What the Data Tells Us About Health Plan Participation in the U.S.

Health plan participation in the US changes year by year. By looking at these statistics, we can see just how many workers in the country are choosing to utilize health care benefits – including the specific types of benefits – available to them. 

The latest numbers are from 2021 courtesy of the Bureau of Labor Statistics (BLS), which includes trends of health plan participation in the US. It’s also worth looking at data from the 2020 Census to get a broader idea of who is being covered for health care, as well as how (i.e. whether the coverage is private or public).

Who is covered by health insurance?

BLS data shows that health care benefits were available to 71% of private industry workers, while 54% of workers participated in the benefit. This results in a 77% take-up rate (this rate refers to the percentage of workers with access to and participating in the health care plan). Meanwhile, 89% of state and local government workers had access to health care benefits, with a take-up rate of 88%.

Already we can see, then, how health plan participation in the US varies based on sector, with government workers being more likely to use health care benefits than those in industry. 

Availability Varies by Sector: We can see, too, how the availability of health care benefits varies depending on the sector someone works in, with government employees more likely to have this option. As further evidence of this, consider how, in 2021, dental care benefits were available to 40% of private industry workers in March 2021 but 60% of state and local government workers.

High Earners Almost Always Have Access to a Health Plan: Those with the highest wages are significantly more likely to be able to participate in a health care plan than those with the lowest wages. In 2021, medical care benefits were available to 95% of workers in the highest 25th percent wage category and available to 72% of those in the lowest 25th percent wage category.

Non-Union vs. Union Workers: A further differentiation we can make in health plan participation is between non-unionized and unionized workers. In 2021, medical care benefits were available to 68% of the former group and 95% of the latter, with a take-up rate of 65% for non-union workers and 81% for union workers. It is clear, therefore, that workers who are part of a union are far more likely to make use of health care benefits provided by their employers.

Full-Time vs. Part-Time Workers: Statistics from the US Census show that, in 2020, 87% of full-time, year-round workers had private insurance coverage, which is up from 85.1% in 2018. In contrast, those not in full-time work year-round were less likely to be covered by private insurance in 2020 than in 2018 (66.7% and 68.5%, respectively). 

So that employees can participate in work-related health plans, employers pay 78% of medical care premiums for single coverage plans and 66% for family coverage plans. Employers pay an average flat monthly premium of $475.69 for single coverage and $1,174.00 for family coverage.

However, in 2020 8.6% of people did not have health insurance at any point during the year. While that might not sound like a lot, it translates into 29 million people who, if a single serious emergency or medical diagnosis should occur, might struggle to pay for treatment without insurance. Conversely, the percentage of people with health insurance coverage for all or part of 2020 was 91.4%.

What kind of health insurance do most Americans have?

In 2020, private health insurance coverage continued to be a more popular option than public coverage (e.g. Medicaid and Medicare), with 66.5% opting for the former and 34.8% using the latter. 

Of the different types of health insurance coverage, work-based insurance was the most common, covering the health and medical needs of 54.4% of the population for some or all of the year. This was followed by Medicare (18.4%), Medicaid (17.8%), direct-purchase coverage (10.5%), TRICARE (2.8%), and Department of Veterans Affairs (VA) or Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) coverage (0.9%).

Health Plan Participation Has Decreased Over Time, with Public Coverage Increasing: Between 2018 and 2020, the rate of private health insurance coverage dropped by 0.8 percentage points to 66.5%, driven by a 0.7 percentage-point decrease in employment-based coverage to 54.5%. In this same time period, the rate of public health insurance coverage increased by 0.4 percentage points to 34.8%

Children in Poverty Are Increasingly Struggling: Census data reveals that more children under the age of 19 living in poverty were not covered by a health insurance plan in 2020 than in 2018. Uninsured rates for this demographic rose 1.6 percentage points to 9.3%.

Based on all of the above statistics collected together, we continue to see how certain sections of the population are missing out on the advantages of health plan coverage, be that private (associated with one’s job or otherwise) or public.

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