Analysis of Claims Data Finds Workers' Out-of-Pocket Health Costs Growing Faster Than Costs Paid by Insurers


The Lund Report, April 13, 2016
by Amy Jeter

For workers covered by their employer's health plans, out-of-pocket costs including deductibles and coinsurance have been increasing significantly faster than costs paid by insurers, reflecting a decade-long trend toward slightly less generous coverage, a new Kaiser Family Foundation analysis finds.

Between 2004 and 2014, covered workers' average out-of-pocket costs grew 77 percent, outpacing health plans’ average payment per enrollee, which rose by 58 percent. Overall, workers' out-of-pocket costs rose from an average of $422 in 2004 to $747 in 2014, while average payments by health plans rose from $2,748 to $4,354. As a result, the average generosity of health plans declined slightly, covering 85.3 percent of covered medical expenses in 2014, compared with 86.7 percent in 2004.

Trends varied for different types of patient cost-sharing. Workers’ payments toward deductibles rose 256 percent (from an average of $99 to $353), and their payments towards coinsurance increased 107 percent (from an average of $117 to $242). Average payments for copays decreased by 26 percent, from $206 to $152.