The growth in so-called “consumer-driven” and high-deductible health plans continues, and now cover 28 percent of those with health insurance, according to the latest report by EBRI.

• The 2013 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS) finds continued slow growth in consumer-driven health plans (CDHPs): 9.7 percent of the population was enrolled in a CDHP, up from 9.6 percent in 2012, while enrollment in high-deductible health plans (HDHPs) increased from 16 percent in 2012 to 18 percent in 2013. Overall, 26.1 million individuals with private insurance, representing 15 percent of that market, were either in a CDHP, or in an HDHP that was eligible for a health savings account (HSA) but had not opened the account.
• Unlike in prior years, when health reimbursement arrangements (HRAs) and HSAs were examined separately, HRA enrollment fell, while HSA enrollment increased. The 2013 CEHCS also found that a growing share of the HDHP market was HSA-eligible. When examining only the number of people enrolled in HSA- or HSA-eligible plans, the overall number of individuals with an HSA or enrolled in an HSA-eligible plan increased from 17.5 million to 20.4 million, a 16 percent increase.
• This study finds evidence that adults in a CDHP and those in an HDHP were more likely than those in a traditional plan to exhibit a number of cost-conscious behaviors. Specifically, those in a CDHP were more likely than those with traditional coverage to say that they had checked whether the plan would cover care; asked for a generic drug instead of a brand name; talked to their doctors about prescription options and costs; talked to their doctors about other treatment options and costs; asked a doctor to recommend less costly prescriptions; developed a budget to manage health care expenses; checked the price of a service before getting care; and used an online cost-tracking tool provided by the health plan.
• There is also some evidence that adults in a CDHP were more likely than those in a traditional plan to be engaged in their choice of health plan: Those in a CDHP were more likely than those with traditional coverage to say that they had visited health plans’ websites to learn about their plans; attended a meeting where health plan choices were explained; used other websites to learn about health plan choices; and consulted with an insurance broker to understand plan choices.
• • CDHP enrollees were more likely than traditional-plan enrollees to take advantage of various wellness programs, such as health-risk assessments, health-promotion programs, and biometric screenings. In addition, financial incentives mattered more to CDHP enrollees than to traditional-plan enrollees.

[ALL THREE QUESTIONS TO BE ASKED OF THOSE AGE 21 -64] Participation in Wellness Programs Figures Enrollment in CDHPs and HD Patient Use of Technology Appendix—Methodology the Consoli References Length of Time in Health Plan dated Omnibus Bu dget R econcil HPs iation Act of 1985 (COBRA), long-term care insura nce, health insurance while Paul Fronstin is director of the Health Research and Education Program at the Employee Benefit Research Institute Findings from the 2013 EBRI/Greenwald & Associates Figure 7 14 In theory, a random sample of 2,000 yields a statistical prec Figure 9 ision of plus or minus 2.2 percentage points (with 95-percent receiving unemployment compensation, and insurance Figure 19 Figure 15 Figure 17 Figure 1 while Figure 13 Figure 5 Figure 1 Figure 3 eligi 1ble for Medicare other than for Medigap, are also tax (EBRI). This Issue Brief was written with assistance from the Institute’s research and editorial staffs. Any views The 1. Indivi Employers an Figure Fronstin, Paul. In 2 amount 0 Whi 1 duals 3 1, , th cPremium Incr h of the followin e C wit od insur f h E time Consumer a HCS contin deducti in ers of divi eases Among Employers -Dri b du fe g u le of at be r a n e als have ven Healt d to st descri u ask abo leas mber of be h t $1, en b Be e u s dif t consumer nefits: A in a 000 your cu fere CDHP for With nt typ in Conti rrent he 10 or Mor divid is s u es of sh e of nuin uorter tha al covera wel alth insu g Evolutio tee chnolo lness benef Em nge, ot ployees, ran gy to hers w n? or $2, c e status: Washin its—progr enga Work h 00 o hav 0 for ge gton, DC: er Earni ie n he ams de f been amily covera aln th-r enro Employ gs a signed elated activities. The nlle d In d in g ee B to promote health eflation, , w tra eh ne o also ditional fit Res ha eve an arch Definitions Cost-Conscious Decision Making, by Type of Health Plan, 2013 Consumer Engagement in Health Care Survey Informed Decision Making fo a r Health Plan Choice, b The findings presented in this Issue Brief were derived from the 2013 EBRI/Greenwald & Associates Consumer Individual Participates in Wellness Program Offered by confidence) of what the result Reasons Percentage of Percentage of s would be Premium Length for Participating HSA if the entire population ages 21– Increases and T Indiv yIndiv of T pes of HRA iduals ime With HRA iduals Cost Enrollment Ain Employ m Re o Reporting ng Employ Information porting That or HSA er's Rates, That They ers With W 64 with Sought, ellness Program, They 2007–2013 , 2005-2013 W private health insur 10 Used ould or More Probably an App 2013 ance coverage were free. This means that distributions used to pay Medicare Part A or B, Medicare Advantage plan premiums, and the (Percentage of Privately Insured Adults Ages 21–64 Who Received Health Care in Past 12 Months) coverage. HSA or HRA expr and to survey foun Institute, 200 essed i pr 1988–2013 ..................................................................................................................... even Am n d t were assigned t tong i t disease. his report are hat abo 2. ndivi ut dua Th 70 e lspercent of the adu 20 th o with the CDHP group in the CE ose of 13 traditio CEHCS the a nal covera examin uthor an lt popul ed avai d sho ge, ati 21 uld HCS. labilit on perc wit not y Those wi h an ent be privat d ha ascribe pa d rticipation e he th a been dalth deducti to t in the insur h in e officers, trustees, or other t ib rl pla ance h eree ty of at l n for had used a smartphone pes o e thr ast $1,000 efe welln to fo .......................... 6 ess pro ur years for in spo div gr a and in with dual ms: a sors in by Type of Health Plan, 2013 I have health insurance through a government plan such as 50% Engagement 8% in Health Care Survey Employ (CEHC er A S), a mon n on g Those Offered a line survey that exa W m eines issues s llness Program, urrounding consumer-directed Participate More than Once Employ in ees, Employ W by o T rker er's for a ype of W Earnings and Smartphone ellness Program, by Health Plan, or Inflation, 1988–2013 2013 Tablet, Various by Various Financial By Paul Fro surveyed with complete accur nstin, Ph.D., Em acy. There are ployeealso other poss Benefit Research Institute ible sources of error in al l surveys that may be more serious than employee share of the premium for employment-based retiree health benefits are allowed on a tax-free basis. Consumer- of EBRI, EBRID -ERF, or riven Heal theirth Plans staffs. Neith er EBRI nor EBRI-ERF lobbies or takes positions on specific policy proposals. 44 coverage (or health the pas perc -risk assessment, a h tent year, for $2,000 and nearly five or mor for fami 5 e0 eyears. This perce alth-promotio ly coverage) nt haco d u 7.6% mpared with who ns pro ed did not a g ram t tablet (u h h27 pe a atve an p inclu from rcent accoun de abo d a an n ut 60 perc d u t wer 28 mber perc e assigne of ent, r ent diffe ae n rent typ d spectively, am d to t 40 perc he H es of ent, res DHP bene grou ong those in p fits ectively, p. , an Thus, d a a in the CDHP Medicare, Medicaid, or Veterans benefits.................................................... 1 (Among Individuals Seeking Cost Information) 20% 2005 2006 2007 2008 2009 2010 2011 2012 2013 December 2013 • No. 393 46% by Type of Health Plan, 2013 Health-Related Incentives Purposes and and Type of Health Plan, 2013 Type of Health Plan, 2013 39% 48%* health care, includi 18.6%ng t 13 he cost of insurance, the cost of care, satisfaction with health care, satisfaction with health care ___ theoretical calc Figure 2, Distribution _____. “Health ulations of sampling erro Savings of Individuals Accounts an Cov r. These include refusals to be intervie e d red Other Accou by Private H nt-e Based alth I Healt nsuranc h Plans.” e, by wed and other forms of nonresponse, the Type o EBRI Issue f Health Brie Plan, f, no 2005–2013 . 273 (Employ ............. ee 6 (Fi HDHP group i EBRI invit biometric 201 g2). ure 4 ) screenin es c . Wh n oile still cludes in mment on Vg. isite low d h eal divi e th th p r t duals lis research. ah ns an th ' web enroll sie te t Wperc o l ant ed ear ed t n a ein an o i n bou mpr tage t th ov HSA-eli eir e of hea pl in alth nsdivi gib duals le healt with h tra plan d w itional ho ha covera d not ope ge, tnhed the e numbe 43% HSr of A. More peopdetai le witl abo h a ut Checked whether plan would cover care 2007 2008 20 41% 09 2010 2011 2012 36% 2013 49%* 100% (Among Those Who Use a Smartphone or Tablet) These refer to 90% account-based health plans that include either a health savings account (HSA) or a health Distributions for nonqualified medical expenses are subject to regular income tax as well as a 20 percent penalty 39% I have health insurance through my job or the job 57% 57% * * plans, reasons for choosing a plan, and sources of health information. It also presents findings from the 2005 ?2007 Benefit Resear 18% ch Institute, September 2004). effects of ques Where the world turns for the facts 7% tion wording a 42% nd question order, and screening. While attempts are on U.S. employee benefits. made to minimize these factors, it is Premium Increase Worker Earnings Increases 42% Overall Inflation Prescription Drug CDHP a the metn hd the odolo len gy is gth 16.7% provided in t of time they he have appen been dix. enrolled in a CDHP plan have be 24% en increasing. In 2013, 28 percent of 17.1% a c reimbursem ent arrangement (HRA), described in more detail b below. of another family member Nutrition information (such as spouse or parent) ................................ 27% 2 48% (increased from 10 percent in 2010 as Tradi a tiona relsult of t HDHPhe CDH Patient Prot P ection and Affordable Care 87% Act of 2010 (PPACA)), Figure 3, HSA 90% and HRA Enrollment Rates, 2007–2013 .............................................................................................. 7 39% 34%* EBRI/Common Introduction wealth Fund Consumerism in Health Care Survey, and the 2008 ?2012 C 37%EHCS. The 2013 CEHCS was 78%* The survey fo impossible to q Among those who used und that C uantify theD a err H sm Po enro rs that may re artphone llees we or tablet, 24–34 percen re more likely sult from them. athan tra t used ditionan app acl-plan for enroll nut ees to report th rition information; 22–29 percent at they had the 80 40 % % 77%* b84%* To maintain current health status 33% 42% CDHP enrollees rep To alrted ked to th frieat th nds, fami ey ly , c hol ald be eagues en abo iut t n th he p e h lansealth plan at least five years, up from 33% 8 percent in 2006 (Figure 5). Asked for generic drug instead of brand name drug 38% Traditional HDHP CDHP 47%* 16% Figure 8 Copyright Information: This report is copyrighted by the Employee Be 22% nefit Research Institut 48%e * (EBRI). It may be which is waived if the o80%* wner of t6.1% he HSA dies, becomes disabled, or is eligible for Medicare. 37% 14.7% 37% ________. “Sources of Heal 79% th Insurance Coverage and Characteristics of the Uninsured: Analysis of the 50%* March 2013 conducte In 2013, 9. d Gwit 7 enepercent rhin th al healthe Un in of t formited States ah tio e npopulation betw wa ee s enrolled n August in 8 a an CDHP d August , about 20, 20 the same as in 13, throu 24% gh a 2012 13-minut (9.6 per e Intern cent); et surv enrollm ey. Th ent ie n I have health insurance that I purchase from a health 78%* option to Employment-based h used one for general fill out a health La e health i b o alth r r-ris a benefits are the most common form diok assessment. Specific lon gy formation; 19–2 36% 6 perce ally, nt 51 used o percent n of e of C heal for wei th insura D5.9% HP enrollees report ght ma n 36% nagement or ce in the Unite ed that diets d St;their ates. In and 2 employer 2–20 29 12 percent , 15 6 Retirement 80% and health benefits are at the heart of workers’, employers’, and our nation’s 29%* 6% Trends in Cost-Conscious Decision Making, by Type of Health Plan, 2005–2013 5.8% 34% Health Savings Accounts 15 Figure 4, Number of Years Covered by Current Health Plan, by Type of Health Plan, 2013 .......................................... 7 used without permission but citation of t 73% he source is required. 73% 73% 70% Current Popul insurance co ation Survey.” mpany EBRI Issue ...................................................................................... Brief, no. 390 (Employee Benefit Research Institute, Se 3 ptember 2013). Permitted insurance also includes workers’ 14% 66% compensation, tort liabilities, an22% d liabilities rel 31% ated to ownership or the use of HDHPs incr national Findings from the 2013 EBRI/Greenwald & Associates or e ba ased se sample from 16 was pe dra rcent i wn nfrom I 2012 p to 18 sos’ onli percent ne panel o in 2013 f I n(Fi tern gur et users e 2)28% . The who 9.7 have a perceg nree t ofd the to partici population pate i w n ith a economic security 70% . Founded in 1978, EBRI is 33% the most authoritative and objective source of 65% offer million used eo d ne for e individuals un a health-risk assessment, compar xercise pro der W age 6 ant gra ed tms o l5 ear , (Fi n m org 58. or ur e a e 19 bou 5 perce ed t ow ). n he with An n al t of ap th r 31 ip is sk tha sper a t population, cprogram ent of 29% tra that diti ho anal-plan runs insi d employme enro d42% e an nt-base llees a other servic n dd 29 healt percent e, h such as a bene of H fits (Fr DH oP nstin, Exercise pr 64% ograms 5.4% 22% Individuals are able to roll Base: Adults Ages 21–64 Who Received Some Health Care in Past 12 Months over funds from one HSA into another HSA without subjecting the distribution to income and Consulted with your employer's HR staff about you choi68% ces 24%* Talked to doctor about prescription options and costs 32% 34%* 63% 70% 67% 67% 67% 41% 29%* 12.1% Familiarity With CDHP A health savings account (HSA) is a tax-exempt trust or custodial account that an in 30% dividual can use to pay for health prop erty (such as automo Obile insurance) ffice visit . 64% 64% 38% 40%* CDHP r research surv epreseeys. Two thousand nts 11.8 million adults a adults ages 21 ges 21–64 - wit 64 w h pri hov had he ate insura alth nin cesurance t , while thh e 18 roug perce h an em nt with a ployer or n HDHP who pur repre chased sents information on these critical, complex issues. 63% a enrolle 201 smartphone 3). In es (Fi ever or gure y year sinc tabl 12 et. U ). Aske 30% nlike e d a 1998, 5.0% fin bout t d pr inemium gs from he av 30% ailabil increases 201i2, C ty ofD hav he HP 30% alth e e e nro -promotio xce llees edewer d w ne o pro rker-ear more like grams, 56 percent nin ly th gs increases an traditional of C anD d HP enrollees and inf plan lation enrol (Fig lees urto e 1 ). I have other health insuranc Weight management or e (specify _______________) ............................... 19% 4 Consumer Engagement in Health Care Survey penalty taxes as long as the 4.9% rollover occurs within 60 days of the date funds are received. Rollover contributions from Figure 5, Le 60 12 % ng % th of Time With HRA or HSA, 2005 ?2013 ........................................................................................... 57%* Traditional 42% 9 Recommended Citation: Paul Fronstin, “Findings from the 2013 EBRI/Greenwald & Associates Consumer 21% 30 5% % 59% Taylor, Hum phrey. “Does Internet Research ‘Work’? Comparin 11.2% g Online Survey Results With Telephone Surveys.” diets 28% 28% 28% 26%* 1 28% care expenses Most people 60% w. Contributions ith a CDHP said to the accou they were fa ntmiliar are deducti with the pla ble from n. Three-quarters taxable income, (7 even 7 percent) of those with a for individuals who do CDHP wer not e 4.6% 43%* 22.1 directly millio from n of a those a carrier were ges 21 drawn ?64 with ran priv dom Coate insura nv ly from t enient to wo h rn e kce. Ipsos sa Among the mple for 22 this .1 mibase sam llion individuals ple. This with sample an HDHP, was stratifi 42 percent ed by 34% 10.1% 26 27% % 27% 36% 27% 40 Health i report perc havin ent o nsuran g f traditional used a ce premiums smartphone or -plan have n enrollees early tr tablet reported that ip for led, w healt hile h th -rel wo eir 2005 ated rker ear em pur ployer 2006 p nin oses such as gs offer 2007 have i ed such a ncrease 2008 nutrit program. d 5 ion in 2009 4 perc formatio One-thir 2010 ent. n, genera 2011 d (35 perc l h 2012 ea ent) of lth 2013 4.5% Archer M edical Savings Accounts (MSAs 10.1% ) are also permitted. Earnings on contribution 38% s are also not subject to income 16 Attended a meeting where your choices were explained 28% Engagement I do not have health insu in Health Care 26% Survey,” rance curr EBRI Issue Br ently ............................................................ ief, no. 393 (December 2013 26%). 5 26% Talked to doctor about treatment options and costs 33%* International Journal of Market Research. Vol. 42, no. 1 (August 2003). Only Medicare enrollees ages 65 and older are allowed to pay insurance premiums from an HSA. A Medicare enrollee under By Paul Fro Balan ncstin, Ph.D e of HSA o De r HRA ntal c., Em are ployee Benefit Research Institute 33% itemize their t 10%axes, and tax-free distributions for qualified medical expenses are not 30%counted as taxable income. Tax- extremely, ver EBRI focus 50% y, or somewh es solelat famil y on emplo iar with y it ee(Figure benefits research — no lobb 6). In contrast, 29 percent of in ying dividuals with or advocacy traditional 4.2% . coverage (or gen Total Sample 9.3 m der, age, illion r)e re gion, porte income, and race. d that they were e The res ligible for an ponse r HaS 953 te was A but did not 1,363 37.2 percent have 1,794 such a (32 percent 1,548n 36 % account. 1,651 * for t 1,601 h Thus e base sample o , overall, 1,509 1,474 21.r1 million 1,423 46% 18% Figure 6, Fami HDHP e information, EBRn I E rolle mploye e ex liarity With sercise reporte e Benepro fit R d t e g s Co ra h ee ams, wei ns availa rchumer-Driven Healt Institbility o ut ge I ht m ssue B fanagem a healt rief (IS he h S Pl nt or Nprom 08 ans 87 di , 2013 ? otion pro 13 et, pr 7X) is ................................................................................. 9 ices 4.1% pu gbli ram fo sh r prescri ed m , signi onthly ficantly p 36% tion by the E drugs, co lom wer t ployee B hntact an o eneffit ing fe R r rates ea h seare ch alth amon Insti pl tut an’s g e, taxes. 50% 23% 23% 8.1% age 65 cannot use an HSA to pay insurance premiums. 10% 42% c [IF Q1 = 1,5, Checked whether health plan would cover care 1100 13t4% h S EBRI PtSKIP THE OTHER 2 Q r.i N ces W for , S stand pr ue ite sc 8 ript s 78, ion alone in em Washington, D U pl CE oyee , 2 S 0TIONS] 005ben -4051, efits at $3 51% rese 00 pear r ych ear or i 58% as san in 50%^ clinde uded as pend 55%^ part eof nt, a m 50%^ nonprofit, and no ember47%^ ship subscri c48% p3.8% tion. npa P 45% rtisan eriodi- 39% In resp were extr free distri onse, emp emel butioy, very, or so ns are loyers hav also all mewhat eo b wed for een seeking famil certa iar wit in premiums. ways to manag h a CDHP , an e the cost increases. During d 36 percent of 7.5% individuals the with p an ast decad HDHP w e, eemp re extre loyers mely, Offered incentive prizes 33% 25% 33%* adults a nationalg sampl es 21e –64 , an wit d 44 h priva perctent for e insura th ne ov ce, rersample). As eprese 9% nting 17 a .3 non perc -pro ent o babi f that mark lity sample, et, tra were eith ditional survey er in a CDHP margi or i n-ofn -err an or 7.3% 21% 27% CDH CDHP P 21% CDHP a customer servi nd tradces, medi itional-plan cal-c enlrollees. aims hisWh tory, and pric en asked abo es u for t bi medical ometric-s care. c 21% reenin g prog 35% rams, 51 percent of CDHP enrollees Report availability: 8% This report is availa 8.0% ble on the Internet at www.ebri.org drugs 18%* 6.9% Used other websites to learn about your choices 30% cals pos 40 ta % ge rate paid in Washington, DC, and additional mailing offices. POSTMASTER: Send address changes to: 20% EBRI Issue Brief, 1100 Asked doctor to recom Outpatient men prd ocledu essr e/s cos ur tlger y presc y ription drug 39% 36%* Asked for generic drug instead of brand-name drug 40% organization. It analyzes and reports resea n/a rch data 48 without 46 spin o 50^r unde 46^ rlying 44 agenda. 46All fin 41^ dings, 37^ 6.3% b a Figure 7, Cost 20%-Conscious Decision Making, by Type of Health Plan, 2013 ........................................................ 24% ......... 10 have i very, or ncreasin somewhat familia gly turned th r with a eir attentio CDHn to P. account-based he 6.1% alth plans—a combi 6.1%n 6.1% atio 6.1% n of health plans with 6.1% b deductibles HDHP that estimates do wa not apply. Ho s eligible for a wever, n HSA had the survey but had not open used ed t a pro h14% e acco babi unt. lity s When t ample, 30% h the eir chil madren ar rgin 38% of * e cou error n for the nationa ted, 26.1 millio l sample n 13th St. NW, Suite 878, Washington18% , DC, 20005-4051. Copyright 2013 by Employee Benefit Research Institute. All right Ts r radi ets io en rv aed. l No. 393. reported that their employer offered such a program, compared with 33 percent among tradition HDH al-plan P enrollees, and Health Reimbursement Arrangements Check provider hours 13% HDHP The HSA is owned by the individual with the high-deductible health plan and is completely portabl 5.5% e. There is no use-it- Endnotes Talked to doctor about prescription options and costs whether on financial data, 17% options, or trends, n/a are reve n/a aling n/a and n/a reliable 35 — the re 35 ason 37 EBRI informatio 30^ 28 n is 17% 6% Reduced premiums 37% 18% 16% 2.9%16% of at Among those least $1,000 who for have emp nev loy eee-only r used a cover n app for age health-relat and tax-prefer ed pur red savin posesg , about s or spendin 35–45 p g accou ercent nts th are at workers very or somewhat a and their 30% 18% 32% b indivi would hav duals 30 e3% wit % beh en ± private i 2.2 per nsur cea nnce, r t. epresenting 15 percent of the market, were either in a CDHP or an HSA-eligible 15% a 30 percent among HDHP enrollees. HDHP Talked to doctor about treatment options and costs Traditional the gold standard for private analysts a AT A GLAN nd 42 de 15% cision 44 make CE 44 rs, gove 45rnme33^ nt policy 31 maker33 s, the media, and 28^ 26 2. Which of the followin or-lose-it rule associated Vig siwit be on ca hst describe an re HSA, as sany money your health pla left in t n's de he accou du 25%ctible nt at t : he end of the year au Trtomatically roll aditional s over A health reimbursement a Asked healthrra plans ngement to send you i(HR nformA ati ) is a on in the n emplo mail yer-funded health plan 19% that reimburses employees for qualified Make an appointment 12% 4.1% Figure 8, Trends Developed budgetin to mana Cost-Consc ge health ca ious Decisio re expenses n Making, by Type of H 17% ealth Plan, 2005–2013 ......................................... 11 30% 13% 17% 21% families interestecan d in u usse to pay ing one the for th ir out-o ings lik f-pocket e nutrit healt ion in hformatio care exn, ex penses. A ha ercise prndfu ograms, w l of eme plo ight mana yers started o gement or fferindiets, g account-based plan. Asked doctor to recommend less costly prescription drug 4% 27 2.3%12% 3112% 30 28%* 36^ 34 32 35c 29^ 27 This survey was made possible with support from: a 1Cost- Cons the cious Beh public. avior 20% 2.2% and is available in the following year. This contrasts with flexible spending accounts (FSAs), which i CDH mpose time P limits on 11% Major Reason medical Calculated from Figure 1. expenses. An HRA is typically combined with a hi 2.1% gh-deductible health plan, th Tough raditiona this l is not required. An HRA Contact health plan's 10% [A deductible 20% is the amount you have to pay before yo To avoid premium increase ur in31% surance plan will 19% start paying any part of your medical To examine the issues mentioned above, the sample was divided into three groups: those with a consumer-drive 2.1% n 7% 2.0% 20% health CDHP enrollees were more li pres Checked price of service before getting care cript pla ion ns in drug 2001, prices wit , m h h ee dical kely than alth reimbursement arra -claims tradi histtory, and ional-plangen ngements enr e 24 o ral llees to he (HRAs alth 20 partic inf)o.rmation In 21 ipate 2004, in 23^ healt (Fi employers we gure h-risk assessments, health 25 20). Amon 24 re a g in ble to start 28^ dividuals 23^ offering with - a 26 The Employee Benefit Research Institute (EBRI) was founded in 1978. Its 1.9% mission is to 12%* customer service 14%* 10 2% % Inpatient surgery 13% 26% Figure 9, Informed Decision Making for Health Plan Choice, by Type of Health Plan, 2013 ........................................ 13 The when theory be the spenhind dingaccount /reimbur -based sement can plans oc ancur before d plans with for high feiting th er dedu e acco ctibles is t unt balanc hat te. he cost-shari 8% ng structure will be more can also be Tal of 2% ked to fere your d on doct a s or or o ta ther nd-a heallth p one rofes bas sional is or w about the ith com plans prehensive 8%* insurance that does not use a high deductible. bills.] 2 14% b When HRAs Ch 10 eck a %n ed HSAs d price of sare ervice ebef xamine ore getd se ting ca par re ately in the CEHCS, it was found that H 33% R *A enrollment fell, while HSA Checked quality rating of doctor/hospital ? The 2013 EBRI/Greenwald contribute to & Associates Consumer , to encourag 18e, an Enga d to enhanc 21 gement in 20e the developmen Health C 25^ 24 are t of sound empl Survey (CEHC 24 27^oy See ben ) finds 26 efit n/a health plan (CDHP), those with a high-de 2.1%ductible health plan (HDHP), and those with HDH traditional P health coverage. 2.5% 8% health pla 2 promotion pro CDHP, 45 n perc s with health g ent rams, were very and bi saving ometric or somewhat s accounts (HSAs) screenings. Thre interested in . Be-quarters y 2 u 013 sing a , 23n p (77 a ep rcen pe p to 16% rcent) of t of check em the bal p CDH loyerP s w enro ance o ith 1 llees f0 th ?499 workers pa e H rticipate SA or HRA. d an in a d 39 health per- - Blue Cross and Blue Shield Association HealthEquity Minor Reason 1.4% 39%* EBRI explo Medical c res the breadth of emplo laims history 8% yee benefits and related issues. More information about HRAs and HSAs ca 10% n be found in the box on page 22 and in Fronstin (2002 and 2004). 1.3% likely to Who we are engage individuals in their health care spending an 14%d select * ion, compared with those enrolled in more traditional Employees ar Developed budget to manage health care expense e eligible for an HRA only To addrprograms and so ess spec wh ificen th he salth p eir rund public policy oble emplo m n/a yer offers suc n/a through objective hn/a a health n/a resear planch and . 153 educati 16 on. EBR 18 I is the only 16 15 enrollment increased (Figure 3). It was also found that a 16%* gro 21% wing share of 26% the HDHP market was HSA-eligible. When continued slow growth in consumer-driven health plans (CDHPs): 9.7 percent cof the population was Individuals were assigned to the CDHP and HDHP groups if they had a deductible of at least $1,000 for individual No deductible cent of risk assessment, compar emplo 0%yers with 5ed 00 with or more 64 percent of tradit workers offered e ion ither a al-plan n HRA enroll - o ee r HSA-e s (Figure ligi13 ble). Over on plan. e-half (57 percent) of 4% CDHP 0% EBRI Me studie ntal heal sth c the worl are d of health and retirement benefits 18% — issue * s such as 401(k)s, IRAs, retirement Figure 10, Availability and Use of Cost Inform 7%ation, 2013 ....................................................................................... 13 12% Eligibility private, nonprofit, nonpartisan, Washington, DC-based organization committed exclusively to Used online cost-tracking tool offered by health plan n/a 8 8 12^ 12 11 11 11 12 Chevron coverage. Th 1% Pis study rices for medi fin cad l cs ev are idence that a 6% dults in 9% 0.2% a CDHP and those National Rural Electric C in an HDHP were, in fact, mor ooperative Associatio e likely than those in n Consulted with an insurance broker to understand your choices 20%* If employer offered If required to If employer offered If employer offered If employer If employer made If employer reduced examini Used onl ng onl ine cosy t-t those e racking toon l roll proved idedin HSA by health p - or lan HSA-eligible plans, 13% the overall number of 0.7% individuals with an HSA or enrolled 3 enrolled in a CDHP, up from 9.6 percent in 2012, whi 12%* le enrollment in high-deductible health plans coverage or 0%$2,000 for family coverage. To be assigned to the CDHP group, they must also have had an account, such income adequacy, consumer-driven benefits, Social Security, tax treatment of both retirement and health CDHP enrollees participated in a health-promotion program, compared with 12% 46 percent of traditional-plan enrollees. Employers hav See www.mere cer.com treme/press-releases/1565095 ndous flexibpublic ility in poli designin cy r esg h earch ealth and pla edu ns that cation on incorporate economic s an H ecuri RtA. For y and em exam plople, t yee bh enefi e amou t issu nt of es. $250 cash incentive participate to enroll time off discounted inc25 re% as *ed premium additional contribution to Individual or Single Coverage b Health-risk Assessment Health-promotion Program Biometric Screening a traditional -2 pl % an to exhibit a number o -1.1% f cost-conscious behaviors. Specifically, among privately-insured adults ages 21- 0% Require10 d b % y employer 20%24% 30%22% 40%HDHP 50% 60% In order to qu 0%alify for tax-free contributions to an HSA, the individual must be covered by a health plan that has an in an HSA-eligible plan increa 0%* sed 16 perc 5%* ent from 10%*17.5 mi 15llion to %* 20 20.4 m %* illion, a 25%*ccordin30 g to t %* he CEHCS. 35%* 40%* Conc Employers hav lusio (HDHP n e s also lo ) increased from 1 ng been i in prn eftereste ered 6 percent in 2 health d in bringi012 to 18 per ng aspect prs of emiu c m cent in 2013. onsume for non- r e pan rtic gip Overall, 26 aant ge sme cn ont t in ributto he .1 ion to million individuals wi alth p HRA lan /HS s a A s a meath ns to as a health sa benefits, vings accou cost nt manage (HSA) or ment healt , h worker a reimbursem nd employe ent arrar ngement attitudes, (HRA) wit policy reform p h a rollover ropo pr sals, ovision that t and pens hion ey assets Figure Deseret Mutual 11, Types of Cost Information So EBRI’s member ught, by ship includes a Type of Health Pla cross-section of Optum n, 2013 ..................................................... pension funds; businesses; trade associations ....... 14 ; Nearly four-fifths (78 percent) of CDHP enrollees participated in a biometric screening, compared with 63 percent of money that is placed Le iss n T th hae n O account, th ne Year e level o1- f th 2 Ye e arde s0%ductible, 10%and the com 3 20 -4% Yearspreh 30e %nsiveness of t 40%5 Yearh s o e he 50 r Mor % alth e insur 60% ance are plan HRA/HSA 0% 10%2005 2006 20% 2007 30% 2008 42009 0% 2010 50% 2011 60 2012 % 2013 4 64 who rece ived My deductibl health car e is less than e in the past 12 $1,000 months, thos e in a CDHP and those in an HDHP were more likely than those annual deductible of not less than $1,250 for self-only coverage and $2,500 for family coverage (minimum deductible and funding. There is wi labor un despread ions; health recog care prov nition iders and insur that if employee be ers; government org nefits data exist, EBRI kno anizations; and service firms. ws it. help control 0% health care spending and costs. As far back as 1978, they adopted Sec. 125 cafeteria plans and flexible See Appendix for more detail private insurance, represen on the meth ting 15 percent of that mark odology. et, were either in a CDHP, or in an HDHP that was could use to -4 pay for m % edical expenses or the ability to take their account with them should they change jobs. The 2013 EBR Source: I/Gr EBR een I/Gwal reenwd ald & Associates & Associates Co Consumer Engagement nsumer En in Health C gagement are Survey, in H 2013.ealth Care Survey (CEHCS) finds continued slow traditional-pla Source: Source: n enro EBR EBRI/G I/G llees. reenw reenw ald & Associates ald & Associates C Consum onsumer er Engagement Engagement in H in Health C ealth C 0% a are Surv re Survey ey20 , , 2013. 2013. % 40% 60% 80% 100% all subject Total Sample to variation. Employers often cover certain preventive services in full, not subjecting them to the deductible. 417 802 1,284 1,484 1,693 1,914 1,762 1,416 1,188 Source: EBRI/Greenw HDH ald & Associates P: HSA-eligibl e Consumer Engagement in Health Ca CDH re Surv P: H eyS , 2013. A CDHP: HRA By way of coSource: amparison, a 1988 EBR 19I/G 89 reenw 1990 n ald & Associates 19 u91 mber 1992 of ot 1993 C19 onsum her surveys trac 94 19 er 95 Engagement 1996 1997in H 1998 ealth C k enro 1999 are Surv 2000 llm 20 eyent 01 , 2013. 2002 in CDHPs. Am 2003 2004 2005 20erica’s Healt 06 2007 2008 2009 h I 20n 10surance Plan 2011 2012 2013 s (AHIP) a a with traditiona Trl covera aditional = health plan ge to say that they with no deductible or <$1,000 (indiv had: idual), <$2,000 (family). T Tr raditional = aditional = health plan health plan w wiith th no no deductible deductible or or <$1,000 (indiv <$1,000 (indiviidual), dual), <$2,000 (family <$2,000 (family). ). amounts are i aaSource: ndexed to i EBRI/Commonw nflation). ealth Fund C Cert onsumerism ain p in H rev ealth C entiare Su ve ser rveyv , 2005–2007; EBR ices can be I/G c reenw ove ald re & d in full and are not Associates Consumer Engagement in subject to Health the Figure 12, Employer O Traditional = health plan ffers Wellness Pro with no deductible or g <$1,000 (indiv ram, by iType dual), <$2,000 (family of Healt ).h Plan, 2013 ........................................................... 14 spending acco eligible for a Trunts (FSAs). aditional = health plan health More rec wsaving ith no deductible se acc ntly, or o <$1,000 (indiv employ unt (HSers ha idual), A) but had not opened th <$2,000 (family ve begu ).n to take a broader v e accoun iew t. of co nsumer engagement in Individuals wit b My deductibl h only a flexe is $1,00 ible spendi 0 or more ng account (FSA) were not included in the CDHP group. growth Checked whether health plan would cover care Sour in ce: EB con Rb b I/HDHP = High-deduc Gsrumer-dr eenwald & Aissoci ven tib at le health es health Consu plan pla me wri th En n deduc ga s (CDHPs): getible men$1,000+ (indiv t in Health 9.7 Ca idual), $2,000+ (fam percent re S 61% urvey, 20 of t 13 62% . ilyh ), no e popul ac 61%* count.ation 61% was enrolle 56%* d 53%*^ in a CDHP, 55%*^ up fro 54%* m 49%*^ HDHP = High-deduc HDHP = High-deductib tiblle e health health plan plan w wiith th deduc deductible tible $1,000+ (indiv $1,000+ (indiviidual), $2,000+ (fam dual), $2,000+ (family ily), no ), no ac acc count. ount. b Care Survey, 2008–2013. Employers can b offer comprehensive health insurance that covers 100 percent of health care costs after the deductible HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. found that 5 a the c HDHP = High-deduc number of tib pe le health ople plan enroll with deduc ed i tible n an $1,000+ (indiv HSA-eligi idual), $2,000+ (fam ble plan i ily n ), no crea accsed from ount. 13.5 million to 15.5 million between c c Traditional = Source: EBR a CDHP = Cons health plaI/C n w ommonw um ith er-driv no de ealth Fund en duhealth ctible o plan C rEBRI’s work advances knowledge and unders onsumerism <$1 wi,th 00 deduc 0 (ind in tible iv H id ealth C u $1,000+ (indiv al), <$ are Surv 2,000 (f ey idual), a , m 2007; ily). $2,000+ (fam EBRI/Greenw ily), w ald & ith ac Associates C count. tanding of emplo onsumer Engagement in y Heal ee benefits and their th Care Survey, EBRI delive CDHP = Cons CDHP = Cons rs a stead um umer-driv er-driven en health health y stream of invaluable research and anal plan plan w wiith th deduc deductible tible $1,000+ (indiv $1,000+ (indiviidual), dual), $2,000+ (fam $2,000+ (family ily), w ), wiith th ac acc count. ount. ysis. ded Traditional plans include a br uctible. Th c c H e out ealth reimbursemen -of-pocke t arrangement. t maximum oad range of pl maan types, includ y not exceed $6, ing health ma 250 for selfintenance orga -only coveragnizations (HMOs), preferred provider e and $12,500 for family CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. health CDHP e Asked for generic drug instead of brand-name drug care. nrolle Se CDHP = Cons o sme are intro were also m umer-drivducin en ohealth re like g plan mor ly tha w/ deduc e workplac n tible traditio $1,000+ (indiv e nal-pla wel idual), $2,000+ (fam lness pr n/a n enro ollees g 60* ram ily), w to is, usually i th ac report t 58* count. h 58* nat th the form eir em 52*^ of ployer heal 50* o th-risk assessments or ffer 54*^ ed a cash 52* 47*^ b Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2013. * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. 9.6 perc HDHP ent i = Hi2008–2013. g * * n h b Differenc Differenc -d201 educt2. Enrol ie e blbetw betw e heeen HDHP/CDHP een HDHP/CDHP alth pl lm an w ent i ith den hi d and T and T uctib gh r rle aditional aditional $1 -de ,000 d is is + ( ucti s st tiatis atis ndible v tic tic ida a u lly lly ahealt ls s ), $ iignific gnific 2,00 ant ant 6h 0+at at pl (fp p ami ans = = 0.05 0.05 ly), n (HDHP or better. or better. o accouns t.) increased to 18 percent. Overall, 21.1 million Source: M Health sav ercer, ings account. National Survey of Employer-Sponsored Health Plans (www.mercer.com/press-releases/1565095), and Bureau of Labor Statistics. Table of Contents has been m et Don’t kno or they may w a o mffer ount of indi coverage vidual dedu with cost sharing ctible after the deductible is met. If employers choose to pay less * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. ? Checked * Differenc w e h betw ether th een HDHP/CDHP e plan and T importance to wo raditional uld cov is ste atis r car th tice nation’s econo ally e signific (57 ant p at ep rcent = 0.05 my or better. CDHP a among policy nd 49 m percent HDH akers, the news P vs. 39 percen media, and the public. It t January 201 c 2 and January 2013, a 15 percent increase. Mercer found that the percentage of workers with Figure 13, In dividual EBRI Participates in publications Welln incluess Program O de in-depth cove ffere rage d by Empl of key issues a oyer Among nd T tren hosde Offered s; summarie a Welln s of rese ess Pr arch ogram, Talked to doctor about prescription options and costs CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,0n/a 00+ (family), n/a with accoun n/a t. n/a 42 40 41 39* 34*^ organizations (PPOs), other managed care ? Unlike in prior years, when health reimb plans, and pla ursemen ns with t arr a broad variety of cost-s angements (HRAs) and haring arra HSAs wer ngem e examined ents. The shared Indivi coverage, duals wit we hre as the deductible counting to signed to the HDHP gro ward this limi up if they did t. The minimum allowable not have an account used dedu for healt ctible and h care maximum o expenses u with t-of- a biometric incentive or scre reenin ward for gs, an parti d em cipatin ployers oft g in ae w n provi ellness deprogra financia m. Just l incent over ives7 to incre 0 percent ase reworker ported a partici cash pation incentive in suc or r h eward for adults ages 21–64 with private insurance, 17.3 percent of that market, were either in a CDHP or in an HDHP that was * Difference between HDHP/CDHP and Traditiodoes this b nal is statistically y co signnducting ificant at p = 0.and p 05 or be ublishing policy re tter. search, analysis, and special reports on than 100 percent of health care expenses after the deductible has been met, they then have the option of designing What we do traditional). employment Talked to doctor about treatment options and costs -based covera findings and ge covere policy d develo by a CDHP i pments; ncreas timel 56* ed from y factsheet 44^ 16 per s 49*^ con ent to hot topics; 18 49 perc37^ ent regula betw r36* up een da 201 tes 39*^ 2 a on legi nd 35*^ 20 slat 13, a ive 33* and by Ty Family Coverage pe of Health Plan, 2013 ................................................................................................................... 15 Introductio separ n .................................................................................................................. ately, HRA enrollment fell, while HSA enrollment increased. The 2013 CEHCS also found ........................................ 4 that a   rollover pocket l characteristics of these plans iprovision or mit are indexed to i portabili n are that they ty if t flation. hey A n chean either have twged ork plan ma jobs. T no d his y impose e grou ductibles or deductibles that ar p in a hi clud gher ed in de divi ducti duals ble and an with e below current thresholds an HSA out-o -e fligi -pocket ble healt limit h f p o that lr out- an programs. A participating i fn ew the health-ri employers shave i k assessment; two-t n emplo troduc yee benef ed private its issues; holding educational br hirds he (64 perc alth insura entn)ce reported a exchaniefings for EBRI memb ges. cash Thiat gives ncentive or r workers more choi ers, congressional and eward for parti cc eipatin s for g eligible for an HSA but 7 had not opened the account. When their children are counted, 26.1 million individuals with the Asked doctor to recommend less costly prescription drug plan with or witho regulu atory t a maximum o development ut-of-pock s; comp et lim rehen it. 46* sive refere 41* nce 43* resources 41 on 39* benefit pro 39* grams 42* and 38*^ workforce 36* 13 percent increase. The National Health I nterview Survey (NHIS) found that the percentage of individuals with private would qualify f growing sh or tax-preferre are of the d HSA contributions HDHP market was HSA-eligible federal agency s or that are generally ass taff, and the news . When exami media; oand sponsoring public opinion survey ciated with HRAs. ning only the number of people enrolled s on employee but of-network ser may also have vicesi. nclu Ind divi ed indivi duals can duals wit have a h a high dedu health plan with a de ctible whoducti are not ble and max eligible to imum out-o contribute f-pocket limit to an HSA. The tha group t My deductible is less than $2,000 for me and my family health in a healt covera h-pro ge a motion pro nd more transparency gram, and nearl re y 72 gard percent ing coverag reporte e choices d a cas ahn inc d th entive e costs a or rewar ssociated with d for a biometric scre each choice.e ning private Enrollment Checked price of service before getting care insura in n CDHPs and H ce, representD ing HPs 15 ................................................................................................. percent of the market35* , were e 23^ ither in 27*^ a CDHP o 23^ r an HSA-eli 29^ 29* gibl8 e plan. ........................... 5 31^ 27*^ 33*^   ? Asked for issue a ges neric ; and dru major survey g instead ofs a o br f pu anblic d nam attitudes. e (50 percent CDHP and 47 percent HDHP vs. 37 percent Figure 14, Employer Offers Cash Incentive or Reward for Participating in Wellness Program, among Workers Whose insurance covered by a CDHP barebenefit issues. ly budged—from EBRI’s Ed 10.8 perc ucation and Re ent in 2012 to searc 1 h0 F .9 und per (EBRI-ERF) performs cent in 2013. The Kaiser the charFa itable mily , in HSA- or HSA-eligible plans, the overall number of individuals with an HSA or enrolled in an HSA-eligible with tr qualifies aditio them na to make l health cov a ta erxa-ge free inclu contr deid i but nidivi on to a duals i n HSA, n a broa but they d range are of plan ty not require pes, d tinclu o make a ding h cont ealth ribution maintenanc or to eopen There is no statutory requirement that an employee have a high-deductible health plan in order to also have an HRA. Health Plan Choice (Fi Checked quality rating of doctor/hospital gure 14). The main reasons enroll Decisions ees participated were 22to improve 18 or maintai 19 22 n health 22(Figur 22 e 15). 27^ There wer 27 e no n/a EBRI meetings present and explore issues with thought leaders from all sectors. traditional). 6 My deductible is $2,00 educa 0 or more for me tional, and scientif and my family ic functions of the Institute. EBRI-ERF is a tax-exempt organization Employer Offers Wellness Program, by Type of Plan, 2013 ......................................................................... 15 Figure 2 Figure 4 Figure 6 Familiar Foun See dation www.aahp.org/hsa2013/ ity Wit (KFF h CDHP ) foun ......................................................................................................... d that the perc entage of workersFigure 20 Figure 14 Figure 12 Figure 18 Figure 16 with a CDHP increased from 19 percen ................................... 8 t to 20 percent between   This Developed budget to manage health care expense Issue Brief presents findings from the 20 s 13 EBRI/Greenwald & Associates Consumer Engagement in Health Care plan increased from 17.5 million to 20.4 million, a 1 n/a 6 percent incr n/a n/a ease. n/a 18 17 20^ 18 17 organiz However, an accou ations (HMOs), pre nit is t. standard pract ferred provi ice amond g er organiz employers that ations ( aPPOs n em) ployee , other m manage ust also choos d care pla e a nhigh-de s, and pl du ans ctible with hea a bro lth plan i ad n The 2013 CEH CS conti EBRI nue regula d tor fin ly provides d that CDco HP enrol ngression lees al are more testimony cost c , an od nscious in t briefs policy heir mdecision akers, mem making t ber o hran ga tho nizations, se in differences found by plan type, so that information is not shown. supported by contributions and grants. There is also some evidence that adults in 9 a CDHP were more likely than those in a traditional plan to be engaged in Distribution Familiarity With Consumer-Dri of Individuals Covv ee red by n Health Plans, 2013 Private Health Number of Years Covered by Current Health Plan, Employ Percentage of Reasons Employ Interest er er Offers Offers W for Not Participating in Using Indiv Cash ellness Program, iduals an Incentiv A Re pp porting That for in e or Employ a Smartphone by Rew Ty a er's pe rd They for of W ellness Health W Participating or T ould ablet, Plan, 2013 Probably Program in 201 Used online cost-tracking tool offered by health plan 2 and 201 Don’t kno 3, a 5 perc went am increase. ount of family deductibl e n/a 6 9^ 10 9* 10101113 Survey (CEHCS). and This stu the medi dy is based on a on employe an onlin r benefits. e survey of 3,853 privately insured adults ages 21 -64 designed to variety of cost-sharing arrangements. The shared characteristics of these group members were that they either had no traditional order to have plan an HRA. s. CDHP enrollees were more likely to use resources to pick their health plan and more likely to use cost Cost-Conscious Behavior 7 ? Talked to their doctors ....................................................................................................... about prescription options and costs (40 percent CDHP and 34 perc ................................. 8 ent HDHP vs.   Figure their ch15, oice Rea of healt sons for Part h plan. S icp ipating in ecifically, t Employer’s hose in a CDH Wellne P were ss Program, more lik2013 ely than ..................................................... those with traditional coverage to ........ 17 say Insurance, by T by y T pe of ype of Health Health Plan, Plan, 2013 2005–2013 See Figure 6 in www.mercer.com/press-releases/1565095 Participate among Those Offered but Not Wellness Program, among in Employ by Health-Related Function, 2013 er's Wellness Program, by WoParticipating in rkers Whose Employ Various Program, er Cost-Sharing Offers 2013 c ? This 70%study finds evidence that adults in a CDHP and those in an HDHP were more likely than those in a To be eligible for an HSA, an individual may not be enrolled in other health coverage, such as a spouse’s plan, unless EBRI issues press releases on newsworthy Figure 10 developments, and iCDHP s among the most widely quoted provide The survey als nationally re o asked r present espoa ntive data re dents their r gardin easons for g trends noti part n accou icipati nt-based ng in their em health plan ploys and high-de er’s wellness program. ductible healt Nearl h pl y ans deductible or Don't know if a deducti have dedu ble that was EBRI Issue Briefs cti be blow le current thr is a monthly esholds fo periodi r HSAcal tax pr with i ef nerenc -depth eevalu anda that tion of em theyplo did not yee benefi have t is an sues information 28 perc before ent gettin traditional g health c ). are ser (Among Tv hose W ices. CDHP ho Never enrollees Used an App f wer or a Sm e more likely th artphone or Tablet an traditional ) -plan enrollees to take 50 10% 0% Extremely or Very Familiar Somewhat Familiar Not Too or Not at All Familiar that they The incre ha ase t d visited health racked betweeplans’ we n 2012 an W Incentiv bsite d ellness Program, by 20 s to lear 13 es was similar and T n aboy upe t thei in of Health Plan, 2013 th r T e y plans CEHCS pe of Plan, 2013 (48 (16 percent), percent CDHP vs. 39 AHIP (15 perc percent tra ent), an ditional); d Mercer Health Plan Choice Decisions .................................................................................................. .............................. 10  sources on employee benefits by all media. 2005 2006 2007 2008 2009 2010 2011 2012 2013 traditional plan to exhibit a number of cost-c Availability and Use of Cost Information, 2013 a b c onscious behaviors. Specifically, those in a CDHP were more that plan is also a high-deductible hea and trends lth plan , as . However well as crit , indivi ical anal duals yses are of allow emplo ed to h yee bea nef ve suppleme it policies and pro ntal covera posalsge . EBRI without 80% (HDHPs), 8 Contr 70 perce ibution n as t rew sp se onde ll as td that the he impact of t y did not hese p pla articip ns and ate be cons cause umer en theyga coul gem d make c ent on the hange behavior an s on their o d att wn itudes (Figure of a 16 d): ult3 s with 1 per- HRA-bas Our ed plan. Traditional HDHP CDHP Figure advantage o 16, Rea 80% f various we sons for 92%Not P llness programs, s articipating in u Employer's ch as healtWellness Pro h-risk assessments, health gram among T -pr hose Off omotion pro ered but grams, and bio Not Participat metric ing in See Figure 6 in www.cdc.gov/nchs/data/nhis/earlyrelease/insur201309.pdf attended (13 percent) surveys. Note t a meeting where h 90% h eat the Merc alth plan cher survey com oices were expl bined HRA ained (43 perc with HSA e ent CD nHP vs. rollmen 30 t. Total percent tra enrolld ment itional estimates in ); used other Total Sample 163 652 a 805 1,077 b 972 c 993 1,432 1,608 1,242 EBRI 89% directs members and other constituencies to the information they need and undertakes new Notes is a monthly periodical providing current information on a variety of employee benefit likely than those with traditional coverage to say that they had checked whether 44% the plan would cover a high deductible for such things as vision care, dental care, spec Traditional ific diseases, and in HDHP surance t CDHP hat pays a fixed amount 45 90 % % 87% a b c private cent cit ? e healt d this Talked to t 60%h as a major insurance cov a heir doctors a reason, and 38 erage. bout The sa other percent cit mple treatment optio Very Inte was ra reste edd i ndtomly as Some n a mi wha s drawn an t Int nor r de cos res from Ipsos’ on ted etason for s (3 No 6 t Int per e not res cent C tedlpartici ine Dpan HP a patin el o nd 3 g. f m 3Lack of tim o perc re than ent 775, HDHP vs e was the 000 . Availability and Use of Cost 86% Information You can make c ...................................................................................... hanges on your own 31% 38% .......................... 10  Program, 2013 ........................................................................................................................................ 17 screenings. In addition, financial incentives mattered mo a Traditional re HDH to C c PDHP CDH en Prollees th 72%* an to traditional-plan enrollees. HRAs are ty Tradi pic tiona ally set l up as 13% notional 16% arrangements and b exist only on paper. A 66% n employee may view the account as if Checked whether health plan would cover care 84% 60%* 62% 56%*60%* 71%* 63%* 61%* 53%*^ 59%*^ 56%* 57%* websites the CEHCS to l were hi earn a resea gher tha bout rch Tried to find the cost of health care services heal on a nth pl AHIP’s c n an c ongoi topics. h eoices (33 nsu ng EBRIef sba . Th sis. e enroll percent is a week 20ment estimat 05 CDHP vs. 2 ly rou 2006ndup of EBRI r 2007 4e percent s in th 2008 e CEHC 20 traditio e09 search 20S may hav 10 and nal); 20insights, as well 11 and cons 20 e 12 been 20 ulted wit 13higher as updates on h for an a Traditiona 15 l HDHP CDHP 70%* publications 82% 9 3. Do you have a special account or fund you can use to pay for medi a cal expe c nses? The accou 69% nts are care; asked for a generic drug instead of a brand name; talked t b o their doctors about prescription options Because per day (or the 70 ot base sample % her period) (n forational sam hospitalizatio plen. ) in In cludividuals ded only 18 enrolle 0 indivi d in M duals in a edicare CDH are not P and eligi 39b 7 i len to mak dividuals e HSA with an HDHP, 26 percent traditional). Internet second-most-popul See Exhibit 5.1 in users 70 80% % whoCHECK OUT EBRI’S WEB SITE! http://kaiserfamilyfounda have agr ar reason for before getting care eed to not partici particpipatin tate in ion.files g, with researc .wordp T 23 perc radi h su r tie ona ss.com/2013 lrveys. Thi ent 22% HDH rePporting s/08/8465-employer survey used CDH 30%* it P as a major reason, a ba 41%* se -health-benefits-20131.pdf sample and of 33 percen 2,000 to dr t aw Asked for generic drug instead of brand-name drug surveys, studies, litigation n/a , legislation and r 54 54* egulation affe 58* cting e 56* mplo 51*^ yee benef 53* it plans, while 53* 50* money was actually being deposited into 78% an account, but an employer does not incur expenses associated with the EBRI maintains an 66%* d analyzes the most comprehensive database of 401(k)-type programs in the insurance bro number of40 r 80 % e % aso ker to u ns: nderstand plan choices (18 percent CDHP vs. 12 percent traditional) (Figure 9). There were few Participation in Wellness Programs ........................................................................................................................ 11  sometimes referred to as Health Savings Accou 51%* 64% nts (HSAs), Health Reimb 64% ursement Accounts 51%* (HRAs), and costs; talked to their d Found information in: octors about other treatme75 nt options an 59* d costs; aske 74 d a doctor to recommend an oversample contributions, although th of individua ey ls are a with b a CDH le to wit 72%* 74% P oh r HDHP draw mon was a 63% ey dde from the HSA d. The ovefor quali rsample fiied m ncluded 1,0 edical expenses and certa 62 individuals with 72%* a inC DHP Figure It is not Talked to doctor about prescription options and costs 17, clear Per from the centage of In data dividuals whether th Repor e ditffer ing eThat nces Th in ey co n/a nsumer e Would Proba n/a ngagement c b n/a ly Participat n/a an be e in Em attribute 44 ployer 38 d to ’s Welln plan-design 41* ess Pro 38* gram, 40* incidence reporting rate it ass a mino for people r reaso win th accou . About EBRI’s Blog one-half nt-based h supplements our regular publications (53 ealth perc pla ent) ns and did not HDHPs part , and icipate becau the ba, off se samp se they ering commentar le was were already comp y o lemented n hea questions lthy with 61% world. Its computer simul 72% ation analyses on Social Security reform and retirement income adequacy 50% 61% 61% 36%* arrangem ent until an employee incurs a claim. By contrast, were an employer to set up the HRA on a funded basis, the differe Personal nces between care accou HDHP 59% n a ts, Personal m nd traditional plan edical fund 59% enrollees s, or . Choi 59% ce funds, and are different from employer-provided 10 16 Health plan's websites 52 36* 49 59% 70% 58% 58% Talked to doctor about treatment options and costs ? Asked a 60% doctor to recommrece end l ived from ess cos news tly pres reporters cript 58*ions , po ( 46^ lic 38 ym perc akers 47 ent C , and others DHP an 46 . EBRI d 3 40* 6 per Fundamentals of Employee c33^ ent HDH 36^ P vs. 27 35* percent 36* See Exhibit 8.1 in less costly prescription http://kaiserfamilyfounda You do ns; d ot have e en veloped a b ough tit me ion.files to par utidget to m ci.pat wordp e ress.com/2013 an 23% age heal/08/8465-employer th care expenses; 33% -health-benefits-20131.pdf checked the price of a and Conclusion .................................................................................................................... premiums. 791 i by Var n 60 divi % An duals ious indivi Financial I with dual an also HDHP, result n may not centives and Ty mak ing in e an a pe of Healt total sa HSA comple ntribution h Plan, (base 2013 if h plus oversample e................................................................. or she is claim ) of ed as 1,24 ...................................... 16 a 2 for depen the C dent D on a HP gro noth up a e.. 18 r nd   differences or 35 70 % % whether various plan designs attract certain kinds of individuals. Regardless, it is clear that the an additio (19 percent reported it ? First, the surv nal random oversample o are uni eys wer as a que. major reason, e conducted at f these two gro and differ 34 percen u ent tim ps. Mo t repo e re s. Th spec rteed it a CEHCS ifically s, the ov a minor was co ersamples reas nducte on). d in A For t were: ugust h 1 e m ) t 201 o hst part, th ose wit 3, a 56% nd t h e h ere wer ie AHI ther an Pe Health plan's customer service department 56% 33 64%* 31 55% 30 employer Flexible Spen would incur t ding Accou he full ex nts. pense at the time of the contribution, even if an employee had not incurred any EBRI’s website is easy to use and packed with useful information! Look for 54% Benefit Programs offers a straightforward, basic explanation of employee benefit programs in Asked doctor to recommend less costly prescription drug 45* 39* 54% 38* 36 39* 37 38 40* 38* traditional). service before getting care; and used an online cost-tracking tool provided by the health plan. 1,18 person’s 8 for ta th x r e HDHP eturn. group. After factoring out the base sample—the 180 individuals with a CDHP and the 397 under lying characteristics of the po 52% Printed material from health plan pulations enrolled in these plans ar 26 e different: 16* Adults in 27 a CDHP were significantly HRA or an no differenc census was HS es in t A, and 2 he co answer )nducte those w s to this seri d iin Ja th an n HDH uary 2 es of P wit 013. questio h out a n 40% ns aby p ccount lan ty but pe. wit h a deductible that is generally high enough to 11 60% Definitions expenses. ................................................................................................................... the private and public sectors. The EBRI Databook on Emplo ....................................... 22 yee Benefits is a statistical   Checked price of service before getting care 29 26* 27* 25 35*^ 27^ 34*^ 32* 39*^ 30 40% % See Exhibit 8.3 in 60% http://kaiserfamilyfoundation.files.wordpress.com/2013/08/8465-employer-health-benefits-20131.pdf Yes 50% 55% 28%* 28%* Figure these special features: 18, Percentage of In Provider's office dividuals Reporting That They Would Proba 23 bly Part 37* icipate in Em 31 ployer’s Wellness Program, Availability and Use of Cost Information 50% indivi EBRI make duals with ans information freel HDHP—there 53% were 1,4 y23 av indiv ailable to al iduals in thle sampl . e with traditio 27%* nal health coverage. more likely to report being in excellent or very good health. Adults in a CDHP were less likely to smoke than were meet the qualifying threshold to mak referen e tacxe work o -preferr ne emplo d cony tributions ee benefit pr to s ogru ams and ch an accou work force-related issues. nt. A high deductible was defined as 35% Checked quality rating of doctor/hospital b 18 19 18 23^ 27* 22^ 27^ 30^ n/a Provider's website 21 11* 24 50% 50% ? Develo HDH ped P a budget to manage health care expenses (28 percent CDHP vs. 15 percent traditional). ? There is also You d some 14% o not nevidenc eed it becau ese that yo 22%* u aradults i e already 25%* heal n a CDHP we thy re more likely 61% than th 33% ose in a traditional plan to be ? Second, by Various Co the Ast-Sharing I HIP census w nca es based on ntives and 9 Ty 1pe o companies. f Health 19%Some insur Plan, 2013 ............................................................. ers may not 34% 4 be reporting HSA-eligible 18 Consumer-Driven Healt EBRI assume h Pla s a publi ns .................................................................................................. c service responsibility to make its findings completely accessi ........................ 22 ble at www.ebri.org   Contr HRAs can Figures ibution 17 be an thought d 1 s 8 contain of as providin findings from g “first-dollar a series of ” covera questions relat ge until fuends d to the in th impact e accou th nt are at finexh ancial auste inc d. Leftov entives cou er fu ld nds at have No 50% 47% adults i The Developed budget to manage health care expense ince n a ntives trad of C itional DHPs ar plan, e and t desih gne ey d wer toe promote he signi s ficantly ight more ened se likelnsitivit y to exercise. y to cost in Peo pe ple in ople’s a CDHP decision were s about t also leh ss likely eir health to an in 12 dividual 25 50 % % deductib31% le of at least $1,000 and a family deducti n/a bn/a le of at least n/a $2,0 n/a00. The 32 fina 25*^ l sample 26* include 26* d 1,242 28* Other websites 5 5 2 • EBRI’s entire library of research publications starts at the m 23% ain Web page. Click on EBRI 30% See Exhibit 8.4 in http://kaiserfamilyfoundation.files.wordpress.com/2013/08/8465-employer-health-benefits-20131.pdf 40% 29% engaged in their choice of health plan: Those in a CDHP were more likely than those with traditional In additio enrollme n 40 to %— bein so that all deci ng s t nu trati m Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2013. bers to AHI fied, th sio e b ns a Pse sa , whic that mple relate to emp h woul was a d mean th lso we loyee ight at th ben ed by e efits, AHIP gen wheth ce dnsus under er, age, er m e ade destimate ucation, in Cong re s HSA-eli ress gion, income, or bo gible ard enrollme a room nd s nor t. 30% on part Used online cost-tracking tool offered by health plan icipation in wellness programs. As in past years, there were ver 21% y few differences by plan type. There were no the end of each year can be carried over to Contact EBRI the follo Publications, (2 wing n/a year (at th 02) 659-0670; 17* e employer’s 20*^ fax publication 20*discretion), 24* orders to allo 20*^wing (20 21* employees 2) 775-6312. 23* to 25*^ care. Yet the ability of people to make informed decisions is highly dependent on the extent to which they have access Both in be obese divi com duap ls and em ared with ploy adults enrol ers are allow led ie nd to co a tradntribut itional e heal to a thn pla HSA. n. C Contributio DHP and HnD s H are e P enro xclu llees ded were also mor from taxable in e li come if kely in an HDHP with either a an HSA or HRA (consumer-driven healt 40% h plans (CDHPs)), 1,188 in an HDHP without an account, Health S Issue Briefs avings Accounts and EBRI Notes ....................................................................................................... for our in-depth and nonpartisan periodicals. ........................... 22  ? Che Not su ckere d the price of a service before getting care (39 percent CDHP and 33 percent HDHP vs. 26 percent Traditional = health plan with no deductible or <$1,000 (individual), <$2,000 (family). 14 19% Figure 19, Per families’ centage of In homedividuals s, are based Repor on the highe ting That Thst ey Us qualit ed a y, nmost depe App More t nda han O ble ninformatio ce for a Smart n. EBRI’s Web phone or Tabl site et, po sts 20 40% % 32% 32% 32% coverage 40% to say that they Subscriptions to had visited h e EBRI alth plan Issue Bri s’ we efs bsite are included s to learn about th as part of EBRI eir membership, or as part of plans; attended a meeting a race/et Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2005-2007; EBRI/Greenwald & Associates Consumer Engagement in hnicity to reflect th b e actual proporti 5 ons in the population ages 21–64 with 31% private health insurance Health Care Survey, 2008- coverage. 13 31% accumulate differences f be unds over tween CDH time, P a and, nd tra in dition prinaci l-plan ple, c enrol reatin lees g thwhen e key it ince came ntive for to time o individu ff (Fi als to make gure 17). How health c ever, CDH are pur P chases to useful information. HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. 30% 30% than traditional-plan enrollees to be 17% highly educated. made and The specific q 1,423 in Orders/ by the a e “tra m uployer a estion was as ditiona nld ” h de efollows: Does your empl ducti alth plan. ble from adjusted gros oyer o s income ffer any of th if ma e de follo by th wing e i welln ndividual. ess programs? The maximum annual 29% ? traditional Third, the CE ). HCS may c be overestimating the percentage of individuals in an HSA-eligible plan, as it is based on 2013. 30all % research findings, publications, and news alerts. EBRI also extends its education and public service by Var 30% ious Health-Related Purposes The program is not $199 annual sub 27% conveniently lo and Type cateds for cription youof to Hea EB 16% lth Plan, 2013 RI Notes 27% and27% E............................................................ BRI Issue Briefs. Change of Address: EBRI, 19 CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. Eligibility where he ................................................................................................................... alth plan choices were explained; used other websites to learn about health plan ch .................................. 22 oices; and   The CDHP • Visit EBRI’s blog, or subscribe to the EBRI and HDHP oversamples 15% were weighted by gender, ef e-lette age, inc r. ome an d race/ethnicity, using the demographic 26% enrollees were more likely than traditional plan enrollees to report that they would probably participate if they were responsibly. Employers can place restrictions on the amount that can be carried over. a 20% 14% contribution is $3,250 for * Difference between HDHP/CDHP and Traditional is statistically significant at p self-only coverage and $6,450 for family coverage = 0.05 or better. in 2013. While pane 15 30 l I % %nternet surveys are nonrandom, studies have demonstrated that such surveys, when carefully designed, Traditional = health plan with no deductible or <$1,000 (individual), <$2,000 (family). 30%role to improving Ameri 1100 13th St. NW, Suite 878, Washington, cans’ financial knowledge through its a DC, 20005-4051, (202) 659-0670; fax number, ward-winning public service campaign self-reported eligibility status. Subscriptions consulted with an insurance broker to understand plan choices. CD profile of the b HP enrollees an CDHP and HDHP d HDHP en ®rol resp lees ond wer ents to the omnib e more likely than traditional us survey de scrib plan enrol ed below. lees to report that they tried to find cost As the CDHP and HDHP markets continue to expand and more enrollees are enrolled for longer periods of time, the This re offered port a Health-risk assessment, where you answer a $25 ex0 cas amines th h ince e f nti in ve, an dingsd bot fromh the CDHP a 2013n CEHCS d HD questionnaire HP enrol as they lees rand then elate were to dif more a me fer lik dical professional examines y ences ely than and simi tradlaritie itional s among plan enro our health indivi llees to duals HDHP = High-deductible health plan with deductible $1,000+ (individual), $2,000+ (family), no account. ?Contributio Used an n on s ................................................................................................................. line cost-tracki(202) 775-6312 ng tool provided ; e-mail: by the he subs alt criptions@ebr h plan (25 per i.orc gent C Me Dmbe HP vs. rship Information: 12 percent .............................. 22 traditional Inquiries )   obtain results comparabl ChoosetoSave e with and random-digit-dia the companio l n telepho site ww ne w.c surveys. hooset Ta osav ylor (2003), e.org for example, provided the results • EBRI’s reliable health and retirement surveys are just a click away through the topic boxes at Figure 20, Int 20% erest in Using an App for a Smartphone or Tablet, by Health-Related Function, 2013 ........................... 19 20% c c 18% 16% Individuals 10wh % o have reached age 55 and are not yet enrolled in Medicare may make catch-up contributions. In 2013, a CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. 20% sustained information Distributions impact that t 20% before getting ca hese plans ar re (Fi regarding gure e h 1 avi 0). ng o EBRI CDHP n cost, membership an enrol qu le ality, an es and traditio d/or con d accteributio ss to health nal plan ns to EBRI-ER enrol calre services ees w F should be dir ere equa can be lly likely ected better to to h EBRI ave enrolle report t d hhisto in tra at th CDH rey wou y to ditional P identify any co ld pro health bably plan nditio partici s, CDHPs ns yo pate if they ,u may and HDHPs. ha were ve or that you The report offered a might be at risk of developing. dis als 16% counted 16% o exami pr nes co emiunsumer enga m. Reduced cgement mor ost sharing m e ay also 56%* 21% 14% 22%* The deta(Fi iled K gurF e 7 F es ). timates on HSAs and HRAs are dif 13%ferent 13% than the other surveys mentioned a Majo brove. K Reason 13%FF found that from a number of surveys that were conducted at the same time using the same questionnaires both via telephone and the top of the page. 10% You just do no t know enough about the program 13% 14% 30% 13% 12% * Difference between HDHP/CDHP and Traditional is statistically significant at p ? CDHP enrollees were more likely than tradition = 0.05 or better. al-plan enrollees to take advantage of various wellness To effici Distributio ently identi ns ................................................................................................................. fy respondents who would qualify for the CDHP and HDHP oversamples, the stud ............................... 22 y used Ipsos’s   President Dallas Salisbury at the above address, (202) 659-0670; e-mail: salisbury@ebri.org $1,000 catch-up contribution was allowed. The catch-up 11% contribution is not indexed to inflation. 10% 10% 10% 11% 10 found information from various sources. understood. The nine years of consumer engagement surveys reported here provide unique data from whic 9.6% h to gene result in rally as great ite perta r participatio ins to he n rates. C alth care D decis HP and HDHP i 9% on makin 9% g en , co rollees st and were quality more likely th 9% information, an traditional participatio n in plan welln enrol 9.7% ess pro lees to report grams, EBRI is supported by organizations from all industries and sectors that appreciate the value of of Dis fe tributio r ratesn fso f r rHSA- om an H eligiR bA f le p olr qua ans flifi ell efd rom 26 medical pe e rce xpe nt to nses17 are m perce ade nt be ontw a ta eex- n 20 favore 12 and d bas 20 is13 . An . The drop in offer employer can also ra let a tes n online. ^ Difference from prior year shown is statistically significant at p He fou 10%nd that the use of demographic = 0.05 or better. weighting alone was sufficient to bring almost all of the results from the 10 5% 10 % % 7% Minor Reas 7% on programs 10% , such as health-risk assessments, health-promotion programs, and biometric screenings. In omnibus survey of more than 45,000 online panel members who met the study’s criteria (having private insurance and Programs for improving your health, like for weight loss, walking or other exercise, nutrition,5% stress management, • Need a number? Check out the EBRI Databook on Employee Benefits. 11 4% There measure has futur beee n cha no nges clear in t incrhis evolvin ease in the g sh type o are of f h CDHP ealth in en surance. rollees ages 21 ?64 who received hea 3% lth care in the 12 opinions that they Health Reim abou woult provi d bursement proba der bly en par Arr gageme taicipate ngements nt, cost if it r ............................................................................................. e-sharin sulted g in in lower centives cost sharin related t go for prescri plan type, a ption nd dru health gs an ind folo rmation tec wer cost sh .................. 23 hn ari ology. ng for   unbiased, reliable information on employee benefits. Visit www.ebri.org/about/join/ for more. employee use an HRA to purchase health insurance directly from an insurer. Since unused 2% funds are allowed to roll was conf Editorial Bo ined tard: o firms Dallas L with . Salisbur three to y, publisher 199 wo ; Stephen Blakely rkers and resu , editor lted . Any in views a drop i expr nes enro sed in this p llment, ublicat but K ion and th FF also ose offound a the authordrop i s should n online survey close to the replies from the parallel telephone survey. He also foun 1% d t 1% hat in some cases propensit th y st addition, financial incentives mattered more to CDHP enrollees than to traditional-plan enrollees. being ages 0% 21–64). The following three questions were used in the omnibus survey running from July 10 to August 1 HDHP e Distributions nrollee s were less likely than traditional plan enrollees to have found information on the cost of health care smoking cessation, and so on. 0% 12 not be ascribed to the officers, Y0% ou are worried that your em trust ployeees, r will km no em w ybour ers, or persoother sponsors of the E nal health mployee Benefit Research Institute, the EBRI Education and months before the survey who reported cost-conscious decision-making over the nine years of the survey (Figure 8). office visits (Figure 18). Cost-sharing incentives to participate mattered to all individuals, regardless of plan type. It was 0% a 13% 20% c over, an enrollment am empl 0% 0% oyee is a ong 0%employer He ble alt to 10 h-r% is s with accumul k Assess 200 me 20% nt ate ?99 funds over 9 work 30% ers (t tim 40 He h % alt e oh . An ugh -promo the employ 50 tio% n dec P b rogre l am in r can 60 e % was not allow 70 a statistically signi % former em Biom 80etr % ic S ploy creeni f 90 ee to icant ng % use a ). 10 These 0% ny leftover weig•htin g Instan (meaning the tly get e-m prop aensity il notifor a ?cations of the latest EB certain type of person to RI data, be online surveys, publications, and m ) reduced the remaining gaps, but eetings in other Contributions ................................................................................................................. Less Than OT nre adi in Y fo ti ear rma onatlion 1–2 Years HDHP 3–4 Years CDH 5 YeP ar.............................. 23 s or More   Nutrition Exercise Weight General health Prices for Prices for other Medical claims Balance of HSA Contact health Make an Check provider services. Among i to ide Resear ntify ch Fund, likely CDHP or n their dividua staffs. and H ls Nothin who sou DHP res g herg p eht co in is to be co ondest information, nts: nstrued as an attem CDHP pt to aid or enrolle hi es wer nder the adoption e more likely tha of any pending le n tradgislat itional ion, plan regulation, Health-risk Assessment Health-promotion Program Biometric Screening Findings from this survey ar Reduced drug co e comp st sharingared w Inicth fi reasendi d drun ggs costfro shar m in the g 20 Reduc 05 ed ? offi 2007 ce-v EBRI isit cost s /Com haring monwealt Increased ofh ficeFu -visnd Co it cost shnsumeri aring sm in Distributions from an HSA can be made at any time. An individual need not be covered by a high-deductible health plan information programs management or information prescription medical care history or HRA* plan's customer appointment hours found that between about 50 percent and about 70 percent of participants said they would participate in wellness money in the HRA to continue to cover qualified medical expenses. Funds can be used for out-of-pocket expenses and results contrast with AHIP’s 15 percent increase and the CEHCS’ 16 percent increase in HSA-eligible enrollment between cases it did no and sem t reduce t inars by clicking on the “Notify Me” or he remaining gaps. Perhaps the most striking dif “RSS” buttons at the top of our ho ference in demographics betwee mn e page. telephone or interpretative rule, or as legal, accounting, diets actuarial, or other such prof drugs essional advice. www.ebri.org service Biometr Source: Source: EBR ic scree EBR I/C I/G ommonw reenw nings, which ar ald & Associates ealth Fund Consumerism Consum e measurements or blood er in H Engagement ealth Care Su in H rv ealth C ey, 2005–2007; EBR are Survey wo , 2013. rk to I/Greenw determine yo ald & Associates Consumer ur health sta Engagement in tus including bl Health Care ood enrollees to Sour have sought ce: EBRI/Greenw co ald st information & Associates Cons um for pr er Engagem escriptio ent in Health n drugs, la Care Surb o vey, r 2013. radiology treatment, and mental health services Health Care Source: Survey, an EBRI/Greenw d th ald & Associates e 2008 ?20 Consum 12 C er E Engagement HCS. in Health Care Survey, 2013. Distributio Source: ns ................................................................................................................. EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2013. ............................... 23  to withdraw m aSource: oney from EBRI/Greenw the ald & Associates HSA (althou Consumg er h he Engagement or sh in He m ealth C uast have re Survey, 2013. been covered by a high-deductible health plan at the Traditional = health plan with no deductible or <$1,000 (individual), <$2,000 (family). programs if t a here was some type of financial incentive to 0% do so. 10% 20% 30% 40% 50% 60% 70% 80% Surv a eys, 2008–2013. premiums 2012 and 20 for a1 Tr3 iaditional = n , as surance, well health plan w as lon Mercer’s g-term ith no deduc care, 13 p tible e C rcent overa orO <$1,000 ( BRA, an individual) d r ll ie ntcrease ,i ree <$2,000 ( heal for C fam th ily )be .DHPs. nefits. An employer is not required to make the and online sur aTrv aditional = eys was th health plan e w under ith no deductible -represe or <$1,000 (indiv ntation o idual), f min <$2,000 (family orities in ). online samples. b Traditional = health plan with no deductible or <$1,000 (individual), <$2,000 (family). Traditional = health plan with no deductible or <$1,000 (individual), <$2,000 (family). pressure, a HDHP = High-deduc cholestero tible l, health weight, plan with height, deductible etc. $1,000+ (individual), $2,000+ (family), no account. b b (Figure 11).T b raditional = health plan with no deductible or <$1,000 (individual), <$2,000 (family). b HDHP = HDHP = High-deduc High-deduc tibtible le health health plan plan with w deduc ith deduc tible $1,000+ (indiv tible $1,000+i dual), $2,000+ (fam (individual), $2,000+ ily), no (fam acily count. ), no account. HDHP = High-deduc EBRI Issue Brief tible ishealth register plan ed in the U. with deductible S. $1,000+ (indiv Patent and T There’s lo idual), $2,000+ (fam rademark ts more! Office. ily), no IS acSN: 0887 c ount. ?137X/90 0887 ?137X/90 $ .50+.50 time the funds c HDHP = High-deduc were placed tible in the HSA) health plan with deduc . Di tible stributions ar $1,000+ (individual), $2,000+ (fam e excluded fro ily), no ac m count. taxable income if they are used to pay for CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. b c unused balanc HDHP = High-deduc c c e available tib to le health a wo plan rker with deduc wh tible en$1,000+ (indiv he or sh idual), $2,000+ (fam e leaves. ily), no account. References ............................................................................................................................... c CDHP = Consumer-driven health plan with deductible $1,000+ (individual), th$2,000+ (family), with account. ........................... 24  CDHP = Cons CDHP = Source: Cons EBR um I/G um er-driv reenw er-driv en ald & Associates en health health plan plan w/ deduc Cw onsum / deduc tible er $1,000+ (indiv Engagement tible $1,000+ in H idual), $2,000+ (fam (indiv ealth C idual), are Surv $2,000+ ey ily , ), w 2013. (fith am ac ily c), w ount. ith account. CDHP = Consumer-driven health plan with deductible $1,000+ (individual), $2,000+ (family), with account. c * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. 1100 13 Street NW · Suite 878 CDHP = Cons Source: EBR um I/G er-driv reenw en ald & Associates health plan with C deduc onsum tible er Engagement $1,000+ (indiv in H idual), ealth C $2,000+ (fam are Surveyily , 2013. ), with account. * Difference between HDHP/CDHP and Traditional is statistically significant at p = 0.05 or better. * Difference between HDHP/CDHP and Traditional is statistically significant at the p = 0.05 or better. * Dif * Differenc * As ferenc ked o e e f CDHP o betw betw een HDHP/CDHP een nlHDHP/CDHP y. and T and T raditional raditional is statis is s tic tatis allytic sia gnific lly sant ignif at icp ant = 0.05 at the or better. p = 0.05 or better. qualified medical expenses as defined under Internal Revenue Code (IRC) Sec. 213(d). Distributions for premiums for Washington, DC 20005 Visit EBRI on-line today: www.ebri.org Endnotes ............................................................................................................................................................ 24  (202) 659-0670 © 2013, Employee Benefit Research Institute ?Education and Research Fund. All rights reserved. www.ebri.org www.choosetosave.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org A monthl ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri Issue Bri y resea Issue Issue Issue Issue Issue Issue Issue Issue Issue Issue rch report f e e e e e e e e e e e e e effffffffffffff • December • December • December • December • December • December • December • December • December • December • December • December • December • December Brief Brief Brief Brief Brief Brief Brief Brief Brief Brief • • • • • • • • • • r December December December December December December December December December December om th2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 2013 • No. 393 e EBRI Education and Re 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 • • • • • • • • • • No. No. No. No. No. No. No. No. No. No. 393 393 393 393 393 393 393 393 393 393 search Fund © 2 013 Em ployee Benefit Research Institute 15 18 14 17 13 11 19 6 9 7 16 24 21 23 22 12 10 20 25 2 3 5 4 8 20%

Volume 393

Pages 28

EBRI Issue Brief

Paul Fronstin

Health