Issue Brief #9 October 2014 Out-of-Pocket Spending Trends KEY FINDINGS: 2013 16.4% (2013) Share of health care costs paid out of pocket. In 2013, 16.4% of health care spending per individual cov- $800 AND 4.0% ered by employer-sponsored insurance (ESI) was paid out of Out-of-pocket spending per capita and pocket. In that year, out-of-pocket expenditures for those growth rate (2012–2013) for national with ESI rose by 4.0% to $800 per capita. Most of the in- ESI population. crease came from rising out-of-pocket spending on profes- $662 AND 0.0% sional services and outpatient visits. In contrast, out-of- Out-of-pocket spending per capita and pocket spending on prescriptions fell for the third consecu- growth rate (2012–2013) for young adult women. tive year. Among the four Census regions studied, the South continued to have the highest level and fastest growing out- $51 AND 10.5% of-pocket spending. Among age groups, out-of-pocket- Out-of-pocket per capita spending and spending growth jumped for pre-Medicare adults (ages 55– growth rate (2012–2013) on acute inpa- tient admissions. 44), while growth slowed for other age groups. Spending differences between men and women generally continued to -0.6% AND -10.2% widen. Unlike the other ESI populations examined, young Growth rates for out-of-pocket spending adult women (ages 19–25) did not experience an increase in (2012–2013) on generic and brand pre- scriptions. out-of-pocket spending in 2013. In this issue brief, HCCI reports on trends in out-of-pocket expenditures per capita for the national, younger than age 65 population covered by employer-sponsored insurance (ESI) for the study period covering 2011 through 2013. Out-of-pocket expenditures are payments made by insureds directly to medical professionals, facilities, pharmacies, and other providers and suppliers, and are among the most visible health care costs to consumers (see “Key definitions”). Between 2012 and 2103, out-of-pocket ex- penditures per capita rose from $769 to $800 (Table 1). This 4.0% increase was the lowest growth in out-of-pocket spending during the study period. However, out-of- pocket expenditures during this time grew at www.healthcostinstitute.org 1 a faster rate than payer expenditures (Figure 1). As expected, out-of-pocket spending levels were substantially low- er than those spent by payers. Out-of- pocket expenditures per insured person remained at 16.4% of total health care spending for the ESI population. Out-of pocket expenditures for professional services continued to grow; spending on prescrip- tions fell In 2013, out-of-pocket spending on pro- fessional services, in addition to ac- counting for the largest portion of this spending (44%), also increased as a share of spending (Table 1 and Figure 2). However, of the medical service cate- gories, professional services had the rates, which rose 9.6% ($11 per capita) In 2013, out-of-pocket spending for slowest growth in out-of-pocket spend- and 7.3% ($6 per capita), respectively. acute inpatient services rose fastest ing at 5.3%, or $18, to $353 per person. Over the study period, outpatient visits (10.5%), but due to the relatively small Outpatient spending accounted for 27% had the highest average spending levels amounts paid out of pocket for inpatient of out-of-pocket spending, with outpa- and grew an average annual rate of care, this represented a $5 increase in tient visits and outpatient-other services 9.6%. In contrast, between 2011 and spending per capita. constituting 16% and 11%, respectively, 2013, out-of-pocket spending growth Conversely, for the third year in a row, of total out-of-pocket spending. Outpa- for outpatient-other services slowed at per capita out-of-pocket spending on tient visits and outpatient-other services an average annual rate of 8.3%. prescriptions declined, driven largely by had the second and third fastest growth declines in out-of-pocket spending on brand prescriptions. In 2013, out-of- pocket spending per capita on generic prescriptions also declined (-0.6%), af- ter increasing 11.0% in 2012. This re- sulted in a $9 decline in out-of-pocket spending on prescriptions ($179 per capita in 2013). The share of spending on brand prescriptions dropped to 9.5%, down from 13.1% in 2011. The share of out-of-pocket spending on ge- neric prescriptions also fell slightly be- tween 2012 and 2013, to 12.8% of total out-of-pocket spending. Out-of-pocket spending highest and grew fastest in the South In 2013, out-of-pocket expenditures growth was higher in the South and www.healthcostinstitute.org 2 Northeast than the other regions (Table 1). In the South, out-of-pocket expendi- tures grew by 4.8% ($40) to $876 per capita. The South experienced the fast- est growth and the highest level of per capita spending in every year between 2011 and 2013. In the Northeast in 2013, out-of-pocket per capita expendi- tures increased by $33 to $737 per capi- ta. In the Midwest in 2013, out-of-pocket expenditures rose 3.3% ($26); per capi- ta spending out of pocket was the sec- ond highest of the four Census regions ($822). The West had the lowest out-of- pocket expenditure growth rate (2.5%), which raised out-of-pocket spending by $17 per person. Compared to other parts of the country, the West continued HCCI AGE GROUPS the highest per capita out-of-pocket ex- for the second consecutive year to have penditures were for the pre-Medicare the lowest levels of out-of-pocket spend- adults (ages 55–64), who spent $1,318 Children ing per capita ($711 in 2013). per capita out-of-pocket in 2013. This Pre-Medicare adult spending out represented a 4.0% increase in their Ages 0 through 18. -of-pocket jumped by $50 per spending, $50 more than in 2012. Unlike person the other age groups, for pre-Medicare adults, out-of-pocket spending grew Young adults Overall, per capita out-of-pocket spend- faster in 2013 than in 2011 or 2012. ing rose with age. In 2013, children (ages 0–18; see “HCCI age groups”), had Difference in spending by gender Ages 19 through 25. the lowest per capita expenditures, at continued to widen $454 (Table 1) and had the highest Intermediate adults In 2013, out-of-pocket expenditures spending growth, up 4.8%, or $21 per grew faster for men (4.5%) than for capita (Figure 3). The lowest growth women (3.7%; Table 1). However, in Ages 26 through 44. rate was for young adults (ages 19–25), each year of the study period, spending which rose 1.8% ($9) to $515 per capita. levels were higher for women. In 2013, This was the first year in the study peri- Middle age adults women’s out-of-pocket per capita ex- od in which young adults had the lowest penditures reached $914, $233 per capi- expenditure growth rate. For intermedi- Ages 45 through 54. ta more than out-of-pocket expenditures ate adults (ages 26–44), out-of-pocket by men – a slightly larger difference expenditures rose 3.6% to $783. For than in 2012 ($230) and 2011 ($215). Pre-Medicare adults middle age adults (ages 45–54), spend- ing rose by 4.1% to $1,005 per capita. As Out-of-pocket spending stayed seen in Figure 3, the growth rates across flat for young adult women Ages 55 through 64 age groups have generally been slowing Between 2012 and 2013, generally, out- over the study period. of-pocket spending rose for the age- In each year between 2011 and 2013, gender groups. For both boys and girls, www.healthcostinstitute.org 3 out-pocket spending rose 4.8% to $467 time in the three-year study period that Inpatient out-of-pocket spending and $439, respectively (Table 2 and Fig- out-of-pocket spending by any age- for women 19-44 driven up by ure 4). Among the different gender-age gender group did not increase between labor and delivery groups, young adult men had the highest years (see “Why didn’t out-of-pocket out-of-pocket growth rate (5.2%) but spending by young adult women grow In 2013, the largest increases in ex- the lowest spending level ($369). For in 2013?”). penditure growth rates for acute inpa- intermediate adults, spending grew tient admissions detailed categories In 2013, in each of the adult age groups, 4.3% for men and 3.2% for women, were for newborns (24.7%, or $1 per per capita out-of-pocket spending was slower rates than in 2012. For both mid- capita) and labor and delivery (LD) ad- higher for women than men. Spending dle age adults and pre-Medicare adults, missions (21.4%, or $2 per capita; Ap- differences between men and women spending grew faster in 2013 than 2012 pendix Table A22). This increase in LD declined with age, however. The differ- (4.1% for middle age men and women, out-of-pocket spending was largely ac- ence was largest for intermediate adults 3.9% for pre-Medicare men, and 4.0% counted for by intermediate women, ($449) and smallest for pre-Medicare for pre-Medicare women). whose spending increased 22.3% or $12 adults ($124). Children were an excep- per capita (Appendix Tables A25a and In contrast to the other age-gender tion, as out-of-pocket spending was A25b). LD out-of-pocket spending also groups, out-of-pocket spending by slightly higher for boys than for girls (a increased for young adult women young adult women stayed flat at $662 $28 difference). (19.3%, or $7 per capita; Appendix Ta- per woman. Notably, this was the first bles A24a and A24b). Spending on new- WHY DIDN’T OUT-OF-POCKET SPENDING BY YOUNG ADULT WOMEN GROW IN 2013? In 2013, out-of-pocket spending per capita was flat for young adult women ($662; Table 2). Comparatively, out-of-pocket expenditures grew at least 3.2% for all other age-gender groups. For young adult women, the rise in out-of-pocket spend- ing on medical services was offset by a drop in prescription spending, resulting in flat growth overall (Appendix Tables A21a and A21b). Per capita spending declined for both brand (-16.7%) and generic (-20.1%) prescriptions, a $10 per cap- ita decline for brand prescriptions and a $17 decline for generic pre- scriptions. The drop in out-of-pocket spending on prescriptions by young adult women was almost completely due to a decline in spending on generic and brand hormone and synthetic substitutes (“hormones”). Out-of- pocket spending declined $19 per capita on generic hormones (Figure 5) and $6 per capita on brand hor- mones. Of the $19 decline in spending on generic hormones, 97.7% was due to a decline in spending on generic con- traceptives. Less than $0.50 of the $19 was attributable to a decline in spending on other types of generic hormones. Less than $0.15 of the decline in spending on brand hor- mones was attributable to brand hormones other than contraceptives. www.healthcostinstitute.org 4 borns increased $2 per boy and per girl was observed for every age group and A27b); the smallest increase was among between 2012 and 2013 (Appendix Ta- gender. The smallest spending increases young adult men and women (Appendix bles A23a and A23b). For other types of on ER visits was for boys and young Tables A24a and A24b). admissions used by other age-gender adult men ($4 per capita; Appendix Ta- Generally, spending out of pocket on groups, there was little change in out-of- bles A23a and A24a); the largest was for outpatient surgery rose with age, with pocket spending. young adult women and intermediate the lowest spending for girls ($27 per women ($10 per capita; Appendix Ta- Despite lower utilization, out-of- capita; Appendix Table A23a) and the bles A24a and A25a). Young adult wom- pocket spending rose for emer- highest on pre-Medicare women ($120 en spent the most out of pocket for ER per capita; Appendix Table A27a). For gency room and outpatient sur- visits ($84 per capita), whereas, pre- each of the adult age groups, spending gery visits Medicare men spent the least ($50 per was higher by women than by men. The capita; Appendix Table A27a). Between 2012 and 2013, the largest largest spending difference between increase in per capita out-of-pocket There was also a large increase in out-of men and women was among intermedi- spending on outpatient services was for -pocket spending in 2013 on outpatient ate adults; the smallest, in the pre- emergency room (ER) visits, which rose surgery (6.7%, or $4 per capita; Appen- Medicare group. 12.9%, or $7 per capita (Appendix Table dix Table A22). The largest spending increase for these services was among Out-of-pocket spending on spe- A22). However, the use of these services declined.1 pre-Medicare women (8.3%, or $9 per cialist office visits up 13.8% capita; Appendix Tables A27a and In 2013, for detailed categories of pro- The increase in spending on ER visits KEY DEFINTIONS Out-of-pocket expenditures per capita: Out-of-pocket payments include the patients’ share of payment for the provision of health care services and prescriptions covered by insurance; this includes any copayments, coinsurance payments, or deductible payments. If an insurance claim was not filed (for example, for the purchase of over-the-counter medicines), the expenditures are not included in this metric. HCCI calculated out-of-pocket expenditures per capita by dividing total out-of-pocket expenditures by the total insured population. Deductibles: A deductible is the amount of health care costs incurred that an insured individual must pay out-of-pocket before the health plan reimbursement begins in a contract period. For example, for health care expenses of $2,000 in a year, an insured with a $1,000 deductible would pay the first $1,000 out of pocket. After the deductible is satisfied, the insured and the health plan jointly pay for the remaining $1,000 of expenses according to the coinsurance and co- payment policy stipulated in the insurance contract. Coinsurance: Coinsurance is the portion of covered health care costs borne by an insured. After insureds meet their de- ductible requirements, they generally pay for a portion of the remaining health care expenses out of pocket. For example, they may pay according to a fixed percentage of the expense, such as 20%. The insurer (payer) pays the other 80%. Co-payments: Co-payments are an out-of-pocket expense in which the insured pays a specified charge for a specified ser- vice. Typical co-payments are fixed fees for services such as physician office visits, prescriptions, or hospital admissions. These payments are in addition to deductibles and coinsurance payments. Payer expenditures per capita: Payer expenditures are the dollars paid by the insurer directly to a health care provider on behalf of the insured. Any rebates, discounts, or incentive payments between insurers and providers not captured by the insureds’ claims data are not included in this metric. HCCI calculated payer expenditures per capita by dividing total payer expenditures by the total insured population. www.healthcostinstitute.org 5 fessional services, the largest out-of- (-3.0%; Appendix Table A23b), young (16.9%, or $13; Appendix Tables A27a pocket spending increase in level and adult women (-20.1%; Appendix Table and A275b), pre-Medicare women (- growth was for office visits to special- A24b), and intermediate adult women (- 21.4%, or $10), and middle age men (- ists, which rose 13.8% ($7 per capita) to 7.8%; Appendix Table A25b). Generic 18.6%, or $7; Appendix Tables A26a and $59 per insured (Appendix Table A22). out-of-pocket spending increased for all A26b). The next largest decline in brand Young adult men had the lowest spend- other age-gender groups. spending was for young adult women, ing level on specialist office visits ($28 whose out-of-pocket spending on brand Most of the decline in young adult wom- per capita; Appendix Table A24a), while hormones declined 22.5%, or $6 per en’s out-of-pocket spending on generic girls experienced the smallest increase capita (Appendix Tables A24a and prescriptions (-55.5%, or $15 per capi- in the level of spending ($4 per capita; A24b). ta) was attributable to lower spending Appendix Table A23a). Pre-Medicare on hormones (Appendix Tables A24a Conclusions women had the highest per capita and A24b). This 2013 spending decline spending level and largest spending in- In 2013, out-of-pocket spending rose by broke a trend of stable spending in the crease on specialist office visits ($100 $31 to $800 (Table 1). Most of this prior years. In 2011 and 2012, generic and $11, respectively; Appendix Table spending increase was due to rising spending was $35 per young adult wom- A27a). spending on professional and outpatient an and $34 per young adult woman, re- services, which was partially offset by Out-of-pocket spending on office visits spectively. A similar break in trend in declines in prescription spending out of to primary care providers (PCPs) in- 2013 was observed for intermediate pocket. The gender and age of the in- creased 4.1%, or $2 per capita, to $52 adult women. Between 2012 and 2013, sured played a role in which services per capita (Appendix Table A22). At the spending on generic hormones declined experienced spending increases or de- same time, out-of-pocket spending on 37.1% from $31 per intermediate adult clines. preventive visits to both specialists and woman to $19 per intermediate adult PCPs declined slightly, although by less woman (Appendix Tables A25a and For the third year in a row, the most out than $1 per capita for the national ESI A25b). -of-pocket spending was on professional population. services and outpatient visits. Out-of- In 2013, generic prescription spending pocket spending grew fastest for acute Large increases in out-of-pocket spend- for girls was highest on anti-infective inpatient admissions, followed by outpa- ing occurred for professional laboratory agents ($11 per capita). For boys, young tient visits. In 2013, the detailed catego- and pathology (lab/path) services ($4 adult men and women, intermediate ries of medical services with the largest per capita). Intermediate adult women adult men and women, middle age adult per capita increases were for ER visits, had the highest spending level and larg- women, and pre-Medicare adult women, office visits to specialists, lab/path pro- est spending increase on professional the highest out-of-pocket spending per fessional services, and outpatient sur- lab/path services ($65 and $9 per capi- capita on generic prescriptions was on gery. ta, respectively; Appendix Table A25a), CNS agents (Appendix Tables A23a- while boys had the lowest per capita A27a). Overall, out-of-pocket spending on ge- spending ($9 per capita; Appendix Table neric prescriptions declined, owing to A23a) and girls had the smallest spend- Brand prescription spending out declines among girls, young adult wom- ing increase (less than $1 per capita). of pocket continued to drop en, and intermediate adult women. For Between 2012 and 2013, out-of-pocket detailed categories of generic prescrip- Largest decline in generic pre- spending generally declined for all de- tions, the largest decline was in young scription out-of-pocket spending tailed categories of brand prescriptions adult women’s spending on hormones. for hormones and synthetic sub- (Appendix Table A22). Only anti- Out-of-pocket spending on brand pre- stitutes infective agents and gastrointestinal scriptions continued to decline for the drugs saw small increases in spending third straight year for every age-gender In 2013, out-of-pocket spending on ge- (6.7% and 0.4%, respectively). The larg- group. The largest spending declines neric prescriptions declined slightly (- est per capita spending declines on were for cardiovascular drugs and CNS 0.6%; Table 1). The drop in generic brand prescriptions were on cardiovas- agents. spending was concentrated among girls cular drugs for pre-Medicare men www.healthcostinstitute.org 6 2013 PAYER EXPENDITURE TRENDS Insurer (payer) expenditures reflect the amounts insurers paid to providers for health care services excluding the portion paid out-of-pocket by the insured (see “Key definitions”). Between 2012 and 2013, payer expenditures re- mained the bulk of expenditures per capita (83.6%) for the ESI population, and increased by 3.9%, from $3,912 to $4,064 (Appendix Table A28 and Figure 1). Between 2011 and 2013, payer expenditures per capita grew each year at rates slightly lower than out-of-pocket per capita expenditures. Between 2012 and 2013, payer spending and growth varied across the four Census regions studied. Payer expendi- tures grew fastest in the Northeast (4.8%) and the Midwest (4.4%). For the third year in a row, the Northeast had the highest per capita payer expenditures ($4,299). Payer growth rates accelerated in the West, rising from 1.5% to 3.1%, but the growth rate remained the lowest of the regions. Spending growth slowed in the South, from 4.4% to 3.4%, and per capita payer spending remained the second high- est ($4,088). Overall in 2013, payers had higher per capita spending for older adults compared with younger adults, as expendi- tures for the pre-Medicare adults reached $7,914 per capita. This was $2,606 per capita more than the expenditures on the next oldest group (middle age adults, $5,308 per capita) and more than twice the amount spent on intermedi- ate adults ($3,475 per capita). For the third year in a row, the highest payer growth rate was for young adults (5.2% in 2103). The second highest payer growth rate by age group was for children (4.5%) and this group had the lowest level of per capita payer spending at $2,120. For payers, there was little change over the study period in the share of spending on each of the service categories. In 2013, the largest share of spending and the highest per capita spending was for professional procedures (31.9% and $1,298, respectively) and acute inpatient admissions (23.0% and $934, respectively). The smallest share of spending and lowest level of spending per capita was on outpatient-other services (10.9% and $441, respectively) and generic prescriptions (4.5% and $184, respectively). In 2013, as in 2012, payer expenditures on generic prescriptions grew the fastest for any subservice category (6.6% in 2013, 14.9% in 2012; Figure 6). The second fastest growth in payer expenditures was for outpatient visits (4.8%) and brand prescriptions (4.8%). Growth was slowest for professional services, at 2.8%. www.healthcostinstitute.org 7 Out-of-pocket spending trends differed 2009 to 2013.3 The HCCI dataset was by age group and gender. Women con- derived from claims for about 40 million tinued to pay more out of pocket than insureds per year. All data used for our men; this gap widened between 2012 study were de-identified and compliant and 2013. Out-of-pocket spending grew with the Health Insurance Portability fastest for young adult men and chil- and Accountability Act. dren. Notably, out-of-pocket spending Claims for 2012 and 2013 were adjusted remained flat only for young adult wom- using actuarial completion to account en, due largely to a decline in spending for claims incurred but not adjudicated. on prescriptions, especially generic pre- HCCI used these weighted and adjusted scriptions. claims to calculate out-of-pocket and Data and methods payer expenditures for 2009 through 2013. HCCI did not correct dollars for This issue brief discusses the out-of- inflation; thus, all reported expenditures pocket payments that the national ESI were in nominal dollars. population made to providers for medi- cal and pharmacy services. For discus- For a more detailed description of the sions of the ESI population’s total per methods and limitations of this study, capita spending trends, use of services see 2013 Health Care Cost and Utiliza- trends, and price trends, see the 2013 tion Report and the corresponding meth- 1,4 Health Care Cost and Utilization Report.1 odology. Appendix tables for this issue brief can Endnotes be found in the 2013 Health Care Cost and Utilization Report Appendix.2 1 Health Care Cost Institute. 2014 Health Care Cost and Utilization Report. For this study, HCCI did not seek to de- HCCI, Oct. 2014. Web. termine what role changes in benefit 2 Health Care Cost Institute. 2014 design played in spending levels or Health Care Cost and Utilization Report changes observed in 2013. National Appendix. HCCI, Oct. 2014. Web. 3 Health Care Cost Institute, Inc. Aggre- changes in insurance regulation through gated ESI Cost and Utilization Dataset the Affordable Care Act affected some (2009-2013). Health Care Cost Institute, services, such as generic prescriptions 2014. Digital file. and preventive visits, for certain age- 4 Health Care Cost Institute. 2013 gender groups. Other changes, such as Health Care Cost and Utilization Report rising professional and outpatient Analytic Methodology v.3.3. Health Care spending, were influenced by a number Cost Institute, Oct. 2014. Web. of factors, including provider network status, the ESI population’s rising use of high deductible health plans, and inten- Copyright 2014 Contact sity of care. Further investigation into these questions is warranted. Health Care Cost Institute, Inc. Health Care Cost Institute, Inc. For the 2013 Health Care Cost and Utili- Unless explicitly noted, the content of 1310 G Street NW, Suite 720 zation Report and this issue brief, HCCI this report is licensed under a Washington, DC 20005 used a subset of a standard analytic da- Creative Commons Attribution Non- 202-803-5200 taset that consisted of weighted and ag- Commercial No Derivatives 4.0 gregated claims data for people younger License than age 65 with ESI for calendar years www.healthcostinstitute.org 8 Table 1: Out-of-Pocket Expenditures Per Capita (2011—2013) Percent Percent Change Change Percent Change 2011 2012 2013 2010 / 2011 2011 / 2012 2012 / 2013 Out-of-Pocket Per Capita $734 $769 $800 4.6% 4.8% 4.0% Share of Expenditures 16.3% 16.4% 16.4% N/A N/A N/A Out-of-Pocket Per Capita by Region Northeast $670 $704 $737 3.2% 5.1% 4.7% Midwest $757 $796 $822 4.8% 5.2% 3.3% South $791 $836 $876 5.6% 5.7% 4.8% West $678 $694 $711 4.0% 2.3% 2.5% Out-of-Pocket Per Capita by Age 18 and Younger $408 $433 $454 6.9% 6.1% 4.8% 19-25 $477 $506 $515 6.0% 6.2% 1.8% 26-44 $711 $756 $783 5.5% 6.4% 3.6% 45-54 $927 $966 $1,005 4.2% 4.2% 4.1% 55-64 $1,239 $1,268 $1,318 3.0% 2.3% 4.0% Out-of-Pocket Per Capita by Gender Men $624 $652 $681 4.7% 4.4% 4.5% Women $839 $882 $914 4.6% 5.0% 3.7% Out-of-Pocket Per Capita by Service Category Inpatient $46 $47 $52 5.0% 3.1% 10.2% Acute Inpatient $45 $46 $51 5.3% 3.1% 10.5% Outpatient $182 $199 $216 9.2% 9.3% 8.7% Visits $107 $118 $129 9.3% 9.9% 9.6% Other $75 $81 $87 9.1% 8.4% 7.3% Professional Procedures $318 $335 $353 6.3% 5.6% 5.3% Prescriptions $189 $188 $179 -2.0% -0.7% -4.8% Brands $96 $85 $76 -5.2% -12.0% -10.2% Generics $93 $103 $102 1.5% 11.0% -0.6% Source: HCCI, 2014. Notes: Data represents the population of insureds 0-64 covered by ESI. Actuarial completion was performed on data from 2012 and 2013. All per capita dollars calculated from allowed amounts. All figures rounded. Skilled nursing facility (SNF), hospice, and ungroupable claims were excluded from analysis of acute inpatient trends due to the lack of claims in this population. www.healthcostinstitute.org 9 Table 2: Total Out-of-Pocket Expenditures Per Capita by Gender and Age Group (2011—2013) Percent Change Percent Change Percent Change 2011 2012 2013 2010 / 2011 2011 / 2012 2012 / 2013 Men Ages 18 and Younger $421 $446 $467 6.9% 6.0% 4.8% Ages 19-25 $330 $351 $369 9.2% 6.4% 5.2% Ages 26-44 $496 $528 $550 5.0% 6.3% 4.3% Ages 45-54 $806 $836 $869 4.4% 3.7% 4.1% Ages 55-64 $1,184 $1,206 $1,254 3.3% 1.8% 3.9% Women Ages 18 and Younger $394 $419 $439 6.9% 6.3% 4.8% Ages 19-25 $624 $662 $662 4.8% 6.2% 0.0% Ages 26-44 $910 $969 $999 5.7% 6.4% 3.2% Ages 45-54 $1,039 $1,087 $1,131 4.0% 4.6% 4.1% Ages 55-64 $1,290 $1,325 $1,378 2.6% 2.8% 4.0% Source: HCCI, 2014. Notes: Data represents the population of insureds 0-64 covered by ESI. Actuarial completion was performed on data from 2012 and 2013. All per capita dollars calculated from allowed amounts. All figures rounded. www.healthcostinstitute.org 10