EBRI Issue Brief
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).