It's not your imagination. If you have employer health insurance, you're probably paying more and more out of your own pocket.
High-deductible plans have been under the microscope during the past year, given their prevalence among new individual coverage plans offered under the Affordable Care Act. But it's also a trend that's also playing out under employer-sponsored health plans covering about 150 million people, as illustrated by the annual survey on employee health benefits from the Kaiser Family Foundation and the Health Research and Educational Trust.
First, the headline findings from the new survey of about 2,000 firms. The average cost of an employer-sponsored family health plan reached $16,384 this year, up 3 percent from the previous year, with employees paying $4,823 toward that. The increase tracks pretty closely with the growth of wages and inflation over the past year, and it continues a few years of relatively modest premium increases. The number of firms offering coverage was down slightly, from 57 percent in 2013 to 55 percent this year, though a vast majority of companies with 50 or more employees offer coverage (92 percent).
While premiums in employer plans have grown 26 percent in the past five years, that's been outpaced over the same time by the 47 percent rise in the average deductible — the amount of care a worker has to pay for before insurance kicks in.
In 2014, 80 percent of people covered by employee plans faced an average annual deductible of $1,217, compared to $826 in 2009. About 41 percent of all companies have an average deductible of at least $1,000, which is a big jump from 10 percent of firms in 2006. And 18 percent of firms have average deductibles of at least $2,000, which is up from just 3 percent in 2006.
Larger firms tend to have more generous coverage, and you can see this in the way deductibles are structured depending on a company's size. The average 2014 deductible is $971 for workers in firms with 200 or more employees, compared to $1,797 in smaller firms (3-199 employees). Compared to the larger firms, employees in small firms are also about twice as likely to have an average deductible of at least $1,000 (61 percent versus 32 percent), and they're three times as likely to have a deductible of at least $2,000.
But at the same time, more employers are limiting how much workers have to actually pay toward their own care. Just 7 percent of workers enrolled in individual employer plans in 2014 had an out-of-pocket maximum exceeding $6,350, which is the new limit for health plans under the Affordable Care Act this year.
High-deductible plans are attractive to employers because they get to bear less of the insurance cost. Many economists also like the plans, because they're supposed to make people spend more wisely on their health care.
The big question is whether employees are prepared to handle potentially big medical bills before they hit their deductible. As the The Upshot noted last week, people in employer insurance recently said they're pretty happy with the services their health plans cover, but they're much less satisfied with what they're paying out of their own pockets.
When federal actuaries released their report on national health spending last week, they said growing deductibles helped keep spending growth at historically low levels for the fifth straight year. And they said with some certainty that high-deductible health plans aren't going anywhere.