2024 Survey Results are in!

Each year, the Kaiser Family Foundation conducts a survey to examine trends in employer-sponsored health benefits. This article summarizes the main points of the 2024 Employer Health Benefits Survey along with our thoughts from the Apex team.

Health Insurance Premiums

In 2024, the average premiums for employer-sponsored health insurance were $8,951 for single coverage and $25,572 for family coverage. The average single and family premiums increased by 6% and 7%, respectively, over the last year, similar to the previous year (7% each).

APEX TEAM INSIGHT: These increases are simply NOT sustainable for any business. Have you been shown a PFA (Participating Funding Arrangement) combined with a HDHP? Have you been exposed to a PFA at all? If not, see how our clients have been using the PFA/HDHP combination to maintain the same health carrier, keep the same benefits, and hold rates constant over mutliple years!!

Additionally, the Kaiser report notes an increase of 4.5% in workers’ wages and inflation of 3.2%. The average premium for family coverage has risen 24% over the last five years, compared with a 28% increase in workers’ wages and a 23% rise in inflation.

Premiums under high deductible health plans with savings options (HDHP/SOs) were still lower than the average premium. HDHP/SOs’ annual premiums for single and family coverages were $8,275 and $24,196, respectively.

Conversely, on average, the premiums for workers enrolled in preferred provider organization (PPO) plans were higher than others. The average PPO premium was $9,383 for single coverage and $26,678 for family coverage in 2024.?

Where does your organization stack up?

APEX TEAM INSIGHT: Based on company size, does your organization fall ahead or behind of these markers? If so, what are the plans to stay under the benchmark? If not, how do you right the ship? Use the next two graphs to start a conversation about your current market condition as well as developing a plan to put controls around cashflow as it relates to healthcare spend regardless of where you stack up against the benchmarks.

APEX TEAM INSIGHTS: Paying $9,000 per year for an individual is a steep price. Historically, we see that the majority of employees spend less than $2,000 per year out of pocket for health insurance costs; yet their premiums are 4-5x those numbers. How do we turn these numbers in your organization's favor? Reach out to our team!

Worker Contributions

The average worker contribution toward premiums was 16% for single coverage and 25% for family coverage in 2024, slightly lower than 2023’s percentages.

In terms of dollar amounts, workers contributed $1,368 and $6,296 toward their premiums for single coverage and family coverage in 2024, respectively. Once again, these numbers were slightly down from 2023, but greater than five years ago.

APEX TEAM INSIGHTS: Below show charts for both single and family coverage. When polling employees about biggest problems with benefits, contributions towards the health insurance always fall close to the top of the list, if not being the number 1 reason for dissatisfaction; and potentially even seeking employment elsewhere.

Self-funding

In the past few years, self-funded plans have become more popular. Many large organizations self-fund or pay for some or all health services for their workers directly from their own funds rather than purchase health insurance. In 2024, 63% of covered workers—including 20% at small firms and 79% in large firms—were enrolled in self-funded plans. The percentage of covered workers in self-funded plans in 2024 was similar to 2023.

APEX TEAM INSIGHTS: We have seen significant savings and success with clients moving to self-funded platforms. Ironically, the largest savings have come from the clients with the worst claims experience. It is simply not a true statement that self-funding only works for "healthy" groups.

APEX CASE STUDY: A self-funded client renewed at a 6% increase after having more than 15 large losses above their spec ($50,000). That increase was mitigated with PBM rebates (over $50,000). On top of that, a specialty drug-carve out program was added that saved them over $54,000 in specialty drugs in the first 3 months of their plan year. If this client were fully insured, their premiums would have been millions of dollars higher!

Employee Cost Sharing

Most workers must pay a share of their health care costs, and the average deductible for single coverage was $1,787 in 2024, similar to last year’s number. The average annual deductible is similar to the deductible amount five years ago and 47% higher over the past decade.

The percentage of covered workers with a general deductible of $2,000 or greater for single coverage has increased by 5% over the last five years.

Beyond deductibles, most workers cover some portion of the costs of their health care services. For example, 59% of covered workers had coinsurance, and 16% had a copay for hospital admissions. The average hospital admission coinsurance rate was 21% in 2024; the average payment amount was $343.?

APEX TEAM INSIGHTS: Another area where we have seen the PFA make significant headway against these increasing costs. Often times we have lowered employee deductibles when implementing the PFA in year 1, while keeping it constant in future years. We have clients who have not seen a premium or deductible increase in 3+ years!

Health Promotion and Wellness Programs

Many firms have programs that help workers identify health issues and manage chronic conditions. The 2024 Kaiser report highlights the following programs

• Health risk assessments—Among organizations offering health benefits, 31% of small firms and 56% of large firms provided workers the opportunity to complete a health risk assessment, similar to last year. Of large firms that offer a health risk assessment, 54% used incentives or penalties to encourage workers to complete the assessment, lower than the percentage (59%) in 2023.
• Biometric screenings—Similar to last year’s trend, in 2024, workers at 9% of small firms and 44% of large firms were given the opportunity to complete a biometric screening. Among large firms with a biometric screening program, 65% use incentives or penalties to encourage workers to complete the assessment, similar to last year (67%).
• Health and wellness promotion programs—Organizations offer these programs to help employees improve their lifestyles and avoid unhealthy habits. Most employers—54% of small and 79% of large—offered a program in at least one of these areas: smoking cessation, weight management, and behavioral or lifestyle coaching. These figures are slightly lower than last year’s.?

APEX TEAM INSIGHTS: Have you used your companies data to create a targeted wellness plan for your employees? Not only is it something that can benefit your organization from a cost standpoint, employees have shown greater appreciation towards their employer for taking a deeper interest in their physical, mental, and emotional health and wellbeing through these type of programs.

GLP-1 Drug Coverage for Weight Loss

Glucagon-like peptide 1 (GLP-1) receptor agonists have grown in popularity due to their effectiveness in helping individuals to lose weight. GLP-1s such as Ozempic and Mounjaro are approved to treat Type 2 diabetes but are also in high demand for off-label weight-loss use. Others, including Wegovy, are approved for qualifying individuals to treat obesity.

In the 2024 survey, 18% of firms with over 200 employees reported covering GLP-1s when used primarily for weight loss. Of these firms, 53% required a specific condition or had a requirement for coverage. These included meeting with a professional (dietitian, psychologist, case worker or therapist) or enrolling in a lifestyle or weight loss program.

APEX TEAM INSIGHTS: Have you discussed the difference of having these drugs in your formulary for anyone to use when prescribed? Or only for certain conditions? Or having a STEP program before they are allowed? These are the types of straetgic conversations that can help drive patient outcomes and cost control within your medical plan.

Of firms that covered GLP-1s for weight loss, 36% said that covering these medications will have a “significant impact” on their prescription drug spending. However, 16% said covering GLP-1s will be “very important” for employee satisfaction with their health plan.

Conclusion - APEX TEAM INSIGHT

As expected, things are moving in the wrong direction during a time when balance sheets might tighten with the upcoming election. What are we doing to create a process interrupt for local clients?

• Prioritizing preventive care for both physical and mental health
• Using claims data to drive plan design and push positive health outcomes
• Benchmarking analysis to drive strategy
• Leaning on vendor resources for members
• Understanding the bigger picture of Total Rewards vs. insurance placement
• Prioritizing the member experience
• Willingness for change

The last reason sounds simple, but the reality is the marketplace is strongly adverse to change UNTIL being backed into a corner by the likes of a big renewal increase, etc. Our advice is simple; dont wait. Proper Risk Management is being aware of all of these factors before they pose a threat to your organization and people.

If you are ready to pioneer change, a simple copy of your benefits guide is all that the Apex team would need to give you a comprehensive report for your benefits package.

For more information on benefits offerings, contact the Apex team today! Interested in your own custom report? Ask about the Apex PEAK Report!