Chartbook #24: Medical Expenditure Panel Survey Insurance Component 2019 Chartbook

Acknowledgments

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

The authors appreciate the efforts of Alon Evron, Jillian Botkin, Christian Evensen and Maryann Deyling of IMPAQ and Karen Turner of the University of Minnesota in preparing the exhibits and compiling and formatting the chartbook, 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, and Steven C. Hill (Senior Economist), Julie Hudson (Senior Economist), Salam Abdus (Senior Economist), Paul D. Jacobs (Senior Service Fellow), and Samuel H. Zuvekas (Senior Research Adviser) of the Division of Research and Modeling in CFACT .

Table of Contents

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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Suggested Citation

Medical Expenditure Panel Survey Insurance Component 2019 Chartbook. Rockville, MD: Agency for Healthcare Research and Quality; October 2020. AHRQ Publication No. 20(21)-0052. https://meps.ahrq.gov/mepsweb/data_files/publications/cb24/cb24.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 2006 to 2019. 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, unless otherwise noted. In some cases, differences noted in the text, in estimates as well as statistical significance of comparisons, may vary slightly from calculations performed using data in the exhibits, MEPS-IC data available on the MEPS website, or MEPS-IC Statistical Briefs due to rounding. All dollar estimates are nominal (not adjusted for inflation).

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Background

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

The MEPS-IC uses two independent samples: the private sector and the public sector. The private-sector sample is composed of approximately 42,000 business establishments from more than 7 million establishments found on the Business Register at the U.S. Census Bureau, with 4.6 percent of the sample determined during the data collection process to be out of scope. In 2019, the response rate for the private sector was 59.2 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 2017 Medical Expenditure Panel Survey Insurance Component (Davis, 2018; PDF).

There was no MEPS-IC survey to collect 2007 data due to the transition from retrospective to current-year data collection. This methodological change improved the accuracy and timeliness of the IC estimates. More information about this design change can be found in Switching From Retrospective to Current-Year Data Collection in the Medical Expenditure Panel Survey – Insurance Component (Kearney & Sommers, 2007). References to changes in all years from 2006 to 2019 in the text refer to 1-year changes except for changes in 2008, which refer to the period from 2006 to 2008.

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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 2017 Medical Expenditure Panel Survey Insurance Component. Methodology Report #31. Rockville, MD: Agency for Healthcare Research and Quality; July 2018. https://meps.ahrq.gov/data_files/publications/mr31/mr31.shtml. Accessed August 23, 2019.

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

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Executive Summary

Overview

Employer-sponsored insurance (ESI) is the primary source of health insurance coverage for individuals under age 65. This chartbook uses data for private-sector establishments in the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to describe trends in employer coverage, premiums, and benefits from 2006 to 2019.

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 59.2 percent in 2019, permits analyses of variations in ESI by firm size and across States that are not readily available from other sources.

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

This chartbook describes trends and patterns in ESI overall, by firm size, and by State from 2006 to 2019. All differences noted are at the 0.05 significance level unless otherwise specified. All dollar estimates are nominal (not adjusted for inflation).

Summary of Findings

Employee Enrollment in Health Insurance

Between 2018 and 2019, there was no significant change in the overall percentage of private-sector employees (47.6 percent in 2019) enrolled in a health insurance plan offered by their employers ("enrollment rate"). There was also no significant change in the enrollment rate in any firm-size category.

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

The overall percentage of employees working at establishments where insurance was offered ("the offer rate") increased between 2018 (84.6 percent) and 2019 (85.3 percent) (Exhibit ES.1).

In 2019, almost all private-sector employees (99.0 percent) in firms with 100 or more employees worked at establishments that offered health insurance. In comparison, about half (50.7 percent) of employees at firms with fewer than 50 employees worked where health insurance was offered.

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The offer rate at small employers (fewer than 50 employees) increased between 2018 (47.3 percent) and 2019 (50.7 percent) (Exhibit ES.1). There was no year-to-year change at medium employers (50 to 99 employees) or at large firms (100 or more employees).

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Because almost all large firms offer health insurance coverage, offer rates among small firms are an important factor contributing to overall State ESI offer rates, along with the distribution of employers by firm size in the State. Eight States had small-employer offer rates significantly above the national average (50.7 percent), and 10 States had small-employer offer rates significantly below the national average (Exhibit ES.2).

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Employee Coverage, Eligibility, and Take-Up Rates

Among establishments that offered insurance, 55.8 percent of employees were enrolled in coverage through their employer (the "coverage rate"), and 77.7 percent were eligible for health insurance (the "eligibility rate"). Among eligible employees, 71.9 percent were enrolled in their employer's health insurance (the "take-up rate") (Exhibits ES.3, ES.4, and ES.5).

There was no significant change in the coverage rate between 2018 and 2019 overall. The coverage rate declined at small firms (from 56.2 percent to 53.9 percent) and increased at medium firms (from 50.3 to 53.8 percent) between 2018 and 2019 (Exhibit ES.3).

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There were no significant changes in the eligibility rate overall or by firm size between 2018 and 2019 (Exhibit ES.4).

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There was no significant change in the overall take-up rate between 2018 and 2019 (Exhibit ES.5). Among small firms, the take-up rate declined from 71.0 to 69.0 percent.

Choice of Plans

The overall percentage of employees with a choice of plans did not significantly change between 2018 (75.7 percent) and 2019 (75.8 percent). In all years from 2006 to 2019, the likelihood that a worker at an offering establishment had a choice of plans increased with firm size. In 2019, the percentage of workers with a choice of plans was 41.4 percent in firms with fewer than 50 employees, 58.7 percent in firms with 50 to 99 employees, and 84.5 percent in firms with 100 or more workers (Exhibit ES.6).

Self-Insured Plans

Between 2018 and 2019, there was no significant change in the overall percentage of offering establishments that self-insured at least one plan. However, this percentage did significantly increase at establishments in firms with 25 to 99 employees (from 12.9 percent to 17.2 percent). No significant changes were observed at establishments in firms of any other size (Exhibit ES.7).

Premiums

In 2019, average annual health insurance premiums per enrolled employee with private-sector employer coverage were $6,972 for single coverage, $13,989 for employee-plus-one coverage, and $20,486 for family coverage (Exhibit ES.8). These amounts represent increases of 3.8 percent for single coverage, 4.2 percent for employee-plus-one coverage, and 4.7 percent for family coverage over 2018 levels (Exhibit ES.9). Between 2006 and 2019, premiums for the three types of coverage grew by between 69.3 percent and 80.0 percent, with average annual growth rates between 4.1 percent and 4.6 percent (data not shown).

There were no significant differences between the 2018 to 2019 and 2017 to 2018 growth rates for single coverage, employee-plus-one coverage, or family coverage. In the 13 years from 2006 to 2019, annual premium growth rates ranged from 2.2 percent to 8.3 percent for family coverage, from 2.6 percent to 6.9 percent for employee-plus-one coverage, and from 2.2 percent to 6.5 percent for single coverage (Exhibit ES.9).

In 2019, average single premiums were lower in medium firms ($6,629) than in small ($6,920) or large firms ($7,019) (Exhibit ES.10).

In 2019, premiums were higher in large firms than in medium firms for employee-plus-one coverage and higher in large versus small firms for family coverage (Exhibits ES.11 and ES.12).

In 2019, average single premiums ranged from $6,054 in Arkansas to $8,933 in Alaska. Ten States had average single premiums significantly below the national average of $6,972, and 10 States had average single premiums significantly above the national average (Exhibit ES.13).

Employee Premium Contributions

In 2019, enrolled employees paid 21.4 percent of total premiums for single coverage, 27.7 percent for employee-plus-one coverage, and 28.0 percent for family coverage. The employee shares of total premiums in 2019 were not significantly different from their 2018 levels for any of the three types of coverage (Exhibit ES.14).

From 2006 to 2019, the percentage of premiums contributed by employees increased by 2.3 percentage points, 3.9 percentage points, and 2.6 percentage points for single, employee-plus-one, and family coverage, respectively (Exhibit ES.14). These increases occurred because employee contributions increased more rapidly than employer contributions from 2006 to 2019 for each type of coverage (Section 4, Exhibits 4.1, 4.3, 4.4, and 4.5).

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Average employee contributions in 2019 were $1,489 for single coverage, $3,881 for employee-plus-one coverage, and $5,726 for family coverage, representing increases of 4.3 percent, 6.8 percent, and 5.4 percent, respectively, over 2018 levels (Exhibit ES.15).

Plan Benefits: Deductibles

There was no significant change in the percentage of enrolled employees in a health insurance plan with a deductible from 2018 (87.3 percent) to 2019 (86.6 percent) (Exhibit ES.16). From 2006 to 2019, the percentage of enrollees in plans with deductibles increased from 66.4 percent to 86.6 percent.

• Among single-coverage enrollees with a deductible, average deductible levels increased from $1,846 in 2018 to $1,931 in 2019 (Exhibit ES.17); among family-coverage enrollees, deductibles rose from $3,392 in 2018 to $3,655 in 2019 (Section 5, Exhibit 5.3).
• Among enrollees with deductibles, average individual deductibles in 2019 were higher in small ($2,386) and medium ($2,441) firms than in large firms ($1,778) (Exhibit ES.17). Family deductibles in 2019 were higher in small firms ($5,067) than in medium firms ($4,353) and both were higher than in large firms ($3,390) (Section 5, Exhibit 5.3).

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 cuts relevant to recent policy changes. More information is available at meps.ahrq.gov. AHRQ welcomes feedback on additional ways to make the data more usable to the public.

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Section 1: Health Insurance Offer Rates

Availability of Coverage to Active Employees and Retirees

In 2019, almost all private-sector employees (99.0 percent) in firms with 100 or more employees worked at establishments that offered health insurance. In comparison, about half (50.7 percent) of employees at firms with fewer than 50 employees worked where health insurance was offered (Exhibit 1.1).

Historically, smaller employers have been less likely to offer health insurance coverage than larger employers for a number of reasons, including:

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

This section presents estimates of the percentage of employees who worked where coverage was offered (the "offer rate"). It also provides information on the characteristics of offered coverage, including the availability of dependent coverage, choice of plans, and retiree coverage. In addition, this section presents estimates of the percentage of offering establishments that self-insured at least one plan.

Offer Rates Overall and by Firm Size

• The overall percentage of employees working at establishments where insurance was offered ("the offer rate") increased between 2018 (84.6 percent) and 2019 (85.3 percent) (Exhibit 1.1).
• The offer rate at small employers (fewer than 50 employees) increased between 2018 (47.3 percent) and 2019 (50.7 percent) (Exhibit 1.1).
• There was no year-to-year change at medium employers (50 to 99 employees) or at large firms (100 or more employees), which had offer rates of 88.0 and 99.0 percent, respectively, in 2018 and 2019 (Exhibit 1.1).
• The only significant change in offer rates by detailed firm-size categories was for firms with 10 to 24 employees. For employees of such firms, the offer rate increased from 53.0 percent in 2018 to 56.7 percent in 2019 (Exhibit 1.2).

Offer Rates by State

• Nationwide, 85.3 percent of all private-sector employees worked at establishments that offered insurance in 2019. The availability of workplace coverage varied substantially across the country (Exhibit 1.3). This variation was driven in part by differences in the distribution of workers by employer size across States (data not shown) and by differences across States in offer rates at smaller employers (Exhibit 1.4).
• In five States, offer rates significantly exceeded the 2019 national average (Exhibit 1.3).
• In nine States, offer rates were significantly below the national average in 2019 (Exhibit 1.3).

Offer Rates at Small Employers, by State

• Nationwide, just over half (50.7 percent) of employees of small firms (fewer than 50 employees) worked at establishments that offered insurance in 2019. However, the availability of workplace coverage at small firms varied substantially across the country (Exhibit 1.4).
• In eight States small-employer offer rates were significantly above the national average (Exhibit 1.4).
• In 10 States, small-employer offer rates were significantly below the national average (Exhibit 1.4).

Offer Rates at Employers That Are Predominantly Low Wage vs. Higher Wage Establishments, by Firm Size

• In 2019, workers at predominantly low-wage small employers (fewer than 50 employees) were less than half as likely to be offered insurance as  those at small employers with higher wages (25.4 percent vs. 58.8 percent) (Exhibit 1.5). (Predominantly low-wage establishments are defined as those where 50 percent or more of an establishment’s workforce were low wage. In 2019, low-wage employees were defined as those earning less than $12.50 per hour. In earlier years, the nominal thresholds were lower and reflected the wage distributions in those years.)
• Among the four subgroups of establishments jointly defined by firm size and wage level, the only significant change in offer rates occurred at small employers with higher wages (establishments that were not predominantly low wage). The offer rate at such employers rose from 55.5 percent in 2018 to 58.8 percent in 2019 (Exhibit 1.5).

Offer Rates by Industry

• In 2019, workers in mining and manufacturing had an offer rate (94.3 percent) that was significantly higher than workers in all other industry sectors. Meanwhile, the offer rate among workers in the agriculture, fisheries, and forestry sector (72.5 percent) was significantly lower than those in all other industry sectors except construction (77.6 percent) and other services (75.6 percent) (Exhibit 1.6).
• Among workers at small firms (fewer than 50 employees), those employed in wholesale trade (72.0 percent) had the highest likelihood of working where health insurance was offered except that there was no significant difference in offer rates between wholesale trade and mining and manufacturing (65.1 percent). Those employed at small firms in the agriculture, fisheries, and forestry sector (33.7 percent), the other services sector (36.6 percent), and the retail trade sector (43.6 percent) were less likely to be offered insurance than employees in other sectors (Exhibit 1.7).

Offer Rates by Selected Employer Characteristics

• Workers at nonprofit employers were more likely to work where health insurance was offered (93.0 percent) than workers at for-profit employers. Among for-profit employers, the offer rate was higher at incorporated employers (86.0 percent) than at unincorporated employers (75.8 percent) (Exhibit 1.8).
• Offer rates increased with the firm’s age, from 53.2 percent at firms 0 to 4 years old to 63.3 percent, 70.5 percent, and 92.7 percent for firms aged 5 to 9 years, 10 to 19 years, and 20 or more years, respectively (Exhibit 1.8).
• Workers at establishments that were part of firms with two or more locations had higher offer rates than those with only one location (98.4 percent vs. 66.0 percent) (Exhibit 1.8).
• Offer rates generally increased with the percentage of workers at the establishment who worked full time. Workers at establishments where 75 percent or more of the employees worked full time had an offer rate of 90.7 percent, compared with 80.4 percent, 81.1 percent, and 57.6 percent for workers at establishments with 50 to 74 percent, 25 to 49 percent, and 0 to 24 percent full-time employees, respectively (Exhibit 1.8).
• Employees in higher wage establishments were more likely to work where health insurance was offered than those in predominantly low-wage establishments (88.3 percent vs. 75.0 percent) (Exhibit 1.8).

Offer Rates by Selected Employer Characteristics and Firm Size

• Among large firms (100 or more employees), employees who worked at an employer that had been in business fewer than 20 years were less likely to be offered health insurance than employees at older firms. Offer rates ranged from 93.5 percent to 97.1 percent at employers in business fewer than 20 years versus 99.4 percent for employers in business 20 years or more (Exhibit 1.9).
• Also among large firms, the offer rate was lower for employers with 0 to 24 percent full-time workers (94.1 percent) compared with those with a higher percentage of full-time workers (ranging from 98.8 percent to 99.4 percent at employers with 25 percent or more full-time workers) (Exhibit 1.10).
• Overall, 50.7 percent of workers in establishments that were part of firms with fewer than 50 workers were offered coverage in 2019 (Exhibit 1.1). However, there was substantial variation by establishment characteristics. Compared with other categories (e.g., for profit, only one location), offer rates were notably higher for small employers that:
• Were nonprofit (60.3 percent).
• Were in business for 20 or more years (60.4 percent).
• Had more than one location (74.6 percent).
• Had workforces with 75 percent or more of employees working full time (63.1 percent).
• Had workforces that were not predominantly low wage (58.8 percent) (Exhibits 1.9 and 1.10).
• Offer rates were lower for workers in predominantly low-wage establishments than in higher wage establishments, regardless of whether they worked at a firm with fewer than 50 workers (25.4 percent vs. 58.8 percent), 50 to 99 workers (71.4 percent vs. 92.6 percent), or 100 or more workers (97.7 percent vs. 99.3 percent) (Exhibit 1.10).

Availability of Self-Insured Plans

• Among employers that offered insurance, 83.1 percent of offering establishments in firms with 1,000 or more employees self-insured at least one plan in 2019. By contrast, 33.9 percent of offering establishments in firms with 100 to 999 employees self-insured at least one plan. Furthermore, among the three detailed firm-size categories with fewer than 100 workers, 12.2 percent to 17.2 percent of establishments self-insured at least one plan. There were similar differences by firm size in the percentage of eligible employees who worked for an employer that self-insured at least one plan (Exhibits 1.11 and 1.12).
• Between 2018 and 2019, there was no significant change in the overall percentage of offering establishments that self-insured at least one plan. However, this percentage did significantly increase at establishments in firms with 25 to 99 employees (from 12.9 percent to 17.2 percent). No significant changes were observed at establishments in firms of any other size (Exhibit 1.11).
• Among employers that offered insurance, there was no significant change from 2018 to 2019 in the overall percentage of eligible employees who worked for an employer that self-insured at least one plan (58.0 percent in 2019 vs. 56.8 percent in 2018). No significant changes were observed for subgroups of employers by employer size, except for employers with 25 to 99 employees, with a significant increase from 14.0 percent to 18.1 percent (Exhibit 1.12).

Availability of Dependent Coverage

• In 2019, 98.7 percent of all workers who were eligible for single coverage were also offered coverage for their dependents (Exhibit 1.13).
• The likelihood of a dependent coverage offer increased with firm size. In 2019, the percentage of eligible employees who were offered coverage for their dependents was:
• 87.1 percent in firms with fewer than 10 employees,
• 94.2 percent in firms with 10 to 24 employees,
• 97.9 percent in firms with 25 to 99 employees,
• 99.6 percent in firms with 100 to 999 employees, and
• 100.0 percent in firms with 1,000 or more employees (Exhibit 1.13).
• In 2019, 93.8 percent of all eligible workers were offered employee-plus-one coverage as an option in addition to an offer of single coverage (Exhibit 1.13).
• The likelihood of employee-plus-one coverage as an option generally increased with firm size. In 2019, the percentage of eligible workers with an offer of employee-plus-one coverage was:
• 71.8 percent in firms with fewer than 10 employees,
• 82.4 percent in firms with 10 to 24 employees,
• 92.0 percent in firms with 25 to 99 employees,
• 93.6 percent in firms with 100 to 999 employees, and
• 97.2 percent in firms with 1,000 or more employees (Exhibit 1.13).

Availability of a Choice of Plans at Employers That Offer Health Insurance, by Firm Size

• In all years from 2006 to 2019, the likelihood that a worker at an offering establishment had a choice of plans increased with firm size. In 2019, the percentage of workers with a choice of plans was 41.4 percent in firms with fewer than 50 employees, 58.7 percent in firms with 50 to 99 employees, and 84.5 percent in firms with 100 or more workers (Exhibit 1.14).
• The overall percentage of employees with a choice of plans did not significantly change between 2018 (75.7 percent) and 2019 (75.8 percent). However, the share of employees at small firms (fewer than 50 employees) with a choice of plans did significantly increase between 2018 (37.8 percent) and 2019 (41.4 percent). No significant change between 2018 and 2019 was observed for employees at firms with 50 to 99 employees or with more than 100 employees.
• The availability of plan choice was significantly higher in 2019 than in 2006 overall (75.8 percent vs. 61.4 percent) and for small employers (41.4 percent vs. 21.5 percent), medium employers (58.7 percent vs. 36.0 percent), and large employers (84.5 percent vs. 74.3 percent) (Exhibit 1.14).

Availability of a Choice of Plans at Employers That Offer Health Insurance, by Industry and Selected Employer Characteristics

• Workers in the financial services and real estate sector (82.7 percent) were significantly more likely to be offered a choice of plans than workers in any other sector (Exhibit 1.15). Workers in construction (55.9 percent) were significantly less likely to be offered a choice of plans than workers in every other sector except that the difference with agriculture, fisheries, and forestry was not statistically significant. Exhibit 1.16 shows variation by industry and firm size.
• Workers at for-profit, unincorporated employers (72.1 percent) were less likely to be offered a choice of plans than workers at for-profit incorporated employers (76.3 percent) and nonprofit employers (77.3 percent) (Exhibit 1.17). Exhibit 1.18 shows variation by ownership and firm size.
• Workers in firms in business for 20 or more years were more likely to be offered a choice of plans (78.5 percent) than employees at younger firms (66.9 percent, 67.8 percent, and 62.5 percent at firms in business for 0 to 4, 5 to 9, and 10 to 19 years, respectively) (Exhibit 1.17).
• Workers at establishments that were part of firms with two or more locations were more likely to be offered a choice of plans than those at firms with only one location (84.0 percent vs. 58.0 percent) (Exhibit 1.17).
• Overall, there was no significant difference in the availability of a choice of plans by whether or not employees worked in predominantly low-wage establishments (Exhibit 1.17). However, among firms with 50 to 99 employees, the choice of plans was less likely in predominantly low-wage establishments compared with establishments with higher wages (43.7 percent vs. 62.0 percent), and there was a smaller but significant difference among firms with 100 or more employees (81.5 percent vs. 85.3 percent) (Exhibit 1.19).

Availability of Retiree Coverage at Establishments That Offer Coverage

• In all years from 2006 through 2019, establishments that offered insurance and were part of the largest firms (1,000 or more workers) were the most likely to offer retiree coverage to retirees under age 65 and retirees age 65 and older. In 2019, 23.7 percent of these establishments offered coverage to retirees under age 65 (Exhibit 1.20), and 20.1 percent offered coverage to retirees age 65 and over (Exhibit 1.21).
• In contrast to the largest employers, in 2019, between 1.8 percent and 4.7 percent of establishments that offered insurance in all other firm-size categories (fewer than 10, 10 to 24, 25 to 99, and 100 to 999 workers) offered retiree coverage to retirees under age 65 or age 65 and over (Exhibits 1.20 and 1.21).
• Among establishments that offered insurance to employees under age 65, there were significant decreases in the rate of offers of retiree coverage between 2018 and 2019 overall (11.1 percent vs. 9.7 percent), among firms with 100 to 999 employees (6.8 percent vs. 4.2 percent), and among firms with 1,000 or more employees (27.4 percent vs. 23.7 percent) (Exhibit 1.20).  
• Between 2006 and 2019, the availability of retiree coverage in the largest firms declined by 16.9 percentage points for retirees under age 65, from 40.6 percent in 2006 to 23.7 percent in 2019. The rate for retirees age 65 and over declined by 15.6 percentage points, from 35.7 percent in 2006 to 20.1 percent in 2019 (Exhibits 1.20 and 1.21).

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The SAS System

Section 2: Employee Eligibility and Enrollment

In 2019, 47.6 percent of private-sector employees were enrolled in a health plan through their employer (“enrollment rate”). Among establishments that offered insurance, 55.8 percent of employees were enrolled in coverage through their employer (“coverage rate”) and 77.7 percent were eligible for health insurance (“eligibility rate”). Among eligible employees, 71.9 percent were enrolled in their employer’s health insurance (“take-up rate”).

This section presents estimates for 2006 to 2019 for private-sector employees for the:

• Enrollment rate (percentage of all employees enrolled in their employer’s health insurance plan regardless of whether the establishment offered health insurance). (Note that in this calculation the number of enrollees is equal to zero at employers that do not offer coverage),
• Coverage rate (percentage of all employees enrolled in their employer’s health insurance plan at establishments that offered health insurance),
• 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).

The coverage rate is equal to the eligibility rate multiplied by the take-up rate, and the enrollment rate is equal to the coverage rate multiplied by the offer rate (the percentage of employees who work at employers that offer insurance). The overall offer rate in 2019 was 85.3 percent. Detailed information on offer rates can be found in Section 1.

This section also presents estimates for 2006 to 2019 for the percentage of enrollees in single, employee-plus-one, and family coverage and examines variation in coverage, eligibility, and take-up rates by firm size, industry, and other employer characteristics. It also presents coverage rates by the State in which the establishment was located.

Changes From 2018 to 2019

Overall

• Between 2018 and 2019, there was no significant change in the overall percentage of private-sector employees enrolled in a health insurance plan offered by their employers (enrollment rate) or the total number of enrollees (Exhibits 2.1 and 2.2).
• Among employees in establishments that offered health insurance, there was no significant change in the coverage, eligibility, or take-up rates from 2018 to 2019 (Exhibits 2.3, 2.5, and 2.7).

By Firm Size

• Between 2018 and 2019, there was no significant change in the enrollment rate in any firm-size category and no significant change in the number of enrollees in either medium firms (50 to 99 employees) or large firms (100 or more employees). However, the number of enrollees in small firms (fewer than 50 employees) increased from 9.1 million to 9.6 million (Exhibits 2.1 and 2.2).
• The coverage rate declined at small firms (from 56.2 percent to 53.9 percent) and increased at medium firms (from 50.3 to 53.8 percent) between 2018 and 2019 (Exhibit 2.3).
• Underlying the lack of significant change in the coverage rate at large firms was a lack of change in eligibility and take-up rates. The decline in the coverage rate among small firms primarily reflects a decline in the take-up rate from 71.0 to 69.0 percent (Exhibits 2.5 and 2.7).
• Eligibility rates did not differ significantly from their 2018 levels for firms with fewer than 50, 50 to 99, or 100 or more employees or in any of the more detailed firm-size categories (Exhibits 2.5 and 2.6). Take-up rates declined from 72.1 to 70.1 percent among firms with 100 to 999 employees, and, as noted above, declined among firms with fewer than 50 employees (Exhibits 2.7 and 2.8).

By Firm Size and Percentage of Establishment's Workforce That Is Low Wage

• Between 2018 and 2019, the coverage rate at small higher wage employers (fewer than 50 employees and less than 50 percent of the establishment’s workforce earning less than $12.50 per hour) decreased from 59.6 percent to 57.4 percent, and the take-up rate for this group declined from 71.9 percent to 70.1 percent. There were no other significant changes in coverage, eligibility, or take-up rates for employers classified by wage category and firm size (Exhibits 2.9, 2.10, and 2.11).
• Throughout the 2006 to 2019 period, coverage and take-up rates were higher at large higher wage employers than at small higher wage employers. In most years, there was no significant difference in eligibility rates by firm size among higher wage employers, although in 2019 eligibility rates were higher among large versus small higher wage employers. Patterns are less consistent in this period for comparisons of coverage, eligibility, and take-up rates between small and large low-wage employers (Exhibits 2.9, 2.10, and 2.11).

Estimates by Selected Characteristics, 2019

Differences by Firm Size, 2019

• In 2019, enrollment rates varied significantly across all firm sizes. Workers in firms with fewer than 50 employees had the lowest enrollment rate (27.3 percent), workers in medium firms (50 to 99 employees) had an enrollment rate of 47.4 percent, and workers in large firms (100 or more employees) had the highest enrollment rate (55.8 percent) (Exhibit 2.1).
• In 2019, the coverage rate was lower in small firms (53.9 percent) than in large firms (56.4 percent) (Exhibit 2.3).
• In 2019, the higher enrollment rates at medium and large firms than at small firms primarily reflect higher offer rates at medium and large employers compared with small employers as well as a higher coverage rate in large versus small firms (Exhibits 2.1 and 2.3, and Exhibit 1.1 on offer rates in Chapter 1).
• The higher enrollment rate for large firms compared with medium firms reflects a higher offer rate at large firms compared with medium firms (Exhibit 2.1 and Exhibit 1.1 on offer rates in Chapter 1).
• From 2006 to 2019, eligibility rates were similar between small and large firms, except for the period from 2014 to 2017, when eligibility rates for small firms were higher than in large firms. In most years from 2006 to 2018, eligibility rates were significantly lower in medium firms than in small and large firms. However, in 2019, there were no significant differences in eligibility rates across the three firm-size groups (Exhibit 2.5).
• Workers in small firms had significantly lower take-up rates than workers in large firms in all years from 2008 to 2019, and workers in medium firms had significantly lower take-up rates than workers in large firms in 2008 and in all years from 2010 to 2019 (Exhibit 2.7).
• The lower coverage rate in 2019 for workers in small firms compared with large firms was driven by the higher take-up rate in large firms (Exhibits 2.3 and 2.7).
• The coverage rate in 2019 for workers in the smallest firms (fewer than 10 employees) was higher than coverage rates for workers in the four other detailed firm sizes (10 to 24, 25 to 99, 100 to 999, and 1,000 or more employees). This higher coverage rate reflects the higher eligibility rate for workers in the smallest firms compared with workers in all other firm-size categories and the higher take-up rate compared with workers in all but the very largest firms (Exhibits 2.4, 2.6, and 2.8).
• Workers in the largest firms (1,000 or more employees) had a higher coverage rate than workers in firms in all other firm sizes except the smallest firms primarily due to a higher take-up rate (Exhibits 2.4 and 2.8).

Differences by State, 2019

• The coverage rate varied by State in 2019, from 48.7 percent in New York to 63.7 percent in Washington. Three States were significantly above the national average of 55.8 percent, and one State was significantly below the national average (Exhibit 2.12).

Differences by Industry, 2019

• Employees in mining and manufacturing had a coverage rate (74.1 percent) that was significantly higher than all sectors except utilities and transportation and financial services and real estate. The high coverage rate in mining and manufacturing was due to an eligibility rate (94.7 percent) that was significantly higher than all other sectors and a take-up rate (78.2 percent) that was significantly higher than all other sectors except utilities and transportation, wholesale trade, and financial services and real estate (Exhibits 2.13, 2.14, and 2.15).
• Conversely, employees in other services had a coverage rate (34.5 percent) that was significantly lower than all other sectors except agriculture, fisheries, and forestry. This lower rate resulted from eligibility (58.4 percent) and take-up (59.0 percent) rates that were significantly lower than all other sectors except agriculture, fisheries, and forestry (Exhibits 2.13, 2.14, and 2.15).

Differences by Selected Firm Characteristics, 2019

• Employees in establishments that were for-profit unincorporated had a lower coverage rate than employees in establishments that were either nonprofit or for-profit incorporated. The eligibility rate was higher at for-profit incorporated establishments than at for-profit unincorporated establishments and nonprofit establishments. Employees in nonprofit establishments had a higher take-up rate than those in for-profit unincorporated establishments or for-profit incorporated establishments (Exhibits 2.16, 2.17, and 2.18).
• Employees in firms that were 20 years old or older had a higher coverage rate than employees in firms that were fewer than 5 years old, 5 to 9 years old, and 10 to 19 years old. The eligibility rate was significantly higher in the oldest firms than in firms 5 to 9 years old, and the take-up rate was higher than in all younger firms (Exhibits 2.16, 2.17, and 2.18).
• Employees in firms with multiple locations had a higher coverage rate than those with a single location. The difference in coverage rates was due to both a higher eligibility rate and a higher take-up rate in firms with multiple locations (Exhibits 2.16, 2.17, and 2.18).
• The coverage, eligibility, and take-up rates increased directly with the percentage of full-time employees at an establishment, with the coverage rate increasing from 14.4 percent for employees in establishments with 0 to 24 percent full-time employees to 66.4 percent in establishments with 75 percent or more full-time employees. The eligibility rate followed the same pattern, increasing from 31.7 percent to 88.5 percent. Take-up rates also followed a similar pattern, increasing from 45.5 percent in establishments with 0 to 24 percent full-time employees to 75.0 percent in firms with 75 percent or more full-time employees (Exhibits 2.16, 2.17, and 2.18).
• Employees in higher wage establishments (less than 50 percent of the employees earned less than $12.50 an hour) had more than double the coverage rate of employees in predominantly low-wage establishments (in which 50 percent or more of the employees earned less than $12.50 an hour). This difference was due to both a higher eligibility rate and a higher take-up rate among employees in higher wage establishments (Exhibits 2.16, 2.17, and 2.18).

Enrollment in Single, Employee-Plus-One, and Family Coverage

Overall

• In 2019, 55.6 percent of enrollees had single coverage, 18.6 percent had employee-plus-one coverage, and 25.8 percent had family coverage (Exhibits 2.19, 2.20, and 2.21).
• Between 2018 and 2019, there was no significant change in the percentage of enrollees with single, employee-plus-one, or family coverage (Exhibits 2.19, 2.20, and 2.21).
• Between 2006 and 2019, the percentage of enrollees with single coverage increased from 48.9 percent to 55.6 percent, and the percentage with employee-plus-one coverage increased from 18.0 percent to 18.6 percent. The percentage with family coverage decreased from 33.2 percent to 25.8 percent (Exhibits 2.19, 2.20, and 2.21).

By Firm Size

• In 2019, a lower percentage of enrollees in large firms than in small and medium firms chose single coverage. A higher percentage of large-firm enrollees chose employee-plus-one coverage and family coverage (Exhibits 2.19, 2.20, and 2.21).
• Between 2018 and 2019, the percentage of employees in medium firms enrolled in single coverage decreased, while there was no significant change in the percentage of enrollees with employee-plus-one or family coverage in any firm-size category (Exhibits 2.19, 2.20, and 2.21).
• In the detailed firm-size categories, the percentage of employees enrolled in single coverage decreased among firms with 10 to 24 employees and increased in firms with 1,000 or more employees between 2018 and 2019. The percentage of employees who chose employee-plus-one coverage increased in firms with 10 to 24 employees and 100 to 999 employees and decreased in firms with 1,000 or more employees. There were no significant changes in the percentages of employees who enrolled in family coverage in any of the detailed firm-size categories (Exhibits 2.22, 2.23, and 2.24).

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