Employers Increasingly Using HSAs

However, one kind of consumer-driven health plan—employer-funded health reimbursement arrangements (HRAs)—declined while enrollment grew in health savings accounts (HSAs) and high-deductible health plans (HDHPs), which can include both employer and employee contributions, according to the 2013 Consumer Engagement in Health Care Survey (CEHCS), conducted by the Employee Benefit Research Institute (EBRI) and Greenwald & Associates. The survey also found a growing share of the HDHP market is HSA-eligible.

“When examining only the number of people enrolled in HSAs or HSA-eligible plans, the overall number of individuals with an HSA or enrolled in an HSA-eligible plan increased from 17.5 million to 20.4 million, a 16% increase,” says Paul Fronstin, director of EBRI’s Health Research and Education Program and coauthor of the survey report.

Based on findings from the 2013 CEHCS, 9.7% of the population is enrolled in a consumer-driven health plan (CDHP), up from 9.6% in 2012. Enrollment in HDHPs increased from 16% in 2012 to 18% in 2013.

CDHP enrollees are more cost conscious in their decisionmaking than those in traditional plans, according to survey results. “Once again, we found that CDHP enrollees were more likely to use resources to pick their health plan, more likely to use cost information before getting health care services, and more likely than traditional-plan enrollees to take advantage of various wellness programs, such as health-risk assessments, health-promotion programs, and biometric screenings,” notes Fronstin.

However, he cautions that it’s not clear from the data whether the differences in consumer engagement can be attributed to plan-design differences or whether various plan designs attract certain kinds of individuals.

Adults in a CDHP or HDHP were more likely than those in a traditional health plan to exhibit a number of cost-conscious behaviors. Specifically, those in a CDHP were more likely than those with traditional coverage to say that they had: checked whether the plan would cover care; asked for a generic drug instead of a brand name; talked to their doctors about prescription options and costs; talked to their doctors about other treatment options and costs; asked a doctor to recommend less costly prescriptions; developed a budget to manage health care expenses; checked the price of a service before getting care; and used an online cost-tracking tool provided by the health plan.

Adults in a CDHP were somewhat more likely than those in a traditional plan to be engaged in their choice of health plan. They were more likely than those with traditional coverage to say that they had: visited health plans’ websites to learn about their plans; attended a meeting where health plan choices were explained; used other websites to learn about health plan choices; and consulted with an insurance broker to understand plan choices.

In addition, financial incentives to participate in wellness programs mattered more to CDHP enrollees than to traditional-plan enrollees.

The survey report, “Findings from the 2013 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey,” is published in the December EBRI Issue Brief, available online at www.ebri.org.