The number of people enrolled in consumer-directed health plans continues to grow, and satisfaction with these plans remains high, according to several recent surveys. Furthermore, many of those covered by consumer-directed plans say they wouldn’t have health insurance coverage otherwise, indicating that consumer-directed plans should be considered a key element of any health care reform proposals.
The Kaiser Family Foundation/Health Research & Educational Trust reports that 13% of firms that offered health benefits in 2008 had a consumer-directed option-a high deductible health plan (HDHP) paired with either a health reimbursement arrangement (HRA) or a health savings account (HSA). This is up from the 10% of employers that offered a consumer-directed plan in the previous year. Enrollment in these plans grew from 5% in 2007 to 8% in 2008, with most of the increase occurring among workers in small firms (three to 99 employees), where 13% of eligible employees now were enrolled in consumer-directed plans.
An annual census of health insurance carriers conducted by the industry trade group America’s Health Insurance Plans shows similar growth. The survey, which focused on HDHP/HSA arrangements only, reported enrollment in these plans in the group market rose to over 4.6 million in 2008, up from 3.4 million in 2007. Almost a third-31%-of new coverage issued in the small group market was for HDHP/HSA products.
The growing number of employees covered by consumer-directed health insurance products report that they are, by and large, satisfied with their coverage, and they also are likely to be actively engaged in their health care. A survey by OptumHealth of individuals enrolled in HSAs found that 82% were satisfied with their accounts. Most of these individuals-80%-had set up HSAs in order to be able to save for future health care expenses, and 70% had an annual income of $75,000 or less. Also, 30% said they would not have health insurance if it weren’t for their consumer-directed plan coverage.
Both the respondents to the OptumHealth survey and those to a survey by HSA Bank reported behaviors indicative of engaged health care consumers. For example, 64% of the OptumHealth survey respondents said they inquired about generic options for medications and 47% said they asked their health care provider about charges for services. Furthermore, a large majority-83%-agreed people should approach purchasing health care services as they do other major consumer purchases, and research their options in an effort to try to get the best price. Among the respondents to the HSA Bank survey who were in a consumer-directed product:
- 26.2% of those who had visited a doctor in the past 12 months had inquired about the cost of the visit prior to making the appointment.
- 32.9% of those who had visited a doctor in the past 12 months had asked about lower cost alternatives for recommended treatments.
- 79.5% of those who were prescribed a prescription drug asked for a generic instead of a brand name product.
With continued growth of consumer-directed plan enrollment, and cost-conscious consumer habits, these types of plans hold great potential for effectively controlling a company’s health plan cost growth.