Consumer-driven health plans with high deductibles continued to gain market share in the U.S. in 2016, and appear to be having the intended effect of encouraging the insured to become more involved in their own health care, according to an analysis of survey data published by the Employee Benefit Research Institute (EBRI) and Greenwald & Associates.

The survey of 3,295 adults with private health insurance coverage through an employer or purchased directly from a carrier or through a government exchange was conducted August 11-24, 2016. A report on the findings of the annual survey was released as an EBRI Issue Brief on May 27, 2017. The results indicated that a steadily growing share of Americans with health coverage are in a consumer-driven health plan (CDHP) associated with a high-deductible health plan (HDHP), a health savings account (HSA), or a health reimbursement arrangement (HRA).

While 73% of the privately insured adults surveyed said they are enrolled in a traditional health care plan, 14% indicated they are enrolled in a CDHP linked to an HSA or an HRA, and 14% reported that they are enrolled in an HDHP (with a deductible of $1,300 or higher for single coverage and of $2,600 for family coverage) not linked to an HSA or an HRA. Researchers noted that among individuals with traditional coverage, a growing number have the option to choose a CDHP, and that those who choose a CDHP are remaining enrolled for a longer time.

The survey findings showed that more than half of CDHP enrollees have an HSA, and are taking advantage of growing employer contributions. Among the respondents who said they are enrolled in a CDHP, 56% (16.3 million) indicated they have an HSA; 19% (5.5 million) said they are enrolled in an HRA; and 25% (7.3 million) said they are enrolled in an HSA-eligible health plan, but do not have an HSA.

The study’s authors observed that it is becoming increasingly common for employers to contribute to their employees’ HSAs, and that the dollar amounts of these contributions are rising. In the 2016 survey, 78% of CDHP enrollees reported that their employer contributed to their account that year, up from 67% of those polled in 2014. Of those CDHP enrollees receiving an employer contribution, 20% reported a contribution of at least $2,000 in 2016, up from 10% in 2014; while 42% reported an employer contribution of $1,000-$1,999 in 2016, up from 36% in 2014.

The survey also found that consumer behaviors are linked to CDHP enrollment, as the respondents in a CDHP or an HDHP were more likely than those in a traditional plan to report engaging in cost-conscious behaviors. For example, the survey showed that respondents in a CDHP were more likely than respondents in a traditional plan to report that they had checked whether the plan would cover care (54% vs. 44%), that they had asked for a generic instead of a brand name drug (48% vs. 37%), and that they had used an online cost-tracking tool provided by the health plan (31% vs. 20%). The results also showed that CDHP and HDHP enrollees were more likely than traditional plan enrollees to indicate that they tried to find cost information before obtaining care: nearly one-half of HDHP enrollees and 43% of CDHP enrollees said they had searched for cost information, compared with 32% of traditional plan enrollees.

In addition, the survey respondents enrolled in CDHPs were more likely than those enrolled in HDHPs or in a traditional plan to report that they have a choice of health plans: two-thirds of CDHP enrollees said they have a choice of health plan, compared with 59% of both HDHP enrollees and traditional plan enrollees.

From Benefit Trends Newsletter, Volume 60, Issue 6

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