High Deductible Health Plan Enrollment Hit Record High in 2021

High deductible health plan (HDHP) enrollment hit a record high in 2021, with nearly six out of ten employer-sponsored health plan members enrolled in a high deductible health plan, according to a ValuePenguin survey.

"With health insurance costs rising over the years, it's not surprising that HDHPs are growing in popularity," says Divya Sangameshwar, a health insurance expert at ValuePenguin.

The researchers used State Health Compare tool data to determine HDHP enrollment rates.

More than half of all American workers were in high deductible health plans (55.7 percent). This is the eighth year in a row that enrollment has increased. It is also the highest enrollment rate since 2012.

In 2012, 34.3 percent of employees were in high deductible health plans. HDHP enrollment grew the most in 2014 and 2017 when enrollment levels rose by 16.0 percent and 14.2 percent respectively.

The state with the highest HDHP enrollment rate was Maine, where 76.2 percent of employees were in HDHPs. Arkansas saw the biggest increase between 2017 and 2021, with HDHP enrollment growing 60.8 percent to hit 58.0 percent. Hawaii was on the opposite end of the spectrum with only 11.6 percent of employees in HDHPs, the lowest enrollment in the states.

Aside from Maine, Tennessee, and Nebraska also saw high enrollment levels. The ValuePenguin researchers pointed out that none of these states were among the three with the highest enrollment—or even the top ten states with the highest enrollment—the year before.

That being said, Maine and Tennessee each had some history of rising to the top. Maine had the highest share of HDHP enrollment in 2014 and 2018 and Tennessee was in the top five for its enrollment levels in 2017 and 2014.

However, Nebraska’s presence in the top three is unique. The state has not been highly ranked in this area since 2012. Its HDHP enrollment rose six percentage points between 2020 and 2021.

Hawaii’s status as the lowest in HDHP enrollment growth is no surprise since the state has been at the bottom of this list eight times over the past decade. For the remaining two years, Hawaii was either second-to-last or not ranked.

The District of Columbia and Alaska had the second and third-lowest enrollment rates in 2021. The District of Columbia saw the biggest decrease in HDHP enrollment that year (13.8 percent).

Separate studies indicated that large employers would continue to favor HDHP plans combined with savings options like health savings accounts (HSAs). Two-thirds of large employers and more than half of mid-sized employers offered HDHPs with savings options in 2021, according to the 2021 Employer Health Benefits Survey. Additionally, HSA investments rose in 2021, pushing the average contribution from $2,645 at the front end of 2021 to $3,902 over the course of the year.

HDHPs are desirable because of their low monthly premiums. They can work with health maintenance organizations, preferred provider organizations, exclusive provider organizations, and point-of-service plans. HDHPs have pros and cons, producing savings on monthly premiums while incentivizing members to forego care if they do not have an HSA.

“An HDHP isn’t the right fit for everyone, but some consumers can really benefit financially from this type of health insurance plan if all goes well with their health,” the ValuePenguin researchers noted.