In 2021, average single and family premiums increased 4% over the past year. At the same time, wages increased 5% and inflation increased 1.9%. The average premium for family coverage has increased 22% over five years and 47% over 10 years, according to a Kaiser Family Foundation study.
Employer Premium Contribution |
Worker Premium Contribution |
|
---|---|---|
HMO | ||
Single | $6,754 | $1,204 |
Family | $17,087 | $5,254 |
PPO | ||
Single | $6,702 | $1,389 |
Family | $16,884 | $6,246 |
POS | ||
Single | $6,587 | $1,183 |
Family | $13,213 | $7,512 |
HDHP/SO | ||
Single | $5,774 | $1,242 |
Family | $15,674 | $5,129 |
All Plans | ||
Single | $6,440 | $1,299 |
Family | $16,253 | $5,969 |
Employee Cost Sharing
Whether or not a deductible applies, a large share of covered workers also pay a portion of the cost when they visit an in-network physician. Average copayments are $25 for primary care and $42 for specialty care. The average coinsurance rates are 19% for primary care and 20% for specialty care, which is similar to those in 2020.
Sixty-eight percent of covered workers have coinsurance and 12% have a copayment for hospital admissions. The average coinsurance rate for a hospital admission is 20% and the average copayment is $321 per hospital admission. The cost sharing requirements for outpatient surgery follow a similar pattern to those for hospital admissions.
Virtually all covered workers are in plans with a limit on in-network cost sharing (called an out-of-pocket maximum) for single coverage, though the limits vary significantly. Among covered workers in plans with an out-of-pocket maximum for single coverage, 13% are in a plan with an out-of-pocket maximum of less than $2,000, while 27% are in a plan with an out-of-pocket maximum of $6,000 or more.