Health Benefits

Health Insights That Might Surprise You

3 weeks ago
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Did you know CalPERS is the largest purchaser of public employee health benefits in California and the second largest public purchaser in the nation after the federal government? Have you ever wondered what plans our members subscribe to, where they live when receiving health care benefits, or what their average out-of-pocket cost is?

We have new insights from our annual Facts at a Glance report that offer a wealth of data about our health program and more, all based on the 2022 calendar year, plus some 2023 data.

Here Are Some Facts You May Find of Interest:

  • 12.7% — The increase in health plan enrollment over 10 years.
    Between 2013 and 2023, our health plan enrollment went from 1,375,960 members to 1,551,249.
  • 58% — The percentage of subscribers and dependents enrolled by the state.
    Out of the 1.5 million members who have CalPERS health benefits, 897,731 (58%) are state subscribers and dependents, while 653,518 (42%) are from public agency and school employers.
  • 94% — Most members who are enrolled in our health benefits program live in California.
    More than 1.4 million members (or 94%) receive their health care benefits in the state and live in California, while only 6% live out-of-state and participate in our health plans. Three percent of our in-state members live in California’s rural areas.
  • 55% — Most members are enrolled in an HMO Basic plan.
    More than 860,000 members (or 55%) are enrolled in the HMO Basic plan, followed by 263,189 (17%) members in our PPO Basic plan. The remaining members are enrolled in the association Basic, Medicare Advantage, Medicare supplemental, and our association Medicare plans.
  • $10.6 billion — The amount we spent to purchase health benefits for active and retired members and their families.
    Seventy-two percent ($7.6 billion) of the premiums paid were for active members and their families, while 28% ($3 billion) went toward benefits for retirees and their families. We purchase health benefits on behalf of the state of California (including the California State University) and nearly 1,200 public agencies and schools.
  • $309 — The average member out-of-pocket cost for health care services and prescription drugs not reimbursed by insurance.
    The highest out-of-pocket costs fall under the PPO Basic plan at $895 a year, while the lowest costs are with the HMO and EPO plans at $117 per year.
  • 22% — How many members have had one or more top chronic conditions.
    Hypertension is the top condition for Basic plan and Medicare members.
  • $680 million — The cost to the CalPERS health fund for the top chronic condition.
    Diabetes is the most costly condition among CalPERS members.

Do You Want to Know More?

Learn more about CalPERS’ health benefits program by reading Facts at a Glance Health Benefits (PDF). You can also read our other Facts at a Glance for more information.