The Agency for Healthcare Research and Quality released a comprehensive survey of employer-sponsored health insurance including offer rates, enrollments, deductibles, and premiums. While many factors remained stable from year to year, premiums in small and large firms increased significantly for single, employee-plus-one, and family coverage.
In 2021, average health insurance premiums were $7,380 for single coverage, representing a 3.2% increase over 2020. Average premiums for employee-plus-one coverage ($14,634) and family coverage ($21,381) also increased from their 2020 levels by about 3%. From 2020 to 2021, premiums in small and large firms increased significantly for single, employee-plus-one and family coverage, with increases ranging from 4.8% to 5.9% in small firms and 2.8% for all coverage types in large firms.
Employee Premium Contributions
In 2021, average employee contributions increased 7.2% to $1,643 for single coverage. Single premium contributions increased 12.3% at small firms, 14.1% at medium firms, and 5.6% at large firms. There was a 4.1% increase in average employee contributions for employee-plus-one coverage to $4,199.
Average employee contributions by employer size in 2021:
• Small employers: $4,984 for employee-plus-one coverage and $6,967 for family coverage
• Medium employers: $5,526 for employee-plus-one coverage and $7,997 for family coverage
• Large employers: $3,986 for employee-plus-one coverage and $5,937 for family coverage
The number of enrollees in a health insurance plan with a deductible in 2021 was not significantly different from 2020 for firms overall (88.5%), nor among small (86%), medium (89.7%), or large employers (88.8%). The number of enrollees with a deductible has increased from 70.7% in 2008 to 88.5% in 2021. In 2021, enrollees in small firms were less likely than those in large firms to have a deductible, as has been the case in every year since 2021.
From 2020 to 2021, average deductible levels for single coverage increased by 3%, to $2,004. Family coverage deductibles increased by 3.9%, to $3,868. There were no significant changes in deductible levels by firm size for single or family coverage. In the 2008 to 2021 period, single and family coverage deductibles increased every year except 2018 and 2020.
Average individual deductibles were higher in small ($2,485) and medium-sized firms ($2,378) than in large firms ($1,865) in 2021. Family deductibles were also higher in small ($4,945) and medium-sized firms ($4,816) than in large firms ($3,646) in 2021.
Enrollment Rates and Covered Employees
From 2020 to 2021, the number of private-sector employees with employer-sponsored health insurance declined from 49.5% to 48%. In 2021, the enrollment rate ranged from 27.1% at small employers to 56.3% at large employers.
The number of private-sector employees working at establishments that offered employer-sponsored coverage declined from 86.9% in 2020 to 85.7% in 2021. Those figures reflect an increase in the number of employees working for small firms. Offer rates at small (50.4%), medium (90.3%), and large firms (98.9%) were unchanged from 2020.
The eligibility rate for employees at private-sector establishments that offered insurance was statistically unchanged in 2021, at 80.3% versus 80.5% in 2020. The eligibility rates in small (79.7%), medium (79.2%), and large (80.5%) firms were not statistically different from 2020.
Take-up rate for employees at private-sector establishments who were eligible for insurance did not show a statistically significant change from 2020 (70.8%) to 2021 (69.8%).