Trends in medical health insurance, costs and expenses by state

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 2003 to 2016.

Medical Expenditure Panel Survey Insurance Component 2016 Chartbook. Rockville, MD:
Agency for Healthcare Research and Quality; September 2017. AHRQ Publication No. 17-0034-EF. https://meps.ahrq.gov/mepsweb/data_files/publications/cb21/cb21.pdf.

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 establishments), combined with a response rate of 67.6 percent in 2016, 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 because of variation in insurance markets along these dimensions. Insurance markets differ 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, health care prices, and utilization, as well as differences in State approaches to regulating private insurance and
administering Medicaid.

The period presented in the chartbook, 2003 to 2016, shows trends through a period of change in national health policy that could have affected national ESI trends, as well as trends by firm size.

Starting in 2014, most people were required to either obtain health insurance or make an
individual shared responsibility payment. The employer shared responsibility provisions began to take effect for employers with 100 or more full-time-equivalent employees in 2015 and for employers with 50 or more employees in 2016.

 

Coinsurance Rates for Physician Office Visits

From 2003 to 2016, the percentage of enrolled employees in plans with coinsurance rates increased from 19.5 percent to 34.9 percent. There were significant year-to-year increases in the percentage of enrolled employees with a coinsurance rate from 2005 to 2006 and from 2009 to 2010 and then each year from 2011 to 2015 (Exhibit 5.7).

The percentage of enrolled employees in a health insurance plan that had a coinsurance rate for physician office visits did not change significantly from 2015 (35.0 percent) to 2016 (34.9 percent) (Exhibit 5.7).

Enrolled employees in large firms (100 or more employees) were more likely to have plans with coinsurance rates than enrolled employees in smaller firms in all years from 2003 to 2016. In 2016, 38.9 percent of enrollees in firms with 100 or more employees had
coinsurance rates compared with 20.6 percent and 21.5 percent in firms with fewer than 50 employees and with 50 to 99 employees, respectively (Exhibit 5.7).

Between 2003 and 2016, the percentage of enrolled employees in health plans with a
coinsurance rate increased for all enrollees, regardless of firm size. However, the increase was more pronounced among enrolled employees in firms with 100 or more employees (17.9 percentage points) than in smaller firms (5.4 and 6.9 percentage point increases at firms with fewer than 50 employees and with 50 to 99 employees, respectively) (Exhibit 5.7).

Among enrolled employees in plans with physician office visit coinsurance rates, average coinsurance rates increased from 18.0 percent in 2003 to 20.5 percent in 2016 (Exhibit 5.8).

Average coinsurance rates rose from 20.1 percent in 2015 to 20.5 percent in 2016, an
increase of 0.4 percentage points. This increase followed increases of 0.6 percentage points from 2013 to 2014 and 0.3 percentage points from 2014 to 2015 (p <0.10) (Exhibit 5.8).

From 2013 to 2014, average coinsurance rates for enrolled employees at firms with 100 or more employees increased from 18.8 to 19.5 percent, but there was no significant change in smaller firms. In contrast, from 2014 to 2015, average coinsurance rates for enrolled employees at firms with fewer than 50 employees increased from 21.5 to 22.6 percent, while there was no significant change at larger employers.

https://meps.ahrq.gov/data_files/publications/cb21/cb21.pdf

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