"Looking forward to 2025, do you anticipate your overall financial situation to be..."

• Better compared to this year: 35%. (Up from 34% a year earlier.)
• About the same as this year: 51%. (Up from 49%.)
• Worse compared to this year: 13%. (Down from 17%.)

• Health/wellness: 45%. (Unchanged from a year earlier.)
• Financial stability: 38%. (Up from 33%.)
• Career/employment: 9%. (Down from 11%.)

• "My physical health will be better in 2025 than it was in 2024": 70% agree.
• "My mental health will be better in 2025 than it was in 2024": 70% agree.

6. U.S. health insurance enrollment

• Private: 214.5 million. (Up 0.3%.)
• Employer:sponsored: 178 million. (Up 0.1%.)
• Percentage of population with coverage: 92.3%. (Down from 92.7%.)

7. U.S. health expenditures

Aggregate:

• Total: $5.3 trillion. (Up 4.9%.)
• Private health insurance: $1.6 trillion. (Up 5.3%.)
• Employer-sponsored plans: $1.4 trillion. (Up 5.1%.)
• Patient out-of-pocket costs: $563 billion. (Up 3.7%.)

• Total: $15,705. (Up 4.2%.)
• Patient out-of-pocket costs: $1,669. (Up 3.1%.)
• Employer-sponsored plans: $7,833. (Up 5.0%.)

8. Health benefits access and participation rates

Civilian workers:

• Offered access to coverage: 75%
• Participate in coverage: 48%

• Offered access to coverage: 89%
• Participate in coverage: 59%

• Offered access to coverage: 26%
• Participate in coverage: 12%

• Offered access to coverage: 94%
• Participate in coverage: 67%

• Offered access to coverage: 45%
• Participate in coverage: 21%

7. The U.S. group health insurance market

Group health sales will be "supported by strong employment levels and wage gains."

Deloitte:

"Relatively high persistency (renewal premiums) in conjunction with elevated wage inflation has helped group insurance performance results over the past few years, reducing reliance on new sales growth. But diminishing persistency due to a slower pace of employment growth is expected for 2025."

8. Self-funded health market trends

1. Increased scrutiny of data transparency at the biggest administrators.
2. A tougher employer approach to "formularies," or lists of covered drugs.
3. Increased focus in Washington on capping the federal health benefits tax deduction.
4. The rise of cash-for-coverage programs based on individual coverage health reimbursement arrangements, or ICHRAs, driven partly by concerns about employer fiduciary risk.
5. Increased use of captives and other alternative financing strategies to manage exposure to claims.

9. Health plan provider networks

• Employers contracting directly with the health care providers.
• Narrow provider networks.
• On-site employer clinics.
• Providers who send employers unusually detailed reports.
• Provider network adequacy indicators.
• Pharmacy-based primary care services.

12. Individual coverage health reimbursement arrangements

"ICHRA is here to stay... It seems likely that Republicans will continue to support employers' ability to have more control over budget and allocation while giving employees more control over spend and selection."

Web broker eHealth, based on its 2024 survey program:

About 55% of the 550 owners and managers of small and midsized businesses surveyed said they knew little or nothing about ICHRAs.

13. Health insurer mergers and acquisitions

Some deals could involve health insurers and health care provider organizations. "Payers continue to focus on expanding the 'payvider' model, combining payer and provider functions, and evaluating geographic expansion opportunities aligned to their strategic missions."

PwC counted 25 health plan deals through Nov. 15. The deals had a total value of $4.8 billion. The number of deals was 19% lower than in the comparable period in 2023, but the dollar value of the deals was more than three times as high.

14. Benefits policy

Gremminger said he believes the new American Relief Act, 2025 package is so lean that it looks as if members of Congress clearly expect to consider additional health policy legislation.

"The table is really set for including the health policy legislation in March. If Congress had chosen to extend a bunch of policies for a year and had left the PBM provisions on the cutting room floor, I’d be more pessimistic, but, given that they've basically just punted for a few months, we will effectively have the same set up as we had in December," he said.

15. Organizations

Here are links to some of the organizations involved in creating the data streams, policy initiatives and other forces that shape the health benefits trends and feed into health benefits market predictions.

• America's Health Insurance Plans CEO: Mike Tuffin.
• American Benefits Council president: Katy Johnson.
• Blue Cross Blue Shield Association CEO: Kim Keck.
• Employee Benefit Research Institute CEO: Barb Marder.
• ERISA Industry Committee CEO: James Gelfand.
• National Alliance of Healthcare Purchaser Coalitions CEO: Shawn Gremminger.
• National Association of Insurance Commissioners CEO: Gary Anderson.
• National Association of Benefits and Insurance Professionals CEO: Jessica Brooks-Woods.
• National Council of Insurance Legislators CEO: Will Melofchik.
• Purchaser Business Group on Health CEO: Elizabeth Mitchell.
• Self-Insurance Institute of America CEO: Mike Ferguson.