Enrollment Rising in High-Deductible Plans

— Traditional health plans lose ground

Last Updated August 8, 2018
MedpageToday

Enrollment in high-deductible health plans (HDHPs) -- including some paired with health savings accounts -- rose quickly during 2007-2017 among people insured through their employers, while enrollment in traditional health plans dropped sharply, according to a report released Thursday by the National Center for Health Statistics.

About 60% of adults in the 18-64 age group got their health insurance from their employer as of 2017, the researchers noted. Of this group, 43.4% were enrolled in an HDHP -- with or without a health savings account -- compared with 14.8% in 2007. Meanwhile, the percentage enrolled in traditional health insurance plans dropped from 85.1% in 2007 to 56.6% in 2017.

Researchers used data from the 2017 National Health Interview Survey (NHIS), a nationally representative sample of more than 46,600 U.S. adults ages 18-64. Data were collected via in-person interview with some follow-up information collected via phone.

The researchers defined HDHPs as "health insurance policies with higher deductibles than traditional health insurance plans." They defined health savings accounts as accounts that "allow pretax income to be saved to help pay for the higher costs associated with an HDHP."

There were differences in which types of workers were enrolling in HDHPs; those ages 18-29 and 45-64 were less likely than those ages 30-44 to enroll in an HDHP combined with a health savings account. However, no age-based differences were found among those enrolled in either traditional plans or HDHPs without savings accounts. There also was no difference between men and women in the type of health plan chosen.

On the other hand, education levels were associated with differences in enrollment -- a higher percentage of workers with less than a high school education (61.1%) were enrolled in traditional health plans in 2017 compared with those with a bachelor's degree or higher (54.3%). Conversely, more workers in the latter group (23.9%) were enrolled in an HDHP combined with a health savings account than those with less than a high school education (10.7%).

For HDHPs not combined with a health savings account, more workers with less than a high school education (28.2%) were enrolled in them compared with those with a bachelor's degree or higher (21.8%).

Income level also was linked with enrollment differences, the investigators found. More workers with incomes at 138% or less of the federal poverty level (59.9%) enrolled in traditional coverage compared with those making more than 400% of the poverty level (55.5%). And more workers at that higher income level enrolled in an HDHP with a health savings account (22.0%) than those making the lesser amount (7.9%).

"The change in HDHP enrollment has been faster among those with employment-based coverage than among those with directly purchased coverage," the researchers noted. "NHIS will continue to monitor the different types of private health insurance, and NHIS data can be used to examine further differences according to plan type."