“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 (2020). doi.org/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.”

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 (2020). doi.org/10.1377/hlthaff.2020.02022

“OOP [Out Of Pocket] payments are healthcare-related costs paid by consumers. They include direct payment for health services, coinsurance, co-payments and deductibles. While OOP payments have fallen as a percentage of the total, real OOP spending has actually risen considerably. This is because the size of the healthcare system has grown so fast. In 1980 per capita OOP spending was $253 of the $932 dollars spent on personal healthcare, representing a 27.1% share (Table 3.6). By 2015 US healthcare consumers spent $1060 in OOP payments of the $8479 dollars spent per capita on personal health expenditures, or 12.5%. In contrast, the consumer price index over this same period grew by only three-fold. In the midst of this general upward trend in OOP payments among OECD countries in recent decades, the United States has historically ranked second highest in per capita OOP spending, after Switzerland (OECD, 2018a).

“The growth rate in OOP payments was not distributed equally across subgroups of the US population and the services they use. The largest increases in OOP spending between 1995 and 2006 were experienced by those with non-Medicaid public insurance (60%), the uninsured (46%) and individuals at or below the poverty line (35%), compared to those with private coverage (15%) (Paez, Zhao & Hwang, 2009). Despite this disparity in OOP spending growth, OOP expenditures as a percentage of total health spending have been steadily decreasing since 2006 for non-elderly adults, with uninsured adults experiencing the largest decreases. Non-elderly, uninsured adults who incurred health expenses in 2006 paid 73% of those expenses OOP, whereas by 2014 that percentage had decreased to 61%.

“Privately insured adults saw decline as well, though to a lesser extent (from 33% in 2006 to 28% in 2014), as did publicly insured adults (13% to 9%) (Roemer, 2017). This trend was also observed for adults aged 65 and older, and by 2014 low-income elderly adults covered by Medicare and other public insurance paid 2.7% of total expenses OOP, compared to 12.9% for those with Medicare and private insurance, and 13.3% for those with Medicare alone (Gwet, Anderson & Machlin, 2016).”

Source: Rice T, Rosenau P, Unruh LY, Barnes AJ, van Ginneken E. United States of America: Health system review. Health Systems in Transition, 2020; 22(4): pp. i–441.

“A consistent finding between private and public insurance was the experience of medical debt. Those who had either form of private insurance (employer sponsored or individually purchased) were more likely to report medical debt compared with individuals covered by any form of public insurance. This is not surprising given that health care costs are increasing faster than the median income in most states.⁴ Reform efforts directed at increasing subsidies, reducing cost sharing and deductibles, and eliminating surprise medical billing may be important tactics for reducing medical debt experienced by those covered by private plans.^4,30-33“

Source: Wray CM, Khare M, Keyhani S. Access to Care, Cost of Care, and Satisfaction With Care Among Adults With Private and Public Health Insurance in the US. JAMA Netw Open. 2021;4(6):e2110275. doi:10.1001/jamanetworkopen.2021.10275.

“In a retrospective analysis of consumer credit reports, the mean amount of medical debt was high, and it was greater among individuals who lived in the South and in zip codes in the lowest income deciles. Medicaid expansion under the ACA was associated with reduced medical debt overall, and with reduced gaps in the amount of medical debt between low-income and high-income communities.

“During the last decade, medical debt has become the largest source of debt in collections. The reductions in nonmedical debt in collections between 2009 and 2020 occurred simultaneously with the economic recovery from the Great Recession, consistent with the well-documented association between unemployment and loan delinquency.¹⁴ In contrast, total medical debt in collections decreased by a more modest amount. As a result, as of June 2020 individuals had $39 more in mean medical debt in collections than they had in mean debt in collections from all other sources combined ($429 vs $390), including credit cards, utilities, and phone bills.”

Source: Kluender R, Mahoney N, Wong F, Yin W. Medical Debt in the US, 2009-2020. JAMA. 2021;326(3):250–256. doi:10.1001/jama.2021.8694

“At the national level, 17.8% of persons with a credit report had medical debt in collections and 13.0% accrued medical debt during the prior year. Conditional on having medical debt, the mean stock was $2424 and the mean flow was $2396.”

Source: Kluender R, Mahoney N, Wong F, Yin W. Medical Debt in the US, 2009-2020. JAMA. 2021;326(3):250–256. doi:10.1001/jama.2021.8694

“This survey study found differences in experiences related to access to care, costs of care, and satisfaction with care among public and private health insurance programs in the US. In analyses adjusted for baseline health status, individuals covered by employer-sponsored and individually purchased private insurance were less likely to report having a personal physician, stability in insurance coverage, and satisfaction with care compared with those covered by Medicare. Moreover, individuals with private health insurance were more likely to report difficulty seeing physicians because of cost, not taking medications because of costs, and having medical debt compared with individuals covered by Medicare. Similar patterns were observed in comparisons between private insurance and VHA or military coverage.

“These data are consistent with findings from prior research,^14-16,26 provide an update on US adults’ experiences with private and public coverage, and suggest that the experiences of individuals covered by private insurance compare less favorably with the experiences of individuals covered by publicly sponsored plans. Although we did not find recently published research comparing experiences among all 5 forms of coverage, our findings are consistent with data from a 2015 Gallup poll of a national sample of US adults that revealed that individuals with Medicare and VHA or military coverage were the most satisfied with the care they received.²⁷ Our findings are also consistent with results of research conducted in 2000 and 2010 that suggested greater overall satisfaction among Medicare beneficiaries compared with those covered by employer-sponsored insurance.^14,15,26“

Source: Wray CM, Khare M, Keyhani S. Access to Care, Cost of Care, and Satisfaction With Care Among Adults With Private and Public Health Insurance in the US. JAMA Netw Open. 2021;4(6):e2110275. doi:10.1001/jamanetworkopen.2021.10275.

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.

“• 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.

“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.

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 July 20, 2021 by Doug McVay, Editor.