This 2013, sh high ri-n le ki vel ng t ana o 58 pe lysis r co censi nt i de n 2020. T rs all wor hi ks er m s i eans n aggr thaetgat a gr e e but ate r m sa har y obs e of cur pat e i ien mpo ts i rn t tan he d t difat fer aba ence se a s f re pa or sub yin gr g a oups. hi For i ghe nrst sh anc are, e of ar e t the hie s r m he ar di ec s al tha ex t pa pend tieint tus r pay o es out of ut o p fock poc et ket be rfio sr ing e co fas ins te ur r f an or ce p b ategi ienn ts s enr , resul ollt ed i ing i n n ce a h rtai ighe n type r sh s of are of hea total lt h c expend are pl itans ure c s pa om id ou pared t of w poc ith o ket the . r plans? Figure 3 November 3, 2022, #443 We disaggregate health plans into four major plan types: (1) h igh-deductible health plans (HDHPs); (2) Share of Patients in Analytical Dataset, by Plan Type, 2013 –2020 consumer-directed health plans (CDHPs); (3) preferred provider organizations (PPOs) and point-of-service (POS) Share High-Deductible Health Plan/Consumer-Driven Health Plan plans; and (4) health maintenance organizations (HMOs) and exc lusive provider organizations (EPOs). Interestingly, we find that patients enrolled in HDHPs paid a s maller share of their total health expenditures out of Share Preferred Provider Organization/Point of Service Plan Out-of-Pocket Health Care Spending: pocket in 2019 (29.9 percent) than in 2013 (31.7 percent). Pat ients enrolled in PPO and POS plans paid the same Share Health Maintenance Organization/Exclusive Provider Organization share out of pocket in 2013 as they did in 2019 (17.9 percent) . Patients enrolled in HMOs and EPOs paid a 80% A Second Opinion About Rising Costs 71% slightly higher share out of pocket in 2019 compared with 2013 (12.3 percent vs. 10.9 percent), as did people covered by CDHPs (25.4 percent vs. 22.6 percent). 70% Spending on health care has increased significantly in the past decades, rising from 5 percent of GDP in 1960 to nearly 20 percent in 2020. Deductibles for people covered by workplace-sponsored health plans have risen dramat 60% ically since 2002, increasing from $650 to $1,945 for workers with individual coverage and from $1,395 to Figure 2 58% $3,722 for workers with family coverage. It’s no wonder that patients feel squeezed. Share of Total Expenditures Paid out of Pocket, 50% by Health Plan Type, 2013 –2020 We analyzed a database of medical claims to examine whether patients covered by workplace-sponsored plans are High-Deductible Health Plan Consumer-Driven Health Plan bearing a greater share of their medical expenditures. We found that, between 2013 and 2019, the share of total 40% Preferred Provider Organization/Point of Service Plan Health Maintenance Organization/Exclusive Provider Organization medical expenditures paid out of pocket by patients increased, from 17.4 percent to 19 percent. (We also observed 35% a decrease to 16.2 percent in 2020, most likely a result of patients delaying and canceling care on account of the 30% 31.7% 28% pandemic.) 30% 29.9% 20% 16% Figure 1 15% 25.8% 25.4% 13% 25% 10% Share of Medical Expenses Paid out of Pocket 22.6% 22.2% 20% 0% 20% 2013 2014 2015 2016 2017 2018 19.0% 2019 2020 17.9% 17.9% 19% ® ® Source: IBM Marketscan Commercial Claims and Encounters Database (CCAE). 18.5% 18.4% 18.3% 15.7% 18.2% 15% 17.9% 18% 12.3% 17.4% 10.9% 10% About EBRI: The Employee Benefit Research Institute is a private, nonpartisan, and nonprofit research 9.4% 17% institute based in Washington, D.C., that focuses on health, savings, retirement, and economic security 16.2% issues. EBRI does not lobby and does not take policy positions. The work of EBRI is made possible by 5% 16% funding from its members and sponsors, which include a broad range of public and private organizations. For more information, visit www.ebri.org. 15% 0% 2013 2014 2015 2016 2017 2018 2019 2020 A Thank You To Our Funders: This study was supported by a grant from the FINRA Investor Note: Outpatient services are defined as care that does not require an overnight hospital stay (e.g., diagnostic tests, primary care physician visits, etc.). 14% Educat Inpatiei non F t servicounda es are defitnie on. The d as care th ast t re udy w quires anas ov co ernignduc ht stay itned a hotshr pita ou l (egh t .g., suhe EB rgeries, chR ildI b C irth, en etct .). er for Research on Health ® ® Source: IBM Marketscan Commercial Claims and Encounters Database (CCAE). Benefits Innovation (EBRI CRHBI), which receives funding support from the following organizations: 13% Aon, Blue Cross Blue Shield Association, FINRA Investor Education Foundation, ICUBA, JP Morgan At first lC ook has , e, P this r fiz eer sul , tand PhR seems aMA. t odds wi Any vi th ews our fexp indirng esse tha d ti pa n thi tient s rep s a or re be t are t arih ng a ose of gr ea the a ter sha uthor re o s and s f theih roul totd al not be 12% medical ex ascr pend ibed t ituo re ts he . H of ow fic coul ers, td rus it be tees t, or hat ou oth t-er of s -poc ponso ket r c s o ost f E s a BrR e r I, EB ising o RI-ver ERal F, or t l, buthei dercr sea tafsfis. ng or stable for two types of p lans and increasing only modestly for two other plan types? 11% FINRA Investor Education Foundation The answ er appears to be that patients are increasingly enrolling in plans with higher deductibles. This is driving 10% up out-of The FI -pocket NR exp A I ens nves es i tor n t Ed he uca aggr tion F egatounda e, even tion, e thoug sth a bl out ishe -ofd i -pock n 20 et 03 by expet nse he F s iin nan hici ghe al I r-ndust deduc ry R tible pl egul ans ato h ry ave 2013 2014 2015 2016 2017 2018 2019 2020 remained Af ut la hor t or i thav y, Inc., e e decm repow asede , ras s under seen se in t rved A he figu mrer e a ic bove. ans wH ith t DH he k Ps hav now e s ledge, een m ski etleo ls, a ric gr nd t ow ootlh s tio n m the pa ake sound st ® ® Source: IBM Marketscan Commercial Claims and Encounters Database (CCAE). decade, as fina the nci y ar al dec e an isat ions tract thr ive op oughtout ion f lio fe. Fo r com r de pani taes ils, l vi ook siitng t ww o ke w.FI ep he NRA alFoundat th care cos ion.o t ir nc g.r eases in check. This trend is reflected in the database we used for this analysis: Pat ients enrolled in high-deductible plans (including both HDHPs and CDHPs) increased from 13 percent of the ### databa se’s population in 2013 to 28 percent in 2020. Meanwhile, patients enrolled in PPO or POS plans represented 71 percent of the population in the database in EBRI’s on Twitter! @EBRI or http://twitter.com/EBRI EBRI blog: https://ebriorg.wordpress.com/ E EB BR RI I on on T Twitt witte er r: : @ @E EB BR RI I o or r htt http:/ p://t /twit witter ter..c com/ om/E EB BR RI I B Blog: log: htt https ps:/ ://ebr /ebrio ior rg. g.wor wordp dpr re es ss s..c com/ om/ © 2022, Employee Benefit Research Institute, 901 D St. SW, Suite 802, Washington, DC 20024, 202/659-0670 www.ebri.org 2 3