Table 1. Family Out-of-Pocket Health Care Burden Among Adults 19 to 64 Years of Age With Employer-Sponsored Insurance, 2011-2015a,b.
| Population Subgroup | High-Deductible Plan | Low-Deductible Plan | No-Deductible Planc |
|---|---|---|---|
| All Individuals (n = 33 619) | |||
| Disposable family income, mean (95% CI), 2015 $d | 76 046e (73 639-78 452) | 72 418 (70 830-74 006) | 72 175 (69 517-74 834) |
| Family out-of-pocket expenditure, mean (95% CI), 2015 $ | |||
| Health care services | 1986 (1856-2116)f | 1481 (1411-1551)f | 1217 (1118-1316) |
| Health insurance premiums | 3537 (3386-3689)f | 3217 (3110-3323)f | 2713 (2598-2828) |
| Adults with total family out-of-pocket health care burden >20% of disposable income, mean (95% CI), %h | 7.3 (6.4-8.3)f | 5.9 (5.2-6.6)g | 4.3 (3.7-4.9) |
| Among Low-Income Enrollees (family income <250% of FPL) With No Chronic Conditions or Only 1 Chronic Condition (n = 5888) | |||
| Disposable family income, mean (95% CI), 2015 $ | 34 452 (32 985-35 920)e | 32 386 (31 467-33 305) | 32 335 (31 211-33 458) |
| Family out-of-pocket expenditure, mean (95% CI), 2015 $ | |||
| Health care services | 1316 (1145-1487)f | 1084 (950-1217)g | 771 (638-904) |
| Health insurance premiums | 3125 (2858-3393)f | 2837 (2589-3085)f | 2232 (2020-2444) |
| Adults with total family out-of-pocket health care burden >20% of disposable income, mean (95% CI), % | 20.6 (16.6-24.6)f | 17.5 (15.0-20.0)f | 11.0 (8.5-13.4) |
| Among Low-Income Enrollees (family income <250% of FPL) With ≥2 Chronic Conditions (n = 1099) | |||
| Disposable family income, mean (95% CI), 2015 $ | 27 561 (25 142-29 980) | 27 454 (25 806-29 102) | 28 998 (26 713-31 282) |
| Family out-of-pocket expenditure, mean (95% CI), 2015 $ | |||
| Health care services | 2967 (2076-3856)e | 2097 (1675-2520) | 1778 (1410-2146) |
| Health insurance premiums | 2980 (2307-3654) | 3138 (2702-3573)g | 2328 (1889-2766) |
| Adults with total family out-of-pocket health care burden >20% of disposable income, mean (95% CI), % | 46.9 (37.5-56.3)f | 36.9 (31.3-42.5)g | 22.0 (14.9-29.0) |
Abbreviation: FPL, federal poverty level.
The sample includes adults 19 to 64 years of age who were enrolled in employer-sponsored health insurance plans throughout the year and did not have any other type of private or public insurance. The estimates are population weighted, and standard errors are adjusted for the complex design of the Medical Expenditure Panel Survey. All dollar values were adjusted to 2015 dollars using the Consumer Price Index for All Urban Consumers.
Based on household-reported conditions that were coded into International Classification of Diseases, Ninth Revision, codes and then translated into Clinical Classification Software codes, we identified the following 20 chronic conditions: hypertension, congestive heart failure, coronary artery disease, cardiac arrhythmias, hyperlipidemia, stroke, arthritis, asthma, autism spectrum disorder, cancer, chronic kidney disease, chronic obstructive pulmonary disease, dementia (including Alzheimer disease and other senile dementias), depression, diabetes, hepatitis, HIV, osteoporosis, schizophrenia, and substance abuse disorders (drug and alcohol). This list of chronic conditions developed by a working group of the Office of the Assistant Secretary for Health in the US Department of Health and Human Services. We examined only treated conditions (ie, conditions for which individuals reported receiving any medical care).
Base group.
Family is defined as Health Insurance Eligibility Units, which include adults plus family members, including children, who would typically be eligible for coverage under the adults’ private health insurance family plans. Family disposable income is defined as after-tax family income. (We adjusted family disposable income for income taxes and Social Security and Medicare taxes using the web-based version of the National Bureau of Economic Research TAXSIM model.)
Statistically significantly different, based on 2-sample t tests, from the no-deductible health plan enrollees at the 5% level.
Statistically significantly different, based on 2-sample t tests, from the no-deductible health plan enrollees at the 0.1% level.
Statistically significantly different, based on 2-sample t tests, from the no-deductible health plan enrollees at the 1% level.
Total family out-of-pocket health care burden = (family out-of-pocket health care services expenditure + family out-of-pocket health insurance premium)/family disposable income.