At a Glance | September 5, 2019 Employer Trends in Self-Insured Health Plan Coverage SELF-INSURANCE TRENDS Private-Sector Establishments Offering a Self-Insured Health Insurance Plan By Organization Size Large firms are much more likely to offer a self-insured health 500+ EMPLOYEES 100–499 EMPLOYEES < 100 EMPLOYEES plan where they collect 79% 29% 13% premiums from enrollees and 2018 assume the responsibility of 76% 31% 16% 2017 paying their medical claims. Since 2013, the percentage of 79% 29% 17% 2016 establishments offering 80% 30% 14% 2015 self-insured health plans has declined for large firms while 81% 26% 13% 2014 increasing for smaller firms. 84% 25% 13% Those trends reversed in 2018. 2013 These data are consistent with the perspective that the Patient self-insured plans, but there are Similarly, there are questions as Protection and Affordable Care now questions as to why this to whether the recent increase Act (ACA) would cause more recent movement may be in self-insurance among large small employers to adopt reversing itself. firms is the start of a new trend. STATE OF THE STATES Percentage of Employers Offering a Self-Insured Health Insurance Plan by State 2018 Self-insurance coverage varied TOP TEN | 45%–53% substantially by state. Overall, BOTTOM TEN | 24%–36% the percentage of WA VT ME establishments offering at least 43% 46% 36% MT ND one self-insured plan ranged 40% 44% MN 41% NH 39% OR from a high of 53 percent in WI NY ID 33% 43% MA 24% SD 31% 35% MI North Carolina to a low of 24 40% RI 34% WY 39% 52% CT 39% PA percent in Massachusetts. IA 44% 41% NE NJ 36% OH NV IL IN 44% 50% 33% DE 46% 36% 51% UT WV CO VA MD 42% CA 46% 41% 40% MO 39% KS KY 27% DC 33% 38% 37% 45% NC 53% TN 38% AZ NM OK SC AR 44% 37% 37% 50% 40% MS AL GA 44% 43% 45% TX 43% LA 39% FL 41% AK HI 46% 29% SOURCE: Paul Fronstin. “Self-Insured Health Plans: Recent Trends by Firm Size, 1996–2018,” EBRI Issue Brief, no. 488 (Employee Benefit Research Institute, August 1, 2019 ). © 2019 EBRI This report is copyrighted by the Employee Benefit Research Institute (EBRI). You may copy, print, or download this report solely for personal and noncommercial use, provided that all hard copies retain any and all copyright and other applicable notices contained therein, and you may cite or quote small portions of the report provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing requires EBRI’s prior express permission. For permissions, please contact EBRI at permissions@ebri.org.