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
- 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
- Small firm workers pay 23% of single premiums ($1,606 average) vs 16% ($1,242) at large firms in 2023
- HDHP/SO enrollees pay 28% of premiums ($1,986 single) compared to 15% for HMOs in 2023
- Average annual employee contribution to family HDHP/SOs was $6,217 in 2023
- Workers' family premium share rose from 23% in 2003 to 29% in 2023
- 56% of covered workers face contributions over $100 monthly for single coverage in 2023
- Northeast employees pay highest family contributions at $7,200 average in 2023
- PPO plan family contributions averaged $6,800 for employees in 2023
- Employee contributions grew 111% since 2003, five times wage growth
- 42% of workers in small firms (3-199) have family contribution caps at 8.2% of income
- Average biweekly employee deduction for family coverage was $252 in 2023
- Low-wage workers (<$54k household) pay 42% of income on family premiums in 2023
- 71% of covered workers have contributions that vary by salary in 2023
- HMO enrollees pay lowest share at 14% ($1,166 single) in 2023
- Average employee HSA contribution was $968 for single coverage in employer-funded HSAs 2023
- Family contribution averaged $500 monthly for 25% of workers in 2023
Employee 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
- 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
- Employers covered 83% of single coverage premiums ($7,129 worker-paid $1,306) in 2023
- In HDHP/SOs, employer contribution to family premiums averaged $14,986 or 71% in 2023
- Small firms contributed average $6,800 to single premiums (83%) in 2023
- Employer premium contributions grew 47% from 2013-2023, outpacing wages by 18%
- 82% of large firms contribute to HSAs for HDHP/SO enrollees in 2023, averaging $968 single
- Employers in the South contributed least to family premiums at $16,200 average in 2023
- For PPOs, employers paid 72% of family premiums ($17,400) in 2023
- Average employer contribution per covered worker for health benefits was $13,741 in 2021
- Firms with 500+ workers contributed 85% to single coverage in 2023
- Employer spending on family coverage rose 5% nominally in 2023 to $17,393
- 76% of covered workers have employer contributions to retirement plans alongside health in 2023
- Average employer-paid premium per enrollee was $15,400 for state/local government workers in 2022
- Employers offered premium reimbursement to 12% of HDHP/SO enrollees in 2023
Employer 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
- 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
- 91% of covered workers have access to prescription drug coverage through their employer-sponsored plans in 2023
- For family coverage in 2023, 73% of covered workers are in PPOs, 18% in HDHP/SOs, 5% in HMOs, and 3% in PPOs
- Small firms (3-199 workers) saw 77% offering coverage to their workers in 2023, down from 81% in 2022
- 99% of large firms (200+ workers) offer health insurance to at least some workers in 2023
- Among firms with 50-199 workers, 92% offer coverage, with 68% of those offering PPOs as the most common plan type
- In 2023, 55% of covered workers have coverage through a self-insured plan, rising to 82% for firms with 5,000+ workers
- 24% of small employers (3-49 workers) offered insurance in 2023, compared to 94% of large firms (1,000+ workers)
- Covered workers in HDHP/SOs account for 29% of enrollment in 2023, with an average out-of-pocket maximum of $4,716 for family coverage
- 196 million non-elderly Americans had employment-based coverage in 2022, representing 52.5% of the under-65 population
- In 2022, 64.8% of workers aged 18-64 had employer-sponsored insurance, varying by income from 79% for highest quartile to 45% for lowest
- Among full-time workers, 73% had ESI in 2022, dropping to 36% for part-time workers
- 89% of firms with 1,000+ workers offered HDHP/SOs in 2023, but only 15% of small firms (3-49) did
- In 2023, 15% of covered workers were in HMOs, primarily in the West region at 23%
- Self-insured plans covered 63% of covered workers in 2023, up from 55% in 2018
- 92% of covered workers have dental coverage offered by employers in 2023
- Vision coverage is offered by 34% of small firms and 77% of large firms in 2023
- 68% of covered workers can choose from three or more plans in 2023
Employer-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
- 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
- 99% of firms 200+ workers offer insurance, with 100% for 5,000+ in 2023
- Small firms saw eligibility rates of 72% for offered plans in 2023
- 25% of workers in firms 3-49 are eligible for coverage where offered, lowest among sizes
- Large firms (1,000+) have 78% enrollment rates among eligible workers in 2023
- Offering rates dropped to 54% for firms 3-199 workers from pre-ACA levels but stabilized in 2023
- 92% of firms 50-99 workers offer coverage in 2023
- Self-insuring is adopted by 90% of firms 5,000+ workers vs 12% of 3-199 in 2023
- 69% of workers employed by small firms (3-199) have access to ESI in 2023
- Firms 200-999 workers have 97% offering rate, with 75% PPO dominant plans
- Enrollment in small firm plans averages 55% of eligible workers in 2023
- 83% of very small firms (3-24 workers) cite cost as top reason for not offering in 2023
- Large firms cover 67% of all ESI enrollees despite being 1% of firms in 2023
- 61% of firms 25-49 workers offer insurance, up 5% from 2022 in 2023 survey
- HDHP/SO offering in small firms rose to 37% in 2023 from 25% in 2018
- 94% of firms 1,000-4,999 offer multiple plan choices in 2023
- Worker access rates are 90% in large firms vs 48% in small firms 3-49 in 2023
- 72% of retail trade firms (small-heavy) offer coverage in 2023
- Average premiums in manufacturing firms (often larger) were $9,200 single in 2023
Firm 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
- 91% of finance/insurance firms offer coverage, highest industry rate in 2023 KFF survey
- In education/health services, 82% of firms offer ESI, covering 15% of all covered workers in 2023
- Leisure/hospitality firms offer at 38% rate, lowest among industries in 2023
- Manufacturing firms have 78% offering rate, with 55% PPO enrollment in 2023
- Wholesale/retail trade offering rate is 72%, but only 45% enrollment among eligible in 2023
- Professional services firms offer at 85%, with average family premiums $25,200 in 2023
- Construction industry offering rate 65%, heavily small-firm influenced in 2023
- Transportation/communications/utilities have 88% offering, 65% self-insured in 2023
- In agriculture/mining/logging, only 52% offer coverage in 2023 KFF data
- Public administration firms offer 98%, with $15,400 average employer premium per enrollee in 2022 BLS data
- Healthcare industry workers have 92% ESI coverage rate among full-time in 2022 Census
- Finance sector average annual premium $24,500 family in 2023, highest industry
- Retail trade enrollment 52% of eligible, lowest due to part-time prevalence in 2023
- Manufacturing HDHP/SO adoption 35%, above average in 2023
- Hospitality worker ESI access only 32% in 2022 MEPS data
Industry-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
- 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
- HDHP/SO premiums were $7,418 single and $21,203 family in 2023, 18% lower than PPOs for family coverage
- From 2013 to 2023, family premiums increased 20% after inflation adjustment, averaging 4% annual growth
- Workers in the Midwest faced average family premiums of $23,315 in 2023, lowest in the South at $22,848
- Small firms saw single premiums rise 4% to $8,435 in 2023, while large firms rose 3% nominally
- Total premium growth was 55% since 2013 for single coverage, outpacing wage growth by 24%
- In 2023, 79% of covered workers experienced premium increases averaging 7%
- HMO premiums averaged $8,332 single and $23,968 family in 2023, similar to PPOs
- Premiums for workers in firms 3-199 workers averaged $8,206 single, 2% below large firm average
- Over five years (2018-2023), family premiums grew 25%, three times inflation at 8.3%
- Single coverage premiums increased 3% nominally in 2023, but 7% after inflation adjustment
- Northeast region had highest family premiums at $24,979 in 2023, 9% above national average
- EPO plan premiums averaged $7,990 single and $22,400 family in 2023
- Since 2003, family premiums have risen 211%, four times general inflation
- Covered workers' average annual premium contribution for family coverage was $6,575 in 2023, up 8% from 2022
- Employer contributions to single coverage averaged $7,129 in 2023, covering 84% of total premium
- Workers in small firms contribute 18% more toward family premiums than large firms in 2023
- Average worker contribution to family PPO premiums was $6,800 in 2023
Premium 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.