Recent Trends in Patient out-of-Pocket Cost Sharing

Employers are increasingly concerned with their workers’ financial wellbeing. At the same time, employers are seeking to control rising health care costs and often do so by increasing health plan deductibles, causing workers to pay more out of pocket for their health care. To the extent that higher deductibles negatively impact workers’ financial wellbeing, these goals may be at odds with each other.
Our analysis reveals that the share of out-of-pocket costs paid by patients with employer-sponsored health plans increased from 17.4 percent in 2013 to 19 percent in 2019, before a pandemic-related decline to 16.4 percent in 2020.
However, disaggregating by health plan type reveals a different story: For most plan types, the share of expenses paid by patients out of pocket has either been stable or decreased modestly. The increase in the share of expenses paid out of pocket observed between 2013 and 2019 appears to be driven by an increase in the number of workers enrolling in plans with higher deductibles.
Out-of-pocket expenditures for outpatient services grew faster between 2013 and 2019 ($470 to $631) than out-of-pocket expenditures for inpatient services ($109 to $127), while prescription drug costs decreased ($158 to $148).
Patients’ health conditions affect how much they spend out of pocket. For instance, the median patient with high cholesterol had higher expenditures than patients in general ($882 vs. $205) and paid a higher share of their expenditures out of pocket (16.9 percent vs. 16.2 percent).

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Shar Share ................................ e of ofT Med otal by ical Per Expend cent Expen ................................ itures ile, ses 2013 Paid Pa –id 2020 ou out t -of of ................................ -Pocke Pockett, .......................... 3 Share HDHP/CDHP Share PPO/POS Share EPO/HMO Jake Spiegel, Employee Benefit Research Institute, and Paul Fronstin, Ph.D., Employee Benefit th 1 $1 Previous be increase de d ,0 drive uctib 30 in n by e d rese les, 2 th 0e 1 aa 9 mo mployer rch h hig befor shter shar as for out e -indicat fsalli ponsor e n pg atient of ed to tot ed $849 that al s healt e ervic x be d pe h ur tw es np idit ng e . On lans. en ures inc the pan 50 T ave h and e decr rag urre de 60 e, mic. d by p patien eas pe rce e Patie CMS at nt of tsients i nts pai ob ver d 16.7 at the sn t er y hi ves hese percent 9 g may h 0spl p pe ende ans be r o centile, mi ut of driven rsgh — p t mean thos i be ock nst pet e ea aiwhi i fo d n t d b o r outpati he le, u y o t spe of top ut pocket. - 10 nt of ent -$ poc pe 2,792 srervices ket cent of out, Outpatient Spending Inpatient Spending Pharmacy Claims Overall Spending MarketS71% can data are a convenience sample; they are not a random sample of all people covered by an employer-sponsored 25th Percentile by 50th P Health ercentile Plan 75 T th y P pe, ercen2013 tile –2020 90th Percentile Average $1,000 Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group. “National Health Methodolo 20%gy ......................................................................................................................................................... 5 The Res answe earch I rs tnsti o these tut e ques tions have important implications for employers. In an effort to improve worker outcomes, s of rising tot pe pock al nd hea ito ng tren et i 19.4 perce lth n 2013 cads b re spe ,y risin nt i pati ndn g ing ents 201 to — $3 e 9 reach , show nroll ,295ed the in n belo i 2 n0 M ir 1pla ed 9w b icar n’ efor in s out F e, Me ig e u drop -re ofdi -7 po c pi .aid ck ng to Patients , CHI et maxim $P, or 3, ’ share 02um 9other i in 20 of (Fronst o 20 nsuranc ut.- of Th in- an poc e c e d os ket R pro ts oe p grams spe bu aid n ck b di ou 202 n y g on particular ts 1). ide p W rth esc hil e ly h e riptio s cop the igh e n datas of dr thi uget ss health plan. As such, there is a possibility that the results may not be generalizable to the United States population as a $3,500 Expenditure Accounts.” 2021. HDHP CDHP PPO/POS HMO/EPO 70% July 28, 2022 • No. 564 Ho such wever, as re s du om cee devi absent denceeis e onm, boos health care ted pr th sp oductivity ending runs c , and thontrar reduced y to stre the s snarrativ , employers e that are i patien ncreas ts are ingly in f creas ocusing ed ly on squ their eezed 19.0% $3,295 Out health analys used for rose -of a small care is. -Pock th is a sp et er amount, end nalys Spee nrs is d di n — g oes from thos Has n ot 2 e Ticked 3. at t conta 8 perce he 75 Up in dat ................................ nt in 2 pa on featur ercentil 013 e, to 90 es 25.of 1 pe p prce ercent lan desi ................................ ntile in , and a gn, 2019 such bove . Fias nall t — y, t he plan’ ha ................................ he ve seen shar s out e the of -of ou ir -pcos ock t-ofts et maxim -pocket ri................... se fast sp uer tha m, we ending n 5 whole. $906 $900 35% 19% by workers rising ’ fin healt ancial well h care th cost being s. th A (cco Copeland rding to 20 e2 s1) timat . Previous es prod re uced search by the indi C cat enters es that for Me worker dicare a s are nd Med sometim th icaid Serv es dist thract ices ed by (CMS), 18.5% pai patien ca n de by xp ts p lor at th ati e en treend ts 2 on 5s in an inpatie out d 50 -of nt - services pocket percentiles spendi rem , at ang l ined relat eas for t prior sever ively to al c the cons ondi start tions tant, ran o. f Pa the tients ging pandem from who ha ic. 6.2 W d been d percent hile the 75 iiag n 20 no and 13 to 6. sed with 90 6 perce pas erce thma ntile nt in , s Charlson, ME, P Pompei, KL Ales, and CR MacKenzie, “A 18.4% New Method of Classifying Prognostic Comorbidity in 2 A Quick Analysis of 2020 and COVID-19 ................................................................ 18.3%.................................................. 8 Introduc Patients wi 31.7% th tio poin nt -of-service (POS) plans 18.2% with capitation were excluded from this analysis. Capitation is a practice i $3,029 n which $3,000 out their pers Add -itio of-pocket nall onal y, w s fin e pe fi anc nd nd evi ies at ng on dewo nc health e rk, that whic c the are co h p may amprises nde hamp mic change er 9.9 prod percent uctivity d the deman of and r total n d and del es ationa ult in l l owe h ivery o ealt r- h qex uali f hpe ealth tynd work it care ure (sFr ., For enro de ons creas tin 2ing f 021) llees rom . of To all the $811 60% metas 20 defi 1nitiona 9. tat All $80 typ ic 0lly can ersep cer, of res spe an ent a d dia nding mi be nority fel 17.9% tes l i n pai 2 of 0 d p 20 aati l , l ow e ikely nts er share , on thes acco e hig of th unt of h eir spe tot the nd alers p ea x h ndem pe an ve seen diic. tures the out o ir out f pock -of-et, as sho pocket obli wn bel gations in ow in creas Figue re Longitudinal Studies: Development and Validation,” Journal of Chronic Disease 40 (5): 373–83, 1987. insurers 1 pay 8% $2,792 a fixed amount to health care providers regardless of the number of services they provide. As a result,58% we are not Rising Disaggr h 3eg 0ealt %ath in c g by T are cos ype ts are of S a concer pending ................................ n for many people in the ................................ United States. In a................................ 2020 poll, the Pew Resear ....................... ch Center 8 pl 11 extent an .3 types, p that ercent ou bo in 2 th their t-of01 -pocket 9. share This c ex ontinues pe of n edi xp tures end a it are de ure c ri ades s p sing for aid -lo out ng w of stea or p kers dy ockd et as w an eclin d the e ell in ir tas de he the psen har ir de ab e nts of solu to , workers tal h te out ea-’ lth of ov -pock c e 29.9% are rall spendin et spe financia ndg pai l well ing fe d be ll out in in g 17.4% s 11 ig,nif than icantly si all pance 201 tients in3, whi gener ch coul al. Results d pote for ntially all con thdi reate tions n com their prising th financial e wCCI ellbein areg. in Appendix Figure 1. $737 Recent Trends in Patient out-of-Pocket Cost Sharing able to reconstruct the costs paid for a given service the same way we can with non-capitated claims. found that 68 percent of voters prioritized health care as part of their voting decisions (Pew 2020). Additionally, there is 20 may of 2 pock 0 bre elative et at an risk d t .represe o 2 And 019 if. nts Whil em pl an o e yers all further -time raise study lo de w d s is iuctibl nce neces CMS es, copa s ary start , t ys ed he decre , or coinsura tracking thi ase in nce s the data , l share oa . ding oa f h medical igher share expe n of ditures health pai care d o ut of Copeland, C $700 raig. “2021 EBRI Financial Wellbeing Employer Survey: Focus on COVID-19 and Diversity Goals.” EBRI $2,500 Disaggregating by Plan Type ................................................................................................................................ 10 5017 %% Figure 7 3 ample evidence that spending on health care goods and services has outpaced other types of spending; as a share of s For severa pocket pending on t by pati l cohe nd ents itions, shoul we o de we bser rs o of bserv ve in 2020 their e worke an i i nte s rs mo r, this est re l ing ike may inter ly att ac pla tually ribu y bta etbl be wee e co to th n un thterprod e e pa absol ndem uctive ute ic am ra ither tha n ount of the conte out n th- xt e s ofof -tart pocket the of ir a spendi fin secu anc 25.8% ilar al ng and See https:// Issue ww Brie w.ah f N ip. o. 5 org/news/arti 44. Octobecl res 20 /health 21. -insurance-providers-respond-to-coronavirus-covid-19 25.4% 16.2% Jake Spiegel, Employe 25% e Benefit Research Institute, and Paul Fronstin, Ph.D., Employee Benefit $631 Share of Medical Expenses Paid out of Pocket by Health Conditions Affect out-of-Pocket Spending .................................................................................................... 12 gross domestic product (GDP), health care spending increased from 5 percent in 1960 to 19.7 percent in 2020 (Centers $600 wel the trend. A Qu lbe shar i ick ng e of ef A fo onalysi rts ut-.of -pocket s of spendin 2020 g and of total COVID medical- e19 xpend itures. For instance, patients diagnosed with metastatic 4 Research I 22.6%nstitute Patients, by Type of Care, 2013–2020 See $ https:// 16 2,00 %0 www.irs.gov/newsroom/irs-outlines-changes-Figure to-health2 -care-spending-available-under-cares-act 22.2% Fronst 40 in, Paul. % “2021 Workplace Wellness Survey.” EBRI Chartbook. 2021. for Me Conclusion dicare ................................ and Medicaid Services ................................ 2020). Patients may ................................ be feeling the squeez ................................ e of rising deductibles .......................... , which have 13 cancer paid only 3.5 percent of their total health expenditures out of pocket but had very high out-of-pocket $544 The COVID-19 pandemic significantly impacted the delivery of health care. There was a widely documented sharp Share O of utp A atill entHealt Servicesh Care Spe Inpatient S nd ervin ices g Paid o Presut crip tiof on Drug Pocke s t 35% 5 After di 20 sag % gregating by plan type, we find that the median share of spending paid out of pocket has either remained $500 ( ) increase The totd al sha signrifi e of out cantly i -of n rec -pocent ket s years pend as e ing is mployers expressed b atte y mpt to ?? = wran S?? gle ?? ???? risin ?? (?? ) g , where OOP is the out health care costs of their -of-poc own. For ket spen ding in expenditures, with the median patient spending $3,500 in 202 ?? 0. Mea ?? nwhi??le, patients afflicted with asthma paid 15.7 decrease in services sought at the onset of the pandemic when stay-at-home orders were issued by cities and states. Append 60% ix ............................................................................................................................................................ 15 15% $470 Fronstin, Paul and Jake Spiegel. “Trends in Health Savings Account Balances, Contributions, Distributions, and 17.9% A T A G L A N C E Me stable tho $or 1,50 decr dology 0 eased for all health plan types. Patients enrolled in HDHPs paid an increasingly low17.9% er share of their time t, ?? (?? ) is the share of enrollees in plan ?? , and ???? ?? (?? ) is the out-of-pocket share of plan i in time t. The change in out-of- employers, raising plan deductibles may very well be a path of least resistance. Employers may find that increasing plan pe rcent of ?? their total health expenditures out of pocket ?? but had much lower average expenditures, with the median These 30 ord % ers also closed many doctors’ offices and caused hospitals to postpone all but the most essential care. One ( ) ( ) ?? (???? ?? ?? +???? ?? ?? ) ?? +1 ?? References Inves ................................ tments and the Impact ................................ of COVID-19.” EBRI ................................ Issue Brief No. 5318. ................................ September 2021. .......................... 16 ® ® expend $ itures 400 out of pocket, while patients in PPO, POS, HMO, and EPO plans paid roughly the same amount in 2013 as pocket spending attributable to shifts in enrollment can be expressed as ? = ? (?? (?? ) - ?? (?? )) 28% deductibles 52%proves easier than changing insurance carriers, seeking higher-quality and lower-cost health care15.7% providers, This study makes use of the IBM Marketscan Commercial Claims and Encou ?? ?? =?? nters ?? +1 Database ?? (CCAE). The Marketscan patient30 spe % nding $1,615 in 2020. Patients diagnosed with any condition from the CCI paid an average of $924 in 2020, 0 2 cro ss •- s15 ectional an Em % ployers alys are is i o ncreas f five st ing ates ly c oncerne found, for d with inst the ancir e, w that orke vis rs’its fina toncial emerg well ency bein de g. partments At the same time, plummeted em b plet oy w ers een 42 are 14% they did in 2020. We find that the increase in the share of expenditures paid out of pocket can be largely attributed to Endnotes chang database ing cont pr ................................ esc ains mem ription drbe ug r fenrollme orm................................ ularies, a nt infn orm d oth ation as er com ................................ w m ell only as use adjud d sica trated tegie ms................................ ed for k ical ee (inp ping cos atient an ts id n c o............................ utpatie heck. nt) and 17 representing 14.8 percent of their total health care expenses. $1,030 $1,00 seeking to con 0 trol rising health care costs and often do so by increasing health plan deductibles, causing Appen and 64 percen dix t when states issued stay-at-home orders (Jeffrey et al. 2020). Another study examining visits to Fronstin, Paul and M Christopher Roebuck. “Persistency in High-Cost Health Care Claims: It’s Where the Spending Is, $849 50% 25.1%12.3% 20 $ % 300 $826 1 a shift in the mix of health plan enrollment. Workers are increasingly switching to HDHPs, with 13 percent of the ph armacy claims. ambulatory 13workers %10.9% care p to rov pa ide y more out rs found that of pocket patient visits for thei were r healt 60 h car perc e. ent To lo the wer in extent April 2 that hi 020 gh ter han d ein duacti ty bl pi es cal n p eg re a-tively pandemic Stupi $737 d.” EBRI Issue Brief No. 493. October 2019. 16% $906 10 25% % Regardless of the root cause, deductibles for workers in employer-sponsored health plans have risen dramatical $811 ly in patients in the Marketscan database enrolled in an HDHP or CDHP in 2013, rising to 27 percent in 2020. Unfortunately, 15% 9.4% impact workers’ financial wellbeing, these goals may Figurebe 11 at odds with each other. year (Mehrota 23.8% et al. 2021). Even after cities and states lifted stay-at-home orders and hospitals and doctors’ offices $ $20 500 0 13% Figures $148 For recent this years analys . Those is, we with exam in in di ed vid cual laims cov data erage rang saw ing ave from rage 20 de 13 du thro ctibl ugh es ri20 se2 from 0. In total, an inflation the an -aalytica djusted l d $ atas 650 et in 20 conta 22.8% 02 ins to our dataset does not allow us to evaluate the extent to which employers exclusively offer HDHPs in lieu of EPO, HMO, 10% Fronst in, Paul, Stuart Hagen, Olivia Hoppe, and Jake Spiegel. “The More Things Change, the More They $287 Stay the Same: 12% reopened, pat $158 ients Abs still exh olute an ibit d ed Sh som aree o deg f ou ree t-oo f-f Pho esita cken t cy C o to s stseek o for S ut e care lecte . d In C Dece ondmber 20 itions, 2 20 01 , 3 w– ell 20 a2 fter 0 the $249 19.4% $151 $1,945 in 2020, an increase of 336 percent, shown below in Figure 1. Those with family coverage saw average data on over 45 million patients who were continuously enrolled in an employer-sponsored health plan at least one year PPO, or 40%POS plans. $205 • Our analysis reveals that the share of out-of-pocket costs paid by patients with employer-sponsored health Figure 1, 5%Inflation-Adjusted Average Deductibles for Individual and Family Coverage, Among Private-Sector Wor $116 kers, 20An Anal % ysis of the Generosity of Employment-Based Health Insurance, 2013–2019.” EBRI Issue Brief No. 545. termination of $109 stay-at-home orders, patients visited hospitals and doctor’s offices less frequently.$40 Pulmonology visits $100 2 $43 $127 de be d tw uctib een 2013 les inc an reas d 202 e mark 0. eIn t dlyota as well, l, patients rising in 289 the databas percent from e acco an unted infla fo tion r -$998 adjust bed illion $1,3 in 95 claims in 2 0 be 02 tween 2 to $3,72 013 a 2 inn 2 d 020. $- $12 plans increased from 17.4 percent in 2013 to 19 percent in 2019, before a pandemic-related decline to 16.4 11%2002–2020 .............................................................................................................................................. 3 Oct As ober 20 thma 21. Metastatic Cancer Depression Dyslipidemia Diabetes Any CCI Condition decreased 11 percent, behavioral health visits decreased 10 percent, and cardiology visits decreased 6 percent relative 0% 2013 2014 2015 2016 2017 2018 2019 2020 In general, we find that most people covered by a workplace-sponsored health plan have not seen their out-of-pocket The Consumer Price Index for All Urban Consumers (CPI-U), a commonly used measure of price levels and inflation, 2020, covering inpatient and outpatient encounters as well as prescription drug claims. Further descriptive statistics are 16.7% Appendix Figure 1 Mepe diarce n nt i 20O 13 n u 202 t-of- 0. M20 ed 14 ian Out-o 20 f-15 Median 2016Out-of- 20 M17 edian Ou20 t-o 18 f- Median 20 19 Out-of- 2020 Median Out-of- $- to a typical pre-pandemic year (Mehrota et al. 2021). Some health care needs have gone completely unaddressed 16.5% Figure 2, 0%Share of All ® Health ® Care Spending Paid out of Pocket ................................................................................. 4 expenditures increase significantly. However, this is not to say that workers’ total health care spending burden has not 15% Source: IBM MarketscanMCom edim ae n rc o iau l Cla t-o im f- sP ao ndc En ke ct o uS nte prs en Dat dian bg as e a (CC nd AE). Share of Total Expenditures Paid out of Pocket, by CCI Condition, 2013–2020 found below, rose only 47 p in ercent Figur d e ur 3.ing that same time frame. Out-of- P20 oc ®13 ket O ®ut- 20 of14 - Pocket20 15 Out-of- 20P 16ocket O 20 u17 t-of- Poc20 ke 18 t Out-of-2019 Pocket 2020 Out-of- Pocket Jeffrey, Molly, Gail D’Onofrio, Hyung Paek, Timothy F Platts-Mills, William E Soares III, Jason A Hoppe, Nicholas Genes, 10% Source: IBM Marketscan Commercial Claims and Encounters Database (CCAE). 30% 2013 2014 2015 2016 2017 2018 2019 2020 during the pandemic. increased. There 20h 13 as been a sign 2014 ificant ris20 e 15 in the prem 20iums w 16 orkers 20 17 pay for the20 ir 18 health care 20pl 19ans, which 20ca 20 n Pocket Spending Pocket Spending Pocket Spending Pocket Spending Pocket Spending Pocket Spending • However, disaggregating by health plan type reveals a different story: For most plan types, the share of Bidisha Nath, ® and Edw ® ard R Melnick. “Trends in Emergency Department Visits and Hospital Admissions in Figure 3, Selected Descriptive Statistics ................................................................................................................... 5 Source: IBM Marketscan Commercial Claims and Encounters Database (CCAE). Note: Outpatient services are defined as care that does not require an overnight hospital stay (e.g., diagnostic tests, primary care physician visits, etc.). Figure 1 Year Acut Se p e M ny d oc ina grdial Share Spending Share Periph S ep ra eln V da in sg cular SharC eerebrov Spe as nc d ul in ag r Share Spending Share Spending Share Figure 3 threaten financial wellbeing. And particularly high users of health care have seen their out-of-pocket expenditures grow Inpatient services are defined as care that requires an overnight stay in a hospital (e.g., surgeries, childbirth, etc.). expenses pai C ®on d b gey stiv patie e H ® eants rt Fa o ilut of ure pocket has either been stable or decreased Dem mo entde ia stly. The incr CO eas PDe in the Rheumatoid Disease Peptic Ulcer Mild Liver Disease Health Ca Source: IBM re S Mys arktems etscan i Com n 5 m St ercates ial Clai i mn s at nhe d En F coir us nte t Months rs Database of (CC t AE). he COVID-19 Pandemic in the US.” JAMA Internal Visits conducted via® telemedi ®cine filled a portion of the gap. Previous work has established that visits conducted via Infarction Disease Disease 10% Source: IBM Marketscan Commercial Claims and Encounters Database (CCAE). $684 17.9In %flatio $2n ,9- 0A 6djus 3te .9% d Avera $1,0 ge 09 Ded 17 uc .8% tibles $792 for Indi1v 8id .4% ual an $1d ,71 Fa 2 mily 15 .7% $838 16.6% 2013 Figure 4, Share of Medical Expenses Paid out of Pocket ............................................................................................ 5 6 Selected Descriptive Statistics at a faster rate than lower-spending patients. Patients with certain medical conditions — such as metastatic cancer, We employ a further analysis to quantify the impact of enrollment in HDHPs on out-of-pocket spending trends. share of expenses paid out of pocket observed between 2013 and 2019 appears to be driven by an increase in Figure 6 Medicine. 2020. telemedicine increased significantly at the onset of the COVID-19 pandemic, with telemedici 6.6% ne visits in general rising Out-of- Out-of- Out-of- Out-of- Out-of- Out-of- Out-of- Out-of- $741 18.9% $ Cov 2,922 erage, A 3.9%mong $1 ,0 Pr 81ivate 18 -Sector .4% $852 Workers 1, 8.2002 9% –2020 $1,792 15.6% $870 17.0% 2014 20% Median Out- Numbe M r e o dfi a P na O tiu e tn - t O su ti-n o fS -Pto u cd ky e t SM am edp ialn e Out- Median Out- Median Out- 45,284,200 Median Out- Median Out- Median Out- Median Out- diabetes, and COPD — have seen their out-of-pocket obligations increase, too. However, they do not represent a Changes in aggregate out-of-pocket spending can be split into two components: changes in out-of-pocket spending in the Pn oumbe cket r of workers Share of enrol ou lin t-g of in -Pocke plans w t P ith o Spen ckhi et gher ding ded , uctibl by Percent Pes. ocke t ile, 2013 P– oc2020 ket Pocket Pocket Pocket Pocket Figure 5, Absolute Amounts of out-of-Pocket Spending, by Percentile, 2013–2020 ...................................................... 7 Year ov oer 12 f-Pocketpe rcent and orisin f-Pocg e ket ven h Spen igher fo ding orf care -Pocke such t as mental of-Poc health ket (Mehrota of -P eo tc al. ket 2021, Spieg oe f-P l o2 c02 ket1) . Even of-Pocket of-Pocket of-Pocket $782 6.2%19.1% $2,917 3.9% $1,123 18.7% $897 19.0% $1,821 15.3% $938 16.6% 2015 Individual Coverage, Real 2020 Dollars Family Coverage, Real 2020 Dollars 6.0% Total Health Care Spending, 2013–2020 $998,476,211,576 Spending Spending Spending Spending Spending Spending Spending Spending maj ority of people covered by an employer-sponsored health plan. the Mehrota plans t , Ate hee ms v, Michael elves, an Che d chang rnew, es in Davi the d Li snets hare ky o, Hilary f patients Hat ech, Davi nrolled id Cutler, a n each plan. nd Er Noitably, c C Sce hneider. nrollment “Ts he hi Imp fts tow actard of Spending 5% Spending Share Spending Spending Spending Spending Spending Spending Spending including The 2013– tel 2019 tre emedicind ne we vis obs its, how erve amon 25ever, th Percth en g te ilt e re w hose as wit a “defi 50h th P em erccit” pl enoy tileo er f -car sponsor e75 de th l Pivered ed erc en healt tile inh pla 2020 90 ns . T th ini P he erc tial decreas enly see tile ms e in as though the shareit l of ies out- Share Share Share Share Share Share Share Share 2016 $813 19.3% $2,999 3.5% $1,119 19.1% $931 19.2% $1,894 14.8% $897 18.6% Figure 6, 50%SharM e eof di aout n A-gof e-Pocket Spending, by Percentile, 2013–2020 ................................ 33 y................................ ears ........ 7 • $4,00 Out 0 -of-pocket expenditures for outpatient services grew faster between 2013 and 2019 ($470 to $631) than Disaggregating by Plan Type COVID-19 on Outpatient Visits in 2020: Visits Remained Stable, Despite a Late Surge in Cases.” HDHPs and CDHPs, in which patients tended to have higher out-of-pocket costs, and enrollment shifts away from PPO 2013 $2,549 $2,511 $1,589 $1,670 $1,628 $708 $1,421 $1,798 $1,775 8.0% 8.6% 12.0% 12.2% 12.0% $3,746 16.3% 12.6% 12.5% 10.4% $3,722 di ofrectly -pock$828 at et eoxpendit dds w 19 ith ures .3 % CMS’ we obs s$ e 3,s2timat 5 erve may 1 ion 3.that 5 very w % patien $ ell be 1,ts 12’ 3out a r-esult of of 19 -pock .3% that et sp $934 ;en care that ding as 1 a w 9. shar 4as % deemed e of $1 al ,96 l i h 7nea ess lth c ential 14.7 are sp %was p ending $937 ostpone is at d 18.6% 2017 Importantly, we find a different trend for patients enrolled in HDHPs. These patients saw their out-of-pocket obligations Share Male 48.50% Also, there are reasons for optimism. The actuarial value — a rough measure of generosity — of HDHPs has bee 9.9% n $3,608 out-of-pocket expenditures for inpatient services ($109 to $127), while prescription drug costs decreased 2014 $2,6 10 69 % $2,685 $1,708 $1,786 $1,625 $777 $1,549 $1,970 $2,010 T and o eval POS uate Com plans th mo e ,8 in whic .nwe e 2% xtent alt to wh h h pati Fund ents ich . Febr th ten e u 8res .de ary 4%d u 2 lts to 0 ob h 21ave .s erve low der o i1n 2.2 tut % he previous -of-pocket se cos ction are 1ts 2.2 , % explai dn rive 58 n p by ercent a c 10.6hange % of the in var the iat un ion de 17o .rly 0bserv %ing ed 12.5% 12.6% 9.8% Fi gure 7, Share of Medical Expenses Paid out of Pocket by Patients, by Type of Care, 2013–2020 ............................... $3,530 9 an andall , i-n ti$833 me som le o w. cas Ho 1 es, 9.w 1 p % ever, ut off b $ oth 3 entirely ,40 5 can b . Prov e 3 tru .3% ide e; the rs di $ share 1 d, 1d 1elive 2 of r e h 19 ealth s.s 4ential % care car $921 expe e, hnd owever, itu 19 res .1% d puring the aid by $2,0 oth 06 h er eight payers 14 of .4% the (e.g., pa $937 ndem Medicar ic, e, 17.9% 2018 Share Named Policyholder 46.10% decreas 4e 5 0% % slightly between 2013 and 2019, declining from 31.7 percent in 2013 to 29.9 percent in 2019 before falling steadily increasing, and if that trend continues, enrollees may pay less out of pocket. While we do not have insights into 2015 $2,708 8.1% $2,467 9.1% $1,789 11.7% $1,861 11.9% $1,998 11.5% $820 17.1% $1,639 12.2% $2,007 12.7% $1,670 11.6% $3,50 ($ 0158 to $148). $3,342 44.7% in com patients position o ’ share of f healt out h plan -of types, w -pocket se disag pending gregat . e out-of-pocket spending trends by plan type. Once we do so, we find 2013 2014 2015 2016 2017 2018 2019 2020 $872 19.3% $3,501 3.6% $1,121 19.9% $975 19.6% $2,032 14.8% $1,003 17.0% 2019 and Medi tcai his care d, Dep may artm b ent e sys of temat Veterans Af ically more fairs, e etc. xpe)nsiv may e tha simn plthe y be types rising of a t a care that faster rate hosp than itals and the d shar octe o p rsai ’ off d o ices ut of post pock pone et d 2016 $3,007 Share Sp $o 2,u 3s 2e 1 of Named Policyh$ o 1l,d 9e 0r 6 $2,000 $2,005 19.60% $856 $1,693 $2,112 $1,658 further Figure i 8n , 202 Aver0 age 7to .1%25 out .8 perc -of-Pock ent et Expen . This, too 9.6% dit,ures, reflects by T rec ypen 1 e o 1.1 t % f tren Care, ds obser 2013–ved 2020 10.i9n % ................................ the gen $3,166 erosity of 11.8 % HDH ............................ Ps. Between 16 2013 .9% 10 12.1% 11.7% 12.6% Pew patien Rts esear ’ HSAs ch Ce , many nter. “ em Elect ployers ion 2 — 020: abo Voters ut 44 are perc Hig ent h— ly mak Engag e contr ed, biut but N ions to HSAs early Half Ex on behal pect to Have f of tDif heir ficulti employe es Vot es ing .” 42.1% markedly different results. In general, out-of-pocket obligations as a total share of health care spending has remained 39.9% 2020 2017 $3,192 $756 7.4 1% 7.9% $2,463 $3,500 9.7 3 % .5%$1,970 $925 11.0% 18.4$ % 2,099 $88210.9% 18$ .2 9,% 031 $1,9 16 14 .6% 1$877 3.8% $924 16.9% $11 ,74 4.9 8% 12.1% $2,254 12.0% $1,699 12.9% by or cance patients led.wi This th wcoul orkpl d ac res eu -sltponsor in patie ednts he al having a lo th care. Unfort wer sunately, si hare of out nce -of-the pock Mark et eets xpe ca nd n itur data es in base 20 on 20ly contains . data on Share Child/Dependent of Named Policyholder 34.30% 40% $2,914 and • 2019 Patients , HDHPs ’ hea becam lth con e relatively mor ditions affecte h gow enerous much ; t they he avera spend geout of actuarial pock va etlue . For ins — a rou tance, gh est the im me ate of dian total co patient with sts paid (Fronstin 2021 Not ). It e: Outp is atiposs ent seibl rvice es that are de the fined a i sncr careeas that ed doe o s nut ot re -of qu- ire pocket e an overnighxpen t hospita dlitures inc stay (e.g., diaurre gnostid c b tesy t ts, phos rimary e ce are nro phylled i sician n vis HSA its, etc.). -eligible August 2020. $3,000 Figure ® 9, Share ®of Total Expenditures Paid out-of-Pocket, by Health Plan Type, 2013–2020 ...................................... 11 2018 relatively $3,246 stable for peopl $2,54e 8 covered by an em $1,9pl 77oyer-sponsored $2 ,PPO 126 /P$2,791 OS plan or$ an 2,08 0 EPO/HMO plan, shown $908 below in $1,787 $2,287 $1,696 7.2% 9.4% 10.7% 10.7% 11.5% 16.8% 11.9% 11.7% 12.9% 0% Inpatient services are defined as care that requires an overnight stay in a hospital (e.g., surgeries, childbirth, etc.). Source: IBM MarketscaE nn r C oo llm ed m in e rci an a lE C P la O im (E s x ac nld u s En ive co P urn otv eid rse r D O atra gb aa nsiz ea (C tio C nA ) E). / HMO (Health Maintenance patients covered by an employer-sponsored health plan, we cannot analyze trends in out-of-pocket spending for by a healt hig h pl h chol an — est oer f ®th ol h ese ad phi la ® gher ns ros expend e from 72 itures t .7 perce han patie nt to 7 nts 6 perce in genera nt (Fronst l ($882 in et vs. al. 2021 $205) and ). Thi paisd provi a higher s des cont hare ext of as $2,643 plans could be So covere urce: IBM d by Marke ts co cantribu n Commtio ercns ma ial Claimsde an dby Enco th une em ters Datp aloye base (CC r as AE).well as the employee, who likely realizes some Health C 1960 onditi 1970 1980 ons A 1990 20ff 00e 20ct 01 20 o 02 ut 20- 03 of 20- 04 Po 2005 ck 20 et S 06 20$2,601 07 pending 2008 2009 20 10 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2019 $3,279 7.9% $2,604 10.1% $2,057 11.7% $2,299 11.9% $2,084 12.3% $937 17.4% $1,877 12.8% $2,339 12.6% $1,789 14.1% Figure 9. Patients enrolled in an HMO/EPO plan paid only a slightly higher share of their total expenditures out of Organization) Plan at Any Point Between 2013 and 2020 14.40% Also, during the pandemic, legislative and regulatory changes may have altered the share of health care spending patien ts enrolled in Medicare, Medicaid, CHIP, or other insurance programs. Fi Spi gure egel, 10 Jake. , Sha“Who, What, re of Patients in Analytica When, Where, l D an atas d Why: et, by Pla Tren nd Ty s ipe n Telem , 2013– edi 20 cin 20e ................................ Usage From 2016–202 ............................ 0.” EBRI Issue Brie 1f2 35% to why pati their ex ents’ pe share nditures out of out-of of -pocket pocket (16. costs d 9 per ecreas cent vs ed. Add . 16.2 itio nall perce y, nt) in 2 . 01 9 the IRS released guidelines expanding the 2020 savings f $3,202 rom HSA 7.7% -eligi $2 b ,4 le pl 69 ans havin 10.0g %lower premi $2,001 ums 11. than 4% tradi $2,211tional hea 11.5% lth plans $1,911. Further 12.0r% esearch $836is necess 15.ary 7% to $1,718 12.6% $2,272 12.5% $1,677 13.7% $2,500 $2,351 Uns urprisinglyE , w nro el le fidnd diffe in a PPrences i O (Prefern reout d Pr-oof vid -pock er Org et sp aniza etnd ionin ) /g Ptr Oend S (Pso c inondi t-of-Stiona ervice l )on Pl atn he patient being diagnosed with pocket in 201 Sourc 9 e : ( Na 12 tio.n3 perc al Healthe Ex nt) pen d com iturespare , Cented rs with for Med2013 icare an ( d 10 Med.i9 caip d ercent) Services. . Patients in a PPO or POS plan paid exactly the same borne by patients. Some barriers to accessing health care services via telemedicine were lowered on account of the 31.6% Diabetes With Moderate/Severe No. 534. August 2021. list of medical goods and services that could be $2,152 covered at no expense to the patient prior to satisfying their deductible, explore this area Dia mo betre es fully. Paralysis Renal Disease Cancer Metastatic Cancer AIDS at Any Point Between 2013 and 2020 70.70% C Fig onclusio ure 11, Absn olute and Share of out-of-Pocket Costs for Selected Conditions, 2013–2020 ........................................ 13 certain health conditions that can be expensive to address and maintain. For example, previous research has found that share out of pocket in 2013 as they did in 2019: 17.9 percent. This reflects the current trends observed in the Complicat $2,026 ions Liver Disease Simply exami pan The s demic hare , o for f n oinstanc ing utpatie the share nt sp e. Som enof e di insur ng p out-of aid ers -pock out o allowed for et cos f pock ts e et fell bm orn ple o t b yers he y mo patie tos wa t, nts de ive cr tecos eas lls an incomp ting b sharing y 2.9el ete sto ntirely percentage ry, for visit ho p w oever. s ints be cond Tuct the we shar ed en 2019 via e of $1,979 Jake Sp 30 iegel % is a Research Associate at the Employee Benefit Research Institute (EBRI). Paul Fronstin is Directo $1,945 29.0% r of the $1,921 $1,921 which might ha En ve rolf le udrther in a re CDdu HPce (C do n th su e m se ha r-D re of irect spe ed Hnd ealin thg P ila ncurr n) / H eD dH b Py ( patients High-Dedu in ct 201 ible 9 and 2020 (Fronstin and Fendrick $2,000 Out-of- Out-of- Out-of- Out-of- $1,847 Out-of- Out-of- Out-of- Out-of- 3 pe Em rs plist oy ently ers fac high e a t health ension care between spende con rs tro are disproport lling the bott iona omtely d -line iim agn pact oseof d w risin ith gcanc healt erh , di care abetes cost , schro andnic helobst ping wo ructive rkers generosity of employer-sponsored EPO, HMO, PPO, and POS plans, which remained relatively stable between 2013 and and out teleme - of 2020 -di pocket cin , con Me, edi a whi cos forming n Ou ch ts t- w pai to od uld bex y manifest pe patien ctat Med ions ts ia nin pa may givtients be en increasin the well ’ shar Mede - ia do g n o, f O cumente bu u out t-t - if of o-ut pocke d fall -of- M p t spen ein ock diame net ob Oudi di t-cal nli g de gatio ser creas vices ns M are sim ing e sought dia. n O Prov utpl - y diuring the s growi ions in ng M th e p at a de ia ann fas O de ut-mic. ter Median Out- Median Out- 27.3% $1,758 Appendix Figure 1, Median out-of-Pocket Spending and Share of Total Expenditures Paid out of Pocket, by CCI Health BenefitH s R eaesear lth Plach n) at at AEBRI ny Po . This int Be tIs we se ue n 2Br 01ief 3 a was nd 2 0written 20 with assistance from $1,699 the In 23.5 stitute 0% ’s research and Pocket Pocket Pocket Pocket Pocket Pocket Pocket Pocket 2021). $1,667 Year of-Pocket Out-of-Pocket of-Pocket of-Pocket of-Pocket of-Pocket of-Pocket of-Pocket While at first blush this see $1,592 ms at odds with the evidence that deductibles have risen significantly, there may be several pulmonary disease (COPD), or cerebrovascular disease (Fronstin and Roebuck 2019). Previous work has estimated that 20 improve t 19 (Froheir nstin fin et a anci l. al 2 021) well.b eing Patients . On in al the o l four ne ha pl nd an, e type mplo s p yers aid a are small mor er share e frequently of th im eir pl eeme xpend ntin itur g es out o financialf pock wellne et i ssn $1,532 pace Out Coro -of navirus than -pocket tot Ai a d, l spe hea Rnd elief, an lth S ing on peca n ® dre ing d E ie np xp conom atie end nt servic ® itu ic re Sec s, t Surity (CA pes, hen end on ing the thRES) te hreat oth Act er h to w Sallow a pnd eork nd, iners ed fell g ’ fi ce by nancial rtain e only six xpens wellbei Sp-etent ndies nghs of ng to be cover posed a percen byS ed ri ptage point. es f ning dor ing out patie -of nts Again, -po cket Spending Spending Spending $1,493 Condition, 2013–2020 ............................................................................................................................ 15 25% Source: IBM Marketscan Commercial Claims and Encounters Database (CCAE). editorial staffs Spen . Any ding views express Spen ed din i gn this report are Spen tho dingse of the auth Speors ndin, and g should not Spen be ascri ding bed to th Spe end oin ff gicers, Spending Spending $1,426 $1,395 $1,500 Share Share Share Share Share Share Share Share explanations. First, the CMS data track all health care spend 4ing,$1,328 including spending by Medicare and Medicaid programs the top 20 as pe a r means to cent of health imp rov care sp e thei enders r empl account oyees’ fi ed nan for cial well 8 $1,315 4 perce being nt of , w total health ith the goal o care spe f reducind ng ab ing.s Ho enteeism a wever, not nd all of 2020, again likely due to effects of the pandemic. cos enrolle this ts ali may gn d in s be w Hit D h ov HPs ex ers pe p tat rior ctat ed to s ions . Watis e , as analy fying their hos ze pi the tals ab and plan’s solute doctor deamo du scti ’ o unt bl ffices e.of Th still deli out ese cha -of-pocket s vered nges ess , too, pendi ential cou ng care ld borne ma du nif b rin est y patients g itn patients he pa ndem to eval payin icuate th . Og uta -of e - This Issue Brief was supported by a grant from the FINRA Investor Education Foundation. The At first, it may seem counterintuitive that we observe $1,220 an increasing share of out-of-pocket spending borne by patients trustees, or other sponsors of EBRI, EBRI-ERF, or their staffs. Neither EBRI nor EBRI-ERF lobbies or takes positions on 2013 $1,084 15.7% $1,531 12.8% $2,583 7.8% $1,639 12.2% $1,397 12.3% $2,614 7.4% $2,906 3.9% $1,520 6.2% $1,120 beneficiaries and Children’s Health Insurance Program (CHIP) beneficiaries, whose out-of-pocket spending may this spending is paid out of pocket, so spe $1,062 cifically examining out-of-pocket trends may tell an entirely different story. increasing productivity. Workers who are preoccupied with their personal finances may be less productive and more relatively pocket s extent to p smaller share endi whicng h thes on pres e ri of scrip in th g co tion d eir sme ts threaten rug dical s fell ex pe f by ina nses 2.ncial 3 perce out of well nt be pocket. age points ing. Add , iti pe onally, many rhaps becaus ins e p ur res ers cri w ption aived drug cost- sspe hari ndi ng for ng is overall 2014 stud 20 and % y was a $1s ,1table 67cond or uev cted en de thcreas ro $1,ug 715ih the ng share EBRI of out Ce $- 2 nter of ,72-6 pocket s for Repsear ending ch o $1, 7based 54 n Heal onth B plan enefits ty$p 1e ,5. 0 0Ho In wnov ever, m atiouc n (EB $ h 2,of 82 8 RI the $2,922 $1,655 15.6% 12.8% 7.7% 12.3% 18.8% 12.6% 6.7% 3.9% 6.0% specific policy proposals. EBRI invites com $929 ment on this research. $882 $1,000 represent a smaller share of their overall health care expenditures than patients enrolled in private employer-sponsored prone to taking time off work to address their needs. On the other hand, to wrangle health care cost increases, Out-of-Poc 17.3%ket Spendi $798 ng Has Ticked Up patien down 2015 sts tream seeki $ o 1ng ,f 2 1other 3 testing an typ 15es .3% dof care vis $1its f ,7or 4, an 7 vis d its poss rel 12ate ib .2% ly d du to $e 2 ,CO t 69o 3VID an - a19 dditiona ,7 w .9% hich l $ w hesitan 1,7oul 91 d furth cy to 12 er vis .0 d %it rive ph $1 d arma ,56 o 7wn c th ies in e 1s 2hare .t 7he % m of $id 2 ,7s9t of 8 a 6.5% $2,917 3.9% $1,747 5.6% CRHBI), which $735 receives funding support from the following organizations: Aon, Blue Cross Blue increase in the out-of-pocket spending can be attributed to more people enrolling in HSA-eligible health plans. Indeed, $650 We examine several conditions that comprise the Charlson Comorbidity Index (CCI). The CCI is a commonly used 16.2% M health uch l p ikla e ns the s . Als hare o, if of th out e pri -of ces -pock insurers et spen pay ding prov , patients iders a’re ri absolute sing fas out ter -of than -pock the et sp pric end es p inatie g has nts incr pay, eas the edn as it well is pos . Th sib e le 2016 $1,254 14.8% $1,793 11.9% $2,800 8.0% $1,864 11.7% $1,665 12.0% $2,997 6.3% $2,999 3.5% $1,918 5.5% employers often turn to raising their health plan’s deductible. Raising deductibles offers a path of lesser resistance expend pandemic itures . patients paid out of pocket. The COVID-19 pandemic altered the delivery of health care in the United After analyzi 15% ng all patients in aggregate, our analysis finds a clear upward trajectory in patients’ out-of-pocket spending the sShiel hare d As of patients sociati enro on, FINR lled in HDHP A Inve s stor and E CDH ducati Ps more on Fo than und dat ou io bln, IC ed betw UBA, JP een 2013 Mor in 20 gan Chase 20, from , 1 Pfizer, an 3 percentd to 28 Suggested citation: Spiegel, Jake, and Paul Fronstin, “Recent Trends in Patient out-of-Pocket Cost Sharing,” EBRI predicto 2017 r of sh $1,2ort 77 -term mortality rates $1,865 (Charlson et al $2,.6 9 1 6987). Comprisi$ng 1,9 017 diffe 8 rent condi $1,7t4ions, 3 the CCI is $o 3,fte 170n used $3,251 $1,988 14.7% 11.8% 8.2% 11.9% 12.0% 6.6% 3.5% 5.3% $500 that out median p -of at-ien pock t covere et spen d by a ding co n em uldpl increase oyer-sp ons while ored healt also rep h res pla entin n spg ent a smaller shar $249 out of poc e of ket in total h 2ealt 013h , ri care spe sing to $ nd 2i8 ng 7 .i n 2019 relative to more intensive ways of managing costs, such as changing networks or a prescription drug formulary. But States, and it appears that its effects transmitted to patients’ out-of-pocket spending as well. on health care, at least until the COVID-19 pandemic struck the United States in early 2020. Specifically, out-of-pocket PhRMA. Any views expressed in this report are those of the authors and should not be ascribed to percent, shown below in Figure 10. The share of patients enrolled in PPO or POS plans, meanwhile, fell from 71 percent Is sue Brief, no. 564 (July 28, 2022). 2018 $1,310 14.4% $1,912 11.5% $2,984 7.8% $1,918 11.7% $1,792 11.9% $3,276 6.6% $3,405 3.3% $1,997 4.9% by researchers as a proxy for health. We derive flags indicating conditions contained in the CCI annually using diagnosis be The absolut fore dropping e amo tount $20 of 5 spe in 20 nd2in 0g by . To ca patie pture nts eon out xpenses pati faced ent s b ervic y the es, t inpatie ypical pers nt servic on cov es, ered and b pharm y an eacy mploy claims er-spo incr nso eas red ed there is a fundamental tension between seeking to improve workers’ financial wellbeing while also asking them to 9.1% 10% costs 2019 for peop $1,le 342enrolled in employer $1,938-sponsored health $3,00 3plans rose from 1 $1,87 96.4 percent in 2013 $1,87 to 1 5 9 percent i $n 3, 2019 274 , $3,501 $2,088 in 2013 to the off 5i8 cers, perce tr nt i usn tee 1 202 4.8% s,0 or . other spon1s 1o .8rs of EBRI % , EBR 8I .4- % ERF, or their staff 12.6% s. 12.9% 7.1% 3.6% 5.2% 9.3% In this paper, we examine the extent to which out-of-pocket spending has increased, if at all, for people with employer- codes from claims. Notably, we find that for many conditions, the share of total expenditures borne out of pocket by $0 pl bean, tween this i 2013 nclu an desd 201 peopl 9 e wh as wel o had no l. As w medi ith the cal expe share of nd ou itur t-es of -ov pocket er th sp e co end ursing e of , w the e obs year erve a . Howeve similr, ar d examini ecreasng e in t onlhe y shoulder higher health care costs. To the extent that these higher costs have a negative impact on workers’ financial 2020 $1,241 13.8% $1,810 11.1% $2,810 8.2% $1,758 12.2% $1,741 12.7% $3,319 7.1% $3,500 3.5% $2,001 4.7% Copyright Information: This report is copyrighted by the Employee Benefit Research Institute (EBRI). You may copy, before declining to 16.2 percent in 2020, shown below in Figure 4. Despite the decrease observed from 2019 to 2020, 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 ® ® sponsored health plans. In particular, we analyze whether cost increases, if any, are a result of secular trends 6.1% (e.g., patients is lower than in the population that had not received a diagnosis of a condition in the CCI. This is despite Source: IBM Marketscan Commercial Claims and Encounters Database (CCAE). median absolute s may amount obfu of s o cate ut- tren of-pocket s ds if the p u endi nde ng rlying in 2020 distri obu n ac tion ab count o ove f th or eb p elow andetmic. he medi Average an cha spe ngnd esi n dr g as on tically outpa . Th tien us t , the Disaggregating by Type of Spending wellbe FINRA ing, raising de Investodu r Edu ctiblcati es as a on Foun means t dati o contro on l health care cost inflation may be counterproductive. 5% print, or download this report solely for personal and noncommercial use, provided that all hard copies retain any and there is a clear upward trajectory in the share of medical expenditures borne by patients. This may have a deleterious rising costs of prescription drugs and health care service th s, a thmark thet-wide tr thend of shifting more costs onto workers, patients with a diagnosis of a condition in the CCI spending more on their care. For instance, the average patient ® ® absolute services samo aw tunt he slar of ge out st -incr of-pocket s ease, gro pwing ending from at the $470 25 in 201 , 50 3 , 75 to $, 6an 31 i d n 90 201 pe 9,rc befor entiles are e decreas shown ing tbe o $ lo 5w, 44 in in 2 Fig 0u 20 re , 5, Source: IBM Marketscan Commercial Claims and Encounters Database (CCAE). Next, we examine whether the steady pre-pandemic increase in medical expenditures paid out of pocket was driven by all copyright and other applicable notices contained therein, and you may cite or quote small portions of the report impact on workers’ personal finances, particularly given that workers’ premiums have increased over the past two EBRI Issue Brief is registered in the U.S. Patent and Tradem ark Office. ISSN: 0887 –137X/90 0887 –137X/90 $ .50+.50 etc.) , or if the costs patients pay increased because workers increasingly enrolled in health care plans with higher di Overa agnos ll, w ede fin with d mo mixed evi derate de or severe nce on tre liver nd d s is in eas out e -pai of-d pock onlet spe y 7.1 p nd ercent ing. I n of the the aggre ir expen gate, out ditures- o ofut o -poc f pock ket spe et i nn 202 ding by 0 but The FINRA Investor Education Foundation, established in 2003 by the Financial Industry Regulatory Authority, and shown bel the sha ow re in of Fout igur -of e 8 -pock . The et spe rise ind n sing b pendy p ingerc on entil inpe atis ient services shown belo wa w is n more mute Figure 6. d, increasing from $109 in 2013 to 0% any particular type of health care spending. For example, due to secular trends in the health care market, we may find provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing requires EBRI’s decades. deductibles. We 20 also 13 seek to ex 2014 amine whether 2015 out-of-p 20 ock 16 et costs ar 20e 17increasing di 2018sproportionat 2019ely for cer 20tain 20 types of paid an average of $3,319 out of pocket. patien Inc., em ts on hpowe ealth rcar s unders e roseerved betw Americans een 2013 an wd ith the 2019, know in both ledg ae, bsol skills, ute and tools terms as well to mak as the e s shar ound e fin of anc totial al e dx ecisions penditures. $127 in 201 © 9 and falli 2022, Empl ng to oyee Be $116 nefi in 202 t Rese 0. Pres arch criptio Institu n dr te – ug Edu spca entio din n and g, meanwhile, Research Fu dropp nd. All ed sli ri gh gh tlyt s reser between ved 2013 . and that out Some of- thi of-s po increas cket spen e may din be attri g on outp buatient table t so p ervices atients incr inc eas reas ed ing at a fas ly enrol ter rate ling in than high - sde pedu ndi cti ng blon e healt inpatien h pla tns (H service DHP s. sThe ). prior express permission. For permissions, please contact EBRI at permissions@ebri.org. ® ® Source: IBM Marketscan Commercial Claims and Encounters Database (CCAE). health care services, such as inpatient care (typically defined as care provided in a hospital and requiring an overnight In 2013, patients paid an average of 17.4 percent of their health care expenditures out of pocket, and the median throughout life. For details, visit www.FINRAFoundation.org. 2019 before increasing slightly in 2020 to $151. Mark High-ets dedu can da ctible he tabas alth e we lev plans have erage f eor xpl thi odse analys d in po is pu conta larityi over th ns patient e pas -levt el de sca pend de, ing with on enro inpat llment ient serv in tices, hese outp plans r atien ising t stay), outpatient care (typically defined as care that does not require an overnight stay in a hospital), or prescription patient paid $249 out of pocket. By 2019, those figures increased to 19 percent and $287, respectively. 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