The Average American Now Pays Enough OOP to Meet Their Deductible on May 19

Deductibles for health insurance have risen for more Americans, with the number of American adults enrolled in high-deductible health plans without a health savings plan growing from 10.6% in 2007 to 24.5% in 2017. This year, the day when enrollees will, on average, have spent enough on healthcare to hit the average deductible in an employer plan will be May 19, 2019, according to research from the Peterson-Kaiser Health System Tracker.

This day, which Kaiser Family Foundation (KFF) has coined as Deductible Relief Day, is falling later and later in the year as the average deductible has risen. In 2009, Deductible Relief Day fell on March 18, 2009. At the time, the average deductible was only $533 for a single person, compared with $1350 in 2018, an increase of more than 150%. Last year, Deductible Relief Day was May 14, 2018.

KFF calculates Deductible Relief Day using employer claims data from IBM’s MarketScan Research Database to calculate total health spending per person for services that typically count toward the deductible. Then, the researchers calculated how many days it takes for the total health spending per person to equal the average deductible, based on KFF’s annual Employee Health Benefit Survey.

The analysis of employer claims data revealed that out-of-pocket (OOP) spending in January is twice as much as what is spent in December, and the deductible accounted for approximately two-thirds of OOP spending at the beginning of the year. In January, the average OOP spending included $66 for the deductible, a $12 co-pay, and $20 coinsurance. In December, coinsurance was the same, the co-pay dropped slightly to $10, and the deductible dropped significantly to $18.

In 2007, OOP spending was still higher in January, but the difference was much smaller. In January 2007, the average OOP spending was $53 and the deductible accounted for less than half ($23). In December 2007, only $5, on average, was spent on the deductible and overall OOP spending was $33.

Some of the limitations that the researchers noted were that claims data does not include information on when each person hits their deductible, and that plan benefit designs vary and may cover some services or prescriptions before the deductible is met.

“In 2019, over a third of the year has passed before the average enrollee has incurred enough spending to meet the average deductible,” the authors concluded. “As many enrollees do not have sufficient assets to be able to pay a typical deductible, these higher, more concentrated costs can lead to delayed or forgone care and difficulty paying medical bills.”