High Deductible Health Plan Enrollees Need Better HSA Education

Although health savings accounts are an important tool for enrollees in high deductible health plans, a large percentage of enrollees in these plans either do not have health savings accounts or do not use their health savings accounts, a study published on JAMA Open Network found.

“Health savings accounts (HSAs) can be used by US residents who are enrolled in a high-deductible health plan (HDHP) to accrue tax-free savings for health care expenses, with the policy goals of lessening patients’ cost burdens and encouraging health care choices that are based on value,” the study explained.

Privately insured high-deductible health plan enrollment rose around 15 percentage points from 2010 to 2016. By 2016, four in ten privately insured adults were enrolled in a high-deductible health plan.

From the increase in high deductible health plan enrollment, to the escalation in healthcare spending which experts expect in the new year, to unexpected costs related to coronavirus, some experts have been pushing HSAs as key to weathering present uncertainties.

“Data on the use of HSAs could help employers, health plans, and health systems develop targeted interventions to encourage use of HSAs as one strategy to help more US residents navigate the rising costs of health care,” the study stated.

Researchers conducted the survey from August 26, 2016 to September 19, 2016 and analyzed it from November 1, 2019, to April 30, 2020. They printed the GfK KnowledgePanel survey to over 1,600 individuals who had been enrolled in a high deductible health plan for a year or more and who fell between the ages of 18 and 64.

Over 40 percent of the participants (42.4 percent) had a chronic disease. More than eight in ten of the participants had an employer-sponsored health plan. Respondents were largely white, male, with a larger income, and had received higher education.

Nearly one-third of US adults with a high deductible health plan (32.5 percent) did not have a health savings account, the survey discovered. Almost 60 percent of them did have a health savings account (58.4 percent). Meanwhile, 9.1 percent were unsure whether they had a health savings account or failed to complete that question.

Those with more health plan options through their employers were more likely to have a health savings account. A little over 36 percent of those who only had one health plan option from their employers (36.5 percent) did not have a health savings account.

Furthermore, respondents who had an Affordable Care Act exchange health plan were less likely to have health savings accounts as well, with seven in ten lacking a health savings account.

The study suggested that this may be because a small percentage of health plans on the Affordable Care Act meets the criteria to incorporate a health savings account — only seven percent in 2020.

However, simply having a health savings account did not mean that members used the account.

In fact, among those who had a high deductible health plan and a health savings account, more than half of those surveyed (55 percent) had not put any funds into their health savings accounts in the past year.

Those who were more likely to use the health savings account tended to have higher education, greater health literacy, and were more likely to be on the Affordable Care Act exchange.

Among those who had a health savings account and did not contribute to it, nearly 45 percent responded that they did not see a need for healthcare services and 40.2 percent stated that they believed they had enough savings to cover any healthcare services that may arise. Still, others said that they had not thought about contributing or that they could not afford to do so.

Slightly over 45 percent of those who did put money into their health savings accounts were contributing around $2,000 or more.

About 60 percent of those who contributed to their health savings account did not have any other form of healthcare savings but slightly more than 20 percent had another place where they also accumulated funds for healthcare spending purposes, such as a flexible spending account.

“Policy reforms could require that HDHPs offered on an exchange be eligible for and linked to an HSA,” the researchers said.

That being said, for the researchers, this data highlighted the fact that policy changes would not be the solution for encouraging health savings account usage for enrollees of high deductible health plans.

Rather, employers and health plans themselves would have to change their outreach strategies.

“Exchanges could better highlight the benefits of HSAs to encourage uptake of HSA-eligible plans at the time of enrollment,” they recommended.

“After enrollment in an HDHP, employers, health plans, and health systems could target messaging to HDHP enrollees to encourage acquisition of an HSA as a strategy to help manage the high cost-sharing of these plans.”

Some major payers recommend using healthcare savings accounts, including UnitedHealthcare, Aetna, and Blue Cross Blue Shield of Michigan which all have web pages dedicated to informing members about health savings accounts.

High deductible health plans in general have been receiving negative feedback in recent months. Last year it came to light the impact that these plans can have on medication adherence. Rising deductibles were also seen as responsible, in part, for pushing healthcare spending higher.