The early versions of health insurance largely provided hospital coverage, always with a deductible and usually with coinsurance. Any physician services that were covered also typically were subject to the deductible and had coinsurance. When HMOs became popular, first dollar coverage or flat dollar copays became prevalent. This may have lessened consumers’ sensitivity to the price of services. In the last few years, high-deductible plans have returned and are spreading rapidly, often called “consumer-directed” and often coupled with some form of health savings account. The notion was to re-sensitize consumers to the cost of the health care they use. A report from AHIP details current enrollment status in these plans. (AHIP Report)
The number of people covered by CDHP/HSA plans was 13.5 million at the start of 2012, up from 11.4 million the year before and more than doubling the 6.1 million in the plans in January 2008. Eleven million are in the group market and 2.5 million in the individual one. Almost all the recent growth is in group plans, particularly among large employers. California, Texas and Illinois have the highest number of members in the plans and Vermont, Minnesota and Montana have the highest percent of people in them. Most plans are PPOs and most of the carriers offer extensive decision support and other tools for members in these plans. Premiums for a month range from $206 in South Dakota for single coverage to $470 in Tennessee, and from $243 for family coverage in Iowa to $1201 in New Hampshire.