Availability, Contributions, Account Balances, and Rollovers in Account-Based Health Plans

This article provides findings from the 2008 EBRI Consumer Engagement in Health Care Survey, as well as earlier surveys, examining the availability of HRA and HSA-eligible plans (so-called consumer-driven health plans or CDHPs). It also looks at employer and individual contribution behavior, time enrolled in such plans, account balances, and rollover behavior. It found that contributions to CDHPs are growing and that account balances are increasing. <A href="http://www.ebri.org/pdf/PR_819_11Dec08.pdf">Press release </A>

• Consumer-driven health surveys: This report presents findings from the 2008 EBRI Consumer Engagement in Health Care Survey, as well as earlier surveys, examining the availability of HRA and HSA-eligible plans (so-called consumer-driven health plans). It also looks at employer and individual contribution behavior, time enrolled in such plans, account balances, and rollover behavior.

• CDHP enrollment: In 2008, 3 percent of the adult population with private health insurance was enrolled in a health reimbursement account (HRA) or had a high-deductible plan with a health savings account (HSA) in 2008. An additional 3.6 percent were eligible for an HSA but did not have such an account. Overall, 6.6 percent of adults with private insurance were either in a consumer-driven health plan (CDHP) or were in a high-deductible plan that was eligible for an HSA, but had not opened an account.

• CDHP eligibility: Among individuals with traditional employment-based health benefits and a choice of health plan, 40 percent were eligible for a CDHP in 2008, up from 33 percent in 2006. About 22 million workers were eligible for such a plan in 2008 but chose to remain in the more traditional plan.

• Contributions: Workers with employee-only coverage and an employer contribution have seen their annual employer contributions increase, and a majority of workers with family coverage receive a contribution of $1,000 or more. The percentage of individuals with employee-only coverage contributing nothing to an HSA was 19 percent in 2008. Persons both with and without health problems are about equally likely to contribute to an HSA, and their contribution levels are about the same.

• Longer time in plan: Between 2006 and 2008, the percentage of individuals in a CDHP for one to two years increased from 30 percent to 41 percent, and the percentage in these plans for three to four years increased from 9 percent to 19 percent.

• Account balances: The amount of money that individuals have accumulated in their accounts has grown. The percentage of individuals reporting that they had nothing in their account declined from 14 percent in 2006 to 9 percent in 2008. The percentage of individuals reporting an account balance of at least $1,000 increased from 25 percent in 2006 to 44 percent in 2007, and remained at 43 percent in 2008.

• Rollover behavior: The percentage of persons reporting no rollover fell from 23 percent to 16 percent between 2006 and 2008. The percentage reporting a rollover of $1,500 or more increased from 13 percent in 2006 to 27 percent in 2008.

EBRI Notes • EBRI Notes • EBRI Notes • EBRI Notes • EBRI Notes • EBRI Notes • EBRI Notes • December 2008 • Vol. 29, No. 12 EBRI Notes • December 2008 • Vol. 29, No. 12 EBRI Notes • December 2008 • Vol. 29, No. 12 EBRI Notes • December 2008 • Vol. 29, No. 12 EBRI Notes • December 2008 • Vol. 29, No. 12 EBRI Notes • December 2008 • Vol. 29, No. 12 EBRI Notes • December 2008 • Vol. 29, No. 12 December 2008 December 2008 December 2008 December 2008 December 2008 December 2008 • • • • • • Vol. 29, No. Vol. 29, No. Vol. 29, No. Vol. 29, No. Vol. 29, No. Vol. 29, No. 12 12 12 12 12 12 Figure 7 increased receiving such a contribution increased substantially The Familyfor both those with and wit and Medical Leave Act of 1993; Fi hout health problem nal Ru between 2006 and le [as published in the s. Among those without health problem 2007, increasing from Federal Register on 52 percens,t Figure 5 Figure 11 Figure 13 Figure 1 Figure 3 Figure 9 Figure 15 Annual Individual Contributions to the Account, g 15 percent rolled over $1,500 or m to 70 Novem Availability, Contributions, Account percent, but ber 17, 2008] then declined to Annual Individual Contributions to the Account, o59 re in 2006 and percent in 20 1 33 pe 08 (which w rcent did so in 2008. 1 as not statistically Fewer individuals with different from the Pension Plans/Retirement Annual Individual Contributions to the Account, Annual Employer Contributions to the Account, Amount Rolled Over from Past Year, Percentage of Individuals With Comprehensive Length of Time With CDHP and Savings Account, 2006–2008 Employment-Based Health 1 1 Amount Rolled Over from Past Year, 1 1 1 health problems rolled ov 52 percent level in 20 http://edocket.access.gpo.gov/2008/pdf/ 06). Among Persons With Employee-Only or Family CDHP er $1,500 or m E8-26577.pdf ore, but the percentage with such a rollover increased fro m 11 Among Persons With Employee-Only CDHP, 2 3 2006–2008 U.S. Government Accountabilit EBRI Notes y Office. (1) Federal Pensions: Judicial Survivors’ Annuities System i Among Persons With Employee-Only or Family CDHP, Among Persons With Employee-Only CDHP, Among Persons With Employee-Only or Family CDHP 2006–2008 2006–2008 80% Benefits Offered HDHP or CDHP, 2006-2008 1 Balances, and Rollovers in Account-Based percent in 2006 to 19 percent in 20 Among and Household Income Under $50,000, 2006–2008 Persons With Employ 08. ee-Only or Family CDHP 80% Costs. (2) Individual Retirement Accounts: Additional IRS Actions Could Help Taxpayers Facing 80% 80% and No Health Problems, 2006–2008 80% and Health Problem, 2006–2008 The Financial Crisis and State/Local D Individual Contributions 80% 80% efined Benefit Plans Challenges in Complying with Key Tax Rules. (3) Pension Benefit Guaranty Corporation: Need for EBRI Emp 70% loyee Benefit Research Institute Notes (ISSN 1085 -4452) is published monthly by the Employee Benefit Research Health Plans 80% 70% http://crr.bc.edu/im Individuals’ th contribut ages/stories/Briefs/ib_8-19. ions to HSA plans 2006 have al pdf so increased. Between 2006 and 2007 2008 2007, the percentage Conclusion 2006 2007 2008 Improved Ov 70% 70% ersight Persists. Order from GAO. Institute, 1100 13 70% St. NW, Suite 878, Washington, DC 20005-4051, at $300 per year or is included as part of a membership NOTES 70% 70% 2006 2007 2008 of individuals with e Rollover amounts and account balances in account-b mployee-only coverage contributing nothing to an HSA ased health plans have increased. decreased from 2 This 8 percent to may be subscription. Periodicals postage rate paid in Washington, DC, and additional mailing offices. POSTMASTER: Send address 2006 2007 2008 2006 2007 2008 by Paul Fronstin, EBRI th 2006 2007 2008 60% 60% 70% changes to: EBRI Notes, 1100 13 St. NW, Suite 878, Washington, DC 20005-4051. Copyright 2008 by Employee Benefit 18 percent, and it rem due to the fact that individ The Fraying Link Between Work an ained at 19 uals have had percent in 2 d Health Insuran CDHPs for a 008 ( ce: Trends in Em Figure 5). I longer period of tim n contrast, th ployer-S e than in the past. ponsored Ins e percentage urance for contributi It may also ng 60% 2006 2007 2008 Soci 60% 60%al Security Reform Research Institute. All rights reserved, Vol. 29, no. 12. 60% 60% between $1,000 and be because both em Employees, 2000-2007 ploy $1,499 increased fr ers and individuals have incr om 9 percent eased their in 2006 to 21 percent in 20 contributions to the accounts. As shown 08, while the percentage December 2008, Vol. 29, No. 12 Kay, Stephen J., and Tapen Sinha. Lessons from Pension Reform in the Americas. $110 + $5.50 S&H. 50% 2006 2007 2008 60% 50% 50% in prior work, the percenta www.kff.org/uninsured/7840.cfm contributing $1,500 or moge of persons re increased from with a 21 percent CDHP working for a larg to 30 percent. Am e em on plg persons with the fam oyer has increased, whic ily h 50% 50% The Employee Benefit Research Institute (EBRI) was founded in 1978. Its mission is to Oxford University Press, Attn: Order Dept., 2001 Evans Rd., Cary, NC 27513, (800) 445-9714, fax: (919) Introduction # 50% 40% # 50% 42% 39% may coverage, the percentage not m partly explain the higher em aking any ployer contributi contrib41% utio on ns was unchanged between 200 levels. Higher deductibles may 6 and in2 part explain 008, but the 37% contribute to, to encourage, and to enhance the development of sound employee benefit 40% 677-1303, e-mail: custserv.us@oup.com, www.oup.com/us # 50% Employers have been interested in bringing aspects of 39%^ consumerism into health plans for many years. 41% 41%^ # 34%^ 40% 40% # 33% programs and sound public policy through objective research and 37% education. EBRI is the only higher in In It for the L percentage co dividual contrib ong Haul: Th ntributing less than $500 fell from utie Investm ons. ent Behavior of P 16 percen ublic Pension t to 5 percent, while the percentage s contributing 32% 40% 40% 40% As far Availability, Contributions, Account Balances, back as 1978, they adopted Sec. 125 cafeteria plans and flexible spending accounts. More 40% private, nonprofit, nonpartisan, Washington, DC-based organization committed exclusively to 28% 28% 28% CHECK 31% OUT EBRI’S WEB SITE! 30% 31% $1,500 www.nirsonline.org/storage/nirs/documen Finally or m , as ore increased f more healthy rom individuals enroll in CDHP 36 percents/In%20it%20for%20t t in 2006 to 51 percen s, driving t in 2008 (Figure 6). It is not surprising he%20Long%20Haul.pdf up the average health stat us of the 30% 30% Who we are 40% 30% Flexible Spending Accounts (FSAs) Sites recently, employers have been increasingly turning their attention to consumer engagement in health care. public policy research and education on economic security and em # ployee benefit issues. 30% 28%^ 30%^ 30% 35% 26% 30% that indivi and Rollove CDHP popul duals with family ation, account balances an rs in Account-Based Health Plans, coverage contribute m d rollover am ore than indivi ounts will duals with em increase. This does not e 28% ployee-only coverage, as p xplain why . 2 30% 28% # # 30% 30% American Federation of State, Count EBRI’s member y and Municipal Em ship includes a cross-section of ployees pension funds; businesses; trade associations; In 2001, they focused on account-based health plans—a 23% 24%^ combination of health plans with deductibles of 27% # 30% 20% 27% 27%^ deductibles are higher for f Individ rollover am ual Retirem ounts have increased for in ent Accounts and amily coverage. 401(k) Plans: dividuals with h Earlyealth proble Withdrawals and Req ms, but that can also be uired Distributions explained by 30% labor unions; health care providers and insurers; government organizations; and service firms. 23% 23%^ 21% 24% 24% # # at least $1,000 for em www.afscme.org/issues/6404.cfm ployee-only coverage and tax-preferred savings or spending accounts that workers 20% EBRI’s Web site is easy to use and packed 19%^ 21% 19% 21% 19% 22% # # 20% 18% 20% 19% Income [ rising em Updated October 27, ployer contributions. Ultimatel #Differences— 19% 2008 19% ] Gen 14% erally, lower-income persons with y, more research is needed in this area. 17% HSAs are less likely 19% to make a 14% 13%^ 19% 20% 21% 19% 16%^ 15% 20% 15% 18%^ 18% and their families can use # to pay their out-of-pocket 18% health care expenses. A few employers first started 10% 16% 12% # 20% 16% 16%^ 13% 19%^ 19% New Publications and Internet Sites, p. 12 15%^ EBRI’s work advances knowledge and unders 12% 15% tanding of employee benefits and their 16% 12% 12% 15% 16% 20% with useful inf 17% ormation! 14%^ contributi http://assets.opencrs.co on to the account m/rpts/RL31770_20081027.pdf than higher-i # ncome persons. 14% 15% Abou 9% t one-quarter of persons in households with 16%^ 13% 13%^ # 7% 11%^ # 12%# Ceridian 10% 13% 7% offering account-based health plans in 2001, when they 15%^ began to offer health reimbursemen 12% t 10% importance to 8% the nation’s economy9% among policym 11% akers, 11% the news media, and the public. It 10% 5% 7% 13% 13 10% % 7%^10% 10% 5% 10% 10% 4% 10% 12% less than $50,000 in income did not contribute to th 1 9% 9% e account in 2008 (Figure 7), while about 15 percent 9%9% 9%^ 12% Endnotes 3% 5% 11% 5% 10% 0% 8% 8% 8% 11% 11% 10% # 10% www.ceridian.com arrangements (HRAs). /m 7% yceri In 2004 d 10% ian/printer/ , emplo friendl yers were able to start y/content/1,,11066-53002,00.htm offering health pl 5%^ l ans with health savings 10% does this by conducting and publishing policy research, analysis, and special reports on 9%^ 9% 7% 6% 4% 6% 1 7% 3% 10% 7% 4% 7% Innovations i of persons with $50, See Paul Fro nn Prevention, st HDHP or CDHP Offered in 2, “C 000 in an ‘CWellness and household in onsumerism’ Sl Risk Reduction co ow me Not Offered a CDHP or HDHP t 6% h did not e Rate of Health contribute (Figure 8). For both incom Benefit Cost Increas Don't Know If CDHP or HDHP Was Offered es?” EBRI Iss e 2% u groups, the e 2% Brief, no. 0% 6% 3% employee benefits issues; holding educational briefings for EBRI members, congressional and 1% # Executive Summary: accounts (HSAs). By 2007, 7 percent Look for these special features: of emplo 4%yers with 10–499 workers and 11 percent of those with 0% 2%^ 247 0% (Emplo Less Than $200 yee Benefit Research In $200–$499 stitute, July 20 $500–$749 02). $750–$999 $1,000 or More Don't Know www.ahip.org/redirect/AH percentage contribut What we do ing $ 1I,50 P_ federal agen Innovations_Prevention.pdf 0 or mocy re incr staff, and th eased between 2006 and 2008 e news media; and sponsoring public opinion survey 3 . Among the lower-inco s on emplom yee e 0% Employ 0% 0% Source: EBRI/Commonwealth Fund Consumerism in Health Care Surveys, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Su ee Benefit Research Institute Nothing Less Than $500 $500–$999 $1,000–$1,499 $1,500 or More rvey. Don't Know 500 or more workers offered either an HRA- or HSA-eligible plan. Employers have also taken a broader 0% Less Than 6 Months 6 Months to Less Than 1–2 Years 3–4 Years 5 or More Years Don't Know 1 Nothing Less Than $100 $100–$299 $300–$499 $500–$999 $1,000–$1,499 $1,500 or More Don't Know benefit issues. EBRI’s Education and Research Fund (EBRI-ERF) performs the charitable, group, the percentage contributing at least $1,500 increased from 16 percent to 27 4 percent, while among Comprehensive = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). Nothing Less Than $500 $500–$999 $1,000–$1,499 $1,500 or More Don't Know Nothing Less Than $500 $500–$999 $1,000–$1,499 $1,500 or More Don't Know • EBRI’s entire library of research publications starts at the approach to c 2 www.ebri.org/pdf/publications/facts/0507fact-flexspend.pdf onsumer engagem 1 Year ent through various other initiatives. 2 Nothing Less Than $100 $100–$299 $300–$499 $500–$999 $1,000–$1,499 $1,500 or More Don't Know • Consumer-driven health surveys: This report presents findings from the 2008 EBRI Consumer HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. educational, and scientific functions of the Institute. EBRI-ERF is a tax-exempt organization ________. “Health Savings Accounts and Other Account-Based Health Plans.” EBRI Issue Brief, no. 273 PBGC Flat Pr the higher inco eme group, mium Rates; 47 percent contributed at Notice of Flat Premium least $1,500 in Rates [as published in the 2008, up from Fe 37 percent in deral Register 2006. on 3 Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Survey. This report pr CDHP = Consumer-driven health plan w/ deductible $1,000+ (individual), $2 000+ (family), with account. Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Sur esents findings from main W the 2008 EBRI Cons eb page. Click on umer Engagem EBRI Issue Briefs ent in Health Care Survey and and vey. EBRI Engagement in Health Care Surve Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Sur Source: EBRI/Commonwealth Fund Consumerism in Health Care Surveys, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Su supported by y , as well as earlie contributions and grants. r surveys, examining the availabilit vey. y of HRA and rvey. (Employee Benefit Research Institute, September 2004). Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Sur Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Sur vey. vey. 1 1 1 ^ Difference from prior year shown is statistically significant at p = 0.05 or better. December 1, 2008] Health 1 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Differences— Persons both with and without health problems are about equally 5 likely to 1 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. 1 Comprehensive = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). U.S. Bureau of Labor Statistics CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. the 2006 and # CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. 2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys. It examines the HSA-eligible plans (so-called consu # Notes mer-driven health plans). It also looks at em for our in-depth and nonpartisan periodicals. ployer and individual # Difference between 2006 and 2008 is statistically significant at p = 0.05 or better. 7 # Difference between 2006 and 2008 is statistically significant at p Source: EBRI/Commonwealth Fund Consumerism in Health Ca = 0.05 or better. re Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Survey. # Difference between 2006 and 2008 is statistically significant at p = 0.05 or better. # # Difference between 2006 and 2008 is statistically significant at p = 0.05 or better. http://edocket contribute to Difference between 2006 and 2008 is statisticall an HSA, and their contri .access.gpo.gov/2008/pdf/ y sigE8-28411.pdf bution nificant at p levels are about th = 0.05 or better. e same. Those with health problems Difference between 2006 and 2008 is statistically significant at p Difference between 2006 and 2008 is statistically significant at p = 0.05 or better. = 0.05 or better. 3 1 EBRI Issue Briefs are periodicals providing expert evaluations of employee benefit issues and www.bls.gov/opub/cwc/cm availability CDHP of HRA and HSA-eligible plans (so-call = Consumer-driven health pl 20031022ar an with deductibl01p1.htm e $1,000+ (individ ual),e $d 2,0consumer-driven health plans or CDHPs), as well 00+ (family), with account. See www.mercer.com/referencecontent.htm?idContent=1287790 contribution behavior, time enrolled in such plans, account balances, and rollover behavior. # contribute slightly more than those without health trends, as well as critical analy problems. Contributio ses of employee benefit pon levels increased significantl licies and proposals. EBRI Notes is a y Difference between 2006 and 2008 is statistically significant at p = 0.05 or better. as em ployer and individual contribution behavior, t • To get answers to many fr ime enrolled equently asked questions about in such plans, account balances, and • CDHP enrollment: In 2008, 3 percent of the adult populatio monthly periodical providing current information on a variety n with private of employ health insurance was ee benefit topics. Pension Sponsorship and Participation: Summary 4for both groups between 2006 and 2007 and were th of Recent Trend en unchanged in s [Updated Septem 2008. Among per ber 8, 2008] sons without In 2001, employers formed a coalition to report health care provider quality measures, and today the group is rollover behavior. Our employee bene? ts, click on Bene? t FAQs. EBRI’s Pension Investment Report provides detailed financial information on the universe of Web Documents enrolled in a health reimbursement account (HRA) or had a high-deductible plan with a health http://assets.opencrs.co health problems, 28 percent contribute m/rpts/RL30122_20080908.pdf d $1,500 or more in 2006 , while 41 percent contributed $1,500 or composed not only of employers but also includes consumer groups and organized labor (see defined benefit, defined contribution, and 401(k) plans. EBRI Fundamentals of Employee The 10 Benefits of Conducting a Personal Health Assessment savings account (HSA) in 2008. An additional 3.6 percent were eligible for an HSA but did not have more in 2007 and 2008 (Figure 9). Similarly, 46 percent of those with a health problem contributed www.healthcaredisclosure.org/). In 2002, there was interest in tiered provider networks (see Paul Fronstin, “Tiered Benefit Programs offers a straightforward, basic explanation of employee benefit programs in CDHP Eligibility • EBRI’s reliable health and retirement surveys are just a click publications www.welcoa.org/freeresources/pdf/aa_7.7_10_benefits.pdf?PHPSESSID=b0e2746129adfc5a0ea8222cc6 such an account. Overall, 6.6 percent of adults with private insurance were either in a consumer- $1,500 or more in 2007 and 2008, up from 33 percent in 2006 (Figure 10). Networks for Hospital and Physician the priv Health ate and Care Serv public sectors ices,” . The EBRI Is EBRI Data sue Brief, book on Emplo no. 260 (Emyee Benefits ployee Benefi is a t R stat esearch istical Public Fund Survey Summary of Findings for FY 2007 As reported in earlier research, 4.2 million adults ages 21–64 with private health insurance, or 3 per- away through the topic boxes at the top of the page. 47181a driven health plan (CDHP) or were in a high-deductible plan that was eligible for an HSA, but had Institute, August 2003). In 2 referen 005, em ce work o ployers started n employee ben to fo efit pr cus ogr on ams and value-b work force-related issues. ased insurance designs that seek to www.publicfundsurvey.org/publicfundsurvey/pdfs/Summary%20of%20Findings%20FY07.pdf cent of the adult population with private health insurance, was enrolled in an HRA or had a high- Figure 8 Figure 10 Figure 12 Figure 14 Figure 4 Figure 6 Figure 2 enco not o uragep tened an account. he use of high-value services while discouraging the use of services when the benefits are not justified Length of Time in Plan 6 • Instantly get e-mail noti? cations of the latest EBRI data, deductible plan with an HS Annual Individual Contributions to the Account, A in 2008, up from 2 percent in 2007 and 1 percent in 2006. An additional Contact EBRI Publications, (202) 659-0670; fax publication 1 orders to (202) 775-6312. Annual Individual Contributions to the Account, by the costs (see Michael E. Percentage of Individuals With Employer Contribution Ch Annual Individual Contributions to the Account, Annual Employer Contributions to the Account, ernew, Amount Rolled Over from Past Year, Allison B. Rosen, and A. Mark Fendrick, “Value-Based Insurance Design,” Amount Currently in Account, Among Persons With CDHP, 2006–2008 2008 While HRAs and HSAs Cumulative List of Changes in Plan Qualification Requirements [ are still relatively new and a relatively N sm otice 2 all percentage of t 008-108] he health • CDHP eligibility: Among individuals with traditional employment-based health benefits and 1 a choice Retirement Security or Insecurity? The Experience of Workers Aged 45 and Older 5.6 million adults ages 21–64 with pr Subscriptions to ivate health EBRI Issue Bri insura efs are included nce, or 3.6 percent, reported that they as part of EBRI 1 membership, or as part of were a 1 1 1 Among Persons With Employee-Only or Family CDHP surveys, publications, and meetings and seminars by clicking Health Affairs Web Exclusto Account, Among Persons With Employment-Based ive, (Jan. 10, 2007): w195-w203). Among Persons With Employee-Only or Family CDHP g New Public Among Persons With Employee-Only or Family CDHP Among Persons With Family CDHP, Among Persons With Family CDHP, ations and Internet Sites 2006–2008 2006–2008 www.irs.gov/pub/irs-drop/ insurance market, a significant change n-08-108.pdf has already occurred in the length of time individuals have been of health plan, 40 percent were eligible for a $199 annual subscription to CDHP EBRI Notes in 2008, u and EBR pI Issue Brie from 33 percent in 2006. A fs. Individual copies are av bout 22 ailable http://assets.aarp.org/rgcenter/econ/retirement_survey_08.pdf eligible for an HSA but did not have such an account. Thus, overall, 9.8 m 1 illion adults ages 21–64 with and Household Income $50,000 or More, 2006–2008 80% on the Sign Up for Updates box at the top of our home page. 80% and Health Problem, 2006–2008 80% Health Benefits and CDHP, and No Health Problems, 2006–2008 2006–2008 [Note: To order U.S. Govern with prepa ment Accountabilit yment for $25 each y Office (GAO) (for printed copie publications s). Change of Address: , call (202) 512-6000.] EBRI, 1100 13th St. enrolled in these plans. Between 2006 and 2008 the percentage of individuals in these plans for one to 5O million workers were eligible for such a plan in rders/ 2008 but chose to remain in the more traditional plan. private insurance, representing 6.6 percent of that market, were either in a CDHP or were in a high- Mo 80%re information about the surveys can be found in Paul Fronstin and Sara Collins, “The 2nd Annual 80% 80% NW, Suite 878, Washington, DC, 20005-4051, (202) 659-0670; fax number, (202) 775-6312; After GASB 45: Sol two years increased fro ving t mh 30 percent to 41 percent, e Unfunded Liability Problem and in Retiree Health Care the percentage in these plans for three to four 80% Social Security: Calculation and History of Taxing Benefits [Updated October 21, 20 70%^ 08] EBRI deductible pl /Commoan that was eligible for nwealth Fund Consumeris an m HSA, but had in Health Care not o Survp ey, 2006 ened an account. : Early Experience With High-Deductible • Contributions: Workers with employee-only coverage and an employer contribution have seen their 70% 70% e-mail: subscriptions@ebri.org Membership Information: Inquiries regarding EBRI 70% www.slge.org/vertical/Sites/%7BA260E1DF-5AEE-459D-84C4- years increased from 9 percent to 19 percent (Figure 11). There’s lots more! subscriptions http://assets.opencrs.com/rpts/RL32552_20081021.pdf and C Aginog Issue nsumer-Dri sve n Health Plans,” 2006 EBRI Iss 2007ue Brief 2008, no. 300 (Employee Benefit Research Institute, December 70% It was found that a significant percentage of workers annual employer contributi membership and/or contributions to EBRI-ERF ons increase, and a majorwith traditional health benefits were eligible for ity of workers with fam should be directed to EBRI President/ASEC ily coverage receive a 70% 70% 66%^ 2006 2007 2008 65% 70% 876EFE1E 4032%7D/uploads/%7BDCB095C2-16EA-4262-9A5E-2C3266A6911E%7D.PDF 2006); Paul Fronstin and Sara R. Collins, “Findings From the 2007 EBRI/Commonwealth Fund Consumerism in Chairman Dallas Salisbury at the above address, (202) 659-0670; e-mail: salisbury@ebri.org Eberts, Randall W., and Richard A. Hobbie. Older and Out of Work: Jobs and Social Insurance for a account-based health plans 60% contribution of $1,0 61%00 or and that t V m isit EBRI on-line today: ore. The percentage he percentage has been growi 2006 of indivi 2007 ng. Am dual www s with em 2008 ong individuals with traditional .ebri.org 59%^ployee-only coverage 2006 2007 2008 60% 60% 2006 2007 2008 Account Balances and Rollover Behavior 2006 2007 2008 Health Survey,” 60% EBRI Issue Brief, no. 315 (Employee Benefit Research Institute, March 2008); and Paul Fronstin, 2006 2007 2008 Updated Static Mortality Changin 60% g Economy. $18. T W.E. Upjohn ables for the Years 2009 t Institute for Em hrough 2013 ployment R [N esear otice 2008- ch, Attn: Publications 85] # employment-based health benefits and a choice of health plan, 40 percent were eligible for an HRA or 60% contributing nothing to an HSA was 19 percent in 2008. Persons both with and without health 51% 60% 50%^ 52% Editorial Board: Dallas L. Salisbury, publisher; Steve Blakely, editor. Any views expressed in this publication and those of the authors should “Fi The Age Disc ndi The am ngs frount of om ri t mhie 200 nation in money 8 EB tha ER mIt C individuals have accu ploy ons muem nt Act (ADE er EngagemA): entm i A Legal Ove unl Heal ated in their accounts has g th Carre Sur view vey,” EBRI Iss rown over time. Th ue Brief, no. 323 e www.irs.gov/pub/irs-drop/ 50% n-08-85.pdf Department, 300 S. Westnedge Ave., Kalamazoo, MI 49007-4686, (888) 227-8569 or (269) 343-5541, HSA-bas problem ed plan in 2008, s are about equall up from y likely 33 percent in 2006 (F to contribute to an HSA, and their contributio igure 1). According to a recent st n levels are about the udy, slightly not be 50% ascribed to the officers, trustees, members, or other sponsors of the Employee Benefit Research Institute, the EBRI Education and 50% 50% (Employee Benefit Research Institute, November 2008). http://assets.opencrs.co percentage of individuals m/r reporting pts/RL34652_20080905.pdf that they had nothin g in their account at the time of the survey 50% 48%^ # # 46%^ 44%^ # Resear fax: (269) ch Fund, 34 or3-731 their staffs. 0, publi Nothin cations@upjohninstitute.or g herein is to be construed as an attem g pt to aid or hinder the adoption of any pending legislation, regulation, mor 50% 50% e same. than one-half (52 percent) of workers were eligible for at least two health plans, t 46% 43% hus about 22 47% declined from 14 percent in 2006 to 9 percent in 2008 (Figure 12). There were also statistically or interpretative rule, or as legal, accounting, actuarial, or other such professional advice. 40% 36% 6 million workers were eligible for such a plan in 2008 but chose to remain in the more traditional plan. Who Gained the Most Under Health Reform in Massachusetts? 40% 40% • Longer time in plan: Between 2006 and 2008, the percentage of individuals in a CDHP for one to Paul 40% Fronstin, “Findings from the 2008 EBRI Consumer Engagement in Health Care Survey,” Issue Brief, no. 323 significant declines in the 40% percentage of individuals with less than $200 and $200–$499. In contrast, the 34% 40% Call to Action: Health Reform 2009 40% 37% Employee Benefits 32% www.urban.org/UploadedPDF/411770_Gained_Massachusetts.pdf # (Employee Benefit Research Institute, November 2008). two years increased from 30 percent to 41 percent, and the percentage in these plans for three to four EBRI Notes is registered in the U.S. Patent and Trademark Office. ISSN: 1085 -44530%^ 2 1085 -4452/90 $ .50+.50 33% 33%^ percentage of indivi 30% duals reporting an account balance of at least $1,000 at the time of the survey http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf 30% Employer Contributions The National Underwriter Company. 2008 Benefits Facts Source Book. $65.35. The National 30% years increased from 9 percent to 19 percent. 30% 30% 30% increased from 25 percent in 2006 to 44 percent in 2007, and remained at 43 25%percent in 2008. 7 26%^ 30% 25% Did The percentage of workers with you read this as a pass-along? an HRA or HSA plan whose emplo Stay ahead of employee benefit issues yer contri with yourbutes to the account has own subscription to EBRI Underwriter Individuals wer Coe m dp eany fine,d Or as h ders Department MP, P. aving a health problem ifO. they said Box 14 th 448, ey w Cincinnati, OH 45250- ere in fair or poor health 044 or h8, (80 ad one0 o ) 54 f eig 3- ht 20% 16% • The am Account balances: ount of money The am being rolled ove ount of mor in the accounts ney that individuals fromhave one y accu ear to the ne mulated in their accounts has xt has also increased. 20% The Commonwealth Fund Notes for only $89/year 2008 electronica International H lly e-mailed to ealth Policy Surve you or $19 15%9/year y in Eig printed a ht Co nd mai untries led. For more information 14% ch not changed s ronic health co ignificantl nditions (art y si hnce 2006. H ritis, asthma, e om wever, afte physema or r lu falling between 2006 and ng disease, can 14% cer, depressio 2007 n, d, the per iabetes, heart centage with attack or 0874, fax: (800) 874-1916, www.nationalunderwriterstore.com 20% 13% 20% 13% 12% 18% 20% 20% 16% 16% The percentage of persons reporting no rollover 11% 11% 11% fell from 15% 23 percent to 16 percent between 2006 and 15% 15% 15% grown. The about subscri 16% 14% ppercentage of individ tions, visit our Web site at uals reporting th www.ebri.org or compl at they e te the for had not 16% h m ing in their a below and return it to EBRI. ccount declined from 20% 14% 14% ot www.co her heart mmo 13% disease, nwealthfund.org/usr_doc/ high chol 15% esterol or hype Schoen_2008intlhltpolic rtension, high blood pressu yre surve , or st yre oike). ghtcountries_chartpack.pdf?sect 9% 13%^ an employer contribution increased from # 61 percent in 2007 to 13% 16% 66 percent in 2008 (Figure 2). 16% 12% 14%^ # # 12% 12% # 11% 12%^ 12%^ 15% 10% 15% 11% 13% 11% 7% 11% 14% 12% 15% 15% 12% # 11% 11% 10% 12% # 12%^ 9% 11% 2008 (Fi 14 percent in 2006 t gure 13). The percentage repo 10%^ 11% o 9 pe 11% 9% 5%^ rcent in 2008. The percen 5% rting a rollover of $1,500 tage of indivi or m duals re ore incr porting an account balance eased from 13 percent in 5%^ 11% 11% 9% 9%^ 12% 9%^ 8% 8% 8% 12% ion=403Nam9e 10%^ 7%^ 4% 4% 10% Among workers with an em 7% ploy # er contribution 7% , those with em 9% ployee-only coverage have seen their 3% Health 10% Care 8% 8%^ 10% 8% 10% 5% # 8% 8% 10% 7% 7% 6% 2006 to 2 of at least $1,000 i 76% percent in 2008. So ncreased from me of 25 percent in 2006 t the increase in rollover am o 44 percent in 2007, and re ounts may be due to the statistically mained at 43 percent 6% 10% 7%^ 5% Organization 4%^ annual employer contributions increase. Between 2006 and 2008 the percentage reporting that their 0% # 6% 5% Atlantic Information Services, Inc. 0% 3% Health Plan Facts, Trends and Data: 2008–2009. Print edition, $398; 2%^ 4% significant decline in the percentage of individuals who reported that they did not know how much money in 2008. 0% th The Decline Employer Contributes to Account of Career E Nothing mLess Than $500 ployment $500–$999 No Employer Contributions $1,000–$1,499 $1,500 or More Don't Know Don't Know employAdder contributed $1,000 or m ress ore to the account increased from 26 percent to 37 percent (Figure 3). 0% Print & CD editions, 0% $548 + $5 S&H. Atlantic Information Services (MFB13/ESPEC4), 1100 17 St., 0% Nothing Less Than $100 $100–$299 $300–$499 $500–$999 $1,000–$1,499 $1,500 or More Don't Know had been rolled over. 0% http://crr.bc.edu/images/stories/ib_8-14.pdf • Rollover behavior: Nothing Nothing The percentage of persons reporting no r Less Than $500 Less Than $200 $500–$999 $200–$499 $1,000–$1,499 $500–$999 ollover fell fro $1,500 or More $1,000 or More m 23 percent to 16 Don't Know Don't Know percent Among workers with family coverage, the percentage reporting a contribution of $200–$499 decreased City/State/ZIP NW, Suite 30 Less Than $200 0, Washington $200–$499 , DC 20036-4631 $500–$749 , (800) 521-43 $750–$999 23 or (202) 77$1,000 or More 5-9008, fax: (202) Don't Know 331-9542, Nothing Less Than $500 $500–$999 $1,000–$1,499 $1,500 or More Don't Know Health Status— Persons with health problems (as defined earlier) rolled over less money than Source: EBRI/Commonwealth Fund Consumerism in Health Care Surveys, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Survey. between 2006 and 2008. The percentage reporting a rollover of $1,500 or more increased from 13 from 11 percent to 6 Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Sur percent between 2006 and 2008, while the percentage reporting cont vey. ributions of Mail to: EBRI, 1100 13th St. NW, Suite 878, Washington, DC, 20005-4051 or Fax to: (202) 775-6312 e-mail: customerserv@aispub.com, www.AISHealth.com/Products/mfbESPEC4.html 1 Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Survey. Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Survey. Comprehensive = Health plan with no deductible or <$1,000 (individual), <$2,000 (family). Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Sur 1Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Survey. vey. persons with no health problems. In 2008, 11 percent of persons with no health problems did not roll 1 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. 1 Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006 & 2007; 2008 EBRI Consumer Engagement in Health Care Survey. percent in 20 1 06 to 27 percent in 2008. $500–$7 1 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. 49 increased from 4 percent to 10 percent between 2007 and 2008 (Figure 4). A majority of CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Defined Contribution Plan ^ Difference from prior year shown is statistically significant at p # CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Distribution Choices at Re = 0.05 or better. tirement: A Survey of Employees Retiring Between 1 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. # Difference between 2006 and 2008 is statistically significant at p = 0.05 or better. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. # over any # # # Difference between 2006 and 2008 is statistically significant at p money, whereas 21 percent of persons with = 0.05 or better. health problems did not roll over any money, Difference between 2006 and 2008 is statistically significant at p = 0.05 or better. Difference between 2006 and 2008 is statistically significant at p Difference between 2006 and 2008 is statisticall Difference between 2006 and 2008 is statistically significant at p © 2008, Employee Benefit Research Institute y significant at p = 0.05 or better. = = 0.05 or better. 0.05 or better. -Education and Research Fund. All rights reserved. # workers with family coverage receive a contribution of $1,000 or more. The percentage of workers 2002 and 2 Difference between 2006 and 2008 is statistically significant at p 007 www.ici.org/pdf/rpt_08_dcdd.pdf = 0.05 or better. although that had fallen significantly from 35 percent in 2006 (Figures 14 and 15). Rollover amounts A monthly newsletter from the EBRI Education and Research Fund © 2008 EBRI www.eb www.eb www.eb www.eb www.eb www.eb www.ebri.o ri.or ri.or ri.or ri.or ri.or ri.org g g g g g rg 12 13 14 9 2 5 www.ebri.org www.ebri.org www.ebri.org www.ebri.org www.ebri.org www.ebri.org www.ebri.org 10 11 8 6 4 3 7