Tables

Appendix Table 1: Employer and Employee Share of Current Spending, Spending Under Medicare Rates, and Potential Reduction, in $ billions 2021
Current Spending ($B) Spending Under Medicare Rates ($B) Potential Reduction in Spending ($B)
Employer-sponsored insurance
Total Spending on health services for enrollees in group health plans $757 $447 $310
Employer share of spending $474 $280 $194
Employee share of spending funded by premiums $175 $103 $72
Employee out-of-pocket spending $107 $63 $44
Private non-group
Total health care spending for private non-group $102 $60 $42
NOTES: All spending numbers are for people under 65 years old. 2021 spending is calculated by multiplying 2018 estimate by projected growth in private health insurance spending in the National Health Expenditures data.
SOURCE: KFF analysis of FAIR Health, MarketScan, American Community Survey, and National Health Expenditures data.
Appendix Table 2: Current Spending for the Privately Insured, Medicare to Allowed Amount Ratio, Spending at Medicare Rates and Potential Reduction in Spending, in $ billions for 2021
Current Total Spending ($B) Private Insurance Allowed Amount to Medicare Ratio Spending Under Medicare Rates ($B) Potential Reduction in Spending ($B)
Health care services $859 170% $507 $352
Service category
Emergency Department $41 221% $19 $23
Inpatient $242 165% $147 $95
Laboratory $13 177% $8 $6
Other $42 181% $23 $19
Outpatient $312 203% $154 $158
Physician Office $202 133% $152 $50
SNFs $2 108% $1 $0
Urgent Care $4 146% $3 $1
Administrative Costs $152 $89 $62
NOTES: All spending numbers are for people under 65 years old with private health insurance coverage. 2021 spending is calculated by multiplying 2018 estimate by projected growth in private health insurance spending in the National Health Expenditures data. Administrative costs assume constant loss ratio of 85%.
SOURCE: KFF analysis of FAIR Health, MarketScan, American Community Survey, and National Health Expenditures data.
Appendix Table 3: Current Spending for the Privately Insured, Medicare to Allowed Amount Ratio, Spending at Medicare Rates and Potential Reduction in Spending, in $ Billions for 2021
Current Total Spending ($B) Private Insurance Allowed Amount to Medicare Ratio Total Spending Under Medicare Rates ($B) Potential Reduction in Spending ($B)  Current OOP Spending ($B) OOP Spending at Medicare Rates ($B) Potential Reduction in OOP Spending ($B) % in group plans % in non-group plans
Age group: 0-3
Female $20 150% $14 $7 $2 $1 $1 92% 8%
Male $25 152% $17 $9 $3 $2 $1 92% 8%
Total $46 151% $30 $15 $5 $3 $2 92% 8%
Age group: 4-18
Female $35 158% $22 $13 $7 $4 $2 90% 10%
Male $37 158% $24 $14 $7 $4 $2 90% 10%
Total $72 158% $46 $27 $13 $9 $5 90% 10%
Age group: 19-35
Female $108 170% $63 $44 $19 $12 $7 88% 12%
Male $54 172% $31 $23 $10 $6 $4 88% 12%
Total $161 170% $95 $67 $29 $17 $11 88% 12%
Age group: 36-44
Female $75 171% $44 $31 $12 $7 $5 91% 9%
Male $43 172% $25 $18 $7 $4 $3 91% 9%
Total $118 171% $69 $49 $19 $12 $7 91% 9%
Age group: 45-54
Female $108 173% $63 $45 $15 $9 $6 89% 11%
Male $81 174% $47 $34 $11 $6 $4 90% 10%
Total $189 173% $110 $80 $25 $15 $10 89% 11%
Age group: 55-64
Female $140 172% $81 $59 $16 $10 $6 84% 16%
Male $132 173% $76 $56 $14 $8 $5 86% 14%
Total $272 173% $158 $115 $30 $18 $12 85% 15%
NOTES: Analysis assumes spending is distributed across enrollees in group and non-group plans consistent with their enrollment in such plans. 2021 spending is calculated by multiplying 2018 estimate by projected growth in private health insurance spending in the National health Expenditures data.
SOURCE: KFF analysis of FAIR Health, MarketScan, American Community Survey, and National Health Expenditures data.
Appendix Table 4: Current Spending Per Person with Private Health Insurance, Spending Per Person at Medicare Rates and Potential Reduction in Spending Per Person, 2021
Current Spending Per Person ($B) Spending Per Person Under Medicare Rates ($B) Potential Reduction in Spending Per Person ($B)
Overall (0-64)  $4,973  $2,933  $2,040
Child (0-18)  $2,932  $1,899  $1,033
Adult (19-64)  $5,012  $2,916  $2,096
Older Adult (60-64)  $10,353  $5,990  $4,363
Age group: 0-3
Female  $4,907  $3,272  $1,635
Male  $5,788  $3,830  $1,958
Total  $5,360  $3,558  $1,802
Age group: 4-18
Female  $2,275  $1,443  $833
Male  $2,288  $1,452  $836
Total  $2,281  $1,447  $834
Age group: 19-35
Female  $4,520  $2,667  $1,852
Male  $2,215  $1,283  $932
Total  $3,356  $1,970  $1,387
Age group: 36-44
Female  $5,825  $3,400  $2,426
Male  $3,370  $1,963  $1,407
Total  $4,612  $2,690  $1,922
Age group: 45-54
Female  $7,113  $4,118  $2,995
Male  $5,608  $3,234  $2,373
Total  $6,378  $3,687  $2,691
Age group: 55-64
Female  $9,282  $5,381  $3,901
Male  $9,437  $5,448  $3,989
Total  $9,356  $5,413  $3,944
NOTES: 2021 spending is calculated by multiplying 2018 estimate by projected growth in per-capita private health insurance spending in the National Health Expenditures data.
SOURCE: KFF analysis of FAIR Health, MarketScan, American Community Survey, and National Health Expenditures data.
Methods

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