While 99% of large companies still provide health insurance, the landscape of employer-sponsored coverage is shifting dramatically, with soaring costs and plan design changes placing a heavier burden on workers than ever before.
Key Takeaways
- In 2023, 53% of firms offering health insurance reported that their largest plan was a PPO, covering 82% of covered workers enrolled in those plans
- Among workers at small firms (3-199 workers), 65% of covered workers are enrolled in a PPO plan as of 2023, compared to 48% at large firms (200 or more workers)
- In 2023, 28% of covered workers were enrolled in HDHP/SOs with an average deductible of $2,017 for single coverage, up from 20% in 2014
- Average annual premiums for single coverage reached $8,435 in 2023, a 7% increase from 2022 after adjusting for inflation
- Family premiums averaged $23,968 in 2023, with workers contributing 29% or $6,575 on average
- Premiums for PPO plans averaged $8,621 for single and $24,182 for family in 2023
- Employer share of family premiums was 71% or $17,393 in 2023
- Large firms (200+ workers) contributed 86% to single premiums ($7,400 average) in 2023
- Total employer spending on health benefits reached $1.2 trillion in 2022 for 155 million covered lives
- Worker average monthly contribution for single coverage was $125 in 2023, up from $118 in 2022
- Employees contribute 17% ($1,401) annually to single coverage premiums on average in 2023
- For family coverage, average employee share is 29% ($6,575 yearly) in 2023
- 86% of small firms (3-49 workers) offer health insurance in 2023, up from 69% in 2010
- 47% of firms with 3-9 workers offered coverage in 2023, compared to 95% for 5,000+ worker firms
- Offering rates among firms 50-199 workers reached 89% in 2023
PPOs dominate employer health plans, but costs are rising for both companies and workers.
Employee Contributions
1Worker average monthly contribution for single coverage was $125 in 2023, up from $118 in 2022
Verified2Employees contribute 17% ($1,401) annually to single coverage premiums on average in 2023
Verified3For family coverage, average employee share is 29% ($6,575 yearly) in 2023
Verified4Small firm workers pay 23% of single premiums ($1,606 average) vs 16% ($1,242) at large firms in 2023
Directional5HDHP/SO enrollees pay 28% of premiums ($1,986 single) compared to 15% for HMOs in 2023
Single source6Average annual employee contribution to family HDHP/SOs was $6,217 in 2023
Verified7Workers' family premium share rose from 23% in 2003 to 29% in 2023
Verified856% of covered workers face contributions over $100 monthly for single coverage in 2023
Verified9Northeast employees pay highest family contributions at $7,200 average in 2023
Directional10PPO plan family contributions averaged $6,800 for employees in 2023
Single source11Employee contributions grew 111% since 2003, five times wage growth
Verified1242% of workers in small firms (3-199) have family contribution caps at 8.2% of income
Verified13Average biweekly employee deduction for family coverage was $252 in 2023
Verified14Low-wage workers (<$54k household) pay 42% of income on family premiums in 2023
Directional1571% of covered workers have contributions that vary by salary in 2023
Single source16HMO enrollees pay lowest share at 14% ($1,166 single) in 2023
Verified17Average employee HSA contribution was $968 for single coverage in employer-funded HSAs 2023
Verified18Family contribution averaged $500 monthly for 25% of workers in 2023
VerifiedEmployee Contributions Interpretation
In a trend that feels less like shared responsibility and more like a slow-motion financial heist, employee contributions for health insurance have surged over 20 years, now forcing low-wage workers to hand over nearly half their income for family coverage while wages have barely budged.
Employer Contributions
1Employer share of family premiums was 71% or $17,393 in 2023
Verified2Large firms (200+ workers) contributed 86% to single premiums ($7,400 average) in 2023
Verified3Total employer spending on health benefits reached $1.2 trillion in 2022 for 155 million covered lives
Verified4Employers covered 83% of single coverage premiums ($7,129 worker-paid $1,306) in 2023
Directional5In HDHP/SOs, employer contribution to family premiums averaged $14,986 or 71% in 2023
Single source6Small firms contributed average $6,800 to single premiums (83%) in 2023
Verified7Employer premium contributions grew 47% from 2013-2023, outpacing wages by 18%
Verified882% of large firms contribute to HSAs for HDHP/SO enrollees in 2023, averaging $968 single
Verified9Employers in the South contributed least to family premiums at $16,200 average in 2023
Directional10For PPOs, employers paid 72% of family premiums ($17,400) in 2023
Single source11Average employer contribution per covered worker for health benefits was $13,741 in 2021
Verified12Firms with 500+ workers contributed 85% to single coverage in 2023
Verified13Employer spending on family coverage rose 5% nominally in 2023 to $17,393
Verified1476% of covered workers have employer contributions to retirement plans alongside health in 2023
Directional15Average employer-paid premium per enrollee was $15,400 for state/local government workers in 2022
Single source16Employers offered premium reimbursement to 12% of HDHP/SO enrollees in 2023
VerifiedEmployer Contributions Interpretation
Employers are essentially running a trillion-dollar shadow healthcare system, lavishly subsidizing our premiums like overzealous fairy godparents while our paychecks gasp for air.
Employer-Sponsored Insurance Coverage
1In 2023, 53% of firms offering health insurance reported that their largest plan was a PPO, covering 82% of covered workers enrolled in those plans
Verified2Among workers at small firms (3-199 workers), 65% of covered workers are enrolled in a PPO plan as of 2023, compared to 48% at large firms (200 or more workers)
Verified3In 2023, 28% of covered workers were enrolled in HDHP/SOs with an average deductible of $2,017 for single coverage, up from 20% in 2014
Verified491% of covered workers have access to prescription drug coverage through their employer-sponsored plans in 2023
Directional5For family coverage in 2023, 73% of covered workers are in PPOs, 18% in HDHP/SOs, 5% in HMOs, and 3% in PPOs
Single source6Small firms (3-199 workers) saw 77% offering coverage to their workers in 2023, down from 81% in 2022
Verified799% of large firms (200+ workers) offer health insurance to at least some workers in 2023
Verified8Among firms with 50-199 workers, 92% offer coverage, with 68% of those offering PPOs as the most common plan type
Verified9In 2023, 55% of covered workers have coverage through a self-insured plan, rising to 82% for firms with 5,000+ workers
Directional1024% of small employers (3-49 workers) offered insurance in 2023, compared to 94% of large firms (1,000+ workers)
Single source11Covered workers in HDHP/SOs account for 29% of enrollment in 2023, with an average out-of-pocket maximum of $4,716 for family coverage
Verified12196 million non-elderly Americans had employment-based coverage in 2022, representing 52.5% of the under-65 population
Verified13In 2022, 64.8% of workers aged 18-64 had employer-sponsored insurance, varying by income from 79% for highest quartile to 45% for lowest
Verified14Among full-time workers, 73% had ESI in 2022, dropping to 36% for part-time workers
Directional1589% of firms with 1,000+ workers offered HDHP/SOs in 2023, but only 15% of small firms (3-49) did
Single source16In 2023, 15% of covered workers were in HMOs, primarily in the West region at 23%
Verified17Self-insured plans covered 63% of covered workers in 2023, up from 55% in 2018
Verified1892% of covered workers have dental coverage offered by employers in 2023
Verified19Vision coverage is offered by 34% of small firms and 77% of large firms in 2023
Directional2068% of covered workers can choose from three or more plans in 2023
Single sourceEmployer-Sponsored Insurance Coverage Interpretation
While the nation's largest companies increasingly shield themselves with self-insurance and offload costs via high-deductible plans, the small business backbone of America is quietly crumbling, offering less coverage each year and leaving a stark two-tiered system where your job's size dictates your health security.
Firm Size and Offering Rates
186% of small firms (3-49 workers) offer health insurance in 2023, up from 69% in 2010
Verified247% of firms with 3-9 workers offered coverage in 2023, compared to 95% for 5,000+ worker firms
Verified3Offering rates among firms 50-199 workers reached 89% in 2023
Verified499% of firms 200+ workers offer insurance, with 100% for 5,000+ in 2023
Directional5Small firms saw eligibility rates of 72% for offered plans in 2023
Single source625% of workers in firms 3-49 are eligible for coverage where offered, lowest among sizes
Verified7Large firms (1,000+) have 78% enrollment rates among eligible workers in 2023
Verified8Offering rates dropped to 54% for firms 3-199 workers from pre-ACA levels but stabilized in 2023
Verified992% of firms 50-99 workers offer coverage in 2023
Directional10Self-insuring is adopted by 90% of firms 5,000+ workers vs 12% of 3-199 in 2023
Single source1169% of workers employed by small firms (3-199) have access to ESI in 2023
Verified12Firms 200-999 workers have 97% offering rate, with 75% PPO dominant plans
Verified13Enrollment in small firm plans averages 55% of eligible workers in 2023
Verified1483% of very small firms (3-24 workers) cite cost as top reason for not offering in 2023
Directional15Large firms cover 67% of all ESI enrollees despite being 1% of firms in 2023
Single source1661% of firms 25-49 workers offer insurance, up 5% from 2022 in 2023 survey
Verified17HDHP/SO offering in small firms rose to 37% in 2023 from 25% in 2018
Verified1894% of firms 1,000-4,999 offer multiple plan choices in 2023
Verified19Worker access rates are 90% in large firms vs 48% in small firms 3-49 in 2023
Directional2072% of retail trade firms (small-heavy) offer coverage in 2023
Single source21Average premiums in manufacturing firms (often larger) were $9,200 single in 2023
VerifiedFirm Size and Offering Rates Interpretation
While small businesses have made a valiant, cost-stricken effort to join the health insurance party since 2010, the stark reality remains that coverage is still largely a privilege of corporate scale, where the giants not only offer tickets but can also afford to design the entire carnival themselves.
Industry-Specific Statistics
191% of finance/insurance firms offer coverage, highest industry rate in 2023 KFF survey
Verified2In education/health services, 82% of firms offer ESI, covering 15% of all covered workers in 2023
Verified3Leisure/hospitality firms offer at 38% rate, lowest among industries in 2023
Verified4Manufacturing firms have 78% offering rate, with 55% PPO enrollment in 2023
Directional5Wholesale/retail trade offering rate is 72%, but only 45% enrollment among eligible in 2023
Single source6Professional services firms offer at 85%, with average family premiums $25,200 in 2023
Verified7Construction industry offering rate 65%, heavily small-firm influenced in 2023
Verified8Transportation/communications/utilities have 88% offering, 65% self-insured in 2023
Verified9In agriculture/mining/logging, only 52% offer coverage in 2023 KFF data
Directional10Public administration firms offer 98%, with $15,400 average employer premium per enrollee in 2022 BLS data
Single source11Healthcare industry workers have 92% ESI coverage rate among full-time in 2022 Census
Verified12Finance sector average annual premium $24,500 family in 2023, highest industry
Verified13Retail trade enrollment 52% of eligible, lowest due to part-time prevalence in 2023
Verified14Manufacturing HDHP/SO adoption 35%, above average in 2023
Directional15Hospitality worker ESI access only 32% in 2022 MEPS data
Single sourceIndustry-Specific Statistics Interpretation
While it's a statistical delight that those in finance are so well-covered, the stark reality is that your access to health insurance remains perilously tied to whether your job involves serving coffee, spreadsheets, or the public good.
Premium Costs and Trends
1Average annual premiums for single coverage reached $8,435 in 2023, a 7% increase from 2022 after adjusting for inflation
Verified2Family premiums averaged $23,968 in 2023, with workers contributing 29% or $6,575 on average
Verified3Premiums for PPO plans averaged $8,621 for single and $24,182 for family in 2023
Verified4HDHP/SO premiums were $7,418 single and $21,203 family in 2023, 18% lower than PPOs for family coverage
Directional5From 2013 to 2023, family premiums increased 20% after inflation adjustment, averaging 4% annual growth
Single source6Workers in the Midwest faced average family premiums of $23,315 in 2023, lowest in the South at $22,848
Verified7Small firms saw single premiums rise 4% to $8,435 in 2023, while large firms rose 3% nominally
Verified8Total premium growth was 55% since 2013 for single coverage, outpacing wage growth by 24%
Verified9In 2023, 79% of covered workers experienced premium increases averaging 7%
Directional10HMO premiums averaged $8,332 single and $23,968 family in 2023, similar to PPOs
Single source11Premiums for workers in firms 3-199 workers averaged $8,206 single, 2% below large firm average
Verified12Over five years (2018-2023), family premiums grew 25%, three times inflation at 8.3%
Verified13Single coverage premiums increased 3% nominally in 2023, but 7% after inflation adjustment
Verified14Northeast region had highest family premiums at $24,979 in 2023, 9% above national average
Directional15EPO plan premiums averaged $7,990 single and $22,400 family in 2023
Single source16Since 2003, family premiums have risen 211%, four times general inflation
Verified17Covered workers' average annual premium contribution for family coverage was $6,575 in 2023, up 8% from 2022
Verified18Employer contributions to single coverage averaged $7,129 in 2023, covering 84% of total premium
Verified19Workers in small firms contribute 18% more toward family premiums than large firms in 2023
Directional20Average worker contribution to family PPO premiums was $6,800 in 2023
Single sourcePremium Costs and Trends Interpretation
The American dream now includes a side hustle to afford your health insurance premiums, which are galloping away from your paycheck like a spooked horse.