25 Health Care Facts and Statistics

Discount Health Plans

  1. More than 30 million Americans are members of discount health plans through a variety of entities, including: associations, senior organizations, educational groups, businesses, nonprofits, financial institutions and unions.
  2. The purpose of a discount health plan is to supplement insurance, save money on out-of-pocket health costs and make ancillary services more affordable.
  3. Discount health plans and savings vary based on services, procedure and location. Typically, plans offer anywhere from 20% to 60% off the regular fee of health care services provided,
  4. Discount health plans are not qualified plans under the Affordable Care Act.
  5. In exchange for a monthly fee, people get a membership, a list of in-network providers, and a discount on services when visiting those providers. Discount health plans typically fall into two categories:
    • Limited to specific type of service with discounts (e.g., dental, prescription, vision).
    • Bundled services with discounts (e.g., dental + vision + telehealth)
    6. Source: Consumer Health Alliance

Health Costs

  1. Total U.S. health care spending is expected to reach $4.8 trillion in 2021, accounting for one-fifth of the U.S. economy, according to the Centers for Medicare and Medicaid Services.
  2. According to a 2012 report from consulting firm Milliman, a family of four in America averages $3,470 in out-of-pocket health costs.
  3. According to a report from The Commonwealth Fund, 41% of U.S. adults have problems paying medical bills.
  4. Medical bills are a major factor in more than 60% of the personal bankruptcies in America, according to a report published in The American Journal of Medicine.

Insurance, Medicare and Medicaid

  1. According to a report from the U.S. Census Bureau, more than 48 million Americans were uninsured in 2012.
  2. As many as 130 million Americans do not have dental insurance, according to a report from the U.S. Senate Committee on Health, Education, Labor and Pensions.
  3. Over the past decade, health insurance premiums have risen three times faster than wages have in the United States, according to a report from The Commonwealth Fund.
  4. Only 14% of Americans ages 25 to 64 years have an accurate understanding of what “deductible,” “co-pay,” “co-insurance” and “out-of-pocket maximum” mean to them, according to a Carnegie Mellon survey published in the Journal of Health Economics.
  5. More than 72 million Americans were enrolled in Medicaid for at least one month in 2012, according to the Medicaid and CHIP Payment and Access Commission.
  6. According to the Centers for Medicare and Medicaid Services, more than 49 million Americans were served by Medicare in 2012.
  7. According to the Medicare Rights Center, health care services not covered by Medicare and Medicaid include, but are not limited to:
    • Alternative medicine
    • Acupuncture
    • Chiropractic services
    • Cosmetic surgery
    • Most dental care
    • Most health care services received outside of the United States
    • Hearing aids or the examinations for prescribing or fitting hearing aids
    • Most housekeeping services
    • Most non-emergency transportation
    • Non-medical services, such as copies of x-rays and missed appointments
    • Most personal care, custodial care and nursing home care
    • Most vision and eye care

    Affordable Care Act

    1. The ACA is expected to reduce the number of uninsured in the United States by almost half, or about 25 million people, in the next 10 years.
    2. All plans offered in the Health Insurance Marketplace must provide a set of 10 essential health benefits that include the following categories:
      • Ambulatory (outpatient) services
      • Emergency services
      • Hospitalization (inpatient services)
      • Laboratory services
      • Maternity and newborn care
      • Mental health and substance use disorder services, including behavioral health treatment
      • Pediatric services, including oral and vision care
      • Prescription drugs
      • Preventive and wellness services and chronic disease management
      • Rehabilitative services and devices
    3. The penalty for not having an ACA-qualified health insurance plan in 2014 is $95, and goes up to $695 by 2016.
    4. In 2016, the ACA will require businesses with 50 or more employees to provide health coverage, or face a fine of $2,000 per employee.

    Employee Benefits

    1. Employer-sponsored insurance covers about 149 million non-elderly people―56% of the non-elderly American population―according to a report from the Kaiser Family Foundation.
    2. According to a report from the Kaiser Family Foundation, the average annual premium for employer-sponsored health insurance in 2013 is $5,884 for single coverage and $16,351 for family coverage.
    3. More than 40% of companies do not offer health benefits to their employees, according to a report from the Kaiser Family Foundation.
    4. Almost two-thirds of employees are very concerned about having access to affordable health insurance as well as having enough money to cover increasing out-of-pocket medical costs, according to a MetLife survey.
    5. According to a MetLife survey, 68% of employees agree that voluntary supplemental benefits are important for helping them to manage their health costs.

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