A new analysis by The Commonwealth Fund found that the combined cost of health care premium contributions and deductibles for family coverage amounted to at least 10% of median family incomes in 19 states. And that doesn't even include additional health insurance costs like copayments. Family coverage premiums averaged $24,540 in 2024, with employees contributing $7,216 annually.
Additionally, deductibles for single coverage were equal to 5% or more of the 2024 median individual income in 26 states.
"The average cost of premium contributions for family coverage in 2024 ranged from $5,584 in Oregon to $9,148 in California," according to the report. "Meanwhile, the average per-enrollee deductible ranged from $1,275 in Hawaii to $2,785 in Nevada. Health insurance costs vary depending on the industry and size of the employer. Health care costs also vary regionally, influencing the cost of health care, premium growth, and the generosity of plan benefits."
Researchers at the private foundation (which is focused on promoting equitable health care) set out to assess health insurance affordability by analyzing the most recent available national data from 2024 on what employees paid for premiums and deductibles in all 50 states and Washington, D.C., compared to state median income. They found that the share of income spent on premium contributions and deductibles for family coverage ranged from a high of 15.6% in Louisiana to a low of 5.7% in Washington, D.C.
"Generally, employees in states with lower median incomes spent a relatively larger share of their income on these costs than those living in states with higher median incomes," the researchers noted.
"Higher employer premiums in 2026 could mean higher premium contributions and deductibles for employees," they added. "If these higher costs are combined with sluggish income growth, the cost of coverage and health care could take a larger bite out of workers' incomes at a time when they are also dealing with higher prices for other household goods. It may be particularly difficult for middle-income workers in states with lower median household incomes to absorb these increased costs. To improve affordability for lower-income workers, employers could consider adjusting premium contributions and out-of-pocket costs based on employee income."
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