US: Health System Costs for Consumers

“Health care spending by households increased 4.5 percent in 2019—similar to the rate of 4.8 percent in 2018 (exhibit 4). Out-of-pocket health spending and households’ contributions to employer-sponsored private health insurance premiums accounted for the largest shares of spending in this category, at 38 percent and 27 percent, respectively (data not shown). Out-of-pocket health spending increased 4.6 percent in 2019 after growth of 3.8 percent in 2018 (exhibit 1), whereas households’ contributions to employer sponsored private health insurance premiums increased 6.3 percent in 2019 compared with growth of 2.9 percent in 2018 (data not shown). Growth slowed for other components of household health spending, offsetting the accelerations in out-of-pocket spending and contributions to private health insurance premiums. These other components include premiums paid by individuals to the Medicare Supplementary Medical Insurance Trust Fund, spending on the medical portion of property and casualty insurance, spending on direct-purchase insurance, and employees’ payroll taxes and voluntary premiums paid to the Medicare Hospital Insurance Trust Fund, which together account for 35 percent of total household health spending (data not shown).”

Source: Anne B. Martin, Micah Hartman, David Lassman, Aaron Catlin, and The National Health Expenditure Accounts Team. National Health Care Spending In 2019: Steady Growth For The Fourth Consecutive Year
Health Affairs https://doi.org/10.1377/hlthaff.2020.02022
https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.02022

“Private health insurance expenditures accounted for 31 percent of total national health care spending and reached $1.2 trillion in 2019 (exhibit 1). Spending in this category increased 3.7 percent in 2019, which was a slower growth rate than the 5.6 percent rate seen in 2018. The deceleration in overall private health insurance spending growth was driven by a 7.9 percent decline in the net cost of private health insurance (data not shown)—a decline that resulted primarily from the suspension of the health insurance tax in 2019 (the tax had been reinstated in 2018 after the moratorium in 2017).³

“Despite the slowdown in overall private health insurance expenditure growth, spending for medical goods and services (representing 89 percent of total private health insurance spending) grew 5.4 percent in 2019, which was faster than the 2018 growth rate of 4.4 percent. This acceleration reflected faster growth in spending for hospital care, physician and clinical services, and retail prescription drugs. Combined, these three medical goods and service categories accounted for 76 percent of total private health insurance spending in 2019.

“Private health insurance enrollment increased slightly in 2019 (0.5 percent; exhibit 5), as small declines in enrollment in Marketplace plans and other directly purchased (non-Marketplace) plans were offset by a 0.7 percent increase in enrollment in employer-sponsored insurance (data not shown). Per enrollee, spending for private health insurance increased 3.2 percent in 2019 and reached $5,927, following growth of 6.4 percent in 2018 (exhibit 5). Again, the reinstatement of the health insurance tax in 2018 and the subsequent moratorium in 2019 contributed to this trend.”

Cost of Single and Family Premiums for Covered Workers In the US

” • The average premium for single coverage in 2019 is $7,188 per year. The average premium for family coverage is $20,576 per year [Figure 1.1].

” • The average annual premium for family coverage for covered workers in small firms ($20,236) is similar to the average premium for covered workers in large firms ($20,717). [Figure 1.2].

” • The average annual premiums for covered workers in HDHP/SOs are lower for single coverage ($6,412) and family coverage ($18,980) than overall average premiums. The average premiums for covered workers enrolled in PPOs are higher for single ($7,675) and family coverage ($21,683) than the overall plan average [Figure 1.1].

” • The average premiums for covered workers with single coverage and for family coverage are similar across regions for all plan types [Figure 1.3].

” • The average premium for single coverage varies across industries. Compared to the average single premiums for covered workers in other industries, the average premiums for covered workers in the Manufacturing and Retail categories are relatively low and the average premium for State and Local Government workers are relatively high [Figure 1.4].

” • The average premiums for covered workers in firms with a relatively large share of lowerwage workers (where at least 35% of the workers earn $25,000 annually or less) are lower than the average premiums for covered workers in firms with a smaller share of lowerwage workers ($6,189 vs. $7,233 for single coverage and $17,633 vs. $20,709 for family coverage) [Figure 1.6].

” • The average premiums for covered workers in firms with a relatively large share of older workers (where at least 35% of the workers are age 50 or older) are higher than the average premiums for covered workers in firms with a smaller share of older workers ($7,485 vs. $6,941 for single coverage and $21,491 vs. $19,807 for family coverage) [Figure 1.6].

” • The average premiums for family coverage for covered workers in firms with a relatively large share of younger workers (where at least 35% of the workers are age 26 or younger) are lower than the average premiums for covered workers in firms with a smaller share of younger workers ($19,094 vs. $20,753) [Figure 1.6].”

Source: Henry J. Kaiser Family Foundation. Employer health benefits: 2019 survey. San Francisco (CA): KFF; Sept. 2019.
https://www.kff.org/health-costs/report/2019-employer-health-benefits-survey/

“• In 2019, covered workers on average contribute 18% of the premium for single coverage and 30% of the premium for family coverage [Figure 6.1].² The average percentage contributed for single coverage has remained stable in recent years. While estimates of the average contribution percentage for family coverage have shown small changes in recent years, the differences are not statistically significant.

“– Covered workers in small firms on average contribute a much higher percentage of the premium for family coverage (40% vs. 26%) than covered workers in large firms [Figure 6.2].

“• Workers with single coverage have an average contribution of $103 per month ($1,242 annually), and workers with family coverage have an average contribution of $501 per month ($6,015 annually) toward their health insurance premiums [Figure 6.3], [Figure 6.4], and [Figure 6.5].

“– The average worker contributions in HDHP/SOs are lower than the overall average worker contribution for single coverage ($1,071 vs. $1,242) and family coverage ($4,866 vs. $6,015). The average worker contributions in PPOs are higher than the overall average worker contribution for single coverage ($1,454 vs. $1,242) [Figure 6.6].

“• Worker contributions also differ by firm size.

“– Covered workers in small firms on average contribute less for single coverage than covered workers in large firms ($1,035 vs. $1,330) [Figure 6.7].

“– Covered workers in small firms on average contribute significantly more annually for family coverage ($7,805 vs. $5,271) [Figure 6.7].

“• Covered workers working for private, not for profit firms have a relatively low average contribution for single coverage ($1,057) while covered workers working for private for profits firms have a relatively high average contribution for single coverage ($1,341).”

Source: Henry J. Kaiser Family Foundation. Employer health benefits: 2019 survey. San Francisco (CA): KFF; Sept. 2019.
https://www.kff.org/health-costs/report/2019-employer-health-benefits-survey/

“Out-of-pocket spending (other than premiums) includes all amounts paid by the privately insured and other insured individuals for coinsurance, deductibles, and services not covered by insurance. It also includes any amounts paid by the uninsured for health care goods and services. Among all individuals, out-of-pocket spending totaled $365 billion (11.0% of total HCE) in 2017.”

Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated March 21, 2019.
https://crsreports.congress.gov/product/pdf/IF/IF10830

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Dec. 18, 2020 by Doug McVay, Editor.