Jul 29, 2022 - Health

Employees are increasingly on the hook for their medical costs

Share of out-of-pocket spending on treatment of select conditions
Data: Spiegel, et al., 2022, “Recent Trends in Patient out-of-Pocket Cost Sharing”; Chart: Kavya Beheraj/Axios

The growth of high-deductible health plans led to people with employer-sponsored coverage paying for a larger share, on average, of their health care costs between 2013 and 2019, according to a new analysis by the Employee Benefit Research Institute.

Why it matters: A large portion are paying significantly more in terms of raw dollar amounts as well, with the biggest increases among the highest spenders — and that's on top of premium increases. As costs rise, even many insured patients struggle to afford their care.

Yes, but: Out-of-pocket spending decreased during 2020, likely a byproduct of the way the pandemic disrupted the health care system and pandemic-era policies that may have lightened patients' cost burden.

By the numbers: The share of their medical expenses paid by people enrolled in employer-sponsored coverage increased from 17.4 percent in 2013 to 19 percent in 2019, the analysis found. It declined to 16.2 percent in 2020.

  • Enrollees spent a median $249 out-of-pocket in 2013, $287 in 2019 and $205 in 2020. This median includes people without any medical expenses. The average out-of-pocket costs rose from $737 in 2013 to $906 in 2019, falling to $811 in 2020.
  • Enrollees in the 75th percentile saw their spending obligation increase from $826 in 2013 to $1,030 in 2019, and those in the 90th percentile saw an even larger increase, from $2,792 to $3,295.
  • Out-of-pocket spending obligations varied significantly among patients with different underlying conditions.

Between the lines: Spending trends also varied based on the type of service.

  • Before the pandemic, both the share of out-of-pocket spending and the absolute amount paid by patients increased most for outpatient services.
  • The average amount spent out-of-pocket on prescription drugs actually decreased between 2013 and 2019, before seeing a slight increase in 2020.
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