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STATISTICAL BRIEF #507:
Out-of-Pocket Health Care Expenses for Non-Elderly Families by Income and Family Structure, 2015

January 2018

Philippe Gwet, PhD and Steven R. Machlin, MS

Highlights

In 2015, the overall median amount paid out of pocket by non-elderly families for health care was $451, but median out-of-pocket expenses increased substantially with family income.
Overall, about 14 percent of families had out-of-pocket expenses exceeding $2,500. However, this proportion ranged from 4 percent of poor families to 22 percent of high income families.
Regardless of the presence or absence of children, out-of-pocket expenses were notably higher for families with 2 or more adult members than those with only 1 adult.

Introduction

Data from the Medical Expenditure Panel Survey Household Component (MEPS-HC) indicate that about one of every eight dollars spent on health care for the U.S. civilian noninstitutionalized population in 2015 was paid out of pocket by families.¹ These out-of-pocket expenditures can constitute a significant financial liability for some families.

The MEPS-HC is the only nationally representative data available for estimating health care expenses at the family level. This brief provides descriptive statistics on the amount that families with no elderly members (i.e., all persons under age 65) paid out of pocket for medical care received in 2015. The focus is on variations in out-of-pocket payment levels by family income (i.e., income as a percentage of the federal poverty level) and by family structure (i.e., number of adults/presence of children).² Estimates of median family out-of-pocket payments (i.e., midpoint level) are presented as well as estimates of proportions of families having "low" out-of-pocket payments of less than $100 and those having "high" out-of-pocket payments of more than $2,500.

Many factors influence the annual level of health care expenses for families and the portion of these expenses that are paid out of pocket. Among these factors are family size; the demographic, socioeconomic, and health status characteristics of family members; and the extent to which members have comprehensive health insurance coverage.

The estimates in this brief pertain to approximately 97.2 million non-elderly families who had medical expenditures paid by any source(s) during the year.³ Family units in the MEPS-HC include related persons living together in the same household and individuals living on their own (i.e., 1-person families). All differences by income or family structure noted in the text are statistically significant at the 0.05 level.

Findings

In 2015, the median amount paid out of pocket by non-elderly families for health care was $451 (figure 1). About one-quarter of families had nominal out-of-pocket expenses (i.e., less than $100) while 14 percent had extensive out-of-pocket expenses (i.e., over $2,500) (figure 2). Variations in these statistics by family income and by family structure are described below.

Variation by family income (figures 1-2)
In 2015, median family out-of-pocket expenses increased substantially with income, ranging from $86 among poor families to $868 among high income families (Figure 1). Just over half of poor families (52 percent) had out-of-pocket expenses under $100 and this proportion decreased steadily with income to only 11 percent of high income families (figure 2). Conversely, over one in five high income families (22 percent) had out-of-pocket expenses of over $2,500, compared to notably smaller proportions of families in the lower income categories. About 4 percent of poor families and 10 percent of low income families had out-of-pocket expenses exceeding $2,500.

Variation by family structure (figures 3-4)
Regardless of the presence or absence of children, in 2015 the median out-of-pocket expense was more than $600 higher for families having 2 or more adult members (i.e., age 18 and older) than those with only 1 adult (figure 3). More specifically, this differential was $869 versus $242 for families without children and $721 versus $116 for families with children. About one-fifth of families comprised of 2 or more adults (19 percent of those with children and 21 percent of those without children) had out-of-pocket expenses of more than $2,500 (figure 4). Only 8 percent of 1-adult families with no children and 6 percent of 1-adult families with children had out-of-pocket expenses of over $2,500.

Data Source

The estimates shown in this Statistical Brief are based on data from the MEPS 2015 Full Year Consolidated Data File (HC-181). This file is available at: https://meps.ahrq.gov/mepsweb/data_stats/download_data_files.jsp

Definitions

Expenses

Out-of-pocket: Total payments made by families directly for services received during the year. (Families' contributions to health insurance premiums are not included.)
Total: The sum of payments made to health care providers for care received during the year, including out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources. Payments for over-the-counter drugs are not collected in MEPS. Indirect payments not related to specific medical events, such as Medicaid Disproportionate Share and Medicare Direct Medical Education subsidies, are also not included.

Poverty status

Poor: Family income less than 125 percent of the federal poverty level.
Low Income: Family income between 125 percent and less than 200 percent of the federal poverty level.
Middle Income: Family income between 200 percent and 400 percent of the federal poverty level.
High Income: Family income greater than 400 percent of the federal poverty level.

Family

A multi-person family generally consists of two or more persons living together in the same household who are related by blood, marriage, or adoption. In this statistical brief, nonmarried partners, foster children, and in-laws are not considered to be part of the same family. However, single people who live with neither a relative nor a person identified as a "significant other" have been treated as one-adult families. College students living away from their parents' home during the school year, were considered as members of the family that identified them.

Family structure

The following four family categories were constructed:

A single adult (age 18 and older) with no children (age 17 and younger)
A single adult with children
Two or more adults with no children
Two or more adults with children

Crosstab of poverty status by family structure:

**Table 1: Number and Percent of Non-Elderly Families with Medical Expenditures by Poverty Status and Family Structure**
Poverty Status	Family Structure (Number and Percentage)
	1 Adult		2 or More Adults		All Families
	No Children	1+ Children	No Children	1+ Children	All Families
Poor	9,999,307 10.3%	4,125,194 4.2%	1,643,690 1.7%	3,625,857 3.7%	19,394,048 20.0%
Low Income	4,966,606 5.1%	1,542,376 1.6%	2,099,368 2.2%	3,550,845 3.7%	12,159,195 12.5%
Middle Income	10,376,047 10.7%	1,756,263 1.8%	6,221,641 6.4%	9,028,253 9.3%	27,382,204 28.2%
High Income	11,690,284 12.0%	932,514 1.0%	15,399,069 15.8%	10,239,641 10.5%	38,261,508 39.4%
All Families	37,032,244 38.1%	8,356,347 8.6%	25,363,768 26.1%	26,444,596 27.2%	97,196,954 100.0%

Note: Percentages may not add to 100% due to rounding.
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, Household Component, 2015.

About MEPS-HC

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, demographic, and economic characteristics for the U.S. civilian noninstitutionalized population. It is cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics.

References

The following methodology reports contain information on the survey and sample designs for the MEPS Household and Medical Provider Components (HC and MPC, respectively). Data collected in these two components are jointly used to derive MEPS health care expenditure data.

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, MD. Agency for Healthcare Policy and Research, 1997. http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr1/mr1.pdf

Ezzati-Rice, T.M., Rohde, F., Greenblatt, J. Sample Design of the Medical Expenditure Panel Survey Household Component, 1998-2007. Methodology Report No. 22. March 2008. Agency for Healthcare Research and Quality, Rockville, MD.http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr22/mr22.pdf

Machlin, S.R., Chowdhury, S.R., Ezzati-Rice, T., DiGaetano R., Goksel H., Wun L.-M., Yu W., Kashihara D. Estimation Procedures for the Medical Expenditure Panel Survey Household Component. Methodology Report No. 24. September 2010. Agency for Healthcare Research and Quality, Rockville, MD.http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr24/mr24.shtml

Stagnitti, M.N., Beauregard, K., Solis, A. Design, Methods, and Field Results of the Medical Expenditure Panel Survey Medical Provider Component (MEPS MPC)-2006 Calendar Year Data. Methodology Report No. 23. November 2008. Agency for Healthcare Research and Quality, Rockville, MD.http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr23/mr23.pdf

Suggested Citation

Gwet, P. and Machlin, S. Out-of-Pocket Health Care Expenses for Non-Elderly Families by Income and Family Structure. Statistical Brief #507. January 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st507/stat507.shtml

* * *
AHRQ welcomes questions and comments from readers of this publication who are interested in obtaining more information about access, cost, use, financing, and quality of health care in the United States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. Please email us at MEPSProjectDirector@ahrq.hhs.gov or send a letter to the address below:

Joel Cohen, PhD, Director
Center for Financing, Access, and Cost Trends
Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857

¹In this report, out-of-pocket spending does not include families' contributions to health insurance premiums.

²The Definitions section describes the income and family structure variables (four categories each) and includes a table with the estimated number and overall proportion of families for a cross-tabulation of these two variables.

³Overall, about 92 percent of non-elderly families had some medical expenses in 2015 (ranging from about 88 percent of poor families to 96 percent of high income families).

The figure contains values of Median family out-of-pocket expenses by family income category, 2015; Figure data for accessible table follows the image

**Figure 1. Median family out-of-pocket expenses by family income category, 2015**
Family Income	Median Family Out-of-Pocket Expense ($)
All Families	451
Poor Families	86
Low-income Families	252
Middle-income Families	504
High-income Families	868

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, Household Component, 2015.

The figure contains Distribution of family out-of-pocket expenses by family income category, 2015; Figure data for accessible table follows the image

**Figure 2. Distribution of family out-of-pocket expenses by family income category, 2015**
Out-of-Pocket Amount	All Families	Poor Families	Low-income Families	Middle-income Families	High-income Families
<$100 (Low)	25%	52%	33%	20%	11%
$100-$2,500	61%	44%	57%	67%	68%
> $2,500 (High)	14%	4%	10%	13%	22%

Note: Percentages may not add to 100% due to rounding.
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, Household Component, 2015.

The figure contains values of Median family out-of-pocket expenses by family structure, 2015; Figure data for accessible table follows the image

**Figure 3. Median family out-of-pocket expenses by family structure, 2015**
Family Structure	Median Family Out-of-Pocket Expenses ($)
All Families	451
1 Adult without Children	242
2 or More Adults without Children	869
1 Adult with Children	116
2 or More Adults with Children	721

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, Household Component, 2015.

The figure contains values of Distribution of family out-of-pocket expenses by family structure, 2015; Figure data for accessible table follows the image

**Figure 4. Distribution of family out-of-pocket expenses by family structure, 2015**
Family Structure	<$100 (Low)	$100-$2,500	>$2,500 (High)
All Families	25%	61%	14%
1 Adult without Children	33%	60%	8%
2 or More Adults without Children	13%	66%	21%
1 Adult with Children	48%	47%	6%
2 or More Adults with Children	17%	65%	19%

Note: Percentages may not add to 100% due to rounding.
Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, Household Component, 2015.

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STATISTICAL BRIEF #507: Out-of-Pocket Health Care Expenses for Non-Elderly Families by Income and Family Structure, 2015

Highlights

Introduction

Findings

Data Source

Definitions

About MEPS-HC

References

Suggested Citation

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Agency for Healthcare Research and Quality

STATISTICAL BRIEF #507:
Out-of-Pocket Health Care Expenses for Non-Elderly Families by Income and Family Structure, 2015