The number of large employers choosing self-pay over fully-insured benefits has declined since 2010, according to a brief from the Employee Benefits Research Institute published Aug. 24.
The share of employers with more than 500 employees that offer at least one self-insured option was 72 percent in 2022, the lowest level since 2010.
More small and medium-sized employers are opting for self-insured plans. Of employers with fewer than 100 employees, 18 percent offered at least one self-paid insurance plan in 2022, up from 13 percent in 2010. Among employers with 100 to 499 employees, 37 percent offered at least one self-insured plan, up from 27 percent in 2010.
Some industry analysts predicted the Affordable Care Act would drive more small employers to fund their own health benefits, as self-paid plans are subject to fewer requirements of the law that could drive up costs.
Trendlines in self-paid plans have ebbed and flowed since 2016, according to the report, and are more clear when broken out by firm size.
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