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.
A large portion is 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.
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.
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 of $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.
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.