee-plus-one coverage, and $21,381 for family coverage, representing increases over 2020 that ranged from 3.0 to 3.2 percent for the three types of coverage (Exhibits ES.8 and ES.9). These 1-year percentage increases were not significantly different from the average annual growth rates from 2009 to 2021, which ranged from 3.9 to 4.2 percent across the three types of coverage.

Average total premiums (standard error) per enrolled employee for single, employee-plus-one and family coverage, 2009-2021
Exhibit ES.8: Average total premiums (standard error) per enrolled employee for single, employee-plus-one and family coverage, 2009-2021
Coverage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Single $4,669 $4,940* $5,222* $5,384* $5,571* $5,832* $5,963* $6,101* $6,368* $6,715* $6,972* $7,149* $7,380*
(Standard Error) ($21) ($22) ($26) ($28) ($23) ($25) ($26) ($27) ($28) ($31) ($35) ($35) ($37)
Plus One $9,053 $9,664* $10,329* $10,621* $10,990* $11,503* $11,800* $12,124* $12,789* $13,425* $13,989* $14,191 $14,634*
(Standard Error) ($34) ($60) ($105) ($56) ($54) ($60) ($58) ($60) ($70) ($70) ($83) ($93) ($84)
Family $13,027 $13,871* $15,022* $15,473* $16,029* $16,655* $17,322* $17,710* $18,687* $19,565* $20,486* $20,758 $21,381*
(Standard Error) ($25) ($75) ($98) ($95) ($61) ($79) ($95) ($84) ($105) ($104) ($125) ($124) ($111)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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Percentage change (standard error) in total premiums from previous year per enrolled employee for single, employee-plus-one, and family coverage, 2009-2021
Exhibit ES.9: Percentage change (standard error) in total premiums from previous year per enrolled employee for single, employee-plus-one, and family coverage, 2009-2021
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%)
2021 3.2%* 3.1%* 3.0%*
(Standard Error) ($0.7%) ($0.9%) ($0.8%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: * indicates the estimate is statistically different from zero at p < 0.05.

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In 2021, there were no differences by firm size in average single and employee-plus one premiums (Exhibits ES.10 and ES. 11).

Average total single premium (standard error) per enrolled
              employee, by firm size, 2009-2021
Exhibit ES.10: Average total single premium (standard error) per enrolled employee, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $4,669 $4,940* $5,222* $5,384* $5,571* $5,832* $5,963* $6,101* $6,368* $6,715* $6,972* $7,149* $7,380*
(Standard Error) ($21) ($22) ($26) ($28) ($23) ($25) ($26) ($27) ($28) ($31) ($35) ($35) ($37)
<50 $4,652 $4,956* $5,258* $5,460* $5,628* $5,886* $5,947 $6,070 $6,421* $6,667* $6,920* $7,045 $7,382*
(Standard Error) ($31) ($34) ($39) ($60) ($39) ($55) ($55) ($53) ($61) ($63) ($73) ($70) ($84)
50-99 $4,614 $4,713 $4,861 $5,246* $5,314 $5,549* $5,642 $5,743 $6,163* $6,287 $6,629* $6,870 $7,189
(Standard Error) ($82) ($52) ($75) ($39) ($73) ($82) ($104) ($96) ($121) ($111) ($99) ($129) ($129)
100+ $4,681 $4,959* $5,252* $5,378* $5,584* $5,851* $6,006* $6,146* $6,377* $6,770* $7,019* $7,197* $7,399*
(Standard Error) ($38) ($23) ($31) ($28) ($29) ($30) ($31) ($32) ($33) ($37) ($42) ($41) ($43)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.
Average total employee-plus-one premium (standard error) per enrolled employee, by firm size, 2009-2021
Exhibit ES.11: Average total employee-plus-one premium (standard error) per enrolled employee, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $9,053 $9,664* $10,329* $10,621* $10,990* $11,503* $11,800* $12,124* $12,789* $13,425* $13,989* $14,191 $14,634*
(Standard Error) ($34) ($60) ($105) ($56) ($54) ($60) ($58) ($60) ($70) ($70) ($83) ($93) ($84)
<50 $9,124 $9,850* $10,253* $10,524 $11,050* $11,386 $11,666 $11,833 $12,558* $13,044* $13,619 $13,522 $14,326*
(Standard Error) ($119) ($80) ($104) ($121) ($92) ($163) ($158) ($156) ($170) ($176) ($248) ($212) ($262)
50-99 $8,852 $9,166 $9,615* $10,178* $10,673 $10,845 $10,885 $11,389 $11,931 $12,593* $13,248 $13,766 $14,314
(Standard Error) ($148) ($124) ($192) ($185) ($330) ($187) ($198) ($227) ($232) ($236) ($321) ($246) ($295)
100+ $9,058 $9,669* $10,394* $10,672* $11,006* $11,571* $11,892* $12,225* $12,878* $13,537* $14,105* $14,304 $14,703*
(Standard Error) ($34) ($62) ($113) ($70) ($59) ($68) ($66) ($68) ($79) ($79) ($92) ($106) ($93)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

In 2021, average total premiums for family coverage were higher in large firms ($21,584) than in small ($20,406) and medium ($20,551) firms (Exhibit ES.12).

Average total family premium (standard error) per enrolled employee, by firm size, 2009-2021
Exhibit ES.12: Average total family premium (standard error) per enrolled employee, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $13,027 $13,871* $15,022* $15,473* $16,029* $16,655* $17,322* $17,710* $18,687* $19,565* $20,486* $20,758 $21,381*
(Standard Error) ($25) ($75) ($98) ($95) ($61) ($79) ($95) ($84) ($105) ($104) ($125) ($124) ($111)
<50 $12,041 $13,170* $14,086* $14,496 $14,787 $15,575* $15,919 $16,471 $17,649* $18,296* $19,417* $19,416 $20,406*
(Standard Error) ($129) ($111) ($145) ($181) ($89) ($177) ($212) ($207) ($192) ($231) ($303) ($283) ($320)
50-99 $12,431 $13,019* $14,151* $15,421* $15,376 $15,732 $16,336 $16,214 $17,735* $18,386 $19,893* $19,827 $20,551^
(Standard Error) ($229) ($153) ($168) ($273) ($268) ($274) ($335) ($348) ($327) ($473) ($435) ($422) ($396)
100+ $13,271 $14,074* $15,245* $15,641* $16,284* $16,903* $17,612* $18,000* $18,911* $19,824* $20,697* $20,990 $21,584*
(Standard Error) ($33) ($85) ($117) ($114) ($82) ($91) ($110) ($95) ($122) ($118) ($143) ($139) ($124)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

Overall, for 2019-2021, the average annual single premium was $7,103. Seventeen States, with average annual premiums ranging from $6,220 in Arkansas to $6,922 in North Carolina, were significantly below the national average. Twelve States, with average annual premiums ranging from $7,485 in Rhode Island to $8,798 in Alaska, were significantly above the national average (Exhibit ES.13).

Average total single premium (standard error) per enrolled employee, by State, 3-year average, 2019-2021
Exhibit ES.13: Average total single premium (standard error) per enrolled employee, by State, 3-year average, 2019-2021
Alabama $6,481* Kentucky $6,918* North Dakota $6,998
(Standard Error) ($101) (Standard Error) ($88) (Standard Error) ($86)
Alaska $8,798* Louisiana $6,696* Ohio $7,030
(Standard Error) ($232) (Standard Error) ($98) (Standard Error) ($100)
Arizona $6,559* Maine $7,467* Oklahoma $6,893*
(Standard Error) ($92) (Standard Error) ($93) (Standard Error) ($104)
Arkansas $6,220* Maryland $7,182 Oregon $6,929
(Standard Error) ($104) (Standard Error) ($116) (Standard Error) ($154)
California $7,165 Massachusetts $7,623* Pennsylvania $7,218
(Standard Error) ($87) (Standard Error) ($101) (Standard Error) ($87)
Colorado $6,819* Michigan $6,804* Rhode Island $7,485*
(Standard Error) ($105) (Standard Error) ($116) (Standard Error) ($104)
Connecticut $7,512* Minnesota $7,020 South Carolina $7,091
(Standard Error) ($113) (Standard Error) ($109) (Standard Error) ($99)
Delaware $7,701* Mississippi $6,533* South Dakota $7,133
(Standard Error) ($162) (Standard Error) ($105) (Standard Error) ($80)
District of Columbia $7,684* Missouri $7,007 Tennessee $6,564*
(Standard Error) ($120) (Standard Error) ($107) (Standard Error) ($90)
Florida $7,002 Montana $6,957 Texas $6,992
(Standard Error) ($116) (Standard Error) ($98) (Standard Error) ($74)
Georgia $6,948 Nebraska $7,263 Utah $6,454*
(Standard Error) ($131) (Standard Error) ($100) (Standard Error) ($103)
Hawaii $6,715* Nevada $6,550* Vermont $7,676*
(Standard Error) ($91) (Standard Error) ($122) (Standard Error) ($90)
Idaho $6,549* New Hampshire $7,662* Virginia $6,948
(Standard Error) ($103) (Standard Error) ($103) (Standard Error) ($88)
Illinois $7,244 New Jersey $7,531* Washington $7,232
(Standard Error) ($82) (Standard Error) ($129) (Standard Error) ($119)
Indiana $7,238 New Mexico $7,165 West Virginia $7,287
(Standard Error) ($102) (Standard Error) ($105) (Standard Error) ($125)
Iowa $6,798* New York $8,126* Wisconsin $7,107
(Standard Error) ($95) (Standard Error) ($93) (Standard Error) ($100)
Kansas $6,563* North Carolina $6,922* Wyoming $7,550*
(Standard Error) ($100) (Standard Error) ($85) (Standard Error) ($159)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from national average of $7,103 at p < 0.05. Note that the standard error on the national estimate of $7,103 is $20.08.

Employee Premium Contributions

In 2021, enrolled employees paid on average 22.3 percent of total premiums for single coverage, 28.7 percent for employee-plus-one coverage, and 28.9 percent for family coverage. Compared with employee shares in 2020, the share for single coverage in 2021 was higher, and the shares for employee-plus-one coverage and family coverage were not significantly different (Exhibit ES.14).

Average percentage (standard error) of premium contributed by employees for single, employee-plus-one, and family coverage, 2009-2021
Exhibit ES.14: Average percentage (standard error) of premium contributed by employees for single, employee-plus-one, and family coverage, 2009-2021
Coverage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Single 20.5% 20.7% 20.9% 20.8% 21.0% 21.2% 21.1% 21.7%* 22.2% 21.3%* 21.4% 21.4% 22.3%*
(Standard Error) (0.3%) (0.2%) (0.2%) (0.3%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.3%) (0.2%) (0.2%)
Plus One 26.1% 25.8% 26.5% 26.6% 26.7% 26.9% 27.3% 27.8% 27.6% 27.1% 27.7% 28.4% 28.7%
(Standard Error) (0.3%) (0.3%) (0.3%) (0.4%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%)
Family 26.7% 26.8% 26.4% 27.4%* 27.6% 27.1% 27.2% 28.0% 27.9% 27.8% 28.0% 28.8% 28.9%
(Standard Error) (0.3%) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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In 2021, the average employee contribution for single coverage was $1,643, representing an increase of 7.2 percent over the 2020 level (Exhibit ES.15). Average employee contributions in 2021 for employee-plus-one ($4,199) and family ($6,174) coverage were not significantly different from their 2020 levels.

Average annual employee contribution (in dollars) (standard error) for single, employee-plus-one, and family coverage, 2009-2021
Exhibit ES.15: Average annual employee contribution (in dollars) (standard error) for single, employee-plus-one, and family coverage, 2009-2021
Coverage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Single $957 $1,021* $1,090* $1,118 $1,170* $1,234* $1,255 $1,325* $1,415* $1,427 $1,489* $1,532 $1,643*
(Standard Error) ($13) ($14) ($9) ($14) ($16) ($13) ($14) ($13) ($15) ($14) ($18) ($16) ($19)
Plus One $2,363 $2,498* $2,736* $2,824 $2,940* $3,097* $3,220* $3,376* $3,531* $3,634 $3,881* $4,035* $4,199*
(Standard Error) ($27) ($42) ($36) ($46) ($23) ($40) ($35) ($36) ($39) ($39) ($54) ($52) ($64)
Family $3,474 $3,721* $3,962* $4,236* $4,421* $4,518 $4,710* $4,956* $5,218* $5,431* $5,726* $5,978* $6,174
(Standard Error) ($44) ($53) ($42) ($69) ($50) ($48) ($56) ($56) ($64) ($63) ($82) ($76) ($87)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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Plan Benefits: Deductibles

The percentage of enrollees in a health insurance plan with a deductible in 2021 was not significantly different from 2020 for firms overall (88.5 percent) or among small (86.0), medium (89.7), or large employers (88.8 percent) (Exhibit ES.16).

From 2020 to 2021, the average deductible level for single coverage increased by 3.0 percent, to $2,004 (Exhibit ES.17), and the average family coverage deductible increased by 3.9 percent, to $3,868 (Section 5, Exhibit 5.3).

For both single and family coverage, the average deductible among enrollees with a deductible was higher in small and medium firms than in large firms (Exhibit ES.17; Section 5, Exhibit 5.3).

Percentage (standard error) of private-sector enrolled employees in a health insurance plan with a deductible, overall and by firm size, 2009-2021
Exhibit ES.16: Percentage (standard error) of private-sector enrolled employees in a health insurance plan with a deductible, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 73.8% 77.5%* 77.8% 79.6%* 81.3% 83.9%* 85.4%* 84.5% 87.5%* 87.3% 86.6% 89.2%* 88.5%
(Standard Error) (0.5%) (0.3%) (0.7%) (0.6%) (0.7%) (0.5%) (0.5%) (0.5%) (0.4%) (0.4%) (0.5%) (0.4%) (0.5%)
<50 73.5% 75.7%* 76.3% 79.5%* 79.5% 80.8% 82.1% 81.7% 82.3% 83.0% 84.1% 86.5%* 86.0%^
(Standard Error) (0.7%) (0.7%) (0.4%) (1.0%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.9%) (0.8%) (0.9%)
50-99 70.6% 78.2%* 79.6% 80.3% 78.0% 82.4%* 85.3% 82.5% 83.7% 85.1% 87.5% 89.0% 89.7%
(Standard Error) (1.9%) (1.5%) (1.7%) (1.4%) (1.1%) (1.5%) (1.5%) (1.5%) (1.6%) (1.4%) (1.5%) (1.5%) (1.3%)
100+ 74.2% 77.8%* 77.9% 79.6% 81.9%* 84.6%* 86.1% 85.2% 88.8%* 88.3% 87.1% 89.7%* 88.8%
(Standard Error) (0.6%) (0.3%) (1.0%) (0.7%) (0.7%) (0.6%) (0.6%) (0.6%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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, 2009-2021
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $917 $1,025* $1,123* $1,167* $1,273* $1,353* $1,541* $1,696* $1,808* $1,846 $1,931* $1,945 $2,004*
(Standard Error) ($9) ($18) ($12) ($8) ($20) ($13) ($16) ($16) ($17) ($17) ($18) ($18) ($20)
<50 $1,283 $1,447* $1,561* $1,628 $1,695 $1,777* $1,964* $2,105* $2,136 $2,327* $2,386 $2,376 $2,485^
(Standard Error) ($24) ($21) ($26) ($25) ($24) ($28) ($35) ($34) ($35) ($36) ($35) ($39) ($43)
50-99 $1,249 $1,522* $1,543 $1,622 $1,755 $1,744 $2,008* $2,173 $2,361 $2,369 $2,441 $2,464 $2,378^
(Standard Error) ($46) ($57) ($49) ($64) ($49) ($59) ($62) ($64) ($85) ($65) ($67) ($67) ($74)
100+ $774 $852* $951* $989* $1,106* $1,205* $1,383* $1,558* $1,681* $1,692 $1,778* $1,814 $1,865
(Standard Error) ($7) ($20) ($14) ($10) ($19) ($14) ($18) ($18) ($20) ($19) ($21) ($20) ($23)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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 and https://datatools.ahrq.gov/meps-ic. AHRQ welcomes feedback on additional ways to make the data more usable.

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Section 1: 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 between the percentage of workers with low wages and firm size and between 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 per employee, and
  • Lack of dedicated staff to select and administer health benefits.

Highlights

  • The percentage of employees working at insurance-offering establishments decreased from 86.9 percent in 2020 to 85.7 percent in 2021, returning closer to the 2019 value of 85.3 percent (Exhibit 1.1). This overall change reflects a compositional shift in employment from medium and large firms toward small firms, largely undoing a similar but directionally opposite compositional shift that occurred in 2020.
  • The overall share of employees at health insurance-offering firms who were offered a choice of two or more health plans did not recover from its reduction in 2020, remaining at 73.9 percent in 2021 relative to the 2019 and 2020 values of 75.8 percent and 73.8 percent, respectively (Exhibit 1.10).
  • Overall, the average annual offer rate for 2019-2021 was 85.9 percent for all firms and 50.6 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 70.8 percent in Wyoming to 97.0 percent in Hawaii.
    • Among small firms, 13 States, with average annual offer rates ranging from 33.7 to 45.2 percent, were significantly below the national average. Another 11 States, with average annual offer rates ranging from 55.7 to 90.6 percent, were significantly above the national average for small firms.

Key Trends and Differences

Many longstanding trends related to insurance coverage offers continued in 2021. Establishments in small firms continued to have a significantly lower offer rate than other firms. In addition, small-firm establishments that did offer insurance were less likely to self-insure their plans, offer dependent coverage, offer a choice of two or more plans, or offer retiree coverage.

Dependent coverage, as in prior years, was available to a very high percentage of employees in establishments where health insurance was offered. Availability of retiree coverage of all kinds remained low and very rare outside of large firms.

ALTER EXB1.1
Exhibit 1.1 Percentage (standard error) of private-sector employees in establishments that offer health insurance, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 87.6% 86.5%* 85.3%* 84.7% 84.9% 83.2%* 83.8% 84.3% 84.5% 84.6% 85.3%* 86.9%* 85.7%*
(Standard Error) (0.2%) (0.2%) (0.2%) (0.3%) (0.3%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.3%)
<50 59.6% 57.8%* 54.7%* 52.9%* 53.1% 49.8%* 47.6%* 47.7% 48.3% 47.3% 50.7%* 50.5% 50.4%^
(Standard Error) (0.5%) (0.5%) (0.4%) (0.6%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%) (0.7%)
50-99 89.6% 87.3% 85.6% 84.1% 87.0% 83.0%* 85.3% 88.6%* 86.3% 88.0% 88.0% 88.5% 90.3%^
(Standard Error) (1.3%) (0.9%) (1.0%) (1.4%) (1.0%) (1.3%) (1.2%) (1.0%) (1.2%) (1.1%) (1.1%) (1.2%) (1.2%)
100+ 98.8% 98.5% 98.1% 98.2% 98.0% 97.3%* 98.8%* 98.9% 98.9% 99.0% 99.0% 98.8% 98.9%
(Standard Error) (0.1%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.
ALTER EXB1.2
Exhibit 1.2 Percentage (standard error) of private-sector employees in establishments that offer, health insurance, by State, 3-year average, 2019-2021
Alabama 88.1%* Kentucky 87.1% North Dakota 84.9%
(Standard Error) (0.8%) (Standard Error) (0.8%) (Standard Error) (0.8%)
Alaska 76.8%* Louisiana 82.9%* Ohio 87.1%
(Standard Error) (1.2%) (Standard Error) (1.1%) (Standard Error) (0.8%)
Arizona 86.1% Maine 81.5%* Oklahoma 85.5%
(Standard Error) (1.0%) (Standard Error) (0.9%) (Standard Error) (0.8%)
Arkansas 82.8%* Maryland 87.1% Oregon 82.2%*
(Standard Error) (0.9%) (Standard Error) (0.9%) (Standard Error) (1.0%)
California 86.2% Massachusetts 89.8%* Pennsylvania 88.8%*
(Standard Error) (0.5%) (Standard Error) (0.8%) (Standard Error) (0.6%)
Colorado 83.5%* Michigan 85.5% Rhode Island 87.2%
(Standard Error) (1.0%) (Standard Error) (0.9%) (Standard Error) (0.9%)
Connecticut 87.3% Minnesota 85.3% South Carolina 84.2%*
(Standard Error) (0.9%) (Standard Error) (0.9%) (Standard Error) (0.8%)
Delaware 86.4% Mississippi 85.5% South Dakota 81.6%*
(Standard Error) (1.0%) (Standard Error) (0.9%) (Standard Error) (0.9%)
District of Columbia 94.5%* Missouri 87.2% Tennessee 87.3%
(Standard Error) (0.5%) (Standard Error) (0.8%) (Standard Error) (0.8%)
Florida 83.9%* Montana 71.6%* Texas 84.7%
(Standard Error) (0.8%) (Standard Error) (1.2%) (Standard Error) (0.7%)
Georgia 86.1% Nebraska 82.8%* Utah 81.6%*
(Standard Error) (0.9%) (Standard Error) (1.0%) (Standard Error) (1.0%)
Hawaii 97.0%* Nevada 86.8% Vermont 80.8%*
(Standard Error) (0.5%) (Standard Error) (0.9%) (Standard Error) (0.9%)
Idaho 76.8%* New Hampshire 86.2% Virginia 87.8%*
(Standard Error) (1.2%) (Standard Error) (0.9%) (Standard Error) (0.8%)
Illinois 88.4%* New Jersey 88.1%* Washington 83.8%
(Standard Error) (0.6%) (Standard Error) (0.8%) (Standard Error) (1.1%)
Indiana 86.0% New Mexico 78.3%* West Virginia 84.9%
(Standard Error) (0.7%) (Standard Error) (1.3%) (Standard Error) (0.9%)
Iowa 86.9% New York 87.5%* Wisconsin 85.0%
(Standard Error) (0.7%) (Standard Error) (0.5%) (Standard Error) (0.8%)
Kansas 86.2% North Carolina 83.5%* Wyoming 70.8%*
(Standard Error) (0.8%) (Standard Error) (0.9%) (Standard Error) (1.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of 85.9 percent at p < 0.05. Note that the standard error on the national estimate of 85.9 percent is 0.1 percent.
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, 2019-2021
Alabama 56.5%* Kentucky 47.8% North Dakota 56.7%*
(Standard Error) (2.5%) (Standard Error) (2.8%) (Standard Error) (2.3%)
Alaska 33.7%* Louisiana 47.1% Ohio 51.5%
(Standard Error) (2.4%) (Standard Error) (2.9%) (Standard Error) (2.6%)
Arizona 45.4% Maine 47.1% Oklahoma 55.4%
(Standard Error) (2.9%) (Standard Error) (2.3%) (Standard Error) (2.4%)
Arkansas 40.3%* Maryland 55.6% Oregon 48.7%
(Standard Error) (2.7%) (Standard Error) (2.6%) (Standard Error) (2.2%)
California 52.4% Massachusetts 62.3%* Pennsylvania 57.2%*
(Standard Error) (1.6%) (Standard Error) (2.6%) (Standard Error) (2.1%)
Colorado 49.5% Michigan 49.8% Rhode Island 59.1%*
(Standard Error) (2.5%) (Standard Error) (2.4%) (Standard Error) (2.7%)
Connecticut 58.6%* Minnesota 48.7% South Carolina 41.7%*
(Standard Error) (2.5%) (Standard Error) (2.5%) (Standard Error) (2.7%)
Delaware 49.9% Mississippi 49.6% South Dakota 49.1%
(Standard Error) (2.9%) (Standard Error) (2.7%) (Standard Error) (2.2%)
District of Columbia 73.1%* Missouri 52.0% Tennessee 46.9%
(Standard Error) (2.6%) (Standard Error) (2.4%) (Standard Error) (2.6%)
Florida 41.4%* Montana 41.6%* Texas 47.6%
(Standard Error) (2.2%) (Standard Error) (2.2%) (Standard Error) (1.7%)
Georgia 42.9%* Nebraska 45.2%* Utah 42.6%*
(Standard Error) (2.8%) (Standard Error) (2.5%) (Standard Error) (2.5%)
Hawaii 90.6%* Nevada 51.4% Vermont 49.8%
(Standard Error) (1.3%) (Standard Error) (2.9%) (Standard Error) (2.1%)
Idaho 41.3%* New Hampshire 53.7% Virginia 53.1%
(Standard Error) (2.4%) (Standard Error) (2.6%) (Standard Error) (2.6%)
Illinois 57.1%* New Jersey 59.4%* Washington 50.6%
(Standard Error) (1.8%) (Standard Error) (2.5%) (Standard Error) (2.4%)
Indiana 42.7%* New Mexico 42.2%* West Virginia 46.1%
(Standard Error) (2.5%) (Standard Error) (2.5%) (Standard Error) (2.8%)
Iowa 52.3% New York 55.7%* Wisconsin 47.3%
(Standard Error) (2.3%) (Standard Error) (1.6%) (Standard Error) (2.4%)
Kansas 55.2% North Carolina 42.5%* Wyoming 38.6%*
(Standard Error) (2.4%) (Standard Error) (2.5%) (Standard Error) (2.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of 50.6 percent at p < 0.05. Note that the standard error on the national estimate of 50.6 percent is 0.4 percent.
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, 2009-2021
Low Wage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
<50% Low-Wage Employees, Small Employers 71.6% 70.2%* 68.0%* 66.8%* 65.6%* 61.0%* 58.4%* 56.9% 57.6% 55.5%* 58.8%* 58.0% 57.3%
(Standard Error) (0.5%) (0.5%) (0.4%) (0.3%) (0.6%) (0.7%) (0.7%) (0.7%) (0.7%) (0.7%) (0.8%) (0.8%) (0.8%)
50%+ Low-Wage Employees, Small Employers 34.3% 34.1% 30.6%* 28.0%* 28.0% 26.6% 23.1%* 24.4% 24.2% 23.6% 25.4% 25.3% 23.9%^
(Standard Error) (0.8%) (0.7%) (0.9%) (1.0%) (1.2%) (1.1%) (1.1%) (1.3%) (1.2%) (1.2%) (1.4%) (1.4%) (1.4%)
<50% Low-Wage Employees, Large Employers 99.1% 98.9% 98.9% 98.6% 98.7% 98.2%* 98.9%* 98.9% 98.7% 98.9% 98.7% 98.7% 98.6%
(Standard Error) (0.2%) (0.2%) (0.2%) (0.1%) (0.1%) (0.2%) (0.1%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%) (0.2%)
50%+ Low-Wage Employees, Large Employers 94.7% 93.5% 91.4%* 92.2% 92.4% 89.6%* 92.7%* 94.5%* 94.0% 94.0% 95.2% 93.8% 95.5%^
(Standard Error) (0.4%) (0.6%) (0.7%) (0.6%) (0.7%) (0.7%) (0.6%) (0.5%) (0.6%) (0.8%) (0.5%) (1.0%) (0.6%)
Key: Small employers = fewer than 50 employees. Large employers = 50 or more employees.
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: Wage levels in the MEPS-IC questionnaires have been adjusted to account for changing wages over time. In 2021, low-wage employees were defined as those earning less than $13.50 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 2021 only.
ALTER EXB1.5
Exhibit 1.5 Percentage (standard error) of private-sector employees in establishments that offer health insurance, overall and by industry, 2021
Industry Percentage
United States 85.7%
(Standard Error) (0.3%)
Agriculture, fisheries, forestry 66.6%*
(Standard Error) (6.1%)
Mining and manufacturing 93.2%
(Standard Error) (0.6%)
Construction 80.2%*
(Standard Error) (1.4%)
Utilities and transportation 90.1%
(Standard Error) (1.4%)
Wholesale trade 91.8%
(Standard Error) (0.9%)
Financial services and real estate 93.0%
(Standard Error) (0.7%)
Retail trade 85.9%*
(Standard Error) (0.9%)
Professional services 89.2%*
(Standard Error) (0.4%)
Other services 75.9%*
(Standard Error) (0.8%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.
ALTER EXB1.6
Exhibit 1.6 Percentage (standard error) of private-sector employees in establishments that offer health insurance, overall and by selected characteristics, 2021
Employer Characteristics Percentage
United States 85.7%
(Standard Error) (0.3%)
Ownership: For Profit Inc. 86.6%*
(Standard Error) (0.3%)
Ownership: For Profit Uninc. 75.1%*
(Standard Error) (1.0%)
Ownership: Nonprofit 93.0%
(Standard Error) (0.6%)
Firm Age: 0-4 Years 42.9%*
(Standard Error) (2.2%)
Firm Age: 5-9 Years 60.8%*
(Standard Error) (1.9%)
Firm Age: 10-19 Years 72.0%*
(Standard Error) (1.1%)
Firm Age: 20+ Years 93.3%
(Standard Error) (0.2%)
# of Locations: 1 Location 64.9%*
(Standard Error) (0.7%)
# of Locations: 2+ Locations 98.8%
(Standard Error) (0.1%)
% Full Time: 0-24% 49.4%*
(Standard Error) (1.9%)
% Full Time: 25-49% 79.0%*
(Standard Error) (1.2%)
% Full Time: 50-74% 84.5%*
(Standard Error) (0.8%)
% Full Time: 75%+ 90.7%
(Standard Error) (0.3%)
% Low Wage: 50%+ 71.3%*
(Standard Error) (1.1%)
% Low Wage: <50% 88.4%
(Standard Error) (0.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Note: "Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 35.1% 35.8% 36.9% 37.2% 37.6% 37.2% 39.0%* 40.7%* 39.2% 38.7% 39.4% 41.9%* 40.1%
(Standard Error) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%)
<10 14.6% 13.1% 12.6% 14.9% 15.2% 14.4% 15.8% 19.3%* 17.7% 13.1%* 14.8% 17.6% 18.9%^
(Standard Error) (0.7%) (0.5%) (0.8%) (0.9%) (0.4%) (0.8%) (1.0%) (1.4%) (1.4%) (1.1%) (1.3%) (1.7%) (1.7%)
10-24 10.4% 11.6% 9.9% 10.7% 9.0% 12.0%* 10.6% 13.6%* 13.3% 13.8% 12.2% 13.1% 12.0%^
(Standard Error) (0.4%) (0.8%) (0.7%) (0.7%) (0.7%) (1.0%) (1.0%) (1.1%) (1.2%) (1.2%) (1.1%) (1.2%) (1.0%)
25-99 13.4% 14.3% 12.2%* 13.5% 12.4% 12.2% 13.7% 16.6%* 16.0% 12.9%* 17.2%* 16.3% 17.7%^
(Standard Error) (0.7%) (0.7%) (0.7%) (0.7%) (0.7%) (0.8%) (0.9%) (0.9%) (0.9%) (0.8%) (0.9%) (0.9%) (1.0%)
100-999 29.9% 30.9% 31.7% 30.1% 30.1% 32.5% 33.7% 34.4% 37.2% 35.1% 33.9% 35.8% 38.0%^
(Standard Error) (0.7%) (0.9%) (1.1%) (0.8%) (1.0%) (1.2%) (1.2%) (1.2%) (1.3%) (1.2%) (1.1%) (1.2%) (1.3%)
1,000+ 85.8% 86.6% 87.5% 87.1% 88.0% 84.2%* 83.8% 81.9% 78.6%* 81.6%* 83.1% 77.8%* 78.1%
(Standard Error) (0.4%) (0.6%) (0.5%) (0.7%) (0.5%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.9%) (0.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 57.2% 58.4% 59.6% 60.1% 58.1%* 59.2% 59.1% 57.3%* 58.2% 56.8% 58.0% 57.1% 57.4%
(Standard Error) (0.7%) (0.7%) (0.6%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%) (0.7%)
<10 12.3% 12.5% 11.5% 12.0% 13.2% 12.9% 13.5% 15.7% 15.6% 12.4% 12.5% 14.4% 16.9%^
(Standard Error) (0.6%) (0.6%) (0.9%) (0.9%) (0.8%) (0.9%) (1.1%) (1.2%) (1.3%) (1.1%) (1.3%) (1.5%) (1.8%)
10-24 9.8% 11.5% 10.1% 11.1% 9.1% 11.4% 10.5% 14.9%* 12.8% 12.9% 12.1% 12.0% 12.6%^
(Standard Error) (0.5%) (1.0%) (0.8%) (1.0%) (0.9%) (1.2%) (1.1%) (1.3%) (1.2%) (1.1%) (1.3%) (1.2%) (1.2%)
25-99 16.0% 17.3% 13.5%* 15.5% 13.4% 14.0% 14.5% 17.1% 15.3% 14.0% 18.1%* 18.0% 18.7%^
(Standard Error) (1.0%) (1.1%) (0.8%) (0.9%) (0.8%) (1.1%) (1.1%) (1.1%) (1.0%) (0.9%) (1.2%) (1.1%) (1.2%)
100-999 31.7% 35.7% 35.0% 35.7% 32.6% 39.5%* 39.5% 37.4% 42.0%* 34.7%* 37.8% 40.5% 41.4%^
(Standard Error) (1.8%) (1.4%) (1.2%) (1.4%) (1.0%) (1.4%) (1.5%) (1.3%) (1.4%) (1.3%) (1.4%) (1.4%) (1.6%)
1,000+ 85.8% 86.6% 89.0%* 89.0% 86.9%* 86.6% 86.4% 82.8%* 82.2% 82.2% 84.1% 77.3%* 79.0%
(Standard Error) (0.7%) (0.6%) (0.4%) (0.5%) (0.4%) (0.7%) (0.7%) (0.8%) (0.7%) (0.9%) (0.8%) (1.0%) (0.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.
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, 2021
Coverage United States <10 Employees 10-24 Employees 25-99 Employees 100-999 Employees 1,000+ Employees
Any Dependent Coverage 98.4% 81.8%* 92.1%* 97.6%* 99.7%* 100.0%
(Standard Error) (0.1%) (2.0%) (1.1%) (0.4%) (0.1%) (0.0%)
Any Family Coverage 97.8% 76.5%* 88.3%* 96.4%* 99.3%* 100.0%
(Standard Error) (0.1%) (2.1%) (1.2%) (0.5%) (0.2%) (0.0%)
Any Employee-Plus-One 93.7% 63.4%* 81.1%* 91.4%* 93.2%* 97.7%
(Standard Error) (0.3%) (2.4%) (1.6%) (0.8%) (0.8%) (0.4%)
Family and Employee-Plus-One 93.0% 58.1%* 77.3%* 90.2%* 92.8%* 97.7%
(Standard Error) (0.3%) (2.4%) (1.7%) (0.8%) (0.8%) (0.4%)
Family Coverage Only 4.8% 18.4%* 11.0%* 6.2%* 6.5%* 2.3%
(Standard Error) (0.3%) (1.9%) (1.2%) (0.7%) (0.8%) (0.4%)
Source:Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 66.5% 65.6% 65.5% 65.3% 66.0% 67.0% 70.2%* 71.7% 72.4% 75.7%* 75.8% 73.8%* 73.9%
(Standard Error) (0.7%) (0.8%) (0.5%) (0.7%) (0.6%) (0.6%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%)
<50 27.3% 26.7% 27.2% 29.3% 28.4% 29.6% 33.6%* 34.2% 34.9% 37.8%* 41.4%* 39.9% 41.0%^
(Standard Error) (0.9%) (0.8%) (0.9%) (0.8%) (1.0%) (0.9%) (1.1%) (1.0%) (1.0%) (1.0%) (1.1%) (1.1%) (1.1%)
50-99 42.8% 44.1% 46.8% 43.7% 46.6% 46.8% 50.2% 56.2%* 59.3% 56.4% 58.7% 58.6% 60.8%^
(Standard Error) (2.0%) (1.9%) (2.2%) (1.7%) (2.2%) (2.1%) (2.2%) (2.0%) (1.9%) (1.9%) (2.0%) (2.1%) (2.2%)
100+ 78.5% 77.3% 76.3% 75.7% 76.5% 77.0% 79.7%* 80.7% 81.0% 84.7%* 84.5% 81.0%* 81.7%
(Standard Error) (0.7%) (1.0%) (0.7%) (0.7%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.5%) (0.6%) (0.6%) (0.6%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.
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, 2021
Industry Percentage
United States 73.9%
(Standard Error) (0.6%)
Agriculture, fisheries, forestry 55.7%*
(Standard Error) (9.4%)
Mining and manufacturing 70.1%*
(Standard Error) (1.7%)
Construction 61.4%*
(Standard Error) (2.8%)
Utilities and transportation 74.3%*
(Standard Error) (2.4%)
Wholesale trade 68.3%*
(Standard Error) (2.9%)
Financial services and real estate 82.4%
(Standard Error) (1.5%)
Retail trade 78.1%*
(Standard Error) (1.5%)
Professional services 76.9%*
(Standard Error) (1.0%)
Other services 70.2%*
(Standard Error) (1.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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.
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, 2021
Employer Characteristics Percentage
United States 73.9%
(Standard Error) (0.6%)
Ownership: For Profit Inc. 73.9%
(Standard Error) (0.7%)
Ownership: For Profit Uninc. 72.8%
(Standard Error) (1.4%)
Ownership: Nonprofit 75.0%
(Standard Error) (1.4%)
Firm Age: 0-4 Years 56.2%*
(Standard Error) (3.9%)
Firm Age: 5-9 Years 62.2%*
(Standard Error) (3.0%)
Firm Age: 10-19 Years 66.3%*
(Standard Error) (1.7%)
Firm Age: 20+ Years 76.2%
(Standard Error) (0.6%)
# of Locations: 1 Location 55.4%*
(Standard Error) (1.1%)
# of Locations: 2+ Locations 81.6%
(Standard Error) (0.6%)
% Full Time: 0-24% 70.5%
(Standard Error) (2.5%)
% Full Time: 25-49% 73.9%
(Standard Error) (1.9%)
% Full Time: 50-74% 75.4%
(Standard Error) (1.6%)
% Full Time: 75%+ 73.9%
(Standard Error) (0.6%)
% Low Wage: 50%+ 74.6%
(Standard Error) (1.4%)
% Low Wage: <50% 73.8%
(Standard Error) (0.6%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Denominator: Within each category, employees in establishments that offer health insurance.
Note: "Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 11.2% 11.6% 13.1%* 12.3% 11.9% 11.6% 11.6% 12.5% 10.8%* 11.1% 9.7%* 10.3% 9.8%
(Standard Error) (0.3%) (0.4%) (0.3%) (0.3%) (0.5%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%)
<10 1.2% 2.0%* 1.6% 1.8% 1.4% 1.4% 1.2% 2.3% 1.6% 2.3% 3.3% 1.6% † 1.3%^
(Standard Error) (0.2%) (0.2%) (0.3%) (0.2%) (0.2%) (0.3%) (0.3%) (0.6%) (0.4%) (0.5%) (0.7%) (0.6%) (0.3%)
10-24 1.6% 1.4% 1.0% 1.2% 1.0% † 1.5% 1.3% 1.7% 2.1% 1.6% 1.8% 1.1% † 1.4%^
(Standard Error) (0.2%) (0.2%) (0.2%) (0.2%) (0.4%) (0.4%) (0.3%) (0.4%) (0.5%) (0.4%) (0.5%) (0.3%) (0.4%)
25-99 2.4% 3.0% 3.1% 2.4% 2.2% 2.4% 1.7% 2.3% 1.9% 2.3% 2.7% 1.9% 2.1%^
(Standard Error) (0.4%) (0.4%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.3%) (0.4%)
100-999 7.5% 6.9% 6.8% 7.4% 6.3% 6.6% 6.0% 6.2% 7.0% 6.8% 4.2%* 5.4% 4.5%^
(Standard Error) (0.4%) (0.6%) (0.2%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%) (0.6%) (0.5%) (0.6%) (0.5%)
1,000+ 34.5% 34.2% 37.7%* 35.3% 34.3% 32.5% 31.6% 32.4% 27.6%* 27.4% 23.7%* 23.5% 25.3%
(Standard Error) (1.2%) (1.3%) (0.9%) (1.1%) (0.9%) (1.2%) (1.1%) (1.0%) (1.0%) (1.0%) (1.0%) (1.1%) (1.1%)
† Estimate does not meet standard of reliability or precision.
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 11.3% 10.8% 11.9%* 11.6% 10.5%* 10.3% 10.4% 10.5% 8.6%* 8.7% 8.6% 7.6% 6.2%*
(Standard Error) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%)
<10 2.6% 2.2% 2.5% 2.6% 2.1% 2.0% 2.2% 3.4% 2.3% 3.1% 2.6% 2.4% 1.4%^
(Standard Error) (0.3%) (0.3%) (0.2%) (0.3%) (0.4%) (0.3%) (0.4%) (0.7%) (0.5%) (0.6%) (0.7%) (0.6%) (0.4%)
10-24 2.7% 2.3% 2.3% 2.8% 2.2% 2.4% 2.4% 2.7% 2.7% 1.5% 3.3%* 1.3%* 2.5%^
(Standard Error) (0.3%) (0.5%) (0.4%) (0.5%) (0.6%) (0.5%) (0.5%) (0.5%) (0.5%) (0.4%) (0.6%) (0.4%) (0.6%)
25-99 3.4% 3.3% 3.7% 3.4% 3.4% 2.9% 3.1% 2.6% 2.9% 2.4% 2.0% 2.2% 1.9%^
(Standard Error) (0.2%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.5%) (0.4%) (0.4%) (0.4%) (0.3%) (0.3%) (0.4%)
100-999 8.6% 7.8% 6.5%* 7.5% 6.3% 7.1% 5.5% 5.9% 5.7% 6.0% 4.7% 4.2% 3.4%^
(Standard Error) (0.4%) (0.4%) (0.4%) (0.8%) (0.7%) (0.6%) (0.6%) (0.7%) (0.6%) (0.6%) (0.5%) (0.5%) (0.5%)
1,000+ 31.8% 29.9% 31.9% 31.1% 27.8%* 26.8% 26.1% 24.8% 20.3%* 19.7% 20.1% 16.1%* 14.4%
(Standard Error) (1.0%) (1.1%) (0.9%) (1.4%) (0.7%) (1.2%) (1.1%) (1.0%) (0.9%) (0.9%) (1.0%) (0.9%) (0.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

Return to Table of Contents


Section 2: 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 insurance (the "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 2009 to 2021 for private-sector employees for the:

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

This section also presents estimates for 2009 to 2021 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, firm age, industry, ownership status, number of locations, percent full-time workers, and percent low-wage workers. Finally, this section presents coverage rates by the State in which the establishment was located.

Highlights

  • From 2020 to 2021, 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 fell from 49.5 percent in 2020 to 48.0 percent in 2021 (Exhibit 2.1). However, this reduction in the overall enrollment rate is not accompanied by a reduction in the total number of employees enrolled in employer-sponsored health insurance (Exhibit 2.2).
  • There were no statistically significant changes from 2020 to 2021 in the eligibility rate for employees at private-sector establishments overall or for employees of small, medium, or large firms. The overall 2021 eligibility rate of 80.3 percent remains elevated relative to the 2019 eligibility rate of 77.7 percent (Exhibit 2.4).
  • Among medium employers, take-up rates fell from 68.8 to 64.7 percent (Exhibit 2.5). As in 2020, the overall take-up rate in 2021 remained lower than in 2019.
  • Across the Nation, nine States had coverage rates above the national average of 56.3 percent, ranging from 58.6 percent in Texas to 64.5 percent in Washington. Eight States had coverage rates below the national average, ranging from 50.4 percent in New York to 53.4 percent in Vermont (Exhibit 2.9).

Key Trends and Differences

Enrollment rates were lower at small and medium firms, compared with large firms, reflecting lower offer rates (presented in Section 1). Coverage, eligibility, and take-up rates were lower among younger firms, firms with one location (versus multiple locations), firms with fewer full-time workers, and firms with 50 percent or more low-wage workers.

For both small employers (firms with fewer than 50 workers) and large employers (firms with 50 or more workers), coverage, eligibility, and take-up rates were substantially lower at firms with 50 percent or more low-wage workers compared with firms with less than 50 percent low-wage workers. Continuing a longstanding pattern, in 2021, a lower percentage of enrollees in large firms compared with small and medium firms chose single coverage, while a higher percentage of large-firm enrollees chose employee-plus-one coverage or family coverage.

ALTER EXB2.1
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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 53.5% 51.8%* 50.6% 49.9% 49.4% 48.1%* 47.8% 47.2% 47.7% 47.8% 47.6% 49.5%* 48.0%*
(Standard Error) (0.4%) (0.5%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%)
<50 35.5% 34.2% 32.0%* 30.5%* 30.3% 28.3%* 27.1% 26.5% 26.7% 26.6% 27.3% 27.8% 27.1%^
(Standard Error) (0.4%) (0.6%) (0.4%) (0.3%) (0.4%) (0.4%) (0.5%) (0.4%) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%)
50-99 53.8% 48.8%* 46.9% 46.6% 47.6% 45.2% 47.0% 45.4% 45.0% 44.3% 47.4% 47.2% 46.3%^
(Standard Error) (1.1%) (1.0%) (1.2%) (0.7%) (0.7%) (1.3%) (1.3%) (1.2%) (1.2%) (1.2%) (1.2%) (1.3%) (1.3%)
100+ 60.9% 59.5% 58.9% 58.5% 57.7% 56.7% 56.4% 56.0% 56.5% 56.5% 55.8% 57.0% 56.3%
(Standard Error) (0.6%) (0.6%) (0.4%) (0.4%) (0.3%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 59.2 56.1* 54.8 55.4 56.3 55.8 57.3 58.2 59.9 62.1* 62.5 60.8 62.2
(Standard Error) (0.7) (0.8) (0.6) (0.6) (0.7) (0.6) (0.6) (0.6) (0.7) (0.7) (0.9) (0.7) (0.7)
<50 10.6 10.2 9.5* 9.3 9.5 8.9* 8.9 8.9 8.9 9.1 9.6* 7.9* 9.2*^
(Standard Error) (0.2) (0.2) (0.1) (0.1) (0.2) (0.1) (0.1) (0.1) (0.1) (0.1) (0.2) (0.1) (0.2)
50-99 4.3 3.8* 3.7 3.8 4.0 4.1 4.0 4.0 4.1 4.2 4.2 4.0 4.1^
(Standard Error) (0.1) (0.2) (0.1) (0.2) (0.2) (0.1) (0.2) (0.1) (0.2) (0.2) (0.2) (0.2) (0.2)
100+ 44.3 42.1* 41.6 42.3 42.9 42.8 44.4* 45.3 46.9 48.9* 48.7 48.8 49.0
(Standard Error) (0.6) (0.8) (0.5) (0.6) (0.7) (0.6) (0.6) (0.6) (0.7) (0.7) (0.8) (0.7) (0.7)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 61.1% 59.8%* 59.4% 58.9% 58.2% 57.8% 57.0% 56.0% 56.5% 56.5% 55.8% 57.0% 56.0%
(Standard Error) (0.4%) (0.5%) (0.2%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%) (0.4%)
<50 59.6% 59.2% 58.6% 57.7% 57.1% 56.8% 57.0% 55.5% 55.4% 56.2% 53.9%* 55.1% 53.8%^
(Standard Error) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%)
50-99 60.1% 55.9%* 54.9% 55.4% 54.7% 54.5% 55.8% 51.2%* 52.2% 50.3% 53.8%* 53.4% 51.3%^
(Standard Error) (1.0%) (0.8%) (1.0%) (1.2%) (0.8%) (1.3%) (1.2%) (1.2%) (1.2%) (1.2%) (1.2%) (1.3%) (1.3%)
100+ 61.6% 60.4% 60.0% 59.5% 58.8% 58.3% 57.1% 56.6% 57.1% 57.1% 56.4% 57.7% 56.9%
(Standard Error) (0.6%) (0.6%) (0.3%) (0.4%) (0.3%) (0.5%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 79.5% 78.2%* 78.0% 77.8% 77.8% 75.4%* 76.0% 76.5% 76.8% 78.0%* 77.7% 80.5%* 80.3%
(Standard Error) (0.3%) (0.5%) (0.4%) (0.3%) (0.2%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%)
<50 79.3% 78.6% 78.7% 77.9% 78.0% 77.7% 79.1% 78.7% 78.3% 79.1% 78.1% 80.2%* 79.7%
(Standard Error) (0.5%) (0.5%) (0.6%) (0.5%) (0.4%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%)
50-99 79.2% 74.5%* 73.6% 76.4% 76.2% 74.1% 77.8%* 76.2% 75.5% 75.6% 78.1% 77.6% 79.2%
(Standard Error) (0.8%) (0.6%) (1.0%) (1.2%) (0.8%) (1.4%) (1.2%) (1.2%) (1.2%) (1.2%) (1.2%) (1.4%) (1.3%)
100+ 79.6% 78.5% 78.3% 77.9% 77.9% 75.0%* 75.2% 76.0% 76.6% 78.0% 77.5% 80.8%* 80.5%
(Standard Error) (0.5%) (0.6%) (0.4%) (0.3%) (0.3%) (0.5%) (0.5%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 76.9% 76.5% 76.1% 75.8% 74.8%* 76.7%* 75.0%* 73.3%* 73.5% 72.4%* 71.9% 70.8%* 69.8%
(Standard Error) (0.3%) (0.2%) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%)
<50 75.2% 75.3% 74.4% 74.1% 73.1% 73.0% 72.1% 70.4%* 70.7% 71.0% 69.0%* 68.7% 67.5%^
(Standard Error) (0.3%) (0.6%) (0.4%) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%)
50-99 75.9% 75.1% 74.5% 72.5% 71.8% 73.5% 71.7% 67.2%* 69.1% 66.6% 68.9% 68.8% 64.7%*^
(Standard Error) (0.9%) (0.7%) (0.6%) (0.8%) (1.0%) (1.0%) (1.1%) (1.2%) (1.1%) (1.1%) (1.0%) (1.0%) (1.2%)
100+ 77.5% 76.9% 76.7% 76.4% 75.5%* 77.8%* 76.0%* 74.4%* 74.5% 73.3%* 72.7% 71.4%* 70.7%
(Standard Error) (0.5%) (0.3%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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, 2009-2021
Low Wage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
<50% Low-Wage Employees, Small Employers 65.1% 64.7% 64.3% 62.9%* 62.1% 61.6% 61.7% 60.1%* 59.7% 59.6% 57.4%* 58.4% 56.0%*
(Standard Error) (0.4%) (0.6%) (0.4%) (0.5%) (0.4%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.8%)
50%+ Low-Wage Employees, Small Employers 35.5% 37.2% 35.8% 35.5% 33.3% 33.5% 29.8% 28.2% 28.9% 32.6% 29.0% 29.1% 33.2%^
(Standard Error) (0.7%) (0.8%) (0.6%) (0.6%) (1.2%) (1.5%) (1.4%) (1.3%) (1.3%) (1.5%) (1.6%) (1.6%) (1.8%)
<50% Low-Wage Employees, Large Employers 70.0% 69.3% 68.8% 69.0% 67.5%* 67.8% 66.3%* 64.1%* 63.8% 63.0% 63.3% 62.5% 60.6%*
(Standard Error) (0.5%) (0.6%) (0.4%) (0.5%) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%) (0.5%)
50%+ Low-Wage Employees, Large Employers 38.3% 34.8%* 33.3% 32.9% 33.2% 30.6%* 26.7%* 27.4% 29.5%* 30.3% 29.7% 31.6% 30.8%^
(Standard Error) (0.8%) (0.9%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%) (0.7%) (0.7%) (0.9%) (0.9%) (0.9%) (1.0%)
Key: Small employer = fewer than 50 employees. Large employer = 50 or more employees.
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021, low-wage employees were defined as those earning less than $13.50 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 2021 only.

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, 2009-2021
Low Wage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
<50% Low-Wage Employees, Small Employers 84.3% 84.0% 84.3% 83.2% 83.3% 83.0% 83.8% 83.8% 83.0% 83.0% 81.8% 83.4% 82.4%
(Standard Error) (0.3%) (0.5%) (0.4%) (0.6%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%)
50%+ Low-Wage Employees, Small Employers 57.1% 57.4% 56.4% 55.2% 52.9% 52.5% 51.9% 49.1% 49.6% 53.2% 51.5% 54.8% 54.9%^
(Standard Error) (1.0%) (1.0%) (1.3%) (1.0%) (1.5%) (1.8%) (1.9%) (2.0%) (1.8%) (1.9%) (2.3%) (2.2%) (2.2%)
<50% Low-Wage Employees, Large Employers 85.4% 85.0% 85.3% 85.4% 84.3%* 84.0% 83.8% 83.4% 83.0% 83.7% 83.5% 84.9%* 84.4%
(Standard Error) (0.5%) (0.7%) (0.5%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.4%)
50%+ Low-Wage Employees, Large Employers 63.3% 59.6%* 56.9%* 57.4% 59.4%* 49.5%* 48.0% 49.7% 51.9% 53.7% 55.8% 58.7% 55.5%*^
(Standard Error) (0.9%) (0.8%) (1.0%) (0.5%) (0.6%) (0.9%) (0.9%) (0.9%) (0.9%) (1.1%) (1.1%) (1.1%) (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, 2009-2021.
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 2021, low-wage employees were defined as those earning less than $13.50 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 2021 only.

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, 2009-2021
Low Wage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
<50% Low-Wage Employees, Small Employers 77.2% 77.0% 76.3% 75.6% 74.5%* 74.2% 73.6% 71.7%* 71.9% 71.9% 70.1%* 70.0% 68.0%*
(Standard Error) (0.4%) (0.5%) (0.4%) (0.2%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%) (0.6%) (0.6%) (0.7%) (0.7%)
50%+ Low-Wage Employees, Small Employers 62.1% 64.9% 63.5% 64.3% 63.0% 63.9% 57.4%* 57.5% 58.3% 61.3% 56.4% 53.0% 60.5%*^
(Standard Error) (1.3%) (1.2%) (1.1%) (1.7%) (1.9%) (2.1%) (2.2%) (2.1%) (2.3%) (2.2%) (2.2%) (2.3%) (2.7%)
<50% Low-Wage Employees, Large Employers 81.9% 81.5% 80.7% 80.8% 80.0% 80.7% 79.1%* 76.9%* 76.9% 75.2%* 75.8% 73.6%* 71.8%*
(Standard Error) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.5%)
50%+ Low-Wage Employees, Large Employers 60.5% 58.4% 58.5% 57.3% 55.9% 61.9%* 55.6%* 55.2% 57.0% 56.5% 53.2% 53.9% 55.4%^
(Standard Error) (0.9%) (1.0%) (0.8%) (1.1%) (0.5%) (0.8%) (1.0%) (1.0%) (1.0%) (1.2%) (1.2%) (1.2%) (1.3%)
Key: Small employer = fewer than 50 employees. Large employer = 50 or more employees.
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021, low-wage employees were defined as those earning less than $13.50 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 2021 only.

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, 2019-2021
Alabama 58.6% Kentucky 60.5%* North Dakota 56.7%
(Standard Error) (1.4%) (Standard Error) (1.2%) (Standard Error) (1.3%)
Alaska 55.7% Louisiana 54.1% Ohio 56.2%
(Standard Error) (1.5%) (Standard Error) (1.3%) (Standard Error) (1.3%)
Arizona 53.9% Maine 56.7% Oklahoma 59.5%*
(Standard Error) (1.8%) (Standard Error) (1.3%) (Standard Error) (1.4%)
Arkansas 59.3%* Maryland 51.1%* Oregon 63.1%*
(Standard Error) (1.2%) (Standard Error) (1.3%) (Standard Error) (1.3%)
California 57.5% Massachusetts 54.5% Pennsylvania 57.0%
(Standard Error) (1.1%) (Standard Error) (1.3%) (Standard Error) (1.0%)
Colorado 57.5% Michigan 57.1% Rhode Island 53.0%*
(Standard Error) (1.4%) (Standard Error) (1.3%) (Standard Error) (1.2%)
Connecticut 55.1% Minnesota 58.6% South Carolina 56.6%
(Standard Error) (1.3%) (Standard Error) (1.3%) (Standard Error) (1.3%)
Delaware 55.0% Mississippi 58.6% South Dakota 56.4%
(Standard Error) (1.8%) (Standard Error) (1.4%) (Standard Error) (1.1%)
District of Columbia 58.5% Missouri 57.9% Tennessee 56.0%
(Standard Error) (1.3%) (Standard Error) (1.4%) (Standard Error) (1.4%)
Florida 52.8%* Montana 57.5% Texas 58.6%*
(Standard Error) (1.5%) (Standard Error) (1.2%) (Standard Error) (1.0%)
Georgia 54.6% Nebraska 57.3% Utah 54.8%
(Standard Error) (1.7%) (Standard Error) (1.3%) (Standard Error) (1.6%)
Hawaii 63.2%* Nevada 54.5% Vermont 53.4%*
(Standard Error) (1.2%) (Standard Error) (1.2%) (Standard Error) (1.2%)
Idaho 59.8%* New Hampshire 52.4%* Virginia 55.0%
(Standard Error) (1.4%) (Standard Error) (1.2%) (Standard Error) (1.4%)
Illinois 55.2% New Jersey 55.3% Washington 64.5%*
(Standard Error) (1.1%) (Standard Error) (1.4%) (Standard Error) (1.7%)
Indiana 56.9% New Mexico 52.7%* West Virginia 51.7%*
(Standard Error) (1.2%) (Standard Error) (1.4%) (Standard Error) (1.4%)
Iowa 56.1% New York 50.4%* Wisconsin 54.3%
(Standard Error) (1.2%) (Standard Error) (0.8%) (Standard Error) (1.2%)
Kansas 57.0% North Carolina 60.4%* Wyoming 57.4%
(Standard Error) (1.3%) (Standard Error) (1.2%) (Standard Error) (2.1%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Denominator: Within each state, all employees in establishments that offer health insurance.
Note: * Statistically different from national average of 56.3 percent at p < 0.05. Note that the standard error on the national estimate of 56.3 percent is 0.25.

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, 2021
Industry Percentage
United States 56.0%
(Standard Error) (0.4%)
Agriculture, fisheries, forestry 51.7%*
(Standard Error) (5.6%)
Mining and manufacturing 73.6%
(Standard Error) (0.7%)
Construction 57.6%*
(Standard Error) (2.2%)
Utilities and transportation 65.0%*
(Standard Error) (1.6%)
Wholesale trade 72.3%
(Standard Error) (1.7%)
Financial services and real estate 71.6%
(Standard Error) (1.0%)
Retail trade 45.0%*
(Standard Error) (1.0%)
Professional services 59.8%*
(Standard Error) (0.6%)
Other services 35.4%*
(Standard Error) (0.9%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.

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, 2021
Industry Percentage
United States 80.3%
(Standard Error) (0.4%)
Agriculture, fisheries, forestry 89.5%
(Standard Error) (2.9%)
Mining and manufacturing 95.1%*
(Standard Error) (0.3%)
Construction 84.4%*
(Standard Error) (2.2%)
Utilities and transportation 89.6%*
(Standard Error) (1.2%)
Wholesale trade 93.1%
(Standard Error) (0.7%)
Financial services and real estate 93.2%
(Standard Error) (0.6%)
Retail trade 69.9%*
(Standard Error) (1.0%)
Professional services 82.2%*
(Standard Error) (0.5%)
Other services 63.9%*
(Standard Error) (1.0%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.

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, 2021
Industry Percentage
United States 69.8%
(Standard Error) (0.4%)
Agriculture, fisheries, forestry 57.8%*
(Standard Error) (5.4%)
Mining and manufacturing 77.4%
(Standard Error) (0.7%)
Construction 68.2%*
(Standard Error) (1.7%)
Utilities and transportation 72.5%*
(Standard Error) (1.4%)
Wholesale trade 77.7%
(Standard Error) (1.5%)
Financial services and real estate 76.8%
(Standard Error) (0.9%)
Retail trade 64.4%*
(Standard Error) (1.0%)
Professional services 72.8%*
(Standard Error) (0.5%)
Other services 55.4%*
(Standard Error) (1.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.

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, 2021
Employer Characteristics Percentage
United States 56.0%
(Standard Error) (0.4%)
Ownership: For Profit Inc. 56.4%
(Standard Error) (0.5%)
Ownership: For Profit Uninc. 52.1%*
(Standard Error) (1.1%)
Ownership: Nonprofit 57.8%
(Standard Error) (0.8%)
Firm Age: 0-4 Years 50.4%*
(Standard Error) (2.5%)
Firm Age: 5-9 Years 47.3%*
(Standard Error) (2.0%)
Firm Age: 10-19 Years 50.7%*
(Standard Error) (1.4%)
Firm Age: 20+ Years 57.5%
(Standard Error) (0.4%)
# of Locations: 1 Location 52.2%*
(Standard Error) (0.7%)
# of Locations: 2+ Locations 57.6%
(Standard Error) (0.5%)
% Full Time: 0-24% 12.8%*
(Standard Error) (0.7%)
% Full Time: 25-49% 24.8%*
(Standard Error) (1.1%)
% Full Time: 50-74% 42.7%*
(Standard Error) (0.9%)
% Full Time: 75%+ 64.8%
(Standard Error) (0.5%)
% Low Wage: 50%+ 31.0%*
(Standard Error) (0.9%)
% Low Wage: <50% 59.8%
(Standard Error) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Denominator: Within each category, all employees in establishments that offer health insurance.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.

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, 2021
Employer Characteristics Percentage
United States 80.3%
(Standard Error) (0.4%)
Ownership: For Profit Inc. 81.3%*
(Standard Error) (0.4%)
Ownership: For Profit Uninc. 78.5%
(Standard Error) (0.9%)
Ownership: Nonprofit 77.5%
(Standard Error) (0.8%)
Firm Age: 0-4 Years 77.9%
(Standard Error) (2.1%)
Firm Age: 5-9 Years 76.2%*
(Standard Error) (1.9%)
Firm Age: 10-19 Years 79.1%
(Standard Error) (1.1%)
Firm Age: 20+ Years 80.7%
(Standard Error) (0.4%)
# of Locations: 1 Location 78.4%*
(Standard Error) (0.7%)
# of Locations: 2+ Locations 81.0%
(Standard Error) (0.4%)
% Full Time: 0-24% 29.7%*
(Standard Error) (1.6%)
% Full Time: 25-49% 43.3%*
(Standard Error) (1.3%)
% Full Time: 50-74% 67.3%*
(Standard Error) (0.8%)
% Full Time: 75%+ 90.0%
(Standard Error) (0.3%)
% Low Wage: 50%+ 55.4%*
(Standard Error) (1.1%)
% Low Wage: <50% 84.0%
(Standard Error) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Denominator: Within each category, all employees in establishments that offer health insurance.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.

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, 2021
Employer Characteristics Percentage
United States 69.8%
(Standard Error) (0.4%)
Ownership: For Profit Inc. 69.4%*
(Standard Error) (0.5%)
Ownership: For Profit Uninc. 66.4%*
(Standard Error) (1.2%)
Ownership: Nonprofit 74.6%
(Standard Error) (0.6%)
Firm Age: 0-4 Years 64.7%*
(Standard Error) (2.4%)
Firm Age: 5-9 Years 62.1%*
(Standard Error) (2.0%)
Firm Age: 10-19 Years 64.1%*
(Standard Error) (1.5%)
Firm Age: 20+ Years 71.2%
(Standard Error) (0.4%)
# of Locations: 1 Location 66.7%*
(Standard Error) (0.7%)
# of Locations: 2+ Locations 71.1%
(Standard Error) (0.5%)
% Full Time: 0-24% 43.3%*
(Standard Error) (2.6%)
% Full Time: 25-49% 57.4%*
(Standard Error) (1.5%)
% Full Time: 50-74% 63.5%*
(Standard Error) (1.0%)
% Full Time: 75%+ 72.0%
(Standard Error) (0.4%)
% Low Wage: 50%+ 56.0%*
(Standard Error) (1.2%)
% Low Wage: <50% 71.2%
(Standard Error) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Denominator: Within each category, eligible employees in establishments that offer health insurance.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.

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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 50.0% 51.3%* 50.2%* 51.3%* 51.3% 52.4%* 53.5%* 55.3%* 54.6% 55.2% 55.6% 55.8% 56.3%
(Standard Error) (0.2%) (0.3%) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%)
<50 58.8% 60.3%* 60.8% 61.4% 62.5% 61.5% 63.5%* 62.8% 63.5% 63.2% 62.5% 63.3% 63.2%^
(Standard Error) (0.5%) (0.6%) (0.7%) (0.5%) (0.7%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%) (0.8%)
50-99 56.7% 57.6% 58.6% 58.1% 59.4% 60.8% 61.7% 63.3% 63.3% 64.6% 61.4%* 65.1%* 63.5%^
(Standard Error) (1.1%) (1.2%) (0.9%) (0.6%) (0.8%) (1.0%) (1.0%) (1.0%) (1.0%) (0.9%) (1.2%) (1.2%) (1.1%)
100+ 47.2% 48.6%* 47.1%* 48.5%* 48.1% 49.7%* 50.8%* 53.1%* 52.1%* 52.9% 53.7% 53.8% 54.5%
(Standard Error) (0.2%) (0.3%) (0.4%) (0.3%) (0.2%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 19.5% 18.3%* 18.9% 18.1%* 18.9%* 18.3%* 18.4% 17.8%* 19.0%* 18.6% 18.6% 18.5% 18.4%
(Standard Error) (0.2%) (0.2%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%)
<50 14.6% 13.8% 14.3% 14.0% 13.4% 13.8% 13.7% 14.5% 13.9% 14.8% 15.7% 15.1% 15.1%^
(Standard Error) (0.4%) (0.3%) (0.2%) (0.4%) (0.2%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.5%) (0.4%) (0.5%)
50-99 17.7% 15.9% 16.4% 16.7% 16.6% 15.8% 16.2% 16.3% 15.8% 16.1% 17.1% 15.3%* 16.6%^
(Standard Error) (0.8%) (0.6%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.5%) (0.6%) (0.6%) (0.6%)
100+ 20.9% 19.6%* 20.1% 19.2%* 20.3%* 19.5%* 19.5% 18.6%* 20.2%* 19.6%* 19.3% 19.3% 19.2%
(Standard Error) (0.2%) (0.3%) (0.3%) (0.2%) (0.1%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 30.5% 30.3% 30.9% 30.6% 29.8%* 29.3% 28.1%* 26.8%* 26.5% 26.2% 25.8% 25.7% 25.2%
(Standard Error) (0.3%) (0.3%) (0.3%) (0.3%) (0.2%) (0.3%) (0.2%) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.3%)
<50 26.6% 25.8% 24.9% 24.6% 24.0% 24.7% 22.8%* 22.7% 22.6% 22.0% 21.8% 21.6% 21.7%^
(Standard Error) (0.5%) (0.4%) (0.6%) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%) (0.6%) (0.6%) (0.7%)
50-99 25.5% 26.5% 25.1% 25.2% 24.0% 23.4% 22.1% 20.4% 20.9% 19.3% 21.5% 19.6% 19.9%^
(Standard Error) (0.7%) (0.9%) (1.0%) (0.7%) (0.5%) (0.8%) (0.9%) (0.9%) (0.9%) (0.8%) (0.9%) (1.1%) (0.9%)
100+ 31.9% 31.8% 32.8%* 32.4% 31.6%* 30.8%* 29.7%* 28.2%* 27.7% 27.5% 27.0% 26.9% 26.4%
(Standard Error) (0.3%) (0.4%) (0.3%) (0.3%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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Section 3: 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 2009 to 2021 overall and by firm size.

This section also presents information on variation in total premiums in 2021 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., the percentage of covered 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 2021, average total health insurance premiums were $7,380 for single coverage, $14,634 for employee-plus-one coverage, and $21,381 for family coverage. These amounts represented an increase over 2020 that ranged from 3.0 to 3.2 percent for the three types of coverage (Exhibits 3.1 and 3.2). These 1-year percentage increases were not significantly different from the average annual growth rates from 2009 to 2021, which ranged from 3.9 to 4.2 percent across the three types of coverage.
  • In 2021, 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. $4,700), employee-plus-one ($21,000 vs. $9,100), and family coverage ($29,000 vs. $14,000) (Exhibit 3.15).
  • Average annual total premiums for 2019-2021 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 Columbia) had higher than average premiums for all three types of coverage.
    • Thirteen 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 two are in the Midwest.

Key Trends and Differences

Variation in total premiums in 2021 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 and in the oldest firms (in business for 20 or more years). For single and employee-plus one coverage, premiums were higher in establishments with less than 50 percent low-wage workers. Premiums for both types of dependent coverage (employee plus one and family) were higher in multilocation firms.

Premiums in small firms (fewer than 50 employees) for single, employee-plus-one, and family coverage were lower than premiums at large firms (100+ employees) at the lower end of the premium distribution (10th percentile and 25th percentiles). However, they were almost always higher at the upper end of the distribution (75th and 90th percentile). The one exception was that there was no difference in the 75th percentile family premium between small and large firms.

chart and data
Exhibit 3.1 Average total premiums (standard error) per enrolled employee for single, employee-plus-one and family coverage, 2009-2021
Coverage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Single $4,669 $4,940* $5,222* $5,384* $5,571* $5,832* $5,963* $6,101* $6,368* $6,715* $6,972* $7,149* $7,380*
(Standard Error) ($21) ($22) ($26) ($28) ($23) ($25) ($26) ($27) ($28) ($31) ($35) ($35) ($37)
Plus One $9,053 $9,664* $10,329* $10,621* $10,990* $11,503* $11,800* $12,124* $12,789* $13,425* $13,989* $14,191 $14,634*
(Standard Error) ($34) ($60) ($105) ($56) ($54) ($60) ($58) ($60) ($70) ($70) ($83) ($93) ($84)
Family $13,027 $13,871* $15,022* $15,473* $16,029* $16,655* $17,322* $17,710* $18,687* $19,565* $20,486* $20,758 $21,381*
(Standard Error) ($25) ($75) ($98) ($95) ($61) ($79) ($95) ($84) ($105) ($104) ($125) ($124) ($111)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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, 2009-2021
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%)
2021 3.2%* 3.1%* 3.0%*
(Standard Error) ($0.7%) ($0.9%) ($0.8%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: * indicates the estimate is statistically different from zero at p < 0.05.

ALTER EXB3.3
Exhibit 3.3 Average total single premium (standard error) per enrolled employee, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $4,669 $4,940* $5,222* $5,384* $5,571* $5,832* $5,963* $6,101* $6,368* $6,715* $6,972* $7,149* $7,380*
(Standard Error) ($21) ($22) ($26) ($28) ($23) ($25) ($26) ($27) ($28) ($31) ($35) ($35) ($37)
<50 $4,652 $4,956* $5,258* $5,460* $5,628* $5,886* $5,947 $6,070 $6,421* $6,667* $6,920* $7,045 $7,382*
(Standard Error) ($31) ($34) ($39) ($60) ($39) ($55) ($55) ($53) ($61) ($63) ($73) ($70) ($84)
50-99 $4,614 $4,713 $4,861 $5,246* $5,314 $5,549* $5,642 $5,743 $6,163* $6,287 $6,629* $6,870 $7,189
(Standard Error) ($82) ($52) ($75) ($39) ($73) ($82) ($104) ($96) ($121) ($111) ($99) ($129) ($129)
100+ $4,681 $4,959* $5,252* $5,378* $5,584* $5,851* $6,006* $6,146* $6,377* $6,770* $7,019* $7,197* $7,399*
(Standard Error) ($38) ($23) ($31) ($28) ($29) ($30) ($31) ($32) ($33) ($37) ($42) ($41) ($43)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB3.4
Exhibit 3.4 Average total employee-plus-one premium (standard error) per enrolled employee, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $9,053 $9,664* $10,329* $10,621* $10,990* $11,503* $11,800* $12,124* $12,789* $13,425* $13,989* $14,191 $14,634*
(Standard Error) ($34) ($60) ($105) ($56) ($54) ($60) ($58) ($60) ($70) ($70) ($83) ($93) ($84)
<50 $9,124 $9,850* $10,253* $10,524 $11,050* $11,386 $11,666 $11,833 $12,558* $13,044* $13,619 $13,522 $14,326*
(Standard Error) ($119) ($80) ($104) ($121) ($92) ($163) ($158) ($156) ($170) ($176) ($248) ($212) ($262)
50-99 $8,852 $9,166 $9,615* $10,178* $10,673 $10,845 $10,885 $11,389 $11,931 $12,593* $13,248 $13,766 $14,314
(Standard Error) ($148) ($124) ($192) ($185) ($330) ($187) ($198) ($227) ($232) ($236) ($321) ($246) ($295)
100+ $9,058 $9,669* $10,394* $10,672* $11,006* $11,571* $11,892* $12,225* $12,878* $13,537* $14,105* $14,304 $14,703*
(Standard Error) ($34) ($62) ($113) ($70) ($59) ($68) ($66) ($68) ($79) ($79) ($92) ($106) ($93)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB3.5
Exhibit 3.5 Average total family premium (standard error) per enrolled employee, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $13,027 $13,871* $15,022* $15,473* $16,029* $16,655* $17,322* $17,710* $18,687* $19,565* $20,486* $20,758 $21,381*
(Standard Error) ($25) ($75) ($98) ($95) ($61) ($79) ($95) ($84) ($105) ($104) ($125) ($124) ($111)
<50 $12,041 $13,170* $14,086* $14,496 $14,787 $15,575* $15,919 $16,471 $17,649* $18,296* $19,417* $19,416 $20,406*^
(Standard Error) ($129) ($111) ($145) ($181) ($89) ($177) ($212) ($207) ($192) ($231) ($303) ($283) ($320)
50-99 $12,431 $13,019* $14,151* $15,421* $15,376 $15,732 $16,336 $16,214 $17,735* $18,386 $19,893* $19,827 $20,551^
(Standard Error) ($229) ($153) ($168) ($273) ($268) ($274) ($335) ($348) ($327) ($473) ($435) ($422) ($396)
100+ $13,271 $14,074* $15,245* $15,641* $16,284* $16,903* $17,612* $18,000* $18,911* $19,824* $20,697* $20,990 $21,584*
(Standard Error) ($33) ($85) ($117) ($114) ($82) ($91) ($110) ($95) ($122) ($118) ($143) ($139) ($124)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXBExhibit 3.6
Exhibit 3.6 Average total single premium (standard error) per enrolled employee, by State, 3-year average, 2019-2021
Alabama $6,481* Kentucky $6,918* North Dakota $6,998
(Standard Error) ($101) (Standard Error) ($88) (Standard Error) ($86)
Alaska $8,798* Louisiana $6,696* Ohio $7,030
(Standard Error) ($232) (Standard Error) ($98) (Standard Error) ($100)
Arizona $6,559* Maine $7,467* Oklahoma $6,893*
(Standard Error) ($92) (Standard Error) ($93) (Standard Error) ($104)
Arkansas $6,220* Maryland $7,182 Oregon $6,929
(Standard Error) ($104) (Standard Error) ($116) (Standard Error) ($154)
California $7,165 Massachusetts $7,623* Pennsylvania $7,218
(Standard Error) ($87) (Standard Error) ($101) (Standard Error) ($87)
Colorado $6,819* Michigan $6,804* Rhode Island $7,485*
(Standard Error) ($105) (Standard Error) ($116) (Standard Error) ($104)
Connecticut $7,512* Minnesota $7,020 South Carolina $7,091
(Standard Error) ($113) (Standard Error) ($109) (Standard Error) ($99)
Delaware $7,701* Mississippi $6,533* South Dakota $7,133
(Standard Error) ($162) (Standard Error) ($105) (Standard Error) ($80)
District of Columbia $7,684* Missouri $7,007 Tennessee $6,564*
(Standard Error) ($120) (Standard Error) ($107) (Standard Error) ($90)
Florida $7,002 Montana $6,957 Texas $6,992
(Standard Error) ($116) (Standard Error) ($98) (Standard Error) ($74)
Georgia $6,948 Nebraska $7,263 Utah $6,454*
(Standard Error) ($131) (Standard Error) ($100) (Standard Error) ($103)
Hawaii $6,715* Nevada $6,550* Vermont $7,676*
(Standard Error) ($91) (Standard Error) ($122) (Standard Error) ($90)
Idaho $6,549* New Hampshire $7,662* Virginia $6,948
(Standard Error) ($103) (Standard Error) ($103) (Standard Error) ($88)
Illinois $7,244 New Jersey $7,531* Washington $7,232
(Standard Error) ($82) (Standard Error) ($129) (Standard Error) ($119)
Indiana $7,238 New Mexico $7,165 West Virginia $7,287
(Standard Error) ($102) (Standard Error) ($105) (Standard Error) ($125)
Iowa $6,798* New York $8,126* Wisconsin $7,107
(Standard Error) ($95) (Standard Error) ($93) (Standard Error) ($100)
Kansas $6,563* North Carolina $6,922* Wyoming $7,550*
(Standard Error) ($100) (Standard Error) ($85) (Standard Error) ($159)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from national average of $7,103 at p < 0.05. Note that the standard error on the national estimate of $7,103 is $20.08.

ALTER EXB3.7
Exhibit 3.7 Average total employee-plus-one premium (standard error) per enrolled employee, by State, 3-year average, 2019-2021
Alabama $13,199* Kentucky $14,238 North Dakota $13,649*
(Standard Error) ($253) (Standard Error) ($271) (Standard Error) ($189)
Alaska $17,229* Louisiana $13,058* Ohio $13,809
(Standard Error) ($296) (Standard Error) ($215) (Standard Error) ($210)
Arizona $13,306* Maine $14,568* Oklahoma $13,584*
(Standard Error) ($241) (Standard Error) ($193) (Standard Error) ($236)
Arkansas $12,452* Maryland $14,662 Oregon $13,985
(Standard Error) ($199) (Standard Error) ($277) (Standard Error) ($257)
California $14,247 Massachusetts $14,833* Pennsylvania $14,451
(Standard Error) ($233) (Standard Error) ($270) (Standard Error) ($205)
Colorado $14,132 Michigan $14,319 Rhode Island $14,873*
(Standard Error) ($263) (Standard Error) ($326) (Standard Error) ($242)
Connecticut $15,241* Minnesota $14,499 South Carolina $14,306
(Standard Error) ($290) (Standard Error) ($205) (Standard Error) ($228)
Delaware $14,015 Mississippi $13,196* South Dakota $14,316
(Standard Error) ($300) (Standard Error) ($254) (Standard Error) ($213)
District of Columbia $15,252* Missouri $13,766 Tennessee $13,049*
(Standard Error) ($284) (Standard Error) ($225) (Standard Error) ($202)
Florida $13,587* Montana $13,538* Texas $13,952
(Standard Error) ($260) (Standard Error) ($231) (Standard Error) ($164)
Georgia $13,853 Nebraska $14,361 Utah $13,007*
(Standard Error) ($287) (Standard Error) ($224) (Standard Error) ($237)
Hawaii $13,207* Nevada $12,924* Vermont $15,585*
(Standard Error) ($297) (Standard Error) ($254) (Standard Error) ($209)
Idaho $12,238* New Hampshire $15,732* Virginia $13,342*
(Standard Error) ($263) (Standard Error) ($274) (Standard Error) ($228)
Illinois $14,394 New Jersey $15,426* Washington $13,877
(Standard Error) ($190) (Standard Error) ($251) (Standard Error) ($252)
Indiana $14,384 New Mexico $13,714 West Virginia $15,331*
(Standard Error) ($217) (Standard Error) ($265) (Standard Error) ($272)
Iowa $13,073* New York $15,957* Wisconsin $14,596*
(Standard Error) ($196) (Standard Error) ($252) (Standard Error) ($202)
Kansas $13,274* North Carolina $13,613* Wyoming $14,888
(Standard Error) ($210) (Standard Error) ($229) (Standard Error) ($377)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from national average of $14,145 at p < 0.05. Note that the standard error on the national estimate of $14,145 is $49.04.

ALTER EXB3.8
Exhibit 3.8 Average total family premium (standard error) per enrolled employee, by State, 3-year average, 2019-2021
Alabama $18,071* Kentucky $20,669 North Dakota $19,527*
(Standard Error) ($288) (Standard Error) ($345) (Standard Error) ($224)
Alaska $22,563* Louisiana $18,918* Ohio $20,079
(Standard Error) ($436) (Standard Error) ($347) (Standard Error) ($351)
Arizona $19,800* Maine $20,832 Oklahoma $19,726*
(Standard Error) ($390) (Standard Error) ($216) (Standard Error) ($301)
Arkansas $17,570* Maryland $20,591 Oregon $19,998*
(Standard Error) ($314) (Standard Error) ($378) (Standard Error) ($298)
California $21,065 Massachusetts $21,659* Pennsylvania $20,503
(Standard Error) ($315) (Standard Error) ($300) (Standard Error) ($300)
Colorado $20,622 Michigan $19,983 Rhode Island $21,228
(Standard Error) ($298) (Standard Error) ($441) (Standard Error) ($302)
Connecticut $22,246* Minnesota $20,724 South Carolina $20,357
(Standard Error) ($362) (Standard Error) ($338) (Standard Error) ($477)
Delaware $21,233 Mississippi $18,955* South Dakota $20,436
(Standard Error) ($433) (Standard Error) ($366) (Standard Error) ($271)
District of Columbia $22,879* Missouri $20,768 Tennessee $18,756*
(Standard Error) ($335) (Standard Error) ($352) (Standard Error) ($253)
Florida $20,721 Montana $20,017* Texas $20,886
(Standard Error) ($416) (Standard Error) ($321) (Standard Error) ($252)
Georgia $20,428 Nebraska $20,323 Utah $19,161*
(Standard Error) ($373) (Standard Error) ($323) (Standard Error) ($257)
Hawaii $18,876* Nevada $19,261* Vermont $22,170*
(Standard Error) ($366) (Standard Error) ($359) (Standard Error) ($310)
Idaho $19,886* New Hampshire $22,375* Virginia $20,392
(Standard Error) ($336) (Standard Error) ($336) (Standard Error) ($308)
Illinois $20,924 New Jersey $22,182* Washington $20,200
(Standard Error) ($292) (Standard Error) ($505) (Standard Error) ($385)
Indiana $20,681 New Mexico $19,346* West Virginia $21,788*
(Standard Error) ($443) (Standard Error) ($427) (Standard Error) ($424)
Iowa $19,220* New York $23,044* Wisconsin $20,822
(Standard Error) ($313) (Standard Error) ($300) (Standard Error) ($271)
Kansas $19,284* North Carolina $20,665 Wyoming $21,083
(Standard Error) ($301) (Standard Error) ($286) (Standard Error) ($385)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from national average of $20,691 at p < 0.05. Note that the standard error on the national estimate of $20,691 is $68.57.

ALTER EXB3.9
Exhibit 3.9 Average total single premium (standard error) per enrolled employee, overall and by industry, 2021
Industry Amount
United States $7,380
(Standard Error) ($37)
Agriculture, fisheries, forestry $6,996*
(Standard Error) ($237)
Mining and manufacturing $7,141*
(Standard Error) ($82)
Construction $6,546*
(Standard Error) ($136)
Utilities and transportation $7,036*
(Standard Error) ($126)
Wholesale trade $7,439
(Standard Error) ($267)
Financial services and real estate $7,666
(Standard Error) ($81)
Retail trade $6,823*
(Standard Error) ($124)
Professional services $7,896*
(Standard Error) ($63)
Other services $7,131*
(Standard Error) ($79)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.

ALTER EXB3.10
Exhibit 3.10 Average total employee-plus-one premium (standard error) per enrolled employee, overall and by industry, 2021
Industry Amount
United States $14,634
(Standard Error) ($84)
Agriculture, fisheries, forestry $12,854*
(Standard Error) ($781)
Mining and manufacturing $14,228*
(Standard Error) ($178)
Construction $13,549*
(Standard Error) ($560)
Utilities and transportation $14,844
(Standard Error) ($326)
Wholesale trade $14,360*
(Standard Error) ($452)
Financial services and real estate $15,351
(Standard Error) ($198)
Retail trade $13,457*
(Standard Error) ($153)
Professional services $15,336
(Standard Error) ($160)
Other services $13,796*
(Standard Error) ($192)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.

ALTER EXB3.11
Exhibit 3.11 Average total family premium (standard error) per enrolled employee, overall and by industry, 2021
Industry Amount
United States $21,381
(Standard Error) ($111)
Agriculture, fisheries, forestry $16,151*
(Standard Error) ($1938)
Mining and manufacturing $20,789*
(Standard Error) ($219)
Construction $19,167*
(Standard Error) ($580)
Utilities and transportation $21,547
(Standard Error) ($394)
Wholesale trade $21,064
(Standard Error) ($542)
Financial services and real estate $22,102
(Standard Error) ($293)
Retail trade $20,046*
(Standard Error) ($242)
Professional services $22,386
(Standard Error) ($196)
Other services $20,779*
(Standard Error) ($331)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.

ALTER EXB3.12
Exhibit 3.12 Average total single premium (standard error) per enrolled employee, overall and by selected characteristics, 2021
Employer Characteristics Amount
United States $7,380
(Standard Error) ($37)
Ownership: For Profit Inc. $7,166*
(Standard Error) ($45)
Ownership: For Profit Uninc. $7,095*
(Standard Error) ($74)
Ownership: Nonprofit $8,436
(Standard Error) ($81)
Firm Age: 0-4 Years $6,484*
(Standard Error) ($189)
Firm Age: 5-9 Years $6,949*
(Standard Error) ($169)
Firm Age: 10-19 Years $7,023*
(Standard Error) ($99)
Firm Age: 20+ Years $7,480
(Standard Error) ($41)
# of Locations: 1 Location $7,299
(Standard Error) ($70)
# of Locations: 2+ Locations $7,415
(Standard Error) ($43)
% Full Time: 0-24% $6,798*
(Standard Error) ($255)
% Full Time: 25-49% $7,081*
(Standard Error) ($100)
% Full Time: 50-74% $7,607*
(Standard Error) ($112)
% Full Time: 75%+ $7,370
(Standard Error) ($41)
% Low Wage: 50%+ $7,072*
(Standard Error) ($108)
% Low Wage: <50% $7,410
(Standard Error) ($39)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.

ALTER EXB3.13
Exhibit 3.13 Average total employee-plus-one premium (standard error) per enrolled employee, overall and by selected characteristics, 2021
Employer Characteristics Amount
United States $14,634
(Standard Error) ($84)
Ownership: For Profit Inc. $14,300*
(Standard Error) ($99)
Ownership: For Profit Uninc. $14,262*
(Standard Error) ($213)
Ownership: Nonprofit $16,200
(Standard Error) ($196)
Firm Age: 0-4 Years $12,815*
(Standard Error) ($643)
Firm Age: 5-9 Years $13,311*
(Standard Error) ($424)
Firm Age: 10-19 Years $14,096*
(Standard Error) ($222)
Firm Age: 20+ Years $14,793
(Standard Error) ($93)
# of Locations: 1 Location $14,274*
(Standard Error) ($183)
# of Locations: 2+ Locations $14,745
(Standard Error) ($95)
% Full Time: 0-24% $13,485*
(Standard Error) ($442)
% Full Time: 25-49% $14,380
(Standard Error) ($310)
% Full Time: 50-74% $14,731
(Standard Error) ($282)
% Full Time: 75%+ $14,640
(Standard Error) ($92)
% Low Wage: 50%+ $13,607*
(Standard Error) ($247)
% Low Wage: <50% $14,705
(Standard Error) ($88)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.

ALTER EXB3.14
Exhibit 3.14 Average total family premium (standard error) per enrolled employee, overall and by selected characteristics, 2021
Employer Characteristics Amount
United States $21,381
(Standard Error) ($111)
Ownership: For Profit Inc. $21,003*
(Standard Error) ($133)
Ownership: For Profit Uninc. $20,831*
(Standard Error) ($280)
Ownership: Nonprofit $23,336
(Standard Error) ($264)
Firm Age: 0-4 Years $19,491*
(Standard Error) ($839)
Firm Age: 5-9 Years $19,019*
(Standard Error) ($710)
Firm Age: 10-19 Years $20,032*
(Standard Error) ($325)
Firm Age: 20+ Years $21,662
(Standard Error) ($120)
# of Locations: 1 Location $20,460*
(Standard Error) ($252)
# of Locations: 2+ Locations $21,665
(Standard Error) ($123)
% Full Time: 0-24% $21,417
(Standard Error) ($984)
% Full Time: 25-49% $20,343
(Standard Error) ($887)
% Full Time: 50-74% $21,678
(Standard Error) ($344)
% Full Time: 75%+ $21,382
(Standard Error) ($119)
% Low Wage: 50%+ $20,598
(Standard Error) ($531)
% Low Wage: <50% $21,420
(Standard Error) ($114)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.

Exhibit 3.15 Premium distributions (standard error) for employees enrolled in single, employee-plus-one, and family coverage, overall and by firm size, 2021
Coverage Estimate Total <50 employees 50-99
employees
100
or more employees
Single Average (mean) $7,380 $7,382 $7,189 $7,399
(Standard Error) ($37) ($84) ($129) ($43)
10 percentile $4,700 $4,200* $4,300* $4,800
(Standard Error) ($52) ($94) ($160) ($42)
25 percentile $5,900 $5,300* $5,400* $6,000
(Standard Error) ($28) ($76) ($126) ($18)
50 percentile (median) $7,100 $6,900 $6,900 $7,100
(Standard Error) ($31) ($121) ($136) ($33)
75 percentile $8,600 $9,000* $8,600 $8,500
(Standard Error) ($56) ($160) ($196) ($59)
90 percentile $10,000 $11,000* $10,000 $10,000
(Standard Error) ($91) ($274) ($211) ($102)
Employee-plus-one Average (mean) $14,634 $14,326 $14,314 $14,703
(Standard Error) ($84) ($262) ($295) ($93)
10 percentile $9,100 $7,200* $8,400* $9,600
(Standard Error) ($144) ($371) ($505) ($102)
25 percentile $12,000 $10,000* $11,000* $12,000
(Standard Error) ($114) ($294) ($347) ($144)
50 percentile (median) $14,000 $13,000* $14,000 $14,000
(Standard Error) ($79) ($318) ($385) ($100)
75 percentile $17,000 $18,000* $18,000* $17,000
(Standard Error) ($89) ($298) ($414) ($109)
90 percentile $21,000 $22,000* $21,000 $20,000
(Standard Error) ($194) ($368) ($796) ($266)
Family Average (mean) $21,381 $20,406* $20,551* $21,584
(Standard Error) ($111) ($320) ($396) ($124)
10 percentile $14,000 $11,000* $13,000 $14,000
(Standard Error) ($207) ($594) ($778) ($332)
25 percentile $17,000 $15,000* $16,000* $18,000
(Standard Error) ($147) ($384) ($523) ($158)
50 percentile (median) $21,000 $20,000* $20,000 $21,000
(Standard Error) ($84) ($304) ($616) ($120)
75 percentile $25,000 $25,000 $24,000* $25,000
(Standard Error) ($128) ($443) ($422) ($142)
90 percentile $29,000 $30,000* $29,000 $29,000
(Standard Error) ($236) ($407) ($877) ($247)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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

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 2009 to 2021 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 2021.

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 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 2021, enrolled employees paid on average 22.3 percent of total premiums for single coverage, 28.7 percent for employee-plus-one coverage, and 28.9 percent for family coverage. Compared with employee shares in 2020, the share for single coverage was higher, and the shares for employee-plus-one coverage and family coverage were not significantly different (Exhibit 4.1).
  • In 2021, average employee and employer contributions for single coverage were $1,643 and $5,737, representing increases of 7.2 percent and 2.1 percent, respectively, over the 2020 levels (Exhibit 4.3).
  • Average employee contributions in 2021 for employee-plus-one ($4,199) and family ($6,174) coverage were not significantly different from their 2020 levels. Average employer contributions in 2021 for these types of dependent coverage were $10,435 and $15,207 representing increases of 2.7 percent and 2.9 percent, respectively, over the 2020 levels (Exhibits 4.4 and 4.5).
  • Average annual employee premium contributions, based on pooled 2019-2021 data, vary widely by State. These contributions ranged from $840 in Hawaii to $1,778 in Connecticut for single coverage; from $3,232 in Michigan to $4,659 in Louisiana for employee-plus-one coverage; and from $4,124 in Michigan to $6,968 in Florida for family coverage (Exhibits 4.15, 4.16, and 4.17).
  • In 2021, the distribution of employee premium contributions showed substantial variation for all three coverage types. Enrolled employees at the 90th percentile of the distribution paid much larger amounts than those at the 10th percentile for single ($3,300 vs. $0), employee-plus-one ($8,200 vs. $760), and family coverage ($13,000 vs. $920) (Exhibit 4.27).

Key Trends and Differences

Variation in employee premium contributions in 2021 exhibited a number of patterns broadly consistent with those seen in previous years:

  • First, in 2021, the employee share of premiums for single, employee-plus-one, and family coverage was lower at nonprofit establishments and establishments where less than 50 percent of the workforce was low wage than at other employers.
  • Second, employee premium contributions showed substantial variation within and across firm size categories. 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 tended to fall as firm size increased.
  • Third, 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 occurred because employee contributions at the top end of the distribution tended to be higher in smaller firms. For example, at the 90th percentile, the employee contribution for family coverage was $16,000 at small firms, $16,000 at medium firms, and $11,000 at large firms.
  • Finally, as in previous years, average annual employee contributions for 2019-2021 showed regional variation that was not always consistent across coverage types.
    • For this 3-year period, seven of the nine States in the Northeast Census region had average annual employee contributions (in dollars) that were higher than the national average for single coverage. However, no Northeastern State had higher than average employee contributions for dependent coverage.
    • Also, for this 3-year period, 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. Employee contributions tended to be lower than or not significantly different from the national average in the West.
ALTER EXB4.1
Exhibit 4.1 Average percentage (standard error) of premium contributed by employees for single, employee-plus-one, and family coverage, 2009-2021
Coverage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Single 20.5% 20.7% 20.9% 20.8% 21.0% 21.2% 21.1% 21.7%* 22.2% 21.3%* 21.4% 21.4% 22.3%*
(Standard Error) (0.3%) (0.2%) (0.2%) (0.3%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.3%) (0.2%) (0.2%)
Plus One 26.1% 25.8% 26.5% 26.6% 26.7% 26.9% 27.3% 27.8% 27.6% 27.1% 27.7% 28.4% 28.7%
(Standard Error) (0.3%) (0.3%) (0.3%) (0.4%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%)
Family 26.7% 26.8% 26.4% 27.4%* 27.6% 27.1% 27.2% 28.0% 27.9% 27.8% 28.0% 28.8% 28.9%
(Standard Error) (0.3%) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

ALTER EXB4.2
Exhibit 4.2 Average annual employee contribution (in dollars) (standard error) for single, employee-plus-one, and family coverage, 2009-2021
Coverage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Single $957 $1,021* $1,090* $1,118 $1,170* $1,234* $1,255 $1,325* $1,415* $1,427 $1,489* $1,532 $1,643*
(Standard Error) ($13) ($14) ($9) ($14) ($16) ($13) ($14) ($13) ($15) ($14) ($18) ($16) ($19)
Plus One $2,363 $2,498* $2,736* $2,824 $2,940* $3,097* $3,220* $3,376* $3,531* $3,634 $3,881* $4,035* $4,199*
(Standard Error) ($27) ($42) ($36) ($46) ($23) ($40) ($35) ($36) ($39) ($39) ($54) ($52) ($64)
Family $3,474 $3,721* $3,962* $4,236* $4,421* $4,518 $4,710* $4,956* $5,218* $5,431* $5,726* $5,978* $6,174
(Standard Error) ($44) ($53) ($42) ($69) ($50) ($48) ($56) ($56) ($64) ($63) ($82) ($76) ($87)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

ALTER EXB4.3
Exhibit 4.3 Average annual employee contribution, employer contribution, and total premium (standard error) for single coverage, 2009-2021
Type of Premium 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Total Premium $4,669 $4,940 $5,222 $5,384 $5,571 $5,832 $5,963 $6,101 $6,368 $6,715 $6,972 $7,149 $7,380
(Standard Error) ($21) ($22) ($26) ($28) ($23) ($25) ($26) ($27) ($28) ($31) ($35) ($35) ($37)
Employer Contribution $3,713 $3,918 $4,132 $4,267 $4,401 $4,598 $4,708 $4,776 $4,953 $5,288 $5,483 $5,617 $5,737
(Standard Error) ($25) ($19) ($25) ($28) ($21) ($25) ($26) ($26) ($29) ($31) ($36) ($35) ($36)
Employee Contribution $957 $1,021 $1,090 $1,118 $1,170 $1,234 $1,255 $1,325 $1,415 $1,427 $1,489 $1,532 $1,643
(Standard Error) ($13) ($14) ($9) ($14) ($16) ($13) ($14) ($13) ($15) ($14) ($18) ($16) ($19)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: The sum of employee and employer contributions may not exactly equal the total premium due to rounding.

ALTER EXB4.4
Exhibit 4.4 Average annual employee contribution, employer contribution, and total premium (standard error) for employee-plus-one coverage, 2009-2021
Type of Premium 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Total Premium $9,053 $9,664 $10,329 $10,621 $10,990 $11,503 $11,800 $12,124 $12,789 $13,425 $13,989 $14,191 $14,634
(Standard Error) ($34) ($60) ($105) ($56) ($54) ($60) ($58) ($60) ($70) ($70) ($83) ($93) ($84)
Employer Contribution $6,690 $7,167 $7,593 $7,797 $8,050 $8,406 $8,579 $8,748 $9,258 $9,791 $10,108 $10,156 $10,435
(Standard Error) ($44) ($40) ($95) ($45) ($55) ($65) ($57) ($61) ($75) ($70) ($93) ($99) ($79)
Employee Contribution $2,363 $2,498 $2,736 $2,824 $2,940 $3,097 $3,220 $3,376 $3,531 $3,634 $3,881 $4,035 $4,199
(Standard Error) ($27) ($42) ($36) ($46) ($23) ($40) ($35) ($36) ($39) ($39) ($54) ($52) ($64)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: The sum of employee and employer contributions may not exactly equal the total premium due to rounding.

ALTER EXB4.5
Exhibit 4.5 Average annual employee contribution, employer contribution, and total premium (standard error) for family coverage, 2009-2021
Type of Premium 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
Total Premium $13,027 $13,871 $15,022 $15,473 $16,029 $16,655 $17,322 $17,710 $18,687 $19,565 $20,486 $20,758 $21,381
(Standard Error) ($25) ($75) ($98) ($95) ($61) ($79) ($95) ($84) ($105) ($104) ($125) ($124) ($111)
Employer Contribution $9,553 $10,150 $11,060 $11,238 $11,608 $12,137 $12,612 $12,754 $13,469 $14,134 $14,760 $14,781 $15,207
(Standard Error) ($48) ($94) ($98) ($74) ($48) ($82) ($94) ($90) ($113) ($110) ($132) ($139) ($116)
Employee Contribution $3,474 $3,721 $3,962 $4,236 $4,421 $4,518 $4,710 $4,956 $5,218 $5,431 $5,726 $5,978 $6,174
(Standard Error) ($44) ($53) ($42) ($69) ($50) ($48) ($56) ($56) ($64) ($63) ($82) ($76) ($87)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: The sum of employee and employer contributions may not exactly equal the total premium due to rounding.

ALTER EXB4.6
Exhibit 4.6 Average percentage (standard error) of premium contributed by employees for single coverage by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 20.5% 20.7% 20.9% 20.8% 21.0% 21.2% 21.1% 21.7%* 22.2% 21.3%* 21.4% 21.4% 22.3%*
(Standard Error) (0.3%) (0.2%) (0.2%) (0.3%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.3%) (0.2%) (0.2%)
<50 17.9% 18.3% 18.3% 17.9% 18.6% 17.6% 17.9% 20.0%* 20.0% 20.3% 21.0% 20.9% 22.4%
(Standard Error) (0.3%) (0.6%) (0.4%) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%) (0.6%) (0.6%) (0.6%) (0.7%)
50-99 19.4% 22.0% 22.7% 20.9% 21.5% 22.0% 21.8% 24.3% 21.9% 24.4%* 23.6% 22.9% 24.9%^
(Standard Error) (1.3%) (0.8%) (1.2%) (0.7%) (1.0%) (1.0%) (1.1%) (1.0%) (0.9%) (0.9%) (1.0%) (0.9%) (1.1%)
100+ 21.4% 21.3% 21.5% 21.6% 21.7% 22.0% 21.8% 21.9% 22.8%* 21.2%* 21.2% 21.4% 22.0%
(Standard Error) (0.4%) (0.4%) (0.2%) (0.3%) (0.2%) (0.2%) (0.3%) (0.2%) (0.3%) (0.2%) (0.3%) (0.3%) (0.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB4.7
Exhibit 4.7 Average annual employee contribution (in dollars) (standard error) for single coverage, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $957 $1,021* $1,090* $1,118 $1,170* $1,234* $1,255 $1,325* $1,415* $1,427 $1,489* $1,532 $1,643*
(Standard Error) ($13) ($14) ($9) ($14) ($16) ($13) ($14) ($13) ($15) ($14) ($18) ($16) ($19)
<50 $834 $907* $960 $979 $1,045 $1,035 $1,065 $1,216* $1,287 $1,351 $1,454 $1,469 $1,650*
(Standard Error) ($12) ($29) ($22) ($20) ($27) ($30) ($29) ($32) ($34) ($39) ($43) ($43) ($47)
50-99 $896 $1,035* $1,101 $1,096 $1,145 $1,220 $1,230 $1,393 $1,349 $1,534* $1,561 $1,571 $1,793*
(Standard Error) ($57) ($34) ($64) ($37) ($59) ($57) ($65) ($60) ($50) ($51) ($69) ($60) ($89)
100+ $1,000 $1,054* $1,127* $1,159 $1,209* $1,287* $1,307 $1,343 $1,451* $1,433 $1,490* $1,540 $1,627*
(Standard Error) ($16) ($20) ($9) ($16) ($13) ($15) ($17) ($15) ($18) ($16) ($21) ($18) ($21)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB4.8
Exhibit 4.8 Average percentage (standard error) of premium contributed by employees for employee-plus-one coverage, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 26.1% 25.8% 26.5% 26.6% 26.7% 26.9% 27.3% 27.8% 27.6% 27.1% 27.7% 28.4% 28.7%
(Standard Error) (0.3%) (0.3%) (0.3%) (0.4%) (0.2%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%)
<50 29.0% 28.8% 28.7% 28.5% 28.2% 28.8% 29.6% 29.4% 29.9% 30.8% 31.2% 32.5% 34.8%^
(Standard Error) (1.0%) (0.8%) (0.8%) (0.9%) (1.0%) (0.8%) (0.9%) (0.9%) (1.0%) (0.9%) (1.2%) (1.2%) (1.7%)
50-99 32.8% 33.3% 33.2% 33.3% 34.0% 33.4% 34.6% 35.8% 36.5% 37.6% 39.0% 38.8% 38.6%^
(Standard Error) (0.9%) (1.5%) (0.7%) (0.8%) (1.0%) (1.4%) (1.5%) (1.3%) (1.3%) (1.3%) (2.2%) (1.3%) (1.3%)
100+ 25.1% 24.8% 25.7% 25.8% 26.0% 26.2% 26.4% 27.0% 26.7% 25.9% 26.4% 27.3% 27.1%
(Standard Error) (0.4%) (0.4%) (0.4%) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB4.9
Exhibit 4.9 Average annual employee contribution (in dollars) (standard error) for employee-plus-one coverage, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $2,363 $2,498* $2,736* $2,824 $2,940* $3,097* $3,220* $3,376* $3,531* $3,634 $3,881* $4,035* $4,199*
(Standard Error) ($27) ($42) ($36) ($46) ($23) ($40) ($35) ($36) ($39) ($39) ($54) ($52) ($64)
<50 $2,648 $2,836 $2,942 $3,004 $3,117 $3,275 $3,454 $3,479 $3,760 $4,017 $4,244 $4,398 $4,984^
(Standard Error) ($114) ($84) ($84) ($87) ($107) ($95) ($101) ($101) ($130) ($120) ($149) ($171) ($288)
50-99 $2,901 $3,056 $3,189 $3,389 $3,630* $3,619 $3,765 $4,077 $4,358 $4,732 $5,163 $5,337 $5,526^
(Standard Error) ($55) ($121) ($68) ($87) ($86) ($140) ($174) ($131) ($176) ($161) ($353) ($196) ($224)
100+ $2,270 $2,398* $2,670* $2,751 $2,862 $3,031* $3,144 $3,307* $3,445* $3,504 $3,723* $3,903* $3,986
(Standard Error) ($35) ($46) ($48) ($49) ($30) ($46) ($37) ($40) ($41) ($43) ($55) ($56) ($62)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB4.10
Exhibit 4.10 Average percentage of premium contributed (standard error) by employees for family coverage, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 26.7% 26.8% 26.4% 27.4%* 27.6% 27.1% 27.2% 28.0% 27.9% 27.8% 28.0% 28.8% 28.9%
(Standard Error) (0.3%) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%)
<50 30.1% 31.3% 29.4% 30.1% 28.6% 28.4% 28.8% 27.4% 30.7%* 32.0% 32.7% 34.6% 34.1%^
(Standard Error) (0.6%) (0.4%) (0.9%) (0.9%) (1.0%) (0.8%) (1.0%) (0.9%) (1.1%) (1.1%) (1.1%) (1.3%) (1.4%)
50-99 33.0% 34.2% 33.0% 31.6% 34.9%* 33.1% 33.7% 35.9% 32.4% 37.9%* 38.3% 36.6% 38.9%^
(Standard Error) (1.0%) (1.7%) (1.3%) (0.8%) (1.3%) (1.3%) (1.6%) (1.8%) (1.7%) (1.9%) (1.8%) (2.6%) (1.8%)
100+ 25.6% 25.5% 25.5% 26.7%* 26.9% 26.5% 26.5% 27.6%* 27.3% 26.6% 26.6% 27.6% 27.5%
(Standard Error) (0.4%) (0.5%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB4.11
Exhibit 4.11 Average annual employee contribution (in dollars) (standard error) for family coverage, by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $3,474 $3,721* $3,962* $4,236* $4,421* $4,518 $4,710* $4,956* $5,218* $5,431* $5,726* $5,978* $6,174
(Standard Error) ($44) ($53) ($42) ($69) ($50) ($48) ($56) ($56) ($64) ($63) ($82) ($76) ($87)
<50 $3,630 $4,117* $4,144 $4,366 $4,228 $4,426 $4,587 $4,510 $5,413* $5,854 $6,341 $6,714 $6,967^
(Standard Error) ($60) ($63) ($148) ($135) ($155) ($122) ($156) ($146) ($188) ($188) ($209) ($271) ($283)
50-99 $4,102 $4,455 $4,669 $4,866 $5,360* $5,206 $5,502 $5,821 $5,738 $6,973* $7,623 $7,261 $7,997^
(Standard Error) ($128) ($196) ($143) ($150) ($201) ($220) ($255) ($330) ($317) ($336) ($354) ($477) ($384)
100+ $3,393 $3,588* $3,882* $4,169* $4,387* $4,483 $4,671* $4,971* $5,154* $5,277 $5,497 $5,804* $5,937
(Standard Error) ($58) ($60) ($62) ($77) ($53) ($54) ($62) ($62) ($70) ($68) ($91) ($79) ($93)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB4.12
Exhibit 4.12 Percentage (standard error) of single-coverage enrollees with no employee premium contribution, overall and by detailed firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 20.6% 18.3%* 17.3% 17.1% 16.6% 15.6% 15.8% 13.5%* 13.4% 13.2% 13.5% 12.5% 12.6%
(Standard Error) (0.5%) (0.7%) (0.6%) (0.6%) (0.6%) (0.4%) (0.5%) (0.5%) (0.4%) (0.4%) (0.6%) (0.4%) (0.5%)
<10 61.4% 58.8% 58.6% 60.0% 59.9% 60.6% 60.5% 57.9% 52.3%* 51.8% 52.0% 51.8% 44.7%^
(Standard Error) (1.2%) (1.6%) (1.1%) (1.6%) (2.0%) (1.6%) (1.8%) (1.9%) (2.0%) (2.0%) (2.4%) (2.8%) (2.7%)
10-24 45.4% 43.3% 38.9% 43.5%* 41.2% 43.5% 44.2% 36.9%* 38.2% 39.2% 31.7%* 37.5%* 32.7%^
(Standard Error) (1.4%) (1.8%) (1.5%) (1.4%) (1.3%) (1.9%) (1.9%) (1.8%) (2.1%) (2.0%) (2.0%) (2.0%) (2.2%)
25-99 33.1% 29.2% 30.6% 27.7% 27.6% 27.2% 27.5% 22.9%* 23.1% 20.8% 22.8% 23.2% 21.5%^
(Standard Error) (1.6%) (1.8%) (1.7%) (1.4%) (1.3%) (1.4%) (1.6%) (1.2%) (1.3%) (1.2%) (1.3%) (1.4%) (1.4%)
100-999 17.7% 16.7% 15.2% 16.5% 14.4% 14.9% 13.9% 13.4% 14.3% 12.6% 13.0% † 12.1% 13.0%^
(Standard Error) (1.0%) (1.3%) (1.4%) (1.0%) (0.8%) (1.2%) (1.1%) (1.3%) (1.2%) (1.0%) (1.2%) (1.0%) (1.4%)
1,000+ 8.9% 6.5%* 5.7% 5.3% 5.2% 3.7% 4.9%* 4.1% 3.9% 4.9% 5.7% 4.9% 5.4%
(Standard Error) (0.7%) (0.8%) (0.7%) (0.4%) (0.8%) (0.4%) (0.4%) (0.5%) (0.4%) (0.4%) (1.0%) (0.5%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 10.3% 9.8% 7.9% 7.7% 6.9% 7.8% 7.6% 7.4% 7.3% 7.1% 8.5%* 7.2% 7.0%
(Standard Error) (0.7%) (0.9%) (0.5%) (0.3%) (0.4%) (0.4%) (0.5%) (0.5%) (0.4%) (0.4%) (0.6%) (0.4%) (0.5%)
<10 47.9% 50.1% 46.6% 54.7%* 49.0% 48.3% 48.3% 48.2% 49.7% 49.9% 48.2% 42.4% 36.9%^
(Standard Error) (1.7%) (2.0%) (2.3%) (2.1%) (3.3%) (2.7%) (3.1%) (3.2%) (3.4%) (3.3%) (3.9%) (4.1%) (4.0%)
10-24 28.8% 25.3% 29.1% 24.0% 24.5% 24.3% 23.1% 21.8% 22.4% 18.9% 19.1% 23.6% 23.3%^
(Standard Error) (1.4%) (2.4%) (1.9%) (2.8%) (3.0%) (2.2%) (2.3%) (2.1%) (2.6%) (2.1%) (2.7%) (2.6%) (3.1%)
25-99 12.3% 12.4% 12.8% 10.9% 10.0% 12.1% 13.9% 10.1%* 11.2% 9.8% 7.5% 9.9% 8.0%^
(Standard Error) (1.5%) (1.3%) (1.0%) (0.7%) (0.7%) (1.5%) (1.5%) (1.1%) (1.5%) (1.2%) (1.0%) (1.2%) (1.1%)
100-999 8.3% 6.8% 5.9% 5.0% 5.6% 5.8% 4.9% 5.0% 5.5% 5.4% 6.0% 6.1% 8.2%^
(Standard Error) (1.5%) (0.9%) (1.0%) (1.0%) (0.6%) (1.1%) (0.7%) (1.0%) (0.8%) (0.8%) (1.1%) (1.1%) (1.6%)
1,000+ 6.6% 6.2% 3.7% 3.7% 3.3% 4.4% 4.3% 4.6% 4.3% 4.2% 6.2%* 4.7% 3.7%
(Standard Error) (0.9%) (1.2%) (0.7%) (0.5%) (0.4%) (0.5%) (0.6%) (0.7%) (0.5%) (0.4%) (0.7%) (0.5%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB4.14
Exhibit 4.14 Percentage (standard error) of family-coverage enrollees with no employee premium contribution, overall and by detailed firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 11.4% 10.4% 9.7% 8.1%* 7.9% 9.2% 8.9% 8.3% 8.8% 7.7% 7.7% 7.0% 7.3%
(Standard Error) (0.7%) (0.5%) (0.5%) (0.4%) (0.6%) (0.5%) (0.5%) (0.5%) (0.6%) (0.5%) (0.7%) (0.6%) (0.5%)
<10 54.2% 51.4% 53.2% 50.9% 53.0% 53.6% 54.4% 52.9% 52.0% 50.2% 48.7% 47.5% 46.3%^
(Standard Error) (1.4%) (0.9%) (1.3%) (2.7%) (3.5%) (2.2%) (2.6%) (2.7%) (2.8%) (3.2%) (3.4%) (4.1%) (4.2%)
10-24 31.0% 29.2% 29.8% 29.6% 28.2% 27.4% 29.5% 35.8% 27.3%* 26.4% 22.1% 25.8% 21.8%^
(Standard Error) (1.5%) (1.6%) (1.4%) (2.8%) (2.6%) (2.2%) (2.6%) (2.9%) (2.6%) (2.5%) (2.4%) (2.6%) (2.9%)
25-99 15.1% 15.3% 16.9% 13.4% 17.0% 17.7% 17.9% 18.6% 19.5% 13.9%* 10.0% 16.2%* 12.6%^
(Standard Error) (1.9%) (1.9%) (1.8%) (1.0%) (1.7%) (2.0%) (2.0%) (2.3%) (2.3%) (1.7%) (1.2%) (2.9%) (1.8%)
100-999 9.1% 7.6% 9.6% 6.3% 7.0% 9.6% 8.7% 5.8% 8.7% 7.6% 5.9% 7.5% 8.4%^
(Standard Error) (1.6%) (1.2%) (1.6%) (0.9%) (1.4%) (1.3%) (1.5%) (0.9%) (1.7%) (1.2%) (1.8%) (1.5%) (1.7%)
1,000+ 5.9% 5.1% 4.0% 3.3% 2.0%* 3.4%* 3.3% 2.7% 3.1% 2.9% 4.4% 2.6% 3.0%
(Standard Error) (0.7%) (0.9%) (0.7%) (0.5%) (0.3%) (0.6%) (0.5%) (0.6%) (0.6%) (0.5%) (0.8%) (0.6%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

Graphics Replay
Exhibit 4.15 Average annual employee contribution (in dollars) (standard error) for single coverage, by State, 3-year average, 2019-2021
Alabama $1,594 Kentucky $1,638 North Dakota $1,364*
(Standard Error) ($49) (Standard Error) ($49) (Standard Error) ($47)
Alaska $1,475 Louisiana $1,726* Ohio $1,587
(Standard Error) ($77) (Standard Error) ($63) (Standard Error) ($44)
Arizona $1,553 Maine $1,500 Oklahoma $1,444
(Standard Error) ($57) (Standard Error) ($44) (Standard Error) ($53)
Arkansas $1,505 Maryland $1,659* Oregon $1,078*
(Standard Error) ($51) (Standard Error) ($55) (Standard Error) ($74)
California $1,380* Massachusetts $1,759* Pennsylvania $1,495
(Standard Error) ($47) (Standard Error) ($56) (Standard Error) ($49)
Colorado $1,559 Michigan $1,456 Rhode Island $1,701*
(Standard Error) ($67) (Standard Error) ($44) (Standard Error) ($51)
Connecticut $1,778* Minnesota $1,467 South Carolina $1,598
(Standard Error) ($72) (Standard Error) ($39) (Standard Error) ($68)
Delaware $1,742* Mississippi $1,552 South Dakota $1,576
(Standard Error) ($62) (Standard Error) ($67) (Standard Error) ($47)
District of Columbia $1,482 Missouri $1,575 Tennessee $1,594
(Standard Error) ($54) (Standard Error) ($56) (Standard Error) ($46)
Florida $1,657* Montana $1,188* Texas $1,513
(Standard Error) ($54) (Standard Error) ($50) (Standard Error) ($32)
Georgia $1,550 Nebraska $1,730* Utah $1,455
(Standard Error) ($58) (Standard Error) ($59) (Standard Error) ($50)
Hawaii $840* Nevada $1,483 Vermont $1,678*
(Standard Error) ($47) (Standard Error) ($61) (Standard Error) ($44)
Idaho $1,176* New Hampshire $1,727* Virginia $1,664*
(Standard Error) ($55) (Standard Error) ($51) (Standard Error) ($59)
Illinois $1,667* New Jersey $1,717* Washington $1,125*
(Standard Error) ($41) (Standard Error) ($58) (Standard Error) ($64)
Indiana $1,638 New Mexico $1,669 West Virginia $1,582
(Standard Error) ($51) (Standard Error) ($78) (Standard Error) ($74)
Iowa $1,698* New York $1,677* Wisconsin $1,623
(Standard Error) ($63) (Standard Error) ($43) (Standard Error) ($46)
Kansas $1,412* North Carolina $1,549 Wyoming $1,316*
(Standard Error) ($55) (Standard Error) ($54) (Standard Error) ($58)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of $1,540 at p < 0.05. Note that the standard error on the national estimate of $1,540 is $10.17.

Graphics Replay
Exhibit 4.16 Average annual employee contribution (in dollars) (standard error) for employee-plus-one coverage, by State, 3-year average, 2019-2021
Alabama $4,032 Kentucky $3,633* North Dakota $3,674*
(Standard Error) ($140) (Standard Error) ($136) (Standard Error) ($124)
Alaska $4,124 Louisiana $4,659* Ohio $3,612*
(Standard Error) ($172) (Standard Error) ($171) (Standard Error) ($141)
Arizona $4,220 Maine $3,879 Oklahoma $4,209
(Standard Error) ($155) (Standard Error) ($112) (Standard Error) ($184)
Arkansas $4,107 Maryland $4,330* Oregon $3,414*
(Standard Error) ($143) (Standard Error) ($153) (Standard Error) ($147)
California $4,040 Massachusetts $3,929 Pennsylvania $3,750*
(Standard Error) ($146) (Standard Error) ($127) (Standard Error) ($122)
Colorado $4,473 Michigan $3,232* Rhode Island $3,997
(Standard Error) ($331) (Standard Error) ($137) (Standard Error) ($116)
Connecticut $4,047 Minnesota $4,084 South Carolina $4,483*
(Standard Error) ($177) (Standard Error) ($153) (Standard Error) ($221)
Delaware $4,224 Mississippi $4,388 South Dakota $4,422*
(Standard Error) ($168) (Standard Error) ($215) (Standard Error) ($118)
District of Columbia $4,184 Missouri $4,127 Tennessee $3,970
(Standard Error) ($151) (Standard Error) ($128) (Standard Error) ($173)
Florida $4,641* Montana $3,530* Texas $4,238*
(Standard Error) ($229) (Standard Error) ($158) (Standard Error) ($106)
Georgia $3,957 Nebraska $4,398* Utah $3,712
(Standard Error) ($140) (Standard Error) ($137) (Standard Error) ($155)
Hawaii $3,811 Nevada $4,032 Vermont $3,824
(Standard Error) ($198) (Standard Error) ($229) (Standard Error) ($125)
Idaho $3,643* New Hampshire $4,203 Virginia $3,856
(Standard Error) ($178) (Standard Error) ($158) (Standard Error) ($132)
Illinois $4,022 New Jersey $4,050 Washington $3,330*
(Standard Error) ($106) (Standard Error) ($197) (Standard Error) ($222)
Indiana $3,725 New Mexico $4,382* West Virginia $3,872
(Standard Error) ($180) (Standard Error) ($163) (Standard Error) ($175)
Iowa $3,654* New York $3,744 Wisconsin $3,661*
(Standard Error) ($115) (Standard Error) ($161) (Standard Error) ($113)
Kansas $3,986 North Carolina $4,264 Wyoming $3,859
(Standard Error) ($125) (Standard Error) ($231) (Standard Error) ($237)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of $4,001 at p < 0.05. Note that the standard error on the national estimate of $4,001 is $32.61.

Graphics Replay
Exhibit 4.17 Average annual employee contribution (in dollars) (standard error) for family coverage, by State, 3-year average, 2019-2021
Alabama $5,865 Kentucky $5,413* North Dakota $5,777
(Standard Error) ($208) (Standard Error) ($224) (Standard Error) ($196)
Alaska $5,537 Louisiana $6,934* Ohio $5,071*
(Standard Error) ($296) (Standard Error) ($252) (Standard Error) ($208)
Arizona $6,052 Maine $6,086 Oklahoma $6,483*
(Standard Error) ($242) (Standard Error) ($165) (Standard Error) ($256)
Arkansas $6,160 Maryland $6,480* Oregon $5,794
(Standard Error) ($238) (Standard Error) ($245) (Standard Error) ($303)
California $6,018 Massachusetts $5,570 Pennsylvania $5,632
(Standard Error) ($215) (Standard Error) ($168) (Standard Error) ($215)
Colorado $6,233 Michigan $4,124* Rhode Island $5,625
(Standard Error) ($300) (Standard Error) ($216) (Standard Error) ($145)
Connecticut $5,696 Minnesota $5,489 South Carolina $6,827
(Standard Error) ($196) (Standard Error) ($212) (Standard Error) ($603)
Delaware $6,627 Mississippi $6,563* South Dakota $6,457*
(Standard Error) ($453) (Standard Error) ($268) (Standard Error) ($163)
District of Columbia $6,736* Missouri $6,726* Tennessee $5,573
(Standard Error) ($276) (Standard Error) ($294) (Standard Error) ($227)
Florida $6,968* Montana $5,332 Texas $6,681*
(Standard Error) ($263) (Standard Error) ($335) (Standard Error) ($185)
Georgia $6,103 Nebraska $6,247 Utah $5,699
(Standard Error) ($218) (Standard Error) ($222) (Standard Error) ($225)
Hawaii $5,336* Nevada $5,954 Vermont $5,523
(Standard Error) ($246) (Standard Error) ($311) (Standard Error) ($234)
Idaho $5,424* New Hampshire $5,815 Virginia $6,549*
(Standard Error) ($211) (Standard Error) ($171) (Standard Error) ($260)
Illinois $5,736 New Jersey $5,812 Washington $4,988
(Standard Error) ($166) (Standard Error) ($290) (Standard Error) ($471)
Indiana $5,347 New Mexico $6,464* West Virginia $5,562
(Standard Error) ($339) (Standard Error) ($258) (Standard Error) ($342)
Iowa $5,684 New York $5,500* Wisconsin $5,084*
(Standard Error) ($158) (Standard Error) ($159) (Standard Error) ($157)
Kansas $6,136 North Carolina $6,372* Wyoming $5,305*
(Standard Error) ($232) (Standard Error) ($215) (Standard Error) ($296)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of $5,904 at p < 0.05. Note that the standard error on the national estimate of $5,904 is $46.97.

ALTER EXB4.18
Exhibit 4.18 Average percentage (standard error) of premium contributed by employees for single coverage, overall and by industry, 2021
Industry Percentage
United States 22.3%
(Standard Error) (0.2%)
Agriculture, fisheries, forestry 27.5%*
(Standard Error) (3.2%)
Mining and manufacturing 20.9%
(Standard Error) (0.5%)
Construction 26.1%*
(Standard Error) (1.4%)
Utilities and transportation 21.3%
(Standard Error) (1.0%)
Wholesale trade 22.5%
(Standard Error) (1.1%)
Financial services and real estate 20.3%
(Standard Error) (0.6%)
Retail trade 26.9%*
(Standard Error) (0.7%)
Professional services 20.0%
(Standard Error) (0.4%)
Other services 25.5%*
(Standard Error) (0.7%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.

ALTER EXB4.19
Exhibit 4.19 Average percentage (standard error) of premium contributed by employees for employee-plus-one coverage, overall and by industry, 2021
Industry Percentage
United States 28.7%
(Standard Error) (0.4%)
Agriculture, fisheries, forestry 46.9%*
(Standard Error) (4.3%)
Mining and manufacturing 25.5%
(Standard Error) (0.8%)
Construction 38.1%*
(Standard Error) (3.0%)
Utilities and transportation 27.5%
(Standard Error) (2.2%)
Wholesale trade 28.3%
(Standard Error) (1.4%)
Financial services and real estate 26.6%
(Standard Error) (1.0%)
Retail trade 32.3%*
(Standard Error) (0.9%)
Professional services 26.9%
(Standard Error) (0.6%)
Other services 34.9%*
(Standard Error) (1.1%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.

ALTER EXB4.20
Exhibit 4.20 Average percentage (standard error) of premium contributed by employees for family coverage, overall and by industry, 2021
Industry Percentage
United States 28.9%
(Standard Error) (0.4%)
Agriculture, fisheries, forestry 33.1%*
(Standard Error) (2.7%)
Mining and manufacturing 24.7%
(Standard Error) (0.8%)
Construction 37.4%*
(Standard Error) (2.9%)
Utilities and transportation 23.7%
(Standard Error) (1.6%)
Wholesale trade 29.6%*
(Standard Error) (1.2%)
Financial services and real estate 26.5%
(Standard Error) (0.8%)
Retail trade 33.8%*
(Standard Error) (1.3%)
Professional services 28.2%
(Standard Error) (0.6%)
Other services 36.0%*
(Standard Error) (1.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
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.

ALTER EXB4.21
Exhibit 4.21 Average percentage (standard error) of premium contributed by employees for single coverage, overall and by selected characteristics, 2021
Employer Characteristics Percentage
United States 22.3%
(Standard Error) (0.2%)
Ownership: For Profit Inc. 23.5%*
(Standard Error) (0.3%)
Ownership: For Profit Uninc. 23.5%*
(Standard Error) (0.7%)
Ownership: Nonprofit 17.4%
(Standard Error) (0.6%)
Firm Age: 0-4 Years 28.9%*
(Standard Error) (2.1%)
Firm Age: 5-9 Years 27.2%*
(Standard Error) (1.5%)
Firm Age: 10-19 Years 23.7%*
(Standard Error) (0.9%)
Firm Age: 20+ Years 21.6%
(Standard Error) (0.3%)
# of Locations: 1 Location 22.7%
(Standard Error) (0.6%)
# of Locations: 2+ Locations 22.1%
(Standard Error) (0.3%)
% Full Time: 0-24% 25.9%
(Standard Error) (2.0%)
% Full Time: 25-49% 25.7%*
(Standard Error) (0.9%)
% Full Time: 50-74% 23.0%
(Standard Error) (0.9%)
% Full Time: 75%+ 21.9%
(Standard Error) (0.3%)
% Low Wage: 50%+ 26.7%*
(Standard Error) (0.7%)
% Low Wage: <50% 21.9%
(Standard Error) (0.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.

ALTER EXB4.22
Exhibit 4.22 Average percentage (standard error) of premium contributed by employees for employee-plus-one coverage, overall and by selected characteristics, 2021
Employer Characteristics Percentage
United States 28.7%
(Standard Error) (0.4%)
Ownership: For Profit Inc. 29.4%*
(Standard Error) (0.5%)
Ownership: For Profit Uninc. 30.3%*
(Standard Error) (1.1%)
Ownership: Nonprofit 25.1%
(Standard Error) (0.9%)
Firm Age: 0-4 Years 43.0%*
(Standard Error) (4.9%)
Firm Age: 5-9 Years 36.9%*
(Standard Error) (2.9%)
Firm Age: 10-19 Years 35.4%*
(Standard Error) (1.1%)
Firm Age: 20+ Years 27.4%
(Standard Error) (0.4%)
# of Locations: 1 Location 35.8%*
(Standard Error) (1.1%)
# of Locations: 2+ Locations 26.6%
(Standard Error) (0.4%)
% Full Time: 0-24% 34.5%*
(Standard Error) (2.5%)
% Full Time: 25-49% 30.0%
(Standard Error) (1.5%)
% Full Time: 50-74% 31.7%*
(Standard Error) (1.7%)
% Full Time: 75%+ 28.2%
(Standard Error) (0.4%)
% Low Wage: 50%+ 35.6%*
(Standard Error) (1.1%)
% Low Wage: <50% 28.3%
(Standard Error) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.

ALTER EXB4.23
Exhibit 4.23 Average percentage (standard error) of premium contributed by employees for family coverage, overall and by selected characteristics, 2021
Employer Characteristics Percentage
United States 28.9%
(Standard Error) (0.4%)
Ownership: For Profit Inc. 29.6%*
(Standard Error) (0.5%)
Ownership: For Profit Uninc. 30.0%*
(Standard Error) (1.0%)
Ownership: Nonprofit 25.7%
(Standard Error) (0.8%)
Firm Age: 0-4 Years 35.0%
(Standard Error) (3.8%)
Firm Age: 5-9 Years 37.4%*
(Standard Error) (3.4%)
Firm Age: 10-19 Years 35.6%*
(Standard Error) (1.6%)
Firm Age: 20+ Years 27.8%
(Standard Error) (0.4%)
# of Locations: 1 Location 34.2%*
(Standard Error) (1.1%)
# of Locations: 2+ Locations 27.3%
(Standard Error) (0.4%)
% Full Time: 0-24% 25.5%
(Standard Error) (4.2%)
% Full Time: 25-49% 34.3%*
(Standard Error) (2.3%)
% Full Time: 50-74% 30.6%
(Standard Error) (1.4%)
% Full Time: 75%+ 28.5%
(Standard Error) (0.4%)
% Low Wage: 50%+ 35.3%*
(Standard Error) (1.5%)
% Low Wage: <50% 28.6%
(Standard Error) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Note: "% Full Time" refers to the percentage of the establishment's workforce that worked full time in 2021. "% Low Wage" refers to the percentage of the establishment's workforce that earned less than $13.50 per hour in 2021. * 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%.

ALTER EXB4.24
Exhibit 4.24 Average percentage (standard error) of premium contributed by enrolled employees for single coverage, by the percentage of the establishment's workforce that is low wage, 2009-2021
Low wage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
50%+ Low-Wage Employees 24.1% 24.6% 24.7% 24.4% 25.7% 25.4% 26.2% 26.2% 26.9% 25.4% 26.3% 25.3% 26.7%^
(Standard Error) (0.3%) (0.5%) (0.8%) (0.4%) (0.6%) (0.5%) (0.8%) (0.5%) (0.6%) (0.8%) (0.7%) (0.7%) (0.7%)
<50% Low-Wage Employees 19.8% 19.9% 20.2% 20.1% 20.1% 20.4% 20.4% 21.1%* 21.6% 20.7%* 20.7% 21.0% 21.9%*
(Standard Error) (0.3%) (0.3%) (0.1%) (0.3%) (0.2%) (0.2%) (0.2%) (0.2%) (0.3%) (0.2%) (0.3%) (0.2%) (0.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: Wage levels in the MEPS-IC questionnaires have been adjusted to account for changing wages over time. In 2021, low-wage employees were defined as those earning less than $13.50 per hour. * indicates the estimate is significantly different from the previous year at p < 0.05. ^ indicates that the estimates for employers with 50%+ low wage employees are statistically different from the estimate for employers with <50% low wage employees at p < 0.05. This test is conducted for 2021 only.

ALTER EXB4.25
Exhibit 4.25 Average percentage (standard error) of premium contributed by enrolled employees for employee-plus-one coverage, by the percentage of the establishment's workforce that is low wage, 2009-2021
Low wage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
50%+ Low-Wage Employees 28.6% 30.9%* 33.3%* 30.9%* 32.4% 32.1% 33.8% 34.4% 34.2% 30.5%* 33.3% 34.0% 35.6%^
(Standard Error) (0.8%) (0.6%) (0.7%) (0.8%) (0.6%) (1.2%) (1.0%) (1.0%) (1.1%) (1.3%) (1.3%) (1.1%) (1.1%)
<50% Low-Wage Employees 25.7% 25.1% 25.7% 26.0% 26.0% 26.3% 26.7% 27.3% 27.1% 26.8% 27.2% 28.0% 28.3%
(Standard Error) (0.3%) (0.4%) (0.3%) (0.4%) (0.2%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.4%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: Wage levels in the MEPS-IC questionnaires have been adjusted to account for changing wages over time. In 2021, low-wage employees were defined as those earning less than $13.50 per hour. * indicates the estimate is significantly different from the previous year at p < 0.05. ^ indicates that the estimates for employers with 50%+ low wage employees are statistically different from the estimate for employers with <50% low wage employees at p < 0.05. This test is conducted for 2021 only.

ALTER EXB4.26
Exhibit 4.26 Average percentage (standard error) of premium contributed by employees for family coverage, by the percentage of the establishment's workforce that is low wage, 2009-2021
Low wage 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
50%+ Low-Wage Employees 30.2% 31.6% 31.0% 33.4%* 31.7% 33.1% 34.4% 35.8% 35.7% 35.8% 34.1% 35.8% 35.3%^
(Standard Error) (1.0%) (0.7%) (0.7%) (0.6%) (0.8%) (0.7%) (0.9%) (0.9%) (1.0%) (1.5%) (1.3%) (0.9%) (1.5%)
<50% Low-Wage Employees 26.2% 26.3% 25.9% 26.7% 27.1% 26.5% 26.7% 27.5% 27.4% 27.2% 27.5% 28.4% 28.6%
(Standard Error) (0.3%) (0.5%) (0.4%) (0.4%) (0.3%) (0.3%) (0.3%) (0.3%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: Wage levels in the MEPS-IC questionnaires have been adjusted to account for changing wages over time. In 2021, low-wage employees were defined as those earning less than $13.50 per hour. * indicates the estimate is significantly different from the previous year at p < 0.05. ^ indicates that the estimates for employers with 50%+ low wage employees are statistically different from the estimate for employers with <50% low wage employees at p < 0.05. This test is conducted for 2021 only.

Exhibit 4.27 Distributions of employee contribution (in dollars) (standard error) for single, employee-plus-one, and family coverage, overall and by firm size, 2021
Coverage Estimate Total <50 employees 50-99 employees 100 or more employees
Single Average (mean) $1,643 $1,650 $1,793 $1,627
(Standard Error) ($19) ($47) ($89) ($21)
10 percentile $0 $0* $0* $310
(Standard Error) ($43) ($96) ($75) ($40)
25 percentile $700 $0* $530* $820
(Standard Error) ($16) ($96) ($132) ($25)
50 percentile (median) $1,400 $1,200* $1,500 $1,400
(Standard Error) ($21) ($67) ($90) ($19)
75 percentile $2,200 $2,600* $2,600* $2,100
(Standard Error) ($28) ($77) ($105) ($30)
90 percentile $3,300 $4,000* $3,800* $3,100
(Standard Error) ($35) ($85) ($206) ($64)
Employee-plus-one Average (mean) $4,199 $4,984* $5,526* $3,986
(Standard Error) ($64) ($288) ($224) ($62)
10 percentile $760 $0* $1,500* $940
(Standard Error) ($101) ($245) ($232) ($65)
25 percentile $2,100 $590 †* $2,800* $2,200
(Standard Error) ($52) ($318) ($214) ($43)
50 percentile (median) $3,500 $4,200* $4,900* $3,400
(Standard Error) ($43) ($306) ($247) ($41)
75 percentile $5,400 $7,300* $7,000* $5,000
(Standard Error) ($79) ($249) ($286) ($68)
90 percentile $8,200 $11,000* $10,000* $7,500
(Standard Error) ($141) ($650) ($506) ($148)
Family Average (mean) $6,174 $6,967* $7,997* $5,937
(Standard Error) ($87) ($283) ($384) ($93)
10 percentile $920 $0* $890 † $1,400
(Standard Error) ($122) ($513) ($501) ($111)
25 percentile $3,000 $0* $3,800 $3,200
(Standard Error) ($100) ($513) ($409) ($99)
50 percentile (median) $5,100 $5,500 $6,600* $5,100
(Standard Error) ($72) ($371) ($306) ($70)
75 percentile $7,900 $11,000* $11,000* $7,400
(Standard Error) ($124) ($443) ($568) ($120)
90 percentile $13,000 $16,000* $16,000* $11,000
(Standard Error) ($307) ($636) ($933) ($318)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2021.
Note: † Estimate does not meet standard of reliability or precision. * 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 5: Employee Cost Sharing

Over the past 12 years, employers have increasingly turned to high-deductible health plans (HDHPs) and other cost-sharing measures to limit growth in health insurance costs and premiums. This section presents trends from 2009 to 2021 in cost-sharing measures overall and by firm size, as well as variation in cost-sharing measures by firm size and State in 2021.

The cost-sharing measures in this section include estimates of the percentages of private-sector employees enrolled in employer-sponsored health insurance (ESI) who face various cost-sharing arrangements, including deductibles, coinsurance rates, copayments, and maximum out-of-pocket payments. The measures also include the percentage enrolled in an HDHP. This section also provides information on average single and family deductibles (overall and among HDHP enrollees), average copayments and coinsurance rates, and average single and family maximum out-of-pocket limits enrolled workers and their families face.

Cost-sharing provisions may vary for different types of healthcare services. The individual and family deductibles reported in this section are general annual deductibles that must be met before many services are covered by the health plan. Coinsurance rates are the percentages of healthcare service expenses paid by the enrollee or family members covered by the plan, and copayments are fixed dollar amounts paid for each healthcare service. Coinsurance rates and copayments are reported separately for office visits to general practitioners and office visits to specialist physicians.

The individual and family maximum out-of-pocket payment limits are the maximum amount a covered individual or family would pay for covered services in a given year. When plans differentiate between in-network and out-of-network providers, the deductibles, coinsurance rates, copayments, and maximum out-of-pocket limits reported in this section are for in-network providers.

HDHPs, as defined in this section, are health insurance plans with deductibles at or above annual thresholds set by the Internal Revenue Service for plans to qualify for Health Savings Accounts. In 2021, the thresholds were $1,400 for single coverage and $2,800 for family coverage.

Highlights

  • The percentage of enrollees in a health insurance plan with a deductible in 2021 was not significantly different from 2020 for firms overall (88.5 percent) or for small (86.0), medium (89.7), or large employers (88.8 percent) (Exhibit 5.1).
  • From 2020 to 2021, average deductible levels for single coverage overall increased by 3.0 percent, to $2,004, and family coverage deductibles increased by 3.9 percent, to $3,868 (Exhibits 5.2 and 5.3).
  • From 2020 to 2021, the percentage of enrollees with a coinsurance payment for physician visits increased overall (from 35.1 to 38.3 percent), among medium firms (from 19.3 to 24.4 percent), and among large firms (from 38.7 to 42.7 percent). The percentage of enrollees with a coinsurance payment for a specialist physician also increased overall (from 36.3 to 38.6 percent) and among large firms (from 40.1 to 43.3 percent) (Exhibits 5.7 and 5.13).
  • Overall, the percentage of single-coverage enrollees with an out-of-pocket payment maximum increased from 2012 (80.7 percent) to 2015 (93.9 percent) and declined slightly over the next 4 years. It then increased from 91.0 percent in 2020 to 93.5 percent in 2021, reaching nearly the same level as in 2015 (Exhibit 5.15).
  • The overall percentage of family-coverage enrollees with an out-of-pocket payment maximum increased from 2012 (80.9 percent) to 2015 (94.3 percent), fell to 88.7 percent in 2020, then did not change significantly between 2020 and 2021 (89.6 percent) (Exhibit 5.16).
  • Among small firms (fewer than 50 employees), the percentage of family-coverage enrollees with an out-of-pocket payment maximum increased by 17.8 percentage points, from 2009 (70.0 percent) to 2015 (87.8 percent). It then fell by 14.0 percentage points to 73.8 percent in 2021 (Exhibit 5.16).
  • Based on average annual estimates for 2019-2021, six states (California, District of Columbia, Hawaii, Massachusetts, New Jersey, and New York), had percentages of enrollees in a plan with a deductible, average individual deductibles, and average family deductibles significantly lower than the national average (Exhibits 5.4, 5.5, and 5.6).
  • In four of these states (California, District of Columbia, Massachusetts, and New York), the percentage of single and family enrollees in HDHPs and average deductibles among single and family enrollees in HDHPs were also significantly lower than the national average (Exhibits 5.21, 5.22, 5.23, and 5.24).

Key Trends and Differences

A number of longstanding differences in cost-sharing provisions between large employers and both small and medium employers were again evident in 20211. Specifically:

  • Small-firm enrollees were less likely than large-firm enrollees to have an annual deductible, but average deductibles among enrollees with a deductible were higher in both small and medium firms than in large firms.
  • For office visits to general practitioners and specialists, large-firm enrollees were less likely to have a copayment and more likely to have coinsurance. Among enrollees with these cost-sharing requirements, large-firm enrollees tended to have significantly lower average copayments and coinsurance rates. The one exception is that there was no significant difference between large- and medium-firm enrollees in physician visit coinsurance rates.
  • In 2021, large-firm enrollees were more likely than medium- and small-firm enrollees to have maximum out-of-pocket payment limits for both single and family coverage (and thus less likely to face the prospect of unlimited out-of-pocket spending). The difference between large and small firms was evident in all years, but the difference between large and medium firms was insignificant in most years. Among enrollees with limits, large-firm enrollees had lower average maximum out-of-pocket amounts for both individual and family coverage.
  • For both single and family coverage, large-firm enrollees were less likely than medium- and small-firm enrollees to be in HDHPs. For small firms, this difference is consistent in nearly every year. For medium firms, the difference is consistent over the last 4 to 5 years.

1 Statistical significance tests for firm-size differences are marked only for 2021.

chart and data
Exhibit 5.1 Percentage (standard error) of private-sector enrolled employees in a health insurance plan with a deductible, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 73.8% 77.5%* 77.8% 79.6%* 81.3% 83.9%* 85.4%* 84.5% 87.5%* 87.3% 86.6% 89.2%* 88.5%
(Standard Error) (0.5%) (0.3%) (0.7%) (0.6%) (0.7%) (0.5%) (0.5%) (0.5%) (0.4%) (0.4%) (0.5%) (0.4%) (0.5%)
<50 73.5% 75.7%* 76.3% 79.5%* 79.5% 80.8% 82.1% 81.7% 82.3% 83.0% 84.1% 86.5%* 86.0%^
(Standard Error) (0.7%) (0.7%) (0.4%) (1.0%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.9%) (0.8%) (0.9%)
50-99 70.6% 78.2%* 79.6% 80.3% 78.0% 82.4%* 85.3% 82.5% 83.7% 85.1% 87.5% 89.0% 89.7%
(Standard Error) (1.9%) (1.5%) (1.7%) (1.4%) (1.1%) (1.5%) (1.5%) (1.5%) (1.6%) (1.4%) (1.5%) (1.5%) (1.3%)
100+ 74.2% 77.8%* 77.9% 79.6% 81.9%* 84.6%* 86.1% 85.2% 88.8%* 88.3% 87.1% 89.7%* 88.8%
(Standard Error) (0.6%) (0.3%) (1.0%) (0.7%) (0.7%) (0.6%) (0.6%) (0.6%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

chart and data
Exhibit 5.2 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, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $917 $1,025* $1,123* $1,167* $1,273* $1,353* $1,541* $1,696* $1,808* $1,846 $1,931* $1,945 $2,004*
(Standard Error) ($9) ($18) ($12) ($8) ($20) ($13) ($16) ($16) ($17) ($17) ($18) ($18) ($20)
<50 $1,283 $1,447* $1,561* $1,628 $1,695 $1,777* $1,964* $2,105* $2,136 $2,327* $2,386 $2,376 $2,485^
(Standard Error) ($24) ($21) ($26) ($25) ($24) ($28) ($35) ($34) ($35) ($36) ($35) ($39) ($43)
50-99 $1,249 $1,522* $1,543 $1,622 $1,755 $1,744 $2,008* $2,173 $2,361 $2,369 $2,441 $2,464 $2,378^
(Standard Error) ($46) ($57) ($49) ($64) ($49) ($59) ($62) ($64) ($85) ($65) ($67) ($67) ($74)
100+ $774 $852* $951* $989* $1,106* $1,205* $1,383* $1,558* $1,681* $1,692 $1,778* $1,814 $1,865
(Standard Error) ($7) ($20) ($14) ($10) ($19) ($14) ($18) ($18) ($20) ($19) ($21) ($20) ($23)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

chart and data
Exhibit 5.3 Average family deductible (in dollars) (standard error) per employee enrolled with family coverage in a health insurance plan with a deductible, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $1,761 $1,975* $2,220* $2,322* $2,491* $2,640* $2,915* $3,069* $3,396* $3,392 $3,655* $3,722 $3,868*
(Standard Error) ($20) ($33) ($31) ($26) ($23) ($28) ($32) ($37) ($48) ($37) ($48) ($52) ($50)
<50 $2,652 $2,857* $3,329* $3,515* $3,761* $3,810 $4,090* $3,940 $4,447* $4,364 $5,067* $4,666* $4,945^
(Standard Error) ($50) ($42) ($57) ($71) ($56) ($71) ($88) ($98) ($126) ($97) ($113) ($126) ($157)
50-99 $2,362 $3,040* $3,349 $3,523 $3,634 $3,404 $3,875* $3,840 $4,218 $4,755 $4,353 $4,761 $4,816^
(Standard Error) ($113) ($101) ($138) ($113) ($157) ($112) ($148) ($174) ($216) ($172) ($166) ($168) ($170)
100+ $1,552 $1,734* $1,954* $2,038 $2,215* $2,408* $2,676* $2,887* $3,195* $3,179 $3,390* $3,540 $3,646
(Standard Error) ($21) ($33) ($37) ($31) ($18) ($31) ($34) ($41) ($53) ($40) ($53) ($58) ($54)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

Graphics Replay
Exhibit 5.4 Percentage (standard error) of private-sector enrolled employees in a health insurance plan with a deductible, overall and by State, 3-year average, 2019-2021
Alabama 90.8% Kentucky 93.0%* North Dakota 95.3%*
(Standard Error) (2.4%) (Standard Error) (1.2%) (Standard Error) (0.8%)
Alaska 91.8% Louisiana 92.0%* Ohio 92.5%*
(Standard Error) (2.1%) (Standard Error) (1.1%) (Standard Error) (1.2%)
Arizona 94.4%* Maine 96.3%* Oklahoma 95.1%*
(Standard Error) (1.3%) (Standard Error) (0.9%) (Standard Error) (0.9%)
Arkansas 95.7%* Maryland 85.1% Oregon 93.8%*
(Standard Error) (0.8%) (Standard Error) (2.0%) (Standard Error) (1.3%)
California 73.2%* Massachusetts 81.6%* Pennsylvania 89.1%
(Standard Error) (1.3%) (Standard Error) (1.6%) (Standard Error) (1.0%)
Colorado 94.4%* Michigan 94.1%* Rhode Island 88.1%
(Standard Error) (0.9%) (Standard Error) (0.9%) (Standard Error) (1.3%)
Connecticut 91.6%* Minnesota 90.0% South Carolina 93.4%*
(Standard Error) (1.2%) (Standard Error) (1.9%) (Standard Error) (1.5%)
Delaware 90.9% Mississippi 96.1%* South Dakota 97.1%*
(Standard Error) (1.5%) (Standard Error) (0.8%) (Standard Error) (0.5%)
District of Columbia 74.6%* Missouri 92.5%* Tennessee 91.1%*
(Standard Error) (1.6%) (Standard Error) (1.0%) (Standard Error) (1.2%)
Florida 90.3% Montana 96.5%* Texas 93.0%*
(Standard Error) (1.4%) (Standard Error) (0.7%) (Standard Error) (0.7%)
Georgia 91.2%* Nebraska 97.5%* Utah 93.9%*
(Standard Error) (1.3%) (Standard Error) (0.6%) (Standard Error) (0.9%)
Hawaii 37.6%* Nevada 84.7% Vermont 95.0%*
(Standard Error) (1.9%) (Standard Error) (1.8%) (Standard Error) (0.8%)
Idaho 94.7%* New Hampshire 91.2%* Virginia 89.7%
(Standard Error) (0.8%) (Standard Error) (1.4%) (Standard Error) (1.4%)
Illinois 88.7% New Jersey 82.4%* Washington 93.5%*
(Standard Error) (1.0%) (Standard Error) (1.9%) (Standard Error) (1.3%)
Indiana 95.2%* New Mexico 92.3%* West Virginia 94.2%*
(Standard Error) (0.9%) (Standard Error) (1.1%) (Standard Error) (0.8%)
Iowa 95.0%* New York 77.6%* Wisconsin 93.2%*
(Standard Error) (0.8%) (Standard Error) (1.2%) (Standard Error) (1.2%)
Kansas 93.7%* North Carolina 94.4%* Wyoming 94.4%*
(Standard Error) (1.0%) (Standard Error) (0.9%) (Standard Error) (1.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of 88.1 percent at p < 0.05. Note that the standard error on the national estimate of 88.1 percent is 0.26.

Graphics Replay
Exhibit 5.5 Average individual deductible (in dollars) (standard error) per employee enrolled with single coverage in a health insurance plan with a deductible, overall and by State, 3-year average, 2019-2021
Alabama $1,587* Kentucky $2,128* North Dakota $1,941
(Standard Error) ($55) (Standard Error) ($53) (Standard Error) ($55)
Alaska $1,894 Louisiana $1,927 Ohio $2,081*
(Standard Error) ($68) (Standard Error) ($59) (Standard Error) ($49)
Arizona $2,274* Maine $2,380* Oklahoma $2,039
(Standard Error) ($66) (Standard Error) ($65) (Standard Error) ($57)
Arkansas $1,828* Maryland $1,658* Oregon $2,121
(Standard Error) ($47) (Standard Error) ($57) (Standard Error) ($148)
California $1,683* Massachusetts $1,693* Pennsylvania $1,711*
(Standard Error) ($41) (Standard Error) ($65) (Standard Error) ($43)
Colorado $2,063 Michigan $1,661* Rhode Island $1,947
(Standard Error) ($62) (Standard Error) ($46) (Standard Error) ($70)
Connecticut $2,130* Minnesota $2,230* South Carolina $2,097*
(Standard Error) ($61) (Standard Error) ($62) (Standard Error) ($67)
Delaware $1,828 Mississippi $1,728* South Dakota $2,407*
(Standard Error) ($61) (Standard Error) ($65) (Standard Error) ($52)
District of Columbia $1,346* Missouri $2,129* Tennessee $2,250*
(Standard Error) ($42) (Standard Error) ($56) (Standard Error) ($66)
Florida $2,087* Montana $2,461* Texas $2,090*
(Standard Error) ($67) (Standard Error) ($70) (Standard Error) ($43)
Georgia $1,976 Nebraska $2,024 Utah $1,819*
(Standard Error) ($60) (Standard Error) ($49) (Standard Error) ($56)
Hawaii $1,273* Nevada $1,839 Vermont $2,032
(Standard Error) ($87) (Standard Error) ($63) (Standard Error) ($61)
Idaho $2,000 New Hampshire $2,429* Virginia $1,868
(Standard Error) ($47) (Standard Error) ($71) (Standard Error) ($62)
Illinois $1,834* New Jersey $1,675* Washington $1,807*
(Standard Error) ($42) (Standard Error) ($55) (Standard Error) ($62)
Indiana $2,165* New Mexico $1,971 West Virginia $1,950
(Standard Error) ($56) (Standard Error) ($94) (Standard Error) ($57)
Iowa $2,155* New York $1,739* Wisconsin $2,174*
(Standard Error) ($50) (Standard Error) ($43) (Standard Error) ($61)
Kansas $1,953 North Carolina $2,258* Wyoming $1,877
(Standard Error) ($61) (Standard Error) ($58) (Standard Error) ($53)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of $1,943 at p < 0.05. Note that the standard error on the national estimate of $1,943 is $10.47.

Graphics Replay
Exhibit 5.6 Average family deductible (in dollars) (standard error) per employee enrolled with family coverage in a health insurance plan with a deductible, overall and by State, 3-year average, 2019-2021
Alabama $3,101* Kentucky $3,851 North Dakota $3,596
(Standard Error) ($152) (Standard Error) ($135) (Standard Error) ($121)
Alaska $3,611 Louisiana $4,138* Ohio $4,011*
(Standard Error) ($175) (Standard Error) ($154) (Standard Error) ($127)
Arizona $4,433 Maine $3,804 Oklahoma $4,075*
(Standard Error) ($378) (Standard Error) ($183) (Standard Error) ($165)
Arkansas $3,550 Maryland $3,287* Oregon $3,509
(Standard Error) ($117) (Standard Error) ($125) (Standard Error) ($161)
California $3,432* Massachusetts $3,384* Pennsylvania $3,185*
(Standard Error) ($124) (Standard Error) ($124) (Standard Error) ($105)
Colorado $4,141* Michigan $3,044* Rhode Island $3,697
(Standard Error) ($162) (Standard Error) ($135) (Standard Error) ($195)
Connecticut $3,985 Minnesota $4,280* South Carolina $3,912
(Standard Error) ($181) (Standard Error) ($153) (Standard Error) ($154)
Delaware $3,355* Mississippi $3,430 South Dakota $4,114*
(Standard Error) ($176) (Standard Error) ($148) (Standard Error) ($131)
District of Columbia $2,867* Missouri $4,142* Tennessee $4,284*
(Standard Error) ($125) (Standard Error) ($128) (Standard Error) ($216)
Florida $3,825 Montana $3,630 Texas $4,023*
(Standard Error) ($188) (Standard Error) ($169) (Standard Error) ($114)
Georgia $4,062 Nebraska $3,829 Utah $3,854
(Standard Error) ($192) (Standard Error) ($123) (Standard Error) ($127)
Hawaii $2,795* Nevada $3,476 Vermont $3,700
(Standard Error) ($171) (Standard Error) ($144) (Standard Error) ($144)
Idaho $3,486 New Hampshire $4,428* Virginia $3,600
(Standard Error) ($130) (Standard Error) ($166) (Standard Error) ($153)
Illinois $3,709 New Jersey $3,309* Washington $3,365*
(Standard Error) ($119) (Standard Error) ($157) (Standard Error) ($149)
Indiana $4,086* New Mexico $4,040* West Virginia $3,749
(Standard Error) ($153) (Standard Error) ($145) (Standard Error) ($163)
Iowa $3,943 New York $3,216* Wisconsin $4,122*
(Standard Error) ($122) (Standard Error) ($83) (Standard Error) ($143)
Kansas $3,627 North Carolina $4,033* Wyoming $3,897
(Standard Error) ($131) (Standard Error) ($144) (Standard Error) ($150)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of $3,715 at p < 0.05. Note that the standard error on the national estimate of $3,715 is $28.24.

chart and data
Exhibit 5.7 Percentage (standard error) of private-sector enrolled employees in a health insurance plan with a physician visit coinsurance rate, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 23.1% 25.1%* 26.1% 27.4%* 30.4%* 32.6%* 35.0%* 34.9% 37.6%* 37.7% 34.5%* 35.1% 38.3%*
(Standard Error) (0.7%) (0.7%) (0.4%) (0.4%) (0.3%) (0.6%) (0.6%) (0.6%) (0.7%) (0.6%) (0.7%) (0.6%) (0.7%)
<50 15.9% 14.9% 15.4% 17.3%* 18.7% 19.5% 20.4% 20.6% 22.1% 22.4% 20.5% 21.2% 20.7%^
(Standard Error) (0.5%) (0.4%) (0.5%) (0.5%) (1.0%) (0.7%) (0.9%) (0.8%) (0.8%) (0.8%) (0.9%) (0.9%) (1.0%)
50-99 13.5% 15.1% 14.8% 17.2% 18.8% 19.1% 21.8% 21.5% 21.8% 21.3% 19.7% 19.3% 24.4%*^
(Standard Error) (1.7%) (1.4%) (1.6%) (1.2%) (1.0%) (1.5%) (1.7%) (1.6%) (1.6%) (1.6%) (1.6%) (1.5%) (1.9%)
100+ 25.7% 28.5%* 29.6% 30.6% 34.1%* 36.6%* 39.2%* 38.9% 41.9%* 42.0% 38.5%* 38.7% 42.7%*
(Standard Error) (0.9%) (0.9%) (0.5%) (0.5%) (0.5%) (0.8%) (0.8%) (0.7%) (0.9%) (0.8%) (0.9%) (0.7%) (0.8%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

chart and data
Exhibit 5.8 Average coinsurance rate (in percentage) (standard error) for a physician office visit per employee enrolled in a health insurance plan with a physician visit coinsurance rate, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 18.6% 18.8% 18.9% 19.0% 19.2% 19.8%* 20.1% 20.5% 20.1% 20.2% 20.0% 20.5%* 20.8%
(Standard Error) (0.1%) (0.2%) (0.2%) (0.2%) (0.1%) (0.1%) (0.1%) (0.1%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%)
<50 20.2% 20.0% 21.5%* 20.8% 21.3% 21.5% 22.6%* 22.2% 22.2% 23.0% 22.8% 23.5% 23.5%^
(Standard Error) (0.3%) (0.2%) (0.3%) (0.2%) (0.4%) (0.3%) (0.4%) (0.4%) (0.4%) (0.4%) (0.4%) (0.6%) (0.5%)
50-99 19.0% 19.6% 20.2% 20.7% 21.0% 21.1% 21.6% 22.3% 21.9% 21.6% 22.4% 23.0% 21.6%
(Standard Error) (0.6%) (0.8%) (0.8%) (0.4%) (0.7%) (0.7%) (0.7%) (0.7%) (0.7%) (0.7%) (0.7%) (0.8%) (0.7%)
100+ 18.4% 18.6% 18.5% 18.7% 18.8% 19.5%* 19.8% 20.2% 19.8% 19.8% 19.6% 20.2%* 20.5%
(Standard Error) (0.2%) (0.2%) (0.2%) (0.2%) (0.1%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

chart and data
Exhibit 5.9 Percentage (standard error) of private-sector enrolled employees in a health insurance plan with a copayment for a physician office visit, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 72.6% 70.0%* 68.2% 66.3% 64.8% 61.3%* 59.9% 60.6% 59.2% 58.1% 59.8% 58.8% 56.8%*
(Standard Error) (0.5%) (0.7%) (0.7%) (0.7%) (0.5%) (0.6%) (0.6%) (0.6%) (0.7%) (0.6%) (0.7%) (0.6%) (0.7%)
<50 73.6% 74.0% 72.6% 72.7% 70.6% 67.3%* 69.6% 69.5% 71.5% 68.3%* 72.3%* 69.4%* 70.2%^
(Standard Error) (0.5%) (0.4%) (0.7%) (1.0%) (0.7%) (0.9%) (1.0%) (0.9%) (0.9%) (0.9%) (1.0%) (1.0%) (1.1%)
50-99 79.4% 75.8% 73.5% 71.2% 71.9% 74.6% 65.2%* 69.3% 70.2% 69.7% 67.1% 68.0% 66.2%^
(Standard Error) (1.8%) (1.6%) (1.1%) (1.7%) (1.5%) (1.6%) (2.0%) (1.8%) (1.8%) (1.8%) (2.0%) (2.0%) (2.1%)
100+ 71.7% 68.5%* 66.7% 64.5% 62.9% 58.9%* 57.4% 58.1% 55.9% 55.2% 56.7% 56.3% 53.5%*
(Standard Error) (0.5%) (0.9%) (0.9%) (0.9%) (0.6%) (0.8%) (0.8%) (0.8%) (0.9%) (0.8%) (0.9%) (0.8%) (0.8%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

chart and data
Exhibit 5.10 Average copayment (in dollars) (standard error) for a physician office visit per employee enrolled in a health insurance plan with a physician visit copayment, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $21.53 $22.82* $23.34* $23.77* $24.31* $24.77* $25.04 $25.89* $26.50* $26.81 $26.68 $26.92 $27.41*
(Standard Error) ($0.10) ($0.10) ($0.11) ($0.16) ($0.13) ($0.12) ($0.12) ($0.12) ($0.13) ($0.14) ($0.16) ($0.17) ($0.18)
<50 $23.66 $24.79* $25.71* $26.07 $26.75* $27.14 $27.30 $27.82 $28.21 $29.16* $29.16 $30.02 $30.46^
(Standard Error) ($0.07) ($0.15) ($0.17) ($0.14) ($0.22) ($0.22) ($0.22) ($0.23) ($0.27) ($0.25) ($0.30) ($0.34) ($0.44)
50-99 $22.93 $24.62* $24.05 $25.05* $25.37 $26.29 $27.06 $27.43 $27.36 $28.37 $27.88 $28.26 $29.36^
(Standard Error) ($0.31) ($0.36) ($0.34) ($0.26) ($0.44) ($0.35) ($0.40) ($0.39) ($0.48) ($0.42) ($0.48) ($0.53) ($0.64)
100+ $20.86 $22.13* $22.68* $23.07 $23.60 $24.03* $24.25 $25.28* $25.99* $26.11 $25.93 $26.17 $26.46
(Standard Error) ($0.12) ($0.11) ($0.12) ($0.22) ($0.17) ($0.14) ($0.15) ($0.15) ($0.16) ($0.16) ($0.20) ($0.20) ($0.19)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB5.11
Exhibit 5.11 Percentage (standard error) of private-sector enrolled employees in a health insurance plan with a copayment for an office visit to a specialist physician, overall and by firm size, 2016-2021
Number of Employees 2016 2017 2018 2019 2020 2021
U.S. 60.8% 58.7%* 58.0% 60.2%* 58.2%* 56.9%
(Standard Error) (0.6%) (0.7%) (0.6%) (0.7%) (0.7%) (0.7%)
<50 69.2% 71.8%* 69.5% 72.3%* 69.5%* 70.2%^
(Standard Error) (0.9%) (0.9%) (0.9%) (1.0%) (1.0%) (1.1%)
50-99 70.2% 71.1% 69.4% 67.0% 68.9% 70.0%^
(Standard Error) (1.8%) (1.8%) (1.8%) (1.9%) (1.9%) (2.0%)
100+ 58.4% 55.2%* 54.9% 57.2% 55.5% 53.3%
(Standard Error) (0.7%) (0.8%) (0.8%) (0.9%) (0.8%) (0.8%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2016-2021.
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 2021 only.

ALTER EXB5.12
Exhibit 5.12 Average copayment (in dollars) (standard error) for an office visit to a specialist physician per employee enrolled in a health insurance plan with a specialist physician copayment at private-sector establishments, overall and by firm size, 2016-2021
Number of Employees 2016 2017 2018 2019 2020 2021
U.S. $40.29 $41.97* $43.36* $43.71 $45.29* $46.29
(Standard Error) ($0.23) ($0.26) ($0.28) ($0.31) ($0.41) ($0.35)
<50 $44.11 $46.27* $49.48* $51.27* $51.98 $54.09^
(Standard Error) ($0.42) ($0.44) ($0.47) ($0.61) ($0.69) ($0.84)
50-99 $43.20 $43.99 $48.22* $47.75 $50.22 $52.29^
(Standard Error) ($0.87) ($0.82) ($0.88) ($0.97) ($1.05) ($1.10)
100+ $39.10 $40.68* $41.40 $41.42 $43.41* $43.71
(Standard Error) ($0.28) ($0.32) ($0.34) ($0.36) ($0.51) ($0.38)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2016-2021.
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 2021 only.

ALTER EXB5.13
Exhibit 5.13 Percentage (standard error) of private-sector enrolled employees in a health insurance plan with a coinsurance payment for an office visit to a specialist physician, overall and by firm size, 2016-2021
Number of Employees 2016 2017 2018 2019 2020 2021
U.S. 35.5% 38.1%* 38.3% 34.6%* 36.3% 38.6%*
(Standard Error) (0.6%) (0.7%) (0.6%) (0.8%) (0.7%) (0.7%)
<50 22.3% 22.3% 22.6% 20.7% 20.8% 20.8%^
(Standard Error) (0.8%) (0.8%) (0.8%) (0.9%) (0.9%) (1.0%)
50-99 22.3% 21.7% 20.7% 19.4% 20.6% 22.6%^
(Standard Error) (1.6%) (1.6%) (1.5%) (1.6%) (1.6%) (1.8%)
100+ 39.3% 42.5%* 42.7% 38.7%* 40.1% 43.3%*
(Standard Error) (0.7%) (0.8%) (0.8%) (0.9%) (0.8%) (0.8%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2016-2021.
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 2021 only.

ALTER EXB5.14
Exhibit 5.14 Average coinsurance rate (in percentage) (standard error) for an office visit to a specialist physician per employee enrolled in a health insurance plan with a specialist physician coinsurance rate at private-sector establishments, overall and by firm size, 2016-2021
Number of Employees 2016 2017 2018 2019 2020 2021
U.S. 20.7% 21.2%* 21.0% 20.7% 21.4%* 22.1%*
(Standard Error) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%)
<50 23.9% 23.1% 24.9%* 24.3% 25.1% 25.6%^
(Standard Error) (0.4%) (0.4%) (0.5%) (0.5%) (0.6%) (0.7%)
50-99 23.3% 22.6% 22.6% 22.5% 23.8% 25.2%^
(Standard Error) (0.8%) (0.7%) (0.8%) (0.7%) (0.9%) (0.9%)
100+ 20.2% 21.0%* 20.5% 20.2% 20.9%* 21.7%*
(Standard Error) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%) (0.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2016-2021.
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 2021 only.

ALTER EXB5.15
Exhibit 5.15 Among private-sector enrolled employees with single coverage, percentage (standard error) in a health insurance plan with an individual maximum out-of-pocket payment, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 79.7% 80.8% 81.0% 80.7% 86.0%* 91.1%* 93.9%* 93.5% 93.4% 92.3%* 90.9%* 91.0% 93.5%*
(Standard Error) (0.6%) (0.5%) (0.5%) (0.3%) (0.5%) (0.4%) (0.3%) (0.4%) (0.3%) (0.3%) (0.4%) (0.4%) (0.3%)
<50 72.3% 73.3% 74.8% 75.4% 81.7%* 85.7%* 88.1%* 88.6% 88.8% 87.3% 84.4%* 82.2% 85.7%*^
(Standard Error) (0.8%) (0.7%) (1.1%) (0.4%) (0.7%) (0.8%) (0.7%) (0.7%) (0.7%) (0.7%) (1.0%) (1.0%) (0.9%)
50-99 78.1% 81.5% 78.3% 77.4% 83.5%* 88.9%* 93.1%* 92.5% 92.5% 89.8% 89.2% 88.5% 92.1%*^
(Standard Error) (1.6%) (2.5%) (1.8%) (2.6%) (0.8%) (1.3%) (1.2%) (1.4%) (1.2%) (1.4%) (1.5%) (1.3%) (1.2%)
100+ 82.1% 83.0% 83.1% 82.6% 87.6%* 92.7%* 95.5%* 94.7% 94.6% 93.7% 92.6% 92.9% 95.3%*
(Standard Error) (0.8%) (0.7%) (0.6%) (0.5%) (0.6%) (0.4%) (0.3%) (0.5%) (0.4%) (0.4%) (0.4%) (0.4%) (0.3%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB5.16
Exhibit 5.16 Among private-sector enrolled employees with family coverage, percentage (standard error) in a health insurance plan with a family maximum out-of-pocket payment, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 78.6% 78.5% 80.3% 80.9% 85.7%* 91.4%* 94.3%* 94.0% 94.4% 93.3% 91.6%* 88.7%* 89.6%
(Standard Error) (0.9%) (0.8%) (0.5%) (0.5%) (0.9%) (0.5%) (0.4%) (0.4%) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%)
<50 70.0% 72.3% 72.0% 75.8%* 80.9%* 83.8% 87.8%* 86.7% 86.8% 83.6% 83.3% 78.1%* 73.8%^
(Standard Error) (1.3%) (0.8%) (0.6%) (1.4%) (1.2%) (1.3%) (1.1%) (1.1%) (1.0%) (1.3%) (1.3%) (1.7%) (2.1%)
50-99 77.2% 80.6% 79.5% 76.4% 83.5%* 88.2% 91.5% 92.7% 94.3% 92.3% 90.2% 85.8% 88.0%^
(Standard Error) (2.5%) (2.0%) (1.6%) (2.7%) (1.9%) (1.8%) (1.5%) (1.4%) (1.2%) (1.6%) (1.7%) (2.3%) (2.0%)
100+ 80.4% 79.6% 81.8% 82.1% 86.7%* 92.9%* 95.4%* 95.3% 95.6% 94.8% 93.1%* 90.3%* 92.2%*
(Standard Error) (0.9%) (0.9%) (0.7%) (0.8%) (1.0%) (0.5%) (0.5%) (0.4%) (0.4%) (0.5%) (0.5%) (0.5%) (0.5%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB5.17
Exhibit 5.17 Average individual maximum out-of-pocket payment (in dollars) (standard error) per employee enrolled with single coverage in a health insurance plan with an individual maximum out-of-pocket payment, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $2,649 $2,939* $2,980 $3,099* $3,259* $3,575* $3,865* $4,099* $4,246* $4,416* $4,476 $4,594* $4,688*
(Standard Error) ($29) ($46) ($18) ($25) ($17) ($30) ($24) ($24) ($21) ($25) ($28) ($25) ($26)
<50 $2,758 $3,177* $3,191 $3,321* $3,515* $3,787* $4,096* $4,420* $4,446 $4,730* $5,126* $5,098 $5,157^
(Standard Error) ($26) ($125) ($43) ($48) ($38) ($49) ($52) ($53) ($47) ($45) ($54) ($58) ($66)
50-99 $2,757 $2,952* $3,019 $3,263 $3,346 $3,885* $4,230* $4,463 $4,678 $4,813 $4,908 $5,032 $5,055^
(Standard Error) ($47) ($84) ($92) ($99) ($71) ($100) ($96) ($81) ($87) ($80) ($76) ($103) ($99)
100+ $2,608 $2,874* $2,920 $3,026* $3,182* $3,489* $3,774* $3,992* $4,158* $4,312* $4,299 $4,467* $4,562*
(Standard Error) ($39) ($68) ($31) ($29) ($21) ($37) ($28) ($28) ($25) ($30) ($34) ($29) ($30)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB5.18
Exhibit 5.18 Average family maximum out-of-pocket payment (in dollars) (standard error) per employee enrolled with family coverage in a health insurance plan with a family maximum out-of-pocket payment, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. $5,438 $5,854* $6,010 $6,356* $6,500* $7,114* $7,542* $7,881* $8,183* $8,375* $8,534 $8,867* $8,983
(Standard Error) ($67) ($78) ($54) ($61) ($40) ($63) ($60) ($67) ($65) ($63) ($65) ($69) ($70)
<50 $5,638 $6,209* $6,210 $6,671* $6,843 $7,488* $7,676 $8,330* $8,821* $9,025 $9,777* $9,785 $9,657^
(Standard Error) ($67) ($129) ($102) ($155) ($140) ($123) ($135) ($155) ($136) ($143) ($157) ($177) ($185)
50-99 $5,340 $6,015* $6,296 $6,299 $6,594 $7,228 $7,608 $8,393* $8,605 $9,219 $9,314 $10,104* $9,465^
(Standard Error) ($159) ($178) ($234) ($277) ($281) ($301) ($239) ($265) ($246) ($231) ($217) ($228) ($254)
100+ $5,410 $5,779* $5,961 $6,311* $6,440 $7,050* $7,519* $7,785* $8,066* $8,240 $8,304 $8,692* $8,871
(Standard Error) ($73) ($97) ($64) ($65) ($53) ($72) ($68) ($76) ($74) ($72) ($73) ($76) ($78)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
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 2021 only.

ALTER EXB5.19
Exhibit 5.19 Among private-sector enrolled employees with single coverage, percentage (standard error) in a high-deductible health insurance plan, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 19.2% 24.6%* 28.0%* 30.7%* 34.1%* 39.2%* 43.9%* 47.1%* 53.0%* 53.6% 55.3% 57.7%* 60.1%*
(Standard Error) (0.6%) (0.7%) (0.4%) (0.4%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.6%) (0.7%) (0.7%) (0.7%)
<50 30.8% 36.8%* 40.9%* 43.3% 45.6% 50.7%* 52.1% 54.9% 55.1% 60.2%* 63.6%* 64.2% 64.4%^
(Standard Error) (1.0%) (0.8%) (0.7%) (1.1%) (1.2%) (1.1%) (1.1%) (1.1%) (1.1%) (1.0%) (1.2%) (1.2%) (1.3%)
50-99 28.0% 39.8%* 38.3% 46.1%* 46.5% 50.0% 55.0% 55.0% 58.9% 62.5% 65.3% 67.4% 64.6%^
(Standard Error) (1.8%) (2.2%) (1.9%) (1.9%) (2.1%) (2.1%) (2.3%) (2.0%) (2.0%) (2.0%) (2.1%) (2.1%) (2.3%)
100+ 14.7% 19.3%* 23.1%* 25.5%* 29.4%* 35.0%* 40.5%* 44.5%* 51.8%* 51.2% 52.4% 55.4%* 58.7%*
(Standard Error) (0.5%) (0.6%) (0.4%) (0.5%) (0.6%) (0.8%) (0.8%) (0.8%) (0.8%) (0.8%) (0.9%) (0.8%) (0.8%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: Single coverage plans are classified as "high deductible" if the individual deductible met or exceeded the Internal Revenue Service (IRS) threshold for a high-deductible plan in a given year. In 2021, the individual deductible threshold was $1,400. Note that plans must also meet other requirements to be considered a high-deductible plan by the IRS. * 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 2021 only.

ALTER EXB5.20
Exhibit 5.20 Among private-sector enrolled employees with family coverage, percentage (standard error) in a high-deductible health insurance plan, overall and by firm size, 2009-2021
Number of Employees 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
U.S. 19.3% 23.7%* 28.8%* 30.3%* 33.9%* 39.4%* 41.9%* 44.4%* 51.9%* 50.7% 53.5%* 55.2% 58.4%*
(Standard Error) (0.6%) (0.7%) (0.5%) (0.4%) (0.4%) (0.8%) (0.8%) (0.8%) (0.9%) (0.8%) (0.9%) (0.9%) (0.9%)
<50 32.7% 37.5%* 42.7%* 44.3% 50.6%* 51.9% 52.7% 49.8% 55.2%* 56.6% 64.4%* 61.6% 62.3%^
(Standard Error) (1.0%) (1.1%) (1.7%) (1.6%) (1.0%) (1.5%) (1.6%) (1.6%) (1.7%) (1.6%) (1.7%) (1.9%) (2.0%)
50-99 25.0% 37.7%* 47.1%* 48.8% 47.1% 46.6% 47.2% 54.6% 53.7% 60.0% 61.1% 62.5% 69.6%^
(Standard Error) (1.7%) (2.4%) (2.1%) (2.6%) (3.0%) (2.6%) (2.8%) (3.1%) (3.1%) (2.9%) (2.7%) (4.1%) (2.6%)
100+ 16.2% 20.0%* 25.1%* 26.6% 30.2%* 36.8%* 39.8%* 42.9%* 51.3%* 49.2% 51.2% 53.9% 57.1%*
(Standard Error) (0.8%) (0.7%) (0.6%) (0.5%) (0.5%) (0.9%) (0.9%) (1.0%) (1.1%) (0.9%) (1.1%) (1.0%) (1.0%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2009-2021.
Note: Family coverage plans are classified as "high deductible" if the family deductible met or exceeded the Internal Revenue Service (IRS) threshold for a high-deductible plan in a given year. In 2021, the family deductible threshold was $2,800. Note that plans must also meet other requirements to be considered a high-deductible plan by the IRS. * 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 2021 only.

Graphics Replay
Exhibit 5.21 Among private-sector enrolled employees with single coverage, percentage in a high-deductible health insurance plan, overall and by State, 3-year average, 2019-2021
Alabama 44.6%* Kentucky 70.7%* North Dakota 61.5%*
(Standard Error) (2.5%) (Standard Error) (1.9%) (Standard Error) (1.9%)
Alaska 54.9% Louisiana 55.6% Ohio 65.1%*
(Standard Error) (2.4%) (Standard Error) (2.2%) (Standard Error) (2.0%)
Arizona 70.6%* Maine 72.0%* Oklahoma 61.6%
(Standard Error) (2.4%) (Standard Error) (1.9%) (Standard Error) (2.2%)
Arkansas 60.0% Maryland 52.3%* Oregon 62.0%
(Standard Error) (2.3%) (Standard Error) (2.4%) (Standard Error) (2.9%)
California 45.1%* Massachusetts 51.6%* Pennsylvania 53.1%*
(Standard Error) (1.6%) (Standard Error) (2.3%) (Standard Error) (1.7%)
Colorado 65.9%* Michigan 56.9% Rhode Island 58.0%
(Standard Error) (2.4%) (Standard Error) (2.2%) (Standard Error) (2.2%)
Connecticut 65.1%* Minnesota 67.0%* South Carolina 64.7%*
(Standard Error) (2.2%) (Standard Error) (2.4%) (Standard Error) (2.4%)
Delaware 55.2% Mississippi 49.2%* South Dakota 76.7%*
(Standard Error) (2.4%) (Standard Error) (2.4%) (Standard Error) (1.9%)
District of Columbia 32.3%* Missouri 65.2%* Tennessee 65.0%*
(Standard Error) (1.8%) (Standard Error) (2.1%) (Standard Error) (2.1%)
Florida 62.9%* Montana 70.5%* Texas 61.1%*
(Standard Error) (2.2%) (Standard Error) (2.0%) (Standard Error) (1.5%)
Georgia 60.2% Nebraska 65.7%* Utah 62.2%
(Standard Error) (2.7%) (Standard Error) (2.4%) (Standard Error) (2.3%)
Hawaii 15.7%* Nevada 49.2%* Vermont 61.1%
(Standard Error) (1.4%) (Standard Error) (2.4%) (Standard Error) (2.0%)
Idaho 66.9%* New Hampshire 70.0%* Virginia 53.8%
(Standard Error) (2.0%) (Standard Error) (2.3%) (Standard Error) (2.5%)
Illinois 54.0%* New Jersey 53.2% Washington 59.8%
(Standard Error) (1.6%) (Standard Error) (2.7%) (Standard Error) (2.4%)
Indiana 67.2%* New Mexico 54.7% West Virginia 58.6%
(Standard Error) (2.0%) (Standard Error) (2.4%) (Standard Error) (2.3%)
Iowa 68.6%* New York 47.1%* Wisconsin 65.9%*
(Standard Error) (1.8%) (Standard Error) (1.5%) (Standard Error) (2.0%)
Kansas 60.0% North Carolina 72.3%* Wyoming 60.1%
(Standard Error) (2.2%) (Standard Error) (1.9%) (Standard Error) (2.6%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of 57.7 percent at p < 0.05. Note that the standard error on the national estimate of 57.7 percent is 0.39.

Graphics Replay
Exhibit 5.22 Among private-sector enrolled employees with family coverage, percentage in a high-deductible health insurance plan, overall and by State, 3-year average, 2019-2021
Alabama 42.5%* Kentucky 65.0%* North Dakota 54.3%
(Standard Error) (3.2%) (Standard Error) (3.4%) (Standard Error) (2.6%)
Alaska 51.1% Louisiana 65.3%* Ohio 64.1%*
(Standard Error) (3.7%) (Standard Error) (2.7%) (Standard Error) (2.7%)
Arizona 68.9%* Maine 60.4% Oklahoma 61.0%
(Standard Error) (3.9%) (Standard Error) (3.6%) (Standard Error) (2.7%)
Arkansas 58.0% Maryland 51.2% Oregon 55.9%
(Standard Error) (2.8%) (Standard Error) (2.8%) (Standard Error) (3.0%)
California 45.7%* Massachusetts 48.3%* Pennsylvania 48.2%*
(Standard Error) (1.9%) (Standard Error) (2.5%) (Standard Error) (2.3%)
Colorado 66.2%* Michigan 55.3% Rhode Island 48.1%*
(Standard Error) (3.0%) (Standard Error) (3.2%) (Standard Error) (2.7%)
Connecticut 62.4%* Minnesota 62.8%* South Carolina 58.6%
(Standard Error) (3.0%) (Standard Error) (2.8%) (Standard Error) (3.3%)
Delaware 47.2%* Mississippi 49.7%* South Dakota 64.8%*
(Standard Error) (3.4%) (Standard Error) (2.9%) (Standard Error) (2.7%)
District of Columbia 35.7%* Missouri 64.3%* Tennessee 60.9%
(Standard Error) (2.4%) (Standard Error) (2.5%) (Standard Error) (3.4%)
Florida 58.3% Montana 55.9% Texas 60.3%*
(Standard Error) (2.7%) (Standard Error) (3.4%) (Standard Error) (2.0%)
Georgia 62.2%* Nebraska 61.1% Utah 65.6%*
(Standard Error) (2.7%) (Standard Error) (2.9%) (Standard Error) (2.3%)
Hawaii 18.0%* Nevada 48.2%* Vermont 57.8%
(Standard Error) (1.7%) (Standard Error) (2.6%) (Standard Error) (2.9%)
Idaho 51.5% New Hampshire 63.8%* Virginia 51.1%
(Standard Error) (2.5%) (Standard Error) (2.8%) (Standard Error) (3.1%)
Illinois 55.9% New Jersey 51.3% Washington 59.5%
(Standard Error) (2.1%) (Standard Error) (4.0%) (Standard Error) (3.6%)
Indiana 65.1%* New Mexico 59.6% West Virginia 57.6%
(Standard Error) (3.0%) (Standard Error) (2.4%) (Standard Error) (2.8%)
Iowa 61.0%* New York 44.8%* Wisconsin 59.9%
(Standard Error) (2.6%) (Standard Error) (1.8%) (Standard Error) (2.5%)
Kansas 53.9% North Carolina 66.1%* Wyoming 60.8%
(Standard Error) (2.5%) (Standard Error) (3.1%) (Standard Error) (3.2%)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of 55.7 percent at p < 0.05. Note that the standard error on the national estimate of 55.7 percent is 0.50.

Graphics Replay
Exhibit 5.23 Average individual deductible (in dollars) per employee enrolled with single coverage in a high-deductible health insurance plan, overall and by State, 3-year average, 2019-2021
Alabama $2,614 Kentucky $2,579 North Dakota $2,621
(Standard Error) ($72) (Standard Error) ($65) (Standard Error) ($57)
Alaska $2,684 Louisiana $2,686 Ohio $2,640
(Standard Error) ($80) (Standard Error) ($63) (Standard Error) ($54)
Arizona $2,797* Maine $2,972* Oklahoma $2,707
(Standard Error) ($63) (Standard Error) ($60) (Standard Error) ($67)
Arkansas $2,456* Maryland $2,297* Oregon $2,863
(Standard Error) ($55) (Standard Error) ($56) (Standard Error) ($154)
California $2,338* Massachusetts $2,300* Pennsylvania $2,417*
(Standard Error) ($42) (Standard Error) ($64) (Standard Error) ($45)
Colorado $2,605 Michigan $2,287* Rhode Island $2,623
(Standard Error) ($57) (Standard Error) ($45) (Standard Error) ($60)
Connecticut $2,731* Minnesota $2,782* South Carolina $2,708
(Standard Error) ($54) (Standard Error) ($54) (Standard Error) ($63)
Delaware $2,600 Mississippi $2,687 South Dakota $2,825*
(Standard Error) ($68) (Standard Error) ($79) (Standard Error) ($43)
District of Columbia $2,318* Missouri $2,696 Tennessee $2,843*
(Standard Error) ($52) (Standard Error) ($60) (Standard Error) ($65)
Florida $2,695 Montana $3,086* Texas $2,778*
(Standard Error) ($67) (Standard Error) ($72) (Standard Error) ($40)
Georgia $2,601 Nebraska $2,587 Utah $2,358*
(Standard Error) ($59) (Standard Error) ($67) (Standard Error) ($50)
Hawaii $2,444 Nevada $2,632 Vermont $2,799*
(Standard Error) ($100) (Standard Error) ($70) (Standard Error) ($57)
Idaho $2,556 New Hampshire $2,947* Virginia $2,626
(Standard Error) ($48) (Standard Error) ($73) (Standard Error) ($67)
Illinois $2,551 New Jersey $2,221* Washington $2,482
(Standard Error) ($45) (Standard Error) ($42) (Standard Error) ($69)
Indiana $2,741* New Mexico $2,820* West Virginia $2,695
(Standard Error) ($55) (Standard Error) ($111) (Standard Error) ($67)
Iowa $2,689 New York $2,437* Wisconsin $2,772*
(Standard Error) ($49) (Standard Error) ($48) (Standard Error) ($62)
Kansas $2,655 North Carolina $2,703 Wyoming $2,469*
(Standard Error) ($68) (Standard Error) ($57) (Standard Error) ($60)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of $2,594 at p < 0.05. Note that the standard error on the national estimate of $2,594 is $10.84.

Graphics Replay
Exhibit 5.24 Average family deductible (in dollars) per employee enrolled with family coverage in a high-deductible health insurance plan, overall and by State, 3-year average, 2019-2021
Alabama $5,124 Kentucky $4,887 North Dakota $5,202
(Standard Error) ($164) (Standard Error) ($170) (Standard Error) ($118)
Alaska $5,261 Louisiana $5,254 Ohio $5,168
(Standard Error) ($181) (Standard Error) ($146) (Standard Error) ($124)
Arizona $5,552 Maine $5,320 Oklahoma $5,553*
(Standard Error) ($366) (Standard Error) ($129) (Standard Error) ($184)
Arkansas $4,849* Maryland $4,641* Oregon $5,095
(Standard Error) ($112) (Standard Error) ($127) (Standard Error) ($166)
California $4,784* Massachusetts $4,684* Pennsylvania $4,745*
(Standard Error) ($135) (Standard Error) ($120) (Standard Error) ($106)
Colorado $5,269 Michigan $4,339* Rhode Island $5,536*
(Standard Error) ($134) (Standard Error) ($123) (Standard Error) ($198)
Connecticut $5,170 Minnesota $5,460* South Carolina $5,284
(Standard Error) ($199) (Standard Error) ($131) (Standard Error) ($157)
Delaware $5,273 Mississippi $5,291 South Dakota $5,374*
(Standard Error) ($167) (Standard Error) ($181) (Standard Error) ($94)
District of Columbia $4,766* Missouri $5,273 Tennessee $5,585*
(Standard Error) ($154) (Standard Error) ($147) (Standard Error) ($197)
Florida $5,140 Montana $5,250 Texas $5,513*
(Standard Error) ($221) (Standard Error) ($176) (Standard Error) ($102)
Georgia $5,313 Nebraska $5,166 Utah $4,908
(Standard Error) ($218) (Standard Error) ($116) (Standard Error) ($126)
Hawaii $4,909 Nevada $5,085 Vermont $5,260
(Standard Error) ($179) (Standard Error) ($173) (Standard Error) ($162)
Idaho $5,080 New Hampshire $5,759* Virginia $5,269
(Standard Error) ($126) (Standard Error) ($158) (Standard Error) ($138)
Illinois $5,179 New Jersey $4,517* Washington $4,640*
(Standard Error) ($114) (Standard Error) ($123) (Standard Error) ($175)
Indiana $5,289 New Mexico $5,471* West Virginia $5,363
(Standard Error) ($151) (Standard Error) ($138) (Standard Error) ($154)
Iowa $5,274 New York $4,603* Wisconsin $5,550*
(Standard Error) ($105) (Standard Error) ($84) (Standard Error) ($150)
Kansas $5,146 North Carolina $5,085 Wyoming $5,173
(Standard Error) ($134) (Standard Error) ($144) (Standard Error) ($154)
Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2019-2021.
Note: * Statistically different from the national average of $5,086 at p < 0.05. Note that the standard error on the national estimate of $5,086 is $29.66.

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