Study Suggests HDHPs Not Working As Intended

HDHP participants are putting off care which could result in greater costs down the road and only 41% say they are better health care consumers.

Employers like high-deductible health plans (HDHPs) because they transfer more of the costs of health care to employees, and many employees choose these plans for the lower premiums, or upfront cost.

However, a survey commissioned by Insurance.com is finding that HDHPs are not working as intended. For one thing, 64% of respondents said they delayed care because they didn’t want to pay the high deductible. Putting off necessary care could result in much higher costs down the road.

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Les Masterson, managing editor of Insurance.com, says health insurers and employers will need to make sure they are implementing plans and programs that actually don’t cost more money in the long run.

In addition, a key part of HDHPs is the idea of creating better health care consumers—one reason HDHPs are often called consumer driven health plans (CDHPs) because the idea is to educate the health care consumer so he/she can make better health care decisions (and save money in the process). But, the survey found mixed results.

Most respondents said they are getting more information from their health insurer (63%) and doctors (61%) to make them better health care consumers. Sixty percent said they shop around for health care services, which is a positive response for HDHPs. However, only 41% of respondents said they now consider themselves better health care consumers.

Thirty-seven percent of respondents have an HDHP. Forty-five percent said they chose an HDHP because it was the most cost-effective option; 37% said it made sense for their situation; and 16% said their employer only gave them an HDHP choice.

NEXT: Employees say they are not saving on health care costs

Though many chose an HDHP because of cost, most respondents said having an HDHP didn’t actually save them money. Sixty-two percent said health care costs either increased or stayed the same in a HDHP compared to their previous plan. Thirty percent said their health care costs decreased.

Most respondents said their deductibles are between $1,501 and $2,000, while 20% said it’s more than $2,000, and 8% said it’s less than $1,500.

Insurance.com notes that an important piece of an HDHP is its associated health savings account (HSA), which allows members to contribute pre-tax money to an account that can be used for health care costs. Employers often also contribute to these accounts.

Respondents reported contributing the following amounts to their HSAs:

  • 38% said they contribute between $1,001 and $2,000 to an HSA annually;
  • 30% put in $500 to $1,000;
  • 14% put it $2,001 to $3,000; and
  • 5% contribute more than $3,000.

Respondents also reported their employers are contributing to these accounts:

  • 32% said their employer contributes between $500 and $1,000;
  • 31% of respondents’ employers put in between $1,001 and $2,000;
  • 16% get nothing;
  • 8% get less than $500; and
  • 3% receive more than $3,000.
Insurance.com commissioned OP4G to survey nearly 2,000 people nationwide in June 2016. More information is here.

Plan Sponsors Can Help With Retirement Income Strategies

An analysis of defined contribution participant distribution behavior supports the use of “through” target-date funds and the allowance of partial distributions from DC plans.

Seven in 10 retirement-age participants (defined as those age 60 and older terminating from a defined contribution (DC) plan) have preserved their savings in a tax-deferred account after five calendar years, according to research from Vanguard.

In total, nine in 10 retirement dollars are preserved, either in an individual retirement account (IRA) or employer-sponsored DC plan account.

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The three in 10 retirement-age participants who cashed out from their employer plan over five years typically held smaller balances. The average amount cashed out is approximately $20,000, whereas participants preserving assets have average balances ranging from $160,000 to $290,000, depending on the termination year cohort.

Only about one-fifth of retirement-age participants and one-fifth of assets remain in the employer plan after five calendar years following the year of termination. In other words, most retirement-age participants and their plan assets leave the employer-sponsored qualified plan system over time.

Vanguard examined the plan distribution behavior through year-end 2015 of 365,700 participants age 60 and older who terminated employment in calendar years 2005 through 2014.

One important question is how plan rules on partial distributions might affect participants’ willingness to stay within an employer plan. Eighty-seven percent of Vanguard DC plans in 2014 required terminated participants to take a distribution of their entire account balance if an ad hoc partial distribution was desired. For example, if a terminated participant has $100,000 in savings, and wishes to make a one-time withdrawal of $100, he or she must withdraw all savings from the plan—for example, by rolling over the entire $100,000 to an IRA and withdrawing the $100 from the IRA, or by executing an IRA rollover of $99,900 and taking a $100 cash distribution.

NEXT: Withdrawal behavior affected by allowing partial distributions

Only 13% of plans allow terminated participants to take ad hoc partial distributions. However, plans allowing partial distributions tend to be larger plans, and as a result, only three in 10 retirement-age participants are in plans allowing ad hoc partial distributions.

The analysis suggests participant behavior is affected by plan rules on partial distributions. For the 2010 termination year cohort, Vanguard analyzed participants in plans allowing partial distributions separately from those in plans that did not. About 30% more participants and 50% more assets remain in the employer plan when ad hoc partial distributions are allowed. In the 2010 cohort, five years after termination, 22% of participants and 26% of assets remain in plans allowing partial distributions compared with only 17% of participants and 18% of assets for plans that do not allow partial distributions.

Jean Young, senior research analyst at the Vanguard Center for Retirement Research and lead author of the study report, says these findings have implications for the design of target-date funds (TDFs) and retirement income programs. “The tendency of participants to preserve plan assets at retirement supports the notion of ‘through’ glide paths in target-date fund design. In other words, target-date designs should encourage an investment strategy at retirement that recognizes assets are generally preserved for several years post-retirement, she says.

“Also, with the rising importance of lump-sum distributions, participants will need assistance in translating these pools of savings into a regular income stream. Based on current retirement-age participant behavior, most of these retirement income decisions will be made in the IRA marketplace, not within employer-sponsored qualified plans, although this may evolve gradually with the growing incidence of in-plan payout structures and the new Department of Labor (DOL) fiduciary rule. One way sponsors might encourage greater use of in-plan distributions is by eliminating rules that preclude partial ad hoc distributions from accounts,” she concludes.

Data for the analysis comes from Vanguard’s DC recordkeeping clients over the period January 1, 2005, through December 31, 2015.

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