In 2014, 162 million Americans were covered by private health insurance. An increasing number have plans with high cost-sharing. Research sponsored by the Employee Benefits Research Institute notes ongoing trends in regard to these consumers. (EBRI Article) The data comes from a survey of over 3500 hundred adults with private insurance. For this survey, a consumer-directed health plan was one with at least a $1300 deductible for single coverage or $2600 for family coverage and availability of an HRA or HSA. People with deductibles this high but no access to a savings account of some type were called high deductible members, while those with deductibles below this level were categorized as having traditional coverage. In 2015, 13% of the population was in a CDHP and 11% in an HDHP, or a total of about 48 million people. For those in a CDHP, 63% had opened an HSA, 13% had an HRA and 24% were eligible for an HSA but hadn’t opened an account. Most people in a CDHP are at least somewhat familiar with how the concept works.
The idea of high deductibles is that consumers will be more aware of and careful about health spending. The survey suggests this is true. About 10% to 15% more CDHP and HDHP members than traditional coverage ones say they check first to see if care is covered, ask for generic drugs instead of brands, talk to their doctor about prescription options and other treatment options, develop a health budget, and use online cost-tracking tools. They are also more likely to spend time carefully considering their health plan choices and gathering information about different health plan options. One barrier to cost-sharing serving its purpose is the availability of timely, accurate cost information on treatment options. 42% of HDHP and 40% of CDHP members, compared to 26% of traditional coverage enrollees, have tried to use multiple sources to access cost information. It is surprising, however, that these numbers are so low, and even among those who look, success rates at finding good information, especially on what it will actually cost the member, are disappointingly low.
CDHP and HDHP members were also more likely than others to engage in wellness programs. 80% of CDHP enrollees participated in a health-risk assessment compared to 66% of traditional members. 76% participated in biometric screening, compared to 66% of traditional plan members. And incentives seemed to be important to these high-deductible plan enrollees, as 70% of CDHP and 75% of HDHP members got an incentive for participating in health risk assessments, compared to only 60% for traditional coverage enrollees, with similar numbers applying to participation in biometric screenings and health promotion programs. As in the past, members who don’t participate in wellness efforts say it is because they are already healthy or they can make changes on their own. Here is the really frightening trend, since 1998 health insurance premiums have tripled, while workers’ incomes have only gone up 58%. The survey suggests that we have a long way to go to help members with significant cost-sharing find good information on which to make decisions and engaging them in those decisions.