Disenrollment From HSA-Eligible Health Plans Increases Employer Health Benefit Costs

Disenrollment from health savings account (HSA)-eligible health plans, which includes a disproportionate number of individuals with health conditions, increases employer spending on health coverage by 2.5% to 3.2%, the Employee Benefit Research Institute (EBRI) found.

The study examines whether disenrollment from HSA-eligible health plans is associated with risk selection, such that once enrolled in an HSA-eligible health plan, less-healthy enrollees are more likely to disenroll from the health plan than healthier enrollees. Overall, 5% of HSA-eligible health plan enrollees in 2013 and 2014 switched to a different type of health plan in 2014 and 2015.

There is evidence that individuals who disenrolled from HSA-eligible health plans were more likely to have certain health conditions than those who remained enrolled in HSA-eligible health plans. Among individuals with no health conditions, 4.2% disenrolled from the HSA-eligible health plan. Five percent of individuals with dyslipidemia disenrolled, along with 5.3% among those with hypertension or depression, 5.6% among those with diabetes, and 6.1% among individuals with schizophrenia/bipolar disorder.

Individuals with multiple conditions were even more likely to disenroll. Individuals with claims related to childbirth were twice as likely as those with no health conditions to disenroll from HSA-eligible health plans.

EBRI also found use of health care services was a statistically significant predictor of disenrollment from HSA-eligible health plans. However, the magnitude of the impact was quite small. For instance, 4.2% of individuals who used no health care disenrolled from HSA-eligible health plans, whereas 4.4% of those at median use disenrolled, and 5.2% of those at the 90th percentile of use disenrolled.yu