High-deductible health plans have become an increasingly popular means for employers to keep health care costs under control. According to data released last summer by the Centers for Disease Control and Prevention, between 2007 through 2017, the percentage of adults 18-64 with employer-provided health insurance who were enrolled in an HDHP with a health savings account increased from 4.2 percent to 18.9 percent, while the percentage enrolled in an HDHP without an HSA rose from 10.6 percent to 24.5 percent.
Over the past three years, however, our benefits research at Gartner shows that their popularity has been leveling off, as deductibles for individual plans have actually been trending downward. (Gartner Total Rewards Leadership Council clients can view our full report on medical plan trends and observations for 2018 here.) This trend suggests that employers are having second thoughts about whether the benefits of HDHPs outweigh the downsides.
A new survey published last month by the nonprofit Employee Benefit Research Institute (EBRI) and research firm Greenwald & Associates provides some insight into these pros and cons. The survey found that people enrolled in HDHPs were more likely to compare cost and quality when selecting non-emergency health care and to make cost-conscious decisions like choosing generic prescription drugs over brand names. HDHP enrollees also more likely to be offered and to participate in wellness programs through their employers, including programs that involve biometric screenings.
On the other hand, this cost-conscious behavior may not be entirely voluntary: 30 percent of HDHP enrollees said they delayed care in the previous year because of costs, compared to 18 percent of respondents covered by traditional health insurance plans. While the EBRI study does not clarify whether this care was essential or non-essential, another recent study of diabetics found that switching to a high-deductible plan increased their likelihood of delaying essential care.
A recent data brief from the Centers for Disease Control and Prevention illustrates the growth in popularity of high-deductible health plans (HDHPs) over the past decade. Between 2007 through 2017, the CDC data show, the percentage of adults 18–64 with employer-provided health insurance who were enrolled in an HDHP with a health savings account increased from 4.2 percent to 18.9 percent, while the percentage enrolled in an HDHP without an HSA rose from 10.6 percent to 24.5 percent. In 2017, enrollment in HDHPs was highest among adults aged 30–44 than among other age demographic.
The greater an individual’s family income level and educational attainment, the more likely they were to be enrolled in an HDHP with an HSA, the CDC found, while the likelihood of enrollment in both traditional health plans and non-HSA high-deductible plans decreased as income and education rose. This may reflect a greater understanding of the investment value of HSAs among higher-earning and more educated employees.
Other recent data tells a similar story: Last year, Bank of America Merrill Lynch’s Plan Wellness Scorecard found that more employers were offering HSAs, more employees were using them, and their account balances were growing. That report also found that employees were using about 70 percent of their HSA contributions to cover health expenditures during the year and saving the other 30 percent for future expenses.
However, while the adoption of HDHPs has certainly grown over the past decade, our benefits research at Gartner shows that their popularity has been leveling off over the past three years, when deductibles for individual plans have actually been trending downward. (Gartner Total Rewards Leadership Council clients can view our full report on medical plan trends and observations for 2018 here.)
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High-deductible health plans have emerged in recent years as an increasingly popular means of controlling the growing costs of employer-sponsored health insurance in the US, particularly for healthy employees who don’t anticipate significant health care expenditures and would prefer to pay lower health insurance premiums, even if it means paying higher out-of-pocket costs when these expenditures do arise.
The State of Employee Benefits 2018 report from the benefits technology and services company Benefitfocus indicates that the shift to HDHPs accelerated last year among large US employers, though in most cases, these plans are offered to employees as a choice alongside traditional plans like preferred provider organizations. SHRM’s Stephen Miller outlines the key findings from the report, which analyzed data from 540 large employers with over 1.3 million insured employees:
For 2018, 70 percent of large employers offered at least one HDHP—either in addition to a traditional health plan (65 percent) or exclusively as a full replacement for traditional health coverage (5 percent). … When employees at large organizations were given options, 35 percent selected an HDHP while 48 percent chose a PPO for 2018. The remainder opted for other types of traditional plans, when available, such as health maintenance organizations.