Chartbook #27: Medical Expenditure Panel Survey Insurance Component 2022 Chartbook

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

The authors appreciate the efforts of Abigail Woodroffe, Alon Evron, Perry Gorelik, and Lauren Kestner of the American Institutes for Research, Abigail Smith of Insignia, and Sean Anderson of Pantheon 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 editing and production assistance of Doreen Bonnett, Nicole Shulman, and Michelle Roberts of AHRQ.

Reviewers of this publication were Joel W. Cohen, Director of CFACT, Salam Abdus, Paul D. Jacobs, Samuel H. Zuvekas and Jessica Monnet of the DRM, CFACT, and Anita Soni of the Division of Survey Operations, CFACT.

Table of Contents

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.

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Medical Expenditure Panel Survey Insurance Component 2022 Chartbook. Rockville, MD: Agency for Healthcare Research and Quality; October 2023. AHRQ Publication No. 23(24)-0077. https://meps.ahrq.gov/mepsweb/data_files/publications/cb27/cb27.shtml.

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 2010 to 2022. 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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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 5.8 percent of the sample determined during the data collection process to be out of scope. In 2022, the response rate for the private sector was 54.6 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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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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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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Overview

Employer-sponsored insurance (ESI) is the primary source of health insurance coverage for individuals under age 65 in the United States. 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 2010 to 2022.

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 54.6 percent in 2022, 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 2010 to 2022. 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

From 2021 to 2022, the percentage of private-sector employees covered by a health insurance plan offered by their employers (the "enrollment rate") did not change significantly overall or within any of the three firm size groups examined in this chartbook. In 2022, the enrollment rate was 47.7 percent overall and ranged from 27.9 percent at small employers (fewer than 50 employees) to 56.2 percent at large employers (100 or more employees).

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 below.

Availability of Coverage: Offer Rates

Overall, there was no significant change in the offer rate (percentage of employees working at an establishment that offered insurance) from 2021 (85.7 percent) to 2022 (85.6 percent) (Exhibit ES.1). The offer rate at small firms, however, increased from 50.4 percent in 2021 to 52.6 percent in 2022, extending the recent period of stability and increases for small firm offer rates. Over the last 7 years, the small firm offer rate either remained stable or increased each year and rose by a total of 5.0 percentage points, from 47.6 percent in 2015 to 52.6 percent in 2022.

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Exhibit ES.1: Percentage (standard error) of private-sector employees in establishments that offer health insurance, by firm size, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	86.5%	85.3%*	84.7%	84.9%	83.2%*	83.8%	84.3%	84.5%	84.6%	85.3%*	86.9%*	85.7%*	85.6%
(Standard Error)	(0.2%)	(0.2%)	(0.3%)	(0.3%)	(0.3%)	(0.2%)	(0.2%)	(0.2%)	(0.2%)	(0.2%)	(0.2%)	(0.3%)	(0.3%)
<50	57.8%	54.7%*	52.9%*	53.1%	49.8%*	47.6%*	47.7%	48.3%	47.3%	50.7%*	50.5%	50.4%	52.6%*^
(Standard Error)	(0.5%)	(0.4%)	(0.6%)	(0.7%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.7%)	(0.7%)	(0.7%)	(0.8%)
50-99	87.3%	85.6%	84.1%	87.0%	83.0%*	85.3%	88.6%*	86.3%	88.0%	88.0%	88.5%	90.3%	91.7%^
(Standard Error)	(0.9%)	(1.0%)	(1.4%)	(1.0%)	(1.3%)	(1.2%)	(1.0%)	(1.2%)	(1.1%)	(1.1%)	(1.2%)	(1.2%)	(1.0%)
100+	98.5%	98.1%	98.2%	98.0%	97.3%*	98.8%*	98.9%	98.9%	99.0%	99.0%	98.8%	98.9%	98.7%
(Standard Error)	(0.2%)	(0.2%)	(0.2%)	(0.2%)	(0.2%)	(0.2%)	(0.1%)	(0.2%)	(0.2%)	(0.1%)	(0.2%)	(0.2%)	(0.2%)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 only.

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Since offer rates are high among medium (91.7 percent in 2022) and large firms (98.7 percent in 2022), 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 2020-2022 was 51.2 percent for small firms, but there was substantial variation across the United States. Among small firms, 14 States, with average annual offer rates ranging from 33.0 to 45.9 percent, were significantly below the national average. Another 11 States, with average annual offer rates ranging from 55.0 to 90.6 percent, were significantly above the national average for small firms (Exhibit ES.2).

Exhibit ES.2: Percentage (standard error) of private-sector employees in establishments that offer health insurance, by State, firm size <50 employees, 3-year average, 2020-2022

TABLE SUMMARY

Alabama	56.2%	Kentucky	44.9%*	North Dakota	55.9%
(Standard Error)	(2.6%)	(Standard Error)	(2.9%)	(Standard Error)	(2.5%)
Alaska	33.0%*	Louisiana	48.7%	Ohio	50.3%
(Standard Error)	(2.6%)	(Standard Error)	(2.9%)	(Standard Error)	(2.8%)
Arizona	49.4%	Maine	47.4%	Oklahoma	58.5%*
(Standard Error)	(2.9%)	(Standard Error)	(2.4%)	(Standard Error)	(2.4%)
Arkansas	41.7%*	Maryland	57.3%*	Oregon	53.3%
(Standard Error)	(2.8%)	(Standard Error)	(2.7%)	(Standard Error)	(2.4%)
California	55.0%*	Massachusetts	59.9%*	Pennsylvania	56.3%*
(Standard Error)	(1.6%)	(Standard Error)	(2.7%)	(Standard Error)	(2.1%)
Colorado	55.3%	Michigan	50.2%	Rhode Island	57.2%*
(Standard Error)	(2.7%)	(Standard Error)	(2.5%)	(Standard Error)	(2.9%)
Connecticut	54.9%	Minnesota	49.0%	South Carolina	37.6%*
(Standard Error)	(2.6%)	(Standard Error)	(2.4%)	(Standard Error)	(2.7%)
Delaware	48.3%	Mississippi	54.1%	South Dakota	48.4%
(Standard Error)	(2.9%)	(Standard Error)	(2.7%)	(Standard Error)	(2.3%)
District of Columbia	73.7%*	Missouri	53.7%	Tennessee	47.9%
(Standard Error)	(2.8%)	(Standard Error)	(2.6%)	(Standard Error)	(2.8%)
Florida	40.7%*	Montana	42.0%*	Texas	47.4%
(Standard Error)	(2.1%)	(Standard Error)	(2.3%)	(Standard Error)	(2.0%)
Georgia	46.4%	Nebraska	43.1%*	Utah	42.5%*
(Standard Error)	(2.7%)	(Standard Error)	(2.6%)	(Standard Error)	(2.6%)
Hawaii	90.6%*	Nevada	50.9%	Vermont	50.3%
(Standard Error)	(1.3%)	(Standard Error)	(3.0%)	(Standard Error)	(2.3%)
Idaho	41.5%*	New Hampshire	52.7%	Virginia	56.2%
(Standard Error)	(2.6%)	(Standard Error)	(2.8%)	(Standard Error)	(2.7%)
Illinois	55.8%*	New Jersey	56.8%*	Washington	54.3%
(Standard Error)	(2.0%)	(Standard Error)	(2.7%)	(Standard Error)	(2.7%)
Indiana	45.9%*	New Mexico	44.1%*	West Virginia	42.7%*
(Standard Error)	(2.5%)	(Standard Error)	(2.6%)	(Standard Error)	(2.8%)
Iowa	52.8%	New York	56.1%*	Wisconsin	50.3%
(Standard Error)	(2.5%)	(Standard Error)	(1.9%)	(Standard Error)	(2.4%)
Kansas	54.7%	North Carolina	42.7%*	Wyoming	39.5%*
(Standard Error)	(2.6%)	(Standard Error)	(2.6%)	(Standard Error)	(2.3%)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020-2022.
Note: * Statistically different from the national average of 51.2 percent at p < 0.05. Note that the standard error on the national estimate of 51.2 percent is 0.4 percent.

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Employee Coverage, Eligibility, and Take-Up Rates

Among establishments that offered insurance in 2022, 55.8 percent of employees were enrolled in coverage through their employer (the "coverage rate") and 80.8 percent were eligible for health insurance (the "eligibility rate") (Exhibits ES.3 and ES.4). Among eligible employees, 69.0 percent were enrolled in their employer's health insurance (the "take-up rate") (Exhibit ES.5).

The overall coverage, eligibility, and take-up rates did not change significantly from 2021 to 2022. From 2010 to 2022, however, the overall take-up rate fell by 7.5 percentage points (from 76.5 to 69.0 percent). In 2022, the take-up rate among large firms (69.9 percent) remained higher than in medium (64.6 percent) and small firms (67.0 percent), as has been true in every year from 2010 through 2022.

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, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	59.8%	59.4%	58.9%	58.2%	57.8%	57.0%	56.0%	56.5%	56.5%	55.8%	57.0%	56.0%	55.8%
(Standard Error)	(0.5%)	(0.2%)	(0.4%)	(0.3%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)	(0.5%)	(0.4%)	(0.4%)	(0.4%)
<50	59.2%	58.6%	57.7%	57.1%	56.8%	57.0%	55.5%	55.4%	56.2%	53.9%*	55.1%	53.8%	53.1%^
(Standard Error)	(0.6%)	(0.5%)	(0.5%)	(0.5%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.7%)	(0.7%)	(0.7%)
50-99	55.9%	54.9%	55.4%	54.7%	54.5%	55.8%	51.2%*	52.2%	50.3%	53.8%*	53.4%	51.3%	50.3%^
(Standard Error)	(0.8%)	(1.0%)	(1.2%)	(0.8%)	(1.3%)	(1.2%)	(1.2%)	(1.2%)	(1.2%)	(1.2%)	(1.3%)	(1.3%)	(1.4%)
100+	60.4%	60.0%	59.5%	58.8%	58.3%	57.1%	56.6%	57.1%	57.1%	56.4%	57.7%	56.9%	56.9%
(Standard Error)	(0.6%)	(0.3%)	(0.4%)	(0.3%)	(0.5%)	(0.5%)	(0.5%)	(0.5%)	(0.5%)	(0.6%)	(0.5%)	(0.5%)	(0.6%)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 only.

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, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	78.2%	78.0%	77.8%	77.8%	75.4%*	76.0%	76.5%	76.8%	78.0%*	77.7%	80.5%*	80.3%	80.8%
(Standard Error)	(0.5%)	(0.4%)	(0.3%)	(0.2%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)
<50	78.6%	78.7%	77.9%	78.0%	77.7%	79.1%	78.7%	78.3%	79.1%	78.1%	80.2%*	79.7%	79.3%^
(Standard Error)	(0.5%)	(0.6%)	(0.5%)	(0.4%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.7%)
50-99	74.5%	73.6%	76.4%	76.2%	74.1%	77.8%*	76.2%	75.5%	75.6%	78.1%	77.6%	79.2%	77.8%^
(Standard Error)	(0.6%)	(1.0%)	(1.2%)	(0.8%)	(1.4%)	(1.2%)	(1.2%)	(1.2%)	(1.2%)	(1.2%)	(1.4%)	(1.3%)	(1.3%)
100+	78.5%	78.3%	77.9%	77.9%	75.0%*	75.2%	76.0%	76.6%	78.0%	77.5%	80.8%*	80.5%	81.5%
(Standard Error)	(0.6%)	(0.4%)	(0.3%)	(0.3%)	(0.5%)	(0.5%)	(0.4%)	(0.5%)	(0.5%)	(0.5%)	(0.5%)	(0.4%)	(0.4%)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 only.

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, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	76.5%	76.1%	75.8%	74.8%*	76.7%*	75.0%*	73.3%*	73.5%	72.4%*	71.9%	70.8%*	69.8%	69.0%
(Standard Error)	(0.2%)	(0.3%)	(0.3%)	(0.2%)	(0.3%)	(0.3%)	(0.3%)	(0.3%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)	(0.5%)
<50	75.3%	74.4%	74.1%	73.1%	73.0%	72.1%	70.4%*	70.7%	71.0%	69.0%*	68.7%	67.5%	67.0%^
(Standard Error)	(0.6%)	(0.4%)	(0.4%)	(0.6%)	(0.5%)	(0.5%)	(0.5%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.7%)	(0.7%)
50-99	75.1%	74.5%	72.5%	71.8%	73.5%	71.7%	67.2%*	69.1%	66.6%	68.9%	68.8%	64.7%*	64.6%^
(Standard Error)	(0.7%)	(0.6%)	(0.8%)	(1.0%)	(1.0%)	(1.1%)	(1.2%)	(1.1%)	(1.1%)	(1.0%)	(1.0%)	(1.2%)	(1.4%)
100+	76.9%	76.7%	76.4%	75.5%*	77.8%*	76.0%*	74.4%*	74.5%	73.3%*	72.7%	71.4%*	70.7%	69.9%
(Standard Error)	(0.3%)	(0.3%)	(0.4%)	(0.3%)	(0.3%)	(0.3%)	(0.4%)	(0.4%)	(0.4%)	(0.5%)	(0.4%)	(0.5%)	(0.6%)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 only.

Choice of Plans

Overall, about three-quarters (74.2 percent) of employees at firms offering health insurance were offered a choice of two or more health plans in 2022, which was not a significant change from 2021 (73.9 percent) (Exhibit ES.6). In all years from 2010 to 2022, the likelihood that an employee of an offering establishment had a choice of plans increased with firm size. In 2022, the percentage of employees with a choice of plans ranged from 42.9 percent at small firms to 82.9 percent at large firms.

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, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	65.6%	65.5%	65.3%	66.0%	67.0%	70.2%*	71.7%	72.4%	75.7%*	75.8%	73.8%*	73.9%	74.2%
(Standard Error)	(0.8%)	(0.5%)	(0.7%)	(0.6%)	(0.6%)	(0.5%)	(0.5%)	(0.5%)	(0.5%)	(0.5%)	(0.6%)	(0.6%)	(0.6%)
<50	26.7%	27.2%	29.3%	28.4%	29.6%	33.6%*	34.2%	34.9%	37.8%*	41.4%*	39.9%	41.0%	42.9%^
(Standard Error)	(0.8%)	(0.9%)	(0.8%)	(1.0%)	(0.9%)	(1.1%)	(1.0%)	(1.0%)	(1.0%)	(1.1%)	(1.1%)	(1.1%)	(1.2%)
50-99	44.1%	46.8%	43.7%	46.6%	46.8%	50.2%	56.2%*	59.3%	56.4%	58.7%	58.6%	60.8%	57.9%^
(Standard Error)	(1.9%)	(2.2%)	(1.7%)	(2.2%)	(2.1%)	(2.2%)	(2.0%)	(1.9%)	(1.9%)	(2.0%)	(2.1%)	(2.2%)	(2.3%)
100+	77.3%	76.3%	75.7%	76.5%	77.0%	79.7%*	80.7%	81.0%	84.7%*	84.5%	81.0%*	81.7%	82.9%
(Standard Error)	(1.0%)	(0.7%)	(0.7%)	(0.7%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.5%)	(0.6%)	(0.6%)	(0.6%)	(0.7%)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 only.

Self-Insured Plans

From 2021 to 2022, the overall percentage of offering establishments that self-insured at least one plan (38.2 percent) did not change significantly, but among the largest firms (1,000 or more employees) this percentage fell from 78.1 to 74.6 percent (Exhibit ES.7). In the three smallest detailed firm-size categories (fewer than 10, 10-24, and 25-99 employees), less than one in five offering establishments self-insured at least one plan.

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, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	35.8%	36.9%	37.2%	37.6%	37.2%	39.0%*	40.7%*	39.2%	38.7%	39.4%	41.9%*	40.1%	38.2%
(Standard Error)	(0.5%)	(0.5%)	(0.5%)	(0.5%)	(0.5%)	(0.5%)	(0.6%)	(0.6%)	(0.6%)	(0.6%)	(0.7%)	(0.7%)	(0.7%)
<10	13.1%	12.6%	14.9%	15.2%	14.4%	15.8%	19.3%*	17.7%	13.1%*	14.8%	17.6%	18.9%	18.2%^
(Standard Error)	(0.5%)	(0.8%)	(0.9%)	(0.4%)	(0.8%)	(1.0%)	(1.4%)	(1.4%)	(1.1%)	(1.3%)	(1.7%)	(1.7%)	(1.7%)
10-24	11.6%	9.9%	10.7%	9.0%	12.0%*	10.6%	13.6%*	13.3%	13.8%	12.2%	13.1%	12.0%	15.1%^
(Standard Error)	(0.8%)	(0.7%)	(0.7%)	(0.7%)	(1.0%)	(1.0%)	(1.1%)	(1.2%)	(1.2%)	(1.1%)	(1.2%)	(1.0%)	(1.4%)
25-99	14.3%	12.2%*	13.5%	12.4%	12.2%	13.7%	16.6%*	16.0%	12.9%*	17.2%*	16.3%	17.7%	19.1%^
(Standard Error)	(0.7%)	(0.7%)	(0.7%)	(0.7%)	(0.8%)	(0.9%)	(0.9%)	(0.9%)	(0.8%)	(0.9%)	(0.9%)	(1.0%)	(1.1%)
100-999	30.9%	31.7%	30.1%	30.1%	32.5%	33.7%	34.4%	37.2%	35.1%	33.9%	35.8%	38.0%	41.2%^
(Standard Error)	(0.9%)	(1.1%)	(0.8%)	(1.0%)	(1.2%)	(1.2%)	(1.2%)	(1.3%)	(1.2%)	(1.1%)	(1.2%)	(1.3%)	(1.4%)
1,000+	86.6%	87.5%	87.1%	88.0%	84.2%*	83.8%	81.9%	78.6%*	81.6%*	83.1%	77.8%*	78.1%	74.6%*
(Standard Error)	(0.6%)	(0.5%)	(0.7%)	(0.5%)	(0.8%)	(0.8%)	(0.8%)	(0.8%)	(0.8%)	(0.8%)	(0.9%)	(0.9%)	(0.9%)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 only.

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Premiums

In 2022, average total health insurance premiums were $7,590 for single coverage, $14,943 for employee-plus-one coverage, and $21,931 for family coverage, representing increases of 2.8, 2.1, and 2.6 percent, respectively, over the 2021 levels (Exhibits ES.8 and ES.9).

Exhibit ES.8: Average total premiums (standard error) per enrolled employee for single, employee-plus-one and family coverage, 2010-2022

TABLE SUMMARY

Coverage	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Single	$4,940	$5,222*	$5,384*	$5,571*	$5,832*	$5,963*	$6,101*	$6,368*	$6,715*	$6,972*	$7,149*	$7,380*	$7,590*
(Standard Error)	($22)	($26)	($28)	($23)	($25)	($26)	($27)	($28)	($31)	($35)	($35)	($37)	($38)
Plus One	$9,664	$10,329*	$10,621*	$10,990*	$11,503*	$11,800*	$12,124*	$12,789*	$13,425*	$13,989*	$14,191	$14,634*	$14,943*
(Standard Error)	($60)	($105)	($56)	($54)	($60)	($58)	($60)	($70)	($70)	($83)	($93)	($84)	($91)
Family	$13,871	$15,022*	$15,473*	$16,029*	$16,655*	$17,322*	$17,710*	$18,687*	$19,565*	$20,486*	$20,758	$21,381*	$21,931*
(Standard Error)	($75)	($98)	($95)	($61)	($79)	($95)	($84)	($105)	($104)	($125)	($124)	($111)	($122)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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Exhibit ES.9: Percentage change (standard error) in total premiums from previous year per enrolled employee for single, employee-plus-one, and family coverage, 2010-2022

TABLE SUMMARY

Year	Single	Plus one	Family
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%)
2022	2.8%*	2.1%*	2.6%*
(Standard Error)	($0.7%)	($0.9%)	($0.8%)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
Note: * indicates the estimate is statistically different from zero at p < 0.05.

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From 2021 to 2022, large firms (100 or more employees) had increases in average premiums of 2.8 to 3.0 percent for single, employee-plus-one, and family coverage, but there were no significant changes in premiums among small and medium firms (Exhibits ES.10, ES.11, and ES.12). In 2022, average family premiums were higher for large employers ($22,228) than for small ($20,406) and medium employers ($21,289).

Exhibit ES.10: Average total single premium (standard error) per enrolled employee, by firm size, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	$4,940	$5,222*	$5,384*	$5,571*	$5,832*	$5,963*	$6,101*	$6,368*	$6,715*	$6,972*	$7,149*	$7,380*	$7,590*
(Standard Error)	($22)	($26)	($28)	($23)	($25)	($26)	($27)	($28)	($31)	($35)	($35)	($37)	($38)
<50	$4,956	$5,258*	$5,460*	$5,628*	$5,886*	$5,947	$6,070	$6,421*	$6,667*	$6,920*	$7,045	$7,382*	$7,513
(Standard Error)	($34)	($39)	($60)	($39)	($55)	($55)	($53)	($61)	($63)	($73)	($70)	($84)	($81)
50-99	$4,713	$4,861	$5,246*	$5,314	$5,549*	$5,642	$5,743	$6,163*	$6,287	$6,629*	$6,870	$7,189	$7,465
(Standard Error)	($52)	($75)	($39)	($73)	($82)	($104)	($96)	($121)	($111)	($99)	($129)	($129)	($153)
100+	$4,959	$5,252*	$5,378*	$5,584*	$5,851*	$6,006*	$6,146*	$6,377*	$6,770*	$7,019*	$7,197*	$7,399*	$7,622*
(Standard Error)	($23)	($31)	($28)	($29)	($30)	($31)	($32)	($33)	($37)	($42)	($41)	($43)	($45)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 only.

Exhibit ES.11: Average total employee-plus-one premium (standard error) per enrolled employee, by firm size, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	$9,664	$10,329*	$10,621*	$10,990*	$11,503*	$11,800*	$12,124*	$12,789*	$13,425*	$13,989*	$14,191	$14,634*	$14,943*
(Standard Error)	($60)	($105)	($56)	($54)	($60)	($58)	($60)	($70)	($70)	($83)	($93)	($84)	($91)
<50	$9,850	$10,253*	$10,524	$11,050*	$11,386	$11,666	$11,833	$12,558*	$13,044*	$13,619	$13,522	$14,326*	$14,093^
(Standard Error)	($80)	($104)	($121)	($92)	($163)	($158)	($156)	($170)	($176)	($248)	($212)	($262)	($240)
50-99	$9,166	$9,615*	$10,178*	$10,673	$10,845	$10,885	$11,389	$11,931	$12,593*	$13,248	$13,766	$14,314	$14,458
(Standard Error)	($124)	($192)	($185)	($330)	($187)	($198)	($227)	($232)	($236)	($321)	($246)	($295)	($350)
100+	$9,669	$10,394*	$10,672*	$11,006*	$11,571*	$11,892*	$12,225*	$12,878*	$13,537*	$14,105*	$14,304	$14,703*	$15,117*
(Standard Error)	($62)	($113)	($70)	($59)	($68)	($66)	($68)	($79)	($79)	($92)	($106)	($93)	($103)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 only.

Exhibit ES.12: Average total family premium (standard error) per enrolled employee, by firm size, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	$13,871	$15,022*	$15,473*	$16,029*	$16,655*	$17,322*	$17,710*	$18,687*	$19,565*	$20,486*	$20,758	$21,381*	$21,931*
(Standard Error)	($75)	($98)	($95)	($61)	($79)	($95)	($84)	($105)	($104)	($125)	($124)	($111)	($122)
<50	$13,170	$14,086*	$14,496	$14,787	$15,575*	$15,919	$16,471	$17,649*	$18,296*	$19,417*	$19,416	$20,406*	$20,406^
(Standard Error)	($111)	($145)	($181)	($89)	($177)	($212)	($207)	($192)	($231)	($303)	($283)	($320)	($310)
50-99	$13,019	$14,151*	$15,421*	$15,376	$15,732	$16,336	$16,214	$17,735*	$18,386	$19,893*	$19,827	$20,551	$21,289^
(Standard Error)	($153)	($168)	($273)	($268)	($274)	($335)	($348)	($327)	($473)	($435)	($422)	($396)	($451)
100+	$14,074	$15,245*	$15,641*	$16,284*	$16,903*	$17,612*	$18,000*	$18,911*	$19,824*	$20,697*	$20,990	$21,584*	$22,228*
(Standard Error)	($85)	($117)	($114)	($82)	($91)	($110)	($95)	($122)	($118)	($143)	($139)	($124)	($139)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 only.

For 2020-2022, the overall national average annual single premium was $7,322. Fifteen States, with average annual premiums ranging from $6,493 in Arkansas to $7,020 in Kentucky, were significantly below the national average. Fifteen States, with average annual premiums ranging from $7,556 in Pennsylvania to $8,681 in Alaska, were significantly above the national average (Exhibit ES.13).

Exhibit ES.13: Average total single premium (standard error) per enrolled employee, by State, 3-year average, 2020-2022

TABLE SUMMARY

Alabama	$6,543*	Kentucky	$7,020*	North Dakota	$7,413
(Standard Error)	($106)	(Standard Error)	($92)	(Standard Error)	($96)
Alaska	$8,681*	Louisiana	$6,902*	Ohio	$7,252
(Standard Error)	($188)	(Standard Error)	($106)	(Standard Error)	($109)
Arizona	$6,816*	Maine	$7,653*	Oklahoma	$6,852*
(Standard Error)	($125)	(Standard Error)	($101)	(Standard Error)	($93)
Arkansas	$6,493*	Maryland	$7,536	Oregon	$7,097
(Standard Error)	($113)	(Standard Error)	($117)	(Standard Error)	($159)
California	$7,379	Massachusetts	$7,827*	Pennsylvania	$7,556*
(Standard Error)	($85)	(Standard Error)	($117)	(Standard Error)	($96)
Colorado	$6,993*	Michigan	$7,016*	Rhode Island	$7,789*
(Standard Error)	($118)	(Standard Error)	($130)	(Standard Error)	($119)
Connecticut	$7,747*	Minnesota	$7,229	South Carolina	$7,300
(Standard Error)	($117)	(Standard Error)	($132)	(Standard Error)	($98)
Delaware	$7,709*	Mississippi	$6,689*	South Dakota	$7,257
(Standard Error)	($167)	(Standard Error)	($105)	(Standard Error)	($93)
District of Columbia	$8,159*	Missouri	$7,339	Tennessee	$6,768*
(Standard Error)	($145)	(Standard Error)	($119)	(Standard Error)	($101)
Florida	$7,336	Montana	$7,309	Texas	$7,154
(Standard Error)	($110)	(Standard Error)	($121)	(Standard Error)	($87)
Georgia	$7,125	Nebraska	$7,613*	Utah	$6,640*
(Standard Error)	($140)	(Standard Error)	($102)	(Standard Error)	($140)
Hawaii	$6,907*	Nevada	$6,658*	Vermont	$8,034*
(Standard Error)	($93)	(Standard Error)	($123)	(Standard Error)	($101)
Idaho	$6,862*	New Hampshire	$7,934*	Virginia	$7,259
(Standard Error)	($127)	(Standard Error)	($126)	(Standard Error)	($132)
Illinois	$7,362	New Jersey	$7,646*	Washington	$7,314
(Standard Error)	($100)	(Standard Error)	($139)	(Standard Error)	($125)
Indiana	$7,453	New Mexico	$7,480	West Virginia	$7,647*
(Standard Error)	($112)	(Standard Error)	($106)	(Standard Error)	($156)
Iowa	$7,086	New York	$8,423*	Wisconsin	$7,318
(Standard Error)	($130)	(Standard Error)	($119)	(Standard Error)	($105)
Kansas	$6,777*	North Carolina	$7,246	Wyoming	$7,846*
(Standard Error)	($108)	(Standard Error)	($149)	(Standard Error)	($175)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2020-2022.
Note: * Statistically different from national average of $7,322 at p < 0.05.

Employee Premium Contributions

In 2022, enrolled employees paid on average 21.6 percent of total premiums for single coverage, 28.4 percent for employee-plus-one coverage, and 29.6 percent for family coverage. These shares are not significantly different from their 2021 levels (Exhibit ES.14).

Exhibit ES.14: Average percentage (standard error) of premium contributed by employees for single, employee-plus-one, and family coverage, 2010-2022

TABLE SUMMARY

Coverage	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Single	20.7%	20.9%	20.8%	21.0%	21.2%	21.1%	21.7%*	22.2%	21.3%*	21.4%	21.4%	22.3%*	21.6%
(Standard Error)	(0.2%)	(0.2%)	(0.3%)	(0.3%)	(0.2%)	(0.2%)	(0.2%)	(0.2%)	(0.2%)	(0.3%)	(0.2%)	(0.2%)	(0.3%)
Plus One	25.8%	26.5%	26.6%	26.7%	26.9%	27.3%	27.8%	27.6%	27.1%	27.7%	28.4%	28.7%	28.4%
(Standard Error)	(0.3%)	(0.3%)	(0.4%)	(0.2%)	(0.3%)	(0.3%)	(0.3%)	(0.3%)	(0.3%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)
Family	26.8%	26.4%	27.4%*	27.6%	27.1%	27.2%	28.0%	27.9%	27.8%	28.0%	28.8%	28.9%	29.6%
(Standard Error)	(0.4%)	(0.3%)	(0.4%)	(0.3%)	(0.3%)	(0.3%)	(0.3%)	(0.4%)	(0.3%)	(0.4%)	(0.4%)	(0.4%)	(0.4%)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
Note: * indicates the estimate is statistically different from the previous year at p < 0.05.

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The average employee contribution in 2022 for family coverage was $6,492, representing an increase of 5.2 percent over the 2021 level. By contrast, average employee contributions in 2022 for single ($1,637) and employee-plus-one ($4,237) coverage were not significantly different from their 2021 levels (Exhibit ES.15).

In 2022, average employee contributions for the two types of dependent coverage, employee-plus-one and family, were lower at large employers ($4,096 and $6,263, respectively) than at small employers ($4,711 and $7,324, respectively) and medium employers ($5,052 and $7,788, respectively) (Chapter 4, Exhibits 4.9 and 4.11).

Exhibit ES.15: Average annual employee contribution (in dollars) (standard error) for single, employee-plus-one, and family coverage, 2010-2022

TABLE SUMMARY

Coverage	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
Single	$1,021	$1,090*	$1,118	$1,170*	$1,234*	$1,255	$1,325*	$1,415*	$1,427	$1,489*	$1,532	$1,643*	$1,637
(Standard Error)	($14)	($9)	($14)	($16)	($13)	($14)	($13)	($15)	($14)	($18)	($16)	($19)	($24)
Plus One	$2,498	$2,736*	$2,824	$2,940*	$3,097*	$3,220*	$3,376*	$3,531*	$3,634	$3,881*	$4,035*	$4,199*	$4,237
(Standard Error)	($42)	($36)	($46)	($23)	($40)	($35)	($36)	($39)	($39)	($54)	($52)	($64)	($56)
Family	$3,721	$3,962*	$4,236*	$4,421*	$4,518	$4,710*	$4,956*	$5,218*	$5,431*	$5,726*	$5,978*	$6,174	$6,492*
(Standard Error)	($53)	($42)	($69)	($50)	($48)	($56)	($56)	($64)	($63)	($82)	($76)	($87)	($93)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 was not significantly different from 2021 for firms overall (89.2 percent) or among small (84.8 percent), medium (86.9 percent), or large (90.3 percent) employers (Exhibit ES.16).

In 2022, the overall average deductibles, among enrollees in plans with a deductible, were $1,992 for individual coverage and $3,811 for family coverage (Exhibits ES.17 and Chapter 5, Exhibit 5.3). From 2021 to 2022, there were no significant changes in average individual or family deductibles overall or for enrollees in small and large firms. For medium-firm enrollees, there was a significant increase in individual deductibles.

The general lack of significant changes in average deductibles continued a recent trend of relatively slow deductible growth. Specifically, the average annual rates of growth for individual and family deductibles were significantly lower in the 5 years from 2017 to 2022 (2.0 and 2.3 percent, respectively) than in the 7 preceding years from 2010 to 2017 (8.4 and 8.1 percent, respectively) (data not shown).

Exhibit ES.16: Percentage (standard error) of private-sector enrolled employees in a health insurance plan with a deductible, overall and by firm size, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	77.5%	77.8%	79.6%*	81.3%	83.9%*	85.4%*	84.5%	87.5%*	87.3%	86.6%	89.2%*	88.5%	89.2%
(Standard Error)	(0.3%)	(0.7%)	(0.6%)	(0.7%)	(0.5%)	(0.5%)	(0.5%)	(0.4%)	(0.4%)	(0.5%)	(0.4%)	(0.5%)	(0.5%)
<50	75.7%	76.3%	79.5%*	79.5%	80.8%	82.1%	81.7%	82.3%	83.0%	84.1%	86.5%*	86.0%	84.8%^
(Standard Error)	(0.7%)	(0.4%)	(1.0%)	(0.8%)	(0.8%)	(0.8%)	(0.8%)	(0.8%)	(0.8%)	(0.9%)	(0.8%)	(0.9%)	(0.9%)
50-99	78.2%	79.6%	80.3%	78.0%	82.4%*	85.3%	82.5%	83.7%	85.1%	87.5%	89.0%	89.7%	86.9%^
(Standard Error)	(1.5%)	(1.7%)	(1.4%)	(1.1%)	(1.5%)	(1.5%)	(1.5%)	(1.6%)	(1.4%)	(1.5%)	(1.5%)	(1.3%)	(1.6%)
100+	77.8%	77.9%	79.6%	81.9%*	84.6%*	86.1%	85.2%	88.8%*	88.3%	87.1%	89.7%*	88.8%	90.3%
(Standard Error)	(0.3%)	(1.0%)	(0.7%)	(0.7%)	(0.6%)	(0.6%)	(0.6%)	(0.4%)	(0.5%)	(0.5%)	(0.5%)	(0.5%)	(0.6%)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 2022 only.

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, 2010-2022

TABLE SUMMARY

Number of Employees	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022
U.S.	$1,025	$1,123*	$1,167*	$1,273*	$1,353*	$1,541*	$1,696*	$1,808*	$1,846	$1,931*	$1,945	$2,004*	$1,992
(Standard Error)	($18)	($12)	($8)	($20)	($13)	($16)	($16)	($17)	($17)	($18)	($18)	($20)	($22)
<50	$1,447	$1,561*	$1,628	$1,695	$1,777*	$1,964*	$2,105*	$2,136	$2,327*	$2,386	$2,376	$2,485	$2,499^
(Standard Error)	($21)	($26)	($25)	($24)	($28)	($35)	($34)	($35)	($36)	($35)	($39)	($43)	($39)
50-99	$1,522	$1,543	$1,622	$1,755	$1,744	$2,008*	$2,173	$2,361	$2,369	$2,441	$2,464	$2,378	$2,596*^
(Standard Error)	($57)	($49)	($64)	($49)	($59)	($62)	($64)	($85)	($65)	($67)	($67)	($74)	($81)
100+	$852	$951*	$989*	$1,106*	$1,205*	$1,383*	$1,558*	$1,681*	$1,692	$1,778*	$1,814	$1,865	$1,814
(Standard Error)	($20)	($14)	($10)	($19)	($14)	($18)	($18)	($20)	($19)	($21)	($20)	($23)	($25)

Source: Medical Expenditure Panel Survey-Insurance Component, private-sector establishments, 2010-2022.
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 health 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 2022 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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This section presents estimates of the percentage of employees who worked where coverage was offered (the "offer rate"), by firm size, State, and 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 State.

This section also 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 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 overall percentage of employees working at insurance-offering establishments held steady between 2021 (85.7 percent) and 2022 (85.6 percent), after declining from 2020 to 2021 (Exhibit 1.1).
• While little change in the percentage of employees working at insurance-offering establishments occurred overall, among employees of small firms (fewer than 50 employees), this percentage rose from 50.4 percent in 2021 to 52.6 percent in 2022 (Exhibit 1.1).
• The overall share of health insurance eligible employees working at establishments that self-insure at least one plan fell from 57.4 percent in 2021 to 54.4 percent in 2022 (Exhibit 1.8). This reduction was driven in large part by a 4.5 percentage point reduction in this measure among health insurance eligible employees that work for large firms (1,000 or more employees).
• In keeping with established patterns, the share of private-sector employees offered health insurance showed substantial variation across the United States (Exhibits 1.2 and 1.3):
  • Among employees of all firms, the 2020-2022 average annual offer rate was 86.0 percent and ranged from 70.5 percent in Wyoming to 97.5 percent in Hawaii.
  • Among employees of small firms (fewer than 50 employees), the 2020-2022 average annual offer rate was 51.2 percent. The 2020-2022 small-firm average annual offer rate was between 41 percent and 58 percent for all but 8 states: Alaska (33.0 percent), South Carolina (37.6 percent), Wyoming (39.5 percent), Florida (40.7 percent), Oklahoma (58.5 percent), Massachusetts (59.9 percent), District of Columbia (73.7 percent), and Hawaii (90.6 percent).

Key Trends

Beyond the highlights presented above, many longstanding trends related to insurance coverage offers continued in 2022. Establishments in small firms continued to have a significantly lower offer rate relative to other firms. In addition, small-firm establishments that did offer insurance were less likely to self-insure their plans, less likely to offer dependent coverage, less likely to offer a choice of two or more plans, and less likely to offer retiree coverage.

Dependent coverage, as in prior years, was available at very high rates wherever health insurance was offered. Availability of retiree coverage of all kinds remained low and very rare outside of large firms. The long-term decline of retiree coverage availability continued in 2022 as well.

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 ("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 2010 to 2022 for private-sector employees for the:

• Enrollment rate (percentage of all employees enrolled in their employer's health insurance plan regardless of whether the establishment offered health insurance). 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 (percentage of all employees enrolled in their employer's health insurance plan at establishments that offered health insurance). The coverage rate is equal to the eligibility rate multiplied by the take-up rate;
• Eligibility rate (percentage of employees eligible for health insurance through their employer at establishments offering health insurance); and
• Take-up rate (percentage of eligible employees who enrolled in their employer's health insurance).

This section also presents estimates for 2010 to 2022 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 2021 to 2022, there were no statistically significant changes in enrollment rates among either private-sector workers overall or workers employed by firms of a given size category. The overall 2022 enrollment rate of 47.7 percent is very similar to the 2019 enrollment rate of 47.6 percent, suggesting that the enrollment rate may have returned to its prior long-term average after increasing in 2020 (Exhibit 2.1).
• There were no statistically significant changes from 2021 to 2022 in the eligibility rate for employees at private-sector establishments overall or for employees of small-, medium-, or large-firms. The overall 2022 eligibility rate of 80.8 percent remains elevated relative to the 2019 eligibility rate of 77.7 percent (Exhibit 2.4).
• Between 2021 and 2022, there were no statistically significant changes in take-up rates. The 2022 overall take-up rate (69.0%) remains low relative to the 2019 take-up rate of 71.9 percent (Exhibit 2.5).
• Across the Nation, eight States had 2020-2022 average coverage rates above the national average of 56.3 percent, ranging from 58.9 percent in California to 65.2 percent in Hawaii. Ten States had coverage rates below the national average, ranging from 49.7 percent in New York to 53.2 percent in Rhode Island (Exhibit 2.9).

Key Trends

Enrollment rates are lower at small and medium firms, compared with large firms, reflecting lower offer rates (presented in Section 1). Coverage, eligibility, and take-up rates are lower among younger firms, firms with one location (versus multiple locations), with fewer full-time workers, and with a majority of workers who are low wage (Exhibit 2.13).

For firms with fewer than 50 workers and firms with 50 or more workers, coverage, eligibility, and take-up rates are generally substantially lower at firms with a majority (50 percent or more) of low-wage workers, compared with firms with less than 50 percent of workers who are low wage (Exhibits 2.6-2.8). Continuing a longstanding pattern, in 2022, a lower percentage of enrollees in large firms than in small and medium firms chose single coverage (Exhibit 2.16), while a higher percentage of large-firm enrollees chose employee-plus-one coverage and family coverage (Exhibits 2.17 and 2.18).