EBRI Issue Brief
Enrollment in HSA-Eligible Health Plans: Slow and Steady Growth Continued Into 2018
Both the number of health savings accounts (HSAs) and enrollment in HSA-eligible health plans have grown significantly since HSAs first became available in 2004. In 2018, enrollment estimates in HSA-eligible health plans varied from 23 million to 36.8 million policyholders and their dependents. But there is one consistency between the enrollment estimates — most sources show that growth appears to have been slowing.
This Issue Brief examines trends in enrollment in HSA-eligible health plans. It compares surveys of individuals, employers, and health plans. It also puts enrollment trends in the context of the health policy environment.
- This Issue Brief examines the findings from five surveys that obtain their results from three different sources.
- Individual interviews: Two surveys — EBRI/Greenwald & Associates and the National Center for Health Statistics (NCHS) — interview individuals with private health insurance obtained either through employment, directly from insurers, or through public exchanges.
- Employer interviews: Another two — Kaiser Family Foundation (KFF) and Mercer — interview employers to determine enrollment.
- Insurance company polls: One survey — conducted by America’s Health Insurance Plans (AHIP) — polls insurance companies and obtains estimates for individuals with private health insurance either through employment, directly from insurers, or through public exchanges.
- Enrollment estimates from the surveys for 2018 range from 23 million to 36.8 million individuals.
- AHIP, whose estimates generally are the lowest, has not released 2018 estimates yet. AHIP, EBRI/Greenwald & Associates, and NCHS estimates are in the low- to mid-20-million range.
- KFF and Mercer estimates are in the low- to mid-30-million range.
- Surveys conducted by AHIP, EBRI/Greenwald & Associates, and NCHS cover the entire privately insured market, whereas those conducted by KFF and Mercer cover only employment-based health plans. Hence, the AHIP, EBRI/Greenwald & Associates, and NCHS estimates should be larger than those reported by KFF and Mercer, but the data show just the opposite.
- Between 2007 and 2018, deductibles in HSA-eligible health plans increased from $1,729 to $2,349 for employee-only coverage, a 36 percent increase. During the same period, deductibles in PPOs increased from $461 to $1,204, a 261 percent increase. In 2007, HSA-eligible health plan deductibles were about 4 times as large as PPO deductibles. By 2018, HSA-eligible health plan deductibles were only twice as large as PPO deductibles. If the gap continues to fall, enrollment in HSA-eligible health plans may begin to accelerate.
- Several factors — such as the delay in the Cadillac tax, low insurance premium increases, and low unemployment — may be holding back growth in HSA-eligible health plan enrollments. Growth in HSA-eligible health plan enrollments may also be held back because what constitutes an HSA-eligible health plan does not provide employers their desired level of flexibility around the design of the health plan. Ultimately, changes to public policy may be needed to expand enrollment.
- All of the surveys find substantial growth in HSA-eligible health plan enrollment since HSAs were established in 2004.
- The surveys consistently find slower growth in HSA-eligible health plan enrollment more recently.
- Two studies focus on growth in the number of HSAs rather than enrollment growth in HSA-eligible health plans.
- Devenir collects data from about 100 HSA providers and tracks the number of accounts universally. It finds that the number of accounts increased from 16.8 million at the end of 2015 to 25.1 million at the end of 2018. The Employee Benefit Research Institute (EBRI) HSA Database, which contained 5.9 million HSAs as of the end of 2017, finds that most HSAs have been established relatively recently, and this indirectly supports the notion that we should be seeing growth in enrollment in HSA-eligible health plans. Data from the EBRI HSA Database show that 15 percent of HSAs were established in 2017.