Health Plan Premiums Jump in 2021

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.
 

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.