Findings from the 2014 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey

People enrolled in so-called “consumer-driven” health plans are more involved in their health care, according to a new report from EBRI.

The 2014 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS) finds that 15 percent of the privately insured population was enrolled in a consumer-driven health plan (CDHP); 11 percent was enrolled in a high-deductible health plan (HDHP); and 74 percent was enrolled in more traditional coverage. Overall, 26 million individuals with private insurance were enrolled in a CDHP—a health plan associated with a health savings account (HSA) or health reimbursement arrangement (HRA), or an HSA-eligible health plan.
The 2014 CEHCS also finds that among individuals enrolled in CDHPs, 57 percent had an HSA or HRA, while 43 percent were enrolled in HSA-eligible health plans but had not opened an account.
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; checked the price of a service before getting care; asked a doctor to recommend less costly prescriptions; talked to their doctors about other treatment options and costs; developed a budget to manage health care expenses; 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. Specifically, those in a CDHP were more likely than those with traditional coverage to say that they had attended a meeting where health plan choices were explained; consulted with their employer’s human resources (HR) staff about health plan choices; and were more likely to have consulted with an insurance broker to understand plan choices.
The survey also finds that CDHP enrollees were more likely than traditional-plan enrollees to take advantage of various wellness programs, such as health-risk assessments, health-promotion programs, as well as biometric screenings. In addition, financial incentives mattered more to CDHP enrollees than to traditional-plan enrollees.

Figure 3, HSA and HRA Enrollment Rates, 2007 ?2014 .............................................................................................. 7 were with an Cost- ___ [ALL THRE Appendix—Methodology Figures Distributio This survey __ also e ___. C 17 inons divi n “ an w q s f S ud ources of d 1 as made E QUE o au c r non lly like al ded ious Beh 8 coqntain luali y to u S possi Cov ctib TIONS TO fie fi h le of e d a ble ndin rage avior me ve sought with at least $1, gs from dical an the d C BE e co x h f a penses are au ASKE st information. racteristics of ndin series of 250 g su an D OF d qu pport subj a fam estions relat THOS the Uni ec Ho of the ily d t to r wever, eE AGE 21 duct fol n esured gu le HD owi lar ibl d to the e :n income ta HP enrol Analysis of g of at or - ganiz impact 64] least lees x as ation t $2, th were hwell e Marc 500, at fin s: American less lik as a but ah ncial 20 201 wel h inc percent 3 Curr y than tr o Express, B report t entives cou ent pe aditio h Pop nalty at th lueulation lnal C d ey ross have plan Findings from the 2014 EBRI/Greenwald & Associates Definitions 4 and Blue Shield Association, HealthEquity, Healthways, Li Figure 13 ncoln Financial, National Rural Electric Cooperative enrolle w on part (incr ereSurvey.” e n ased fro es to o icipat t eligh ion in ib EBRI a m lve sought e 10 percent to ope w Issue Br ellnn ess programs. As i in an fief, io HS nrmation on 2 nA. 010 o. 39 T as h0 e a fina (Emplo dental a rensl sample past y ult of t yee B nd visio e hars, t inc e ene Pa Figure 19 Figure 15 Figure 17 Figure 1 lu fit Figure 5 Figure 7 Figure 1 Figure 3 tient Prot n h ded 1, care. ere Research Institut wer 459 1ection and Afforda e ver in a y CDHP few e, Se dif wit fere ptem h e nbces by ile tber h Care er a 201 n plan Act o HSA 3). ty or fpe. 201 HRA, 9 Ther 0 (PPACA e 7wer 8 ine )), a no n The theory behind CDHPs and HDHPs is that the cost-sharing structure is a tool that will be more likely to engage Consumer Engagement in Health Care Survey 1. Figure Which of the 4, Number o following be f Years Covered by C st describ urrent es your current health insu Hea5lth Plan, by Type of Health Pla rance status: n, 2014 .......................................... 7 Individual Participates in Wellness Program Offered by Association, Optum, a The findings presented n in d Pru thid sentia Issue Brief l Finan ci were derived from the 2014 al Inc. EBRI/Greenwald & Associates Consumer Reasons Cost-Conscious Premium Percentage of Percentage of for HSA Participating Length Increases T and yDecision pes of Indiv HRA Indiv of TCost A iiEnrollment duals me With CDHP iduals in m Making, o Employ ng Employ Information Reporting Reporting by er's Rates, Ty , 2005-2014 ers With W pe Found, That They ellness That They of Health Plan, 2014 2005–2014 10 Program, or W Used ould More 2014 dif which HDHP, an fere is nces waive d be 1,450 tween d if in th a mor CDH e owner Pe a traditio n of t d tra he H dnal ition SA di he al-plan alth es, becom plan. enrol le ees s disabled, when it or came is eto time o ligible for M ff (Fi edicare. gure 17 ). However, CDHP individuals in their health care, compared with people enrolled in more traditional coverage. This study found evidence Consumer-Driven Health Plans (CDHPs) Taylor, Humphrey. “Does Internet Employ Researc er, Am h ‘Work’? ong Those Offered Comparing Ona line W e Survey R llness Program, esults With Telephone Surveys.” 50% Engagement Among in 20 divi % i dn u Healt als seekin h Car g c e Survey ost informatio (CEHCn S, 6 ), a 7n ? on 80 line perc survey that ent sought i exa nfom rmation on ines issues s cost sharing; urrounding co 47 ? nsumer-driven 59 percent sought Employ Probably an App (Percentage of privately ees, More Than Once Participate in Employ W by o T rker ype of Earnings and Health for a insured adults Smartphone Plan, er Inflation, 1988 Wellness 2014 21–64 or Program, Ta ?blet, 2014 By Paul Fronstin, Ph.D., Employee Benefit Research Institute, and Anne Elmlinger, Greenwald & enrollees were more likely than traditional plan enrollees to report that they would probably participate if they were that adults in a CDHP and those in an HDHP were more likely than those in a traditional plan to exhibit a number of Figure 5, Length of Time With CDHP, 2005 ?2014 ..................................................................................................... 9 I have health insurance through a government p by Type of Health Plan, lan such a 2014 s December 2014 • No. 407 CDHPs refer t Internation 20% o healt al Journal o h by plans V by fa that Mark V rious arious have a et Resea Health-Related Purposes (Among w Financial ho deducti r received health care ch. V individuals seeking cost b oIncentiv le of at l. 42, no. 1 (August 200 least es and $1,2 and in T 5 last 12 months) y 0pe of f Ty oinformation) r individu pe of 3).Health Health al c Plan, overage Plan, 2014 an 2014 d $2,500 for family health information Indivi The remain duals ar care,der on in e able to cludi what of this re ng t insura roll he port co o nv ce wo st of insur examin er funds uld an es the fro anc d m e wo one HSA i findings , the uld not cost of from t pay nto another care, towar he 2014 CEHC satisfacti d th HSA e co witho on wit st of care; S as th u ht su hey rel ealth bjecting t 42 ? care, satisfact a48 te to perc hdifferences and similariti e distri ent so bution iught on with cost to i healt ncome an h care es d Paul Fronstin is director of the Health Education and Research Program at the Employee Benefit Research Institute 18.6% Associates offered a $250 cash incentive, and CDH Wanted t P enro o improv lle e es w healthere more likely t 45% han traditional plan 35% enrollees to report that they 90% cost-conscious behaviors. Specifically, among privately insured adults ages 21 ?64 who received health care in the past 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 90% 2005 2006 2007 2008 Figure 9 2009 2010 2011 2012 2013 2014 90% 18% Medicare, Medicaid, or Veterans benefits ......................................... 1 (Among Those Who Use a Smartphone or Tablet) coverage in 2014, and include either a health savings account (HSA)-eligible health plan, with or without the HSA, or a plans, r penalty information on provider cost among i tax enasons for c div eis duals enro as long as the hoosing lled in rollover a pla s; and traditional n, an about occur d so h o e urces of hea sn alth withi e-quarter plans, n 60 so da C ltD h ys ught HPs, an in of the formation. informat d HDHPs. The repo date It also ion on tota funds are presen rece l prrt also examin ovider c ted ived. finRollover din harges (Figure gs fres consumer om the contributio 20 11 05 ). n ? s f T 200 h rere om 7 (EBRI). Anne Elmlinger is vice president, Healthcare Practice lead, with Greenwald & Associates. Any views expressed in 17.1% Premium Increase Worker Earnings Increases Overall Inflation 18% would probably participate if the employer increased premiums for non-participants. When it came to b the impact of cost Figure 6, Familiarity With Consumer-Driven Healt Availability and Use of Cost Information, 2014 h Plans a , 2014 ................................................................................. 9 c a c 12 months, those in a CDHP were more likely than those with tra b ditional coverage to say that t 43%hey had checked 81% I have health insurance 80% through my job or the job Traditional HDHP CDHP Traditional HDHP CDHP a c Checked whether plan would cover care b 79% 47% health reimbursement arrangement (HRA), described in more detail below. 26% 80% 78%* EBRI/Common Archer M were enga no geme di e80 dica nt ffer %more genera e l Savin w nces ealth ig n Fun s Acco the t d ll C y. It ex yunts (MSAs pe o onsumerism in f cos amines t i)n a f healt orrmation sought by e also Health h car permitt Care e decision maki S eu d. Ear rvey, an pla nin n type, wit gs o n d th g, cost an e n 20 contri h 08 on ? d bution 20 e qu 13 ex ality in ception: C s are also EHCS. Th formati CDHP not e 2 on, parti enroll 0 77%* subject to i 14 CEHCS ees cipati wer w o nn in co a es more me this report are those o 80% f the authors an To maintain d sh curren ould t health s not tat T us be raditiascr onal ibed to HDHP the o CDHPfficers, trustees, or other sponsors of EBRI, Exercise programs 32% 21% 41% 55%* sharing, there were no differences by plan type (Figure 18). However, cost-sharing ince a b ntives to c participate still 39% 75%* whether th40 e % plan wo 75% uld cover care (55 percent CDHP vs. 43 percent traditional); asked for a generic drug instead of a 16% Traditional HDHP CDHP29% 16%of another family member (such as spouse or p 74%* arent) ...................... 2 Endnotes 73% 73%* 16.7% 14.7% conducte taxes. likely tha wellness pro n d tra wit gr d hin th a itional ms, opinio e Un plan ited States ns enabout rollees to provider betw ha eve sought en Au engagement, g. 7 a inn fo d Aug. rm cost ation on 27, -sharing i 2 w 01h4at insuranc , throu ncentives r gh an e ew lat 11-m ould ed to inute and wo plan ty Intul ernet surv pe, an d not pay d hey. e tow alth The ard th e Employee Benefit Research Institute-Education and Research Fund (EBRI-ERF), or their staffs. Neither EBRI nor EBRI- Figure 7, Cost-Conscious Decision 70% Tried to find the cost of health care services before Maki 70%ng, by 70% Type of Health Plan, 2014 ........................................................ 35% 26% ......... 10 This survey was made possible with support from: mattered to many individuals, regardless of plan type. It was found that, concerning most ques 69% tions, between about 20%* brand nam I have health insurance e (44 Nutrperc it 68% ion inent C formatioD nHP and 42 that I purcha percent HDH sP e from a health vs. 35 percent traditional); talked to their doctors about 42%* 70 70 70% % % Asked for generic drug 67% instead of brand name drug 67% 67% 29% Health Savings Accounts 66% 66% 66% 14% getting care 65% 21% 29%* 36%* 44%* national Findings from the 2014 EBRI/Greenwald & Associates cost of car information or eba te . se sample chnology. was drawn from I Conv psos’ onli enient to wone rk panel o 32% f Internet users who 38%have agreed to participate in ERF lobbies or takes positions on specific policy pro 34% posals. EBRI invites comment on this research. 14% 56 percent and about 69 percent of participants said they would participate in wellness programs if there was some 1 prescription oinsurance company ptions and costs (38 perce ........................................................................... nt CDHP vs. 29 percent traditional); checked th 24% e price 3 of a service before 61% 12.1% Calculated from Figure 1. General health information 20% Found information 74 60* 73 59%* 60% 32% Figure 8, Informed Decision Making for Health Plan Choice, by Type of Health Plan, 2014 ........................................ 10 Health Rei mbursement Arrangements 29% 27% research surv American Exp 60%eys. Near ress ly, 2,000 adults ages 21 -64 who had health Lincoln Finan insurance tcial hrough an employer, purchased directly A health savin 60% gs account (HSA) is a tax-exempt trust or custodial account that an individual can use to pay for health 58% 31% 56% 12% 11.2% type o Consumer Engagement in Health Care Survey f financi 60T % alka ed to l inc doentive ctor about p rel rea sc ted to ription o cost s ptions and c har osing for ts office visits and prescription 30% drugs. I have other health insurance (specify _______________) .................... 4 getting care (37 percent CDHP and 34 percent HDHP vs. 27 percent traditional); asked a doctor to recommend less 30% Health plan's website 30%30% 30% 54 44 53 30% Weight management or 18% 30% 38%* Findings from this survey are compared with findings from the 2005 ?2007 EBRI/Commonwealth Fund Consumerism in 10.1% Participation in Wellness Program 1230 % % 29% s 15% 2 Wanted to learn more about own health risks 31% 53%* 38% from a care expenses carrier,. Contributions or purchased through to the accou a gov ne t are rnment deducti exch bange le from were taxa dra ble income, wn randomly even from the Ipsos for individuals who sample do for th not is 52% A health reimbursement a diets rrangement 10.1% (HRA) is an emplo 28% yer-funded health plan that reimburses 26%* employees for qualified More info I do not have health insurance curr rmation about HRAs and HSAs can be found o ently n................................................. pg. 21 and in Fronstin (2002 and 2004). 5 Cop yright Information: Health plan's customer service department This report is copyrighted by the Employee 34 Benefit Resear 32 ch Institut 39 e (EBRI). It may be Blue Cross an costly prescriptions (35 d Blue Shield Association percent CDHP an d 33 percent HDHP vs. 23 Nation percent tra al Rural Electric Cooperative A ditional); talked to their doctors a ssociation b out 50% 48% 10% 27% Figure 9, Avai 50% lability and Use of Cost In 47% for 47% mation, 2014 ...................................................................... 27% ................... 12 By Paul Fronstin, Employee Benefit Research Institute Health Care Survey, and the 2008 ?2013 CEHCS. , and Anne Elmlinger, Greenwald & 50% 26% 26% 26% 26% 26% base sample. This sample was stratified by gender, age, region, income, and race. The response rate was 36.3 percent itemize their taxes, an Checked ta d pricx-free distri e of service beforbutio e gettinn g c s for are qualified me 44% dical expenses are not 34% counted as ta * xable income. Tax- EBRI Employe Balance e o Bf HS eneA o fit R r HRA Printed material from health plan esearch Institute Issue Brief (ISSN 08878.1% ?137X) is publis 30 hed monthly by 15* the Employee B 28 enefit Research Institute, Employers an medical expen d insur ses. An HRA ers offeis typical r a numb ly com er of dif bine fere d with nt typ a eh s of 25% igh-de weldlness benef uctible healt 25% its—progr h plan, 25% tams de hough this signed 25% is not re to promote health quired. An HRA used without permission, but citation of the source is required. 42% 19% other treatment options and costs (34 percent CDHP vs. 44% 26 percent traditional); develope 37%*d a budget to manage health 3 9.6% 9.7% 7.5% 24% 10% 8.0% 7.3% Associates See 110 http://www.mercer. 0 13th S t. NW, Suite 8c78, om/ Wc aontent/mercer shington, DC, 20/ 0global/al 05-4051, at l/en/news $300 per room/m year or is i od ncest-health-benefit-cost luded as part of a membersh -gro ip su wbs thcri -continues-as- ption. Periodi- HealthEquity 8% Offered incentive prizes 34%Optum 27% 40% 23%23% Provider's office 23% 18 23% 30 27 6.9% (26 percent fo Patient Use of Technology free distributior the base sample or ns are also allowed for nat certa ional sampl in premiums. e, and 48 percent 15% for the oversample). As a non-probability sample, 40% a [IF Q1 = 1,5, SKIP THE can als and to pr o be even oft disease. fered on a s Th ta en 20 OTHER 2 QUESTIONS] d-a 14 lone CEHCS basisexamin or with com ed avai pr labilit ehensive y an insur d participation ance that in doe ths ree ty not use pes o a h f welln igh de ess pro ductibg le. ra ms: a 22% 22% Figure 10, Types of Cost Check provider hoInformation So urs ught, by Type o 11% f Health Plan, 2014 ..................................................... 22% ....... 12 care expenses (23 percent CDHP vs. 17 percent traditional); and used an onli 23% ne cost-trackin 6.3% g tool Tr adi provide tional d by the cals postage rate paid in Washington, DC, and additional m 6.1% ailing offices. POSTMASTER: S 6.1% end 6.1% ad 6.1% dress changes to6.1% : EBRI Issue Brief, 1100 40% Enrollment in CDHPs and HD 21% HPs 8.4% 21% 18% 21% Provider's website 19 21 25 Recommended C Asked doctor to r itation: ecommend l Paul ess coFronstin stly prescripti and A on drug nne Elmlinger. “Findings from the 2 33% 014 EB * RI/Greenwald & Associates consumerism-kicks-into-high-gear.html 10 5.5% traditional survey margin-of-error estimates do not apply. However, had the survey used a 20% probability sample, the 13th St. NW, Suite 878, Washington, DC, 20005-4051. Copyright 2014 by Employee Benefit Research Institute. All rights reserved. No. 407. In 2 health Employees ar 01-risk assessment, a h 4, th6% e C e eli EHCS contin gible for a ue n ealth-promotio HRA only d to ask abo wh u n en th t consumer prog eir ram to emplo u addr se of yer offers suc ess a specific technology to h a healt health enga h issue, an pla ge in n 35% . he * ad lth-r a bio elated activities. The metric screening. Healthways 13% Prudential Financial Inc. 8% 19% health plan 30 20 (2 % % 0 percent CDHP vs. 12 percent traditional) (Figure 7). Other websites 11% 7 12 4 Make an appointment 30% 18% 27% Consumer Engagement in Health Care Sur Reduc vey.” ed prem EBRI iums Issue Brief, no. 407, December 2014. b Indivi The HSA is o duals wit wh ned by t a deducti he individual ble of at leas witth $1, th 7.0% e hi 250gh for -de ind divid uctible ual covera he 36% alt16% h pla ge n or $2, and 50 is compl 20% 0 for fe ately portabl mily coverae g6.9% .e w Thh ere is o also no u have an se-it- 4.1% 25% margin 2. Which of t of error for t he following he nationbest descr al sample wo ibuld es your health plan's de have been ±2.2 percent. 17% ductible: 3.9% Figure 4 11, Types of Cost Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2014. Information Found, by Type of Health Plan, 2014 .............................................................. 13 24% HDHP survey foun 30d t % hat 76 percent of the adult population with private health insuranc 26% e had used a smartphone more than 23% See Appendix for more detail on th 16%e methodology. 6.3% 6.3% a 9% 4%TCo alkntac ed to t h do eal cto th r abo plan's ut treatment options and coAT A GLAN sts CE 29% Traditional = Health plan with no deductible or <$1,250 (individual), <$2,500 (family) in 2014. HRA, or or-lose-itwho rulewere associated enrollewit d in an h an HSA-eli HSA, as g 5% iany money ble health pla left n in t (regar he accou dless 15% of w nt at t heth he eend r the HS of the year 15% A was o au pened tomatically roll ) were assigned s over 20% Employers hav The survey found that C e a tremen Ddo HPus amount o enrollees arfe more likely flexibility in de than tra signing h ditiona ealth l- pla plann e s that nrolleinc es 34% to report orporate * an H thatR they A. For 2.1% had the exam option ple, the 18% 18% 6% customer se b rvice 14%* 20% once within the past year, and nearly 58 percent had used a tablet (up from about 60 percent a a nd 40 percent, Health Plan Choice Decisions HDHP = High-deductible health plan with deductible $1,250+ (individual), $2,500+ (family), not HSA-eligible in 2014. Major reason Report Availability: This r c eport is available on the Internet at www.ebri.org Traditional 5.0% c To avoid premium increase To e 5 xamine the issues me CDHP = Consumer-driven health plan with deductible $1,250+ (individual), $2,500+ (family), with HRA, HSA, or HSA-eligible ntioned above, the sample 9% was divided into 31% three 18% groups: those with a consumer-driven Figure to the and is availa CDHP 12, Employer O 20% group i ble in the n th fol ffers e CE low Wellness Pro ing y HCS. Everyon ear. gram, by e else wit Type h a deducti of Healt bh le Plan, 2014 of at least ..................................................... $1,250 for individua CDH l co Pverage or $2, ...... 13 500 [A deductibl 2% e is the amount you have to pay before 4.5% your insurance plan 17% 4.6% will start paying any part of amount of to fill out a h mo ealth-risk asses ney that is plas cment. Specifi ed in t The Em he accplo c oally, 4 unt, the yee 7% Benefi 6 perce levt Research Institut el of nt of CDHP the deducti ene rollees r b le, (EBand the RI) was founded in 1978. Its eported comprehe that their employer o nsiveness of t mission is to hffered a e health Traditional plans include a br Medical claims history oad range of plan types, including health maintenance orga 4.4%nizations (HMOs), preferred provider 2.1% respectively, from 2012). Among those who used a 2.5% smartphone or tablet, 20–29 percent used an app for nutrition * Difference between HDHP/CDHP and Traditional is statistically significant at the p 13%* 17% = 0.05 or better. 4.2% 10% Developed budget to manage health care expenses b 3.8% There was also some evidence that adults in a CDHP were more likely than those in a traditional plan to be engaged in 10% contribute to, to encourage, and to enhanc 23% e the developmen * HDHPt of sound employee benefit health for fam pla ily cov n (CeDHP), rage was those assigned to with a high-de the H ductibl DHP group. e health In dividu plan (HDH als wP), ith and t no deduct hose ibl wit eh or a traditional deductibl heealth cov below $ erage. 1,250 for your medica 4% l bills.] insurance health- ? rThe 2014 EB isk assessment, com are 10% all subject RI/Greenwald to vp ariation. Em ared 3.4% with & Associ 36 ployers often perce ates Consumer nt of tra cod ver itional certai Engage -plan n pre ment in envrollees entive servic Health C (Figure 1 es in a2 re ).full, About Survey (CEHC not o subjecting the ne-fifth S (22 ) finds that pe m rcent) to organizations (PPOs), other managed care plans, and pla 9% ns with a broad variety of cost-s 3.3% haring arra Mino nge r reas m on ents. The shared information; 0% 20 Prices ?27 percent used for medical care one for general 8% health information; 15 ?26 percent used one for weight management Who we are 10% In order to qualify for tax-f 2.7% ree contr programs and so ibutions to an und public policy HSA, 11% the indivi through objective dual must be cover resear ed ch and by a educati healthon. EBR plan that I is the only has an Figure their ch13, oice In of dividual health Partic plan. S ipates in pTecif o addr ically, t esWelln s spech ifess Program O ic o he se in alth pra CDH oblem P fwere fere 17% d more by Empl likely than 32% oyer Among those T with hose Offered traditiona a Welln l covera ess Pr ge toogram, say 12% c Individuals were assigned to the CDHP and HDHP 0.2% groups if they had a deductible of at least $1,250 for individual indivi dual cov 0%erage and $2,500 for family coverage were assigned to the “traditional” coverage category. More detail 15 percent of the privately insured population was enro 2.3% lled in a consumer-driven health plan (CDHP); the Introduction of HDHP deductible enrol. Employers c lees reported t ah n of e avai fer comprehensive lability of a healt he h ri als th insur k assessment program, ance that covers signi 100 percent CDH ficantly P lower of health c than offer are cost rates s after characteristics of these plans Used online cost tracking to are that they ol provided by hea either have lth plan no deductibles or deductibles that ar 10% e below current thresholds that 2.0% or diets; and P 21–29 percent used rices for prescription one for exercise pro 9% grams (Figure 19). There were few differences by plan type. 0% private, nonprofit, nonpartisan, Washington, DC-based organization committed exclusively to If employer offered If employer offered If employer offered If employer If employer made If required to If employer reduced by Type of Health Plan, 2014 .................................................................................................. 20%* ................. 14 8% annual deduct 2% -2% ible of not less than $1,250 for self-only coverage and $2,500 for family coverage (minimum deductible that they had attended a meeting where health -1.1% plan choices were explained (37 percent CDHP vs. 30 percent No deductible drugs 11% coverage or about the me $2,500 thodology Cost sh for fami aring is (cpr opay ly coverage. ovided in the s, Amount insTo be assign uappendix. rance would or ed Avera to ge the costs o CDHP r range g ofroup, th Total costey mu charged tsot yo als ur o have Total cos b t oe uts en ide o eli f y gour ible to $250 cash incentive time off discounted increased premium additional participate to enroll contribution to the among C deductible 11 percent was enr DHP and tra has 1.1% been d 1.1% itio met nalo - or th pla lled in a high-deductible health n e ey may nrolleeoffer s. Whe covera n aske ge d a with bou cost sha t t plan (HD he availabil ring after HP); and 74 percent was enrolled in more ity of health-promotio the deductible is met. If n programs, 52 per- employers would qualify for tax-preferred HSA contributions. public policy research and education on economic security and employee benefit issues. Employment-based h 0% ealth benefits are the most common form of health insurance in the United States. In 2012, coinsurance, deductibles, would not pay costs charged by the insurance plan insurance plan prem 0%ium for 10 n% on-participant 20 s% contribution 30 to % in pref40 ered % health 50HRA % /HSA** 60% amounts are indexed to inflation). Cert Re aiqui n prev red by e entive mployer services can 19% be 17% covered in full and are not subject to the traditional); consulted with their employer’s HR staff about health plan choices (35 percent CDHP vs. 25 percent Individual or Single Coverage Health ri0% sk assessment 5% 10% Health prom15 oti% on program 20% 25% Biometric sc 30 reen % ing 35% contribute to an HSA or had a health reimbursement arrangement (HRA) with a rollover provision that they could use to EBRI’s membership includes a cross-section of pension funds; businesses; trade associations; Table of Contents tradition -4% al coverage. Ov etc.) erall, 26 million individuals prov with private insurance wer ider e enrolled in a CDHP—a Among those choose to cent of CDH pay P who less than 100 perc enrolle have es an nev d e 42 r used a perc ent o ent o nf a health car p f p for traditional health-relat e expenses -plan enro ed after pur llees p the ose reported that s, about deductible HRA/HSA*38 * th –4 has been m 9 p eir em epl rc anent ployer are et, they then hav overy or somewhat ffered such ae the 156 million individuals under age 65, or 58.5 percent of that population, had employment-based health benefits Figure 14, Employer Offers Cash Incentive or Reward for Participating in Wellness Program, Among Workers Whose 6 0% 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 0% ded This survey uctible. fo Th My deductible is le und that e health pla in 20 n’s14, out-o 15labor un ss tha pe f-pocket rcent ions; h n of t $1,000 maximum h ee alth popula car ma e prov ti y not e on was iders and insur x enrol ceed $6,3 led ers; in a 5government org 0 for se CDHPlf; 11 -only cove p ae nizations; rcent rag we an a and service firms. s enroll d $12, ed70 in0 for an traditional See https://www.ahip.org/2 ); a Source: nd tEBR hat th I/Greenw ey c ald & Associates o 014/HSA-Census-Report/ nsulted wit Consum h er an insura Engagement in H n ce ealth C brok are Surv er to ey, understand 2014. plan choices (19 percent CDHP vs. 12 per- pay for medical expenses or the ability to take their account with them should they change jobs. Individuals with only a Source: EBRI/Greenwald & Associates With HRA Consum or HS er A Engagement in Health Care Survey, 2014. HSA-eligible without account intereste Introductio option o program. health plan fd i One-quart des n n Source: .................................................................................................................. Source: u ignin sing on Source: EBR EBR g th I/G er a I/G EBR reenw s e e reenw s (24 I/G o for th plan cia ald & Associates reenw ald & Associates percent t with ed wit ald & Associates ings lik or )h of HDHP enrol C e n C onsum a healt witho onsum u Consum er trit er u Engagement Engagement t a ma ion in h er s Engagement avings acc formatio ximum in H lees in H ealth C ealth C in H re out-o ealth C apo n, ex a re Surv re Surv orted th unt are Surv ey ercise f ey -pocket (HSA) or h , , 2014. 2014. ey e av , 2014. prailabil limit. ograms, w eia ty of a lth reimburse eight mana health promotio ........................................ 4 m geme ent arra nt or n pro nge diets, gm ram, ent (HRA), Employer O a Le ffers Wellness Pr ss Than One Year ogram, by Ty 1-2 Ye pe of Pla ars0% n, 2014 20%....................................................................... 3-4 Ye 40 ar% s 60% 5 Yea80 rs o % r More 100% .. 14 (Fronstin, 2013). In nearly every year since 1998, premium increases have exceeded worker-earnings increases and Traditional = Health plan with no deductible or <$1,250 (individual), <$2,500 (family) in 2014. a a a a Traditional = Health plan with no deductible or <$1,250 (individual), <$2,500 (family) in 2014. Traditional = Traditional = Health Health plan w plan w ith no ith deductible no deductible or <$1,250 (indiv or <$1,250 (indiv idual), <$2,500 (family idual), <$2,500 (family ) in 2014. ) in 2014. Traditional = Health plan with no deductible or <$1,250 (individual), <$2,500 (family) in 2014. family cover HDHP; an d 74 a bMy deductible is $1,000 ge, wit percent h th was e deenrolle ductibd le in tra counti or more ditional ng toward this covera ge limit. (Figu The re 2). min The imum allo 15 percen wabl t of t e dedu he ctibl popul e a ation w nd maith a ximum CD out- HP cent traditiona Source: M HDHP = High-deduc l) (Figur ercer, e National 8). tibl e Survey of Em CDHP a health plan n w ploy id tra th deduc er-Sponsored d tible itional $1,250+ (indiv Health plan Plans idual), $2,500+ (fam enrollees wer ily), not e equal HSA-eligible in ly likely t 2014. o report that they visited health b flexible spendi b ng acco b unt (FSA) were not included in the CDHP group. b HDHP = High-deductible health plan with deductible $1,250+ (individual), $2,500+ (family), not HSA-eligible in 2014. 7 or an HSA-eli HDHP = High-deduc HDHP = High-deduc HDHP = High-deduc gible health p tib tib le le health health tible health plan plan ww iplan l th ian. th deduc deduc with tible deduc tible $1,250+ (indiv $1,250+ (indiv tible $1,250+ (indiv idual), $2,500+ (fam idual), $2,500+ (fam idual), $2,500+ (fam ily ily ), not ), not ily HSA-eligible in ), not HSA-eligible in HSA-eligible in 2014. 2014.2014. pres signific cript antly ion dr lower t c ug prices han o , m ffer edical rates amon -claims h g isCDHP a tory, and for gene nd traditional ral health -plan en informat rollees. Wh ion ( en F asked abo igure 20). u Atm biometr ong indivi ic-scr duals eenin with g inflation (Figur CDHP = Cons e 1). He um alth er-driv in en surance health plan wipremi th deductible ums have $1,250+ (indiv nea idual), rly tripl $2,500+ (fam ed, ily w ), wih th iHRA, le worker HSA, or HSA-eligible in earnings h 2014. ave increased 58 percent See Figure 6 i c ( c http nc ://www.m http://www. ercer.comercer.com m/content/mercer/ /cogn lob tent/mercer/global/all al/all/en/newsroom/modest -/e hen/newsroom alth -benefit -cost -gro /modes wth -cont t-health-benefit-cost inues -as -consumerism - -growth- Enrollment in c Source: CDHP = Cons CDHPs and H EBRI/C um ommonw er-drivD en ealth HPs health Fund C ................................................................................................. plan onsumerism with deductible in H $1,250+ (indiv ealth Care Suirv dual), ey, 2005–2007; EBR $2,500+ (family), w I/Gireenw th HRA, ald HSA, & Associates or HSA-eligible in Consumer 20 Engagement in 14. H ........................... 5 ealth CDHP = Cons CDHP = Cons umer-driv umer-driv en health en health plan EBRI’s work advances knowledge and unders w plan ith deduc with deduc tible $1,250+ (indiv tible $1,250+ (indiv idual), idual), $2,500+ (fam $2,500+ (fam ily), wily ith ), w HRA, ith HRA, HSA, HSA, tanding of emplo or HSA-eligible in or HSA-eligible in 2014.2014.yee benefits and their CDHP = Cons Source: EBRum I/Commonw er-driven ealth health Fund C plan w onsumerism ith deductible in H $1,250+ (indiv ealth Care Su idual), rvey, $2,500+ (fam 2005–2007; EBR ily), w I/G ith reenw HRA, ald HSA, & Associates or HSA-eligible in Consumer 2014. Engagement in Health Don’t know amount of individual deductible of-pock represee nt lim ted a * it Source: Differenc b are out EBR e indexe 26 betw I/G millio reenw een HDHP/CDHP dald & Associates t n in o infl dividuals a and T tion. A C ronsum aditional with n er e is Engagement twork stprivate atistically plan in H si in gnific ealth C m suran ant a at ay impose re Surv the p ce, =ey 0.05 whil , 2014. or better. a h e the igher 11 deduct percenibl t with e an an d a HDH n out P- re of-pock present et lim ed about it for plans’ websites to learn about their plans; talked to friends, family, and colleagues about the plans; used other websites There is no statutory re 1 quirement that an employee have a high-deductible health plan in order to also have an HRA. Figure 15, Rea * Differenc sons for Part e between HDHP/CDHP icipating in and Traditional Employer’s is statistically Wellne significant ss Program, at the p = 0.05 or better. 2014 ............................................................. 16 * * kicks Differenc C Differenc are Surv * -into Differenc e e -betw ey high betw , 2008 e een HDHP/CDHP -een HDHP/CDHP ge betw ar.ht –2014. een HDHP/CDHP ml), and and T Bureau of and T raditional and T raditional Labor Statistics. raditional isis s s tatis tatis istic s tic a tatis a lly lly s tic is gnific ia gnific lly s ant ignific ant at at the p ant the p at =the p = 0.05 0.05 = or better. 0.05 or better. or better. a CDHP, programs, 5347 pe Cpercent of CDHP enrol arcent re Surveywere , 2008 ?2014. very or somew lees h re aported th t interested in at their using employer an app t offer o check ed suc the h a balance program, co of thmpared with e HSA or HRA. 35 per- during that period. ** Asked of CDHP o nly. importance to the nation’s economy among policymakers, the news media, and the public. It continues-as-consumerism-kicks-into-high-gear.html Family Coverage Indivi out-of-net 20 miduals llion in wor we dik viduals. re as services. In sign ed to dividuals c the HDHP an gro hau ve a p if t healt hey r he plan ported with that th a deductibl ey were e an not d m elig aibl ximum o e for an ut-of HS-pocket A. The group with limit that to learn Length of abo Tim ute their in Healt choic h Pla es; asked n ................................................................................................. health plans to send information in the mail; and talked to their ............................... 5 doctor or other However, ? The 2014 CEH it is standard pract CS also ice amon finds that amon g employers that g individuals an em enrolled ployee in C mu D st also choos HPs, 57 perce a ent high-de had an HSA or ductible H hea RA, wh lth plan i ile n does this by conducting and publishing policy research, analysis, and special reports on cent among traditional-plan enrollees and 23 percent among HDHP enrollees. What we do My deductible is less than $2,000 for me and my family Figure traditional 8 16, h Rea eals th covera ons for Not P ge inarticipati cluded in ndivi g in duals i Employer’s n a broWellness Pro ad range of pl gra an types, incl m Among Tho uds ing h e Offeealth red m but aintena Not Partici nce pating in qualifies them to make a tax-free contribution to an HSA, but they are not required to make a contribution or to open health pro 43 perc fessional ent we abo re uten th rolle e pld anin s. emplo HSA-eli yee benef gible h its issues; holding educational br ealth plans but had not opened an iefings for EBRI memb account. ers, congressional and order to have an HRA. See Table 10 in http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201409.pdf In response, employers have been seeking ways to manage the cost increases. During the past decade, employers Familiarity With CDHP ............................................................................................................................................ 5 Among th Program, 2014 e 15 My deductible is $2,000 percent o ................................................................................................................. f individuals enroll or more for me and my f ed in a CDHP, 57 percent (or amily 9.3 million) had an HRA or had o ....................... 16 pened an HSA, federal agency staff, and the news media; and sponsoring public opinion surveys on employee organiz an accou ations (HMOs), pre nt. ferred provider organizations (PPOs), other managed care plans, and plans with a broad CDHP enrollees were more likely than traditional-plan enrollees to participate in health-risk assessments, health- Conclusion have tur ned their attention to consumer-driven health plans (CDHPs)—a combination of health coverage with high 9 Don’t know amount of family deductible benefit issues. EBRI’s Education and Research Fund (EBRI-ERF) performs the charitable, while Cost-Conscious Behavior 43 percent were enroll ....................................................................................................... ed in an HSA-eligible health plan but had not opened an HSA (Figure ................................. 8 3). There were also differences between HDHP and traditional plan enrollees. HDHP enrollees were more likely than HRAs are ty See Exhibit 5.1 in ? This pic study fin ally set http://files.kff.org/attachment/2014-employ d up as s evidence that adults in notional arrangements a CDHP and those in and exist er-health-b only on paper. A enefits-survey-full-report an HDHP were m n employee may vi ore likely than ew the acco those in a unt as if variety of cost-sharing arrangements. The shared characteristics of these group members were that they either had no promotion programs, and biometric screenings when they are offered by their employers. Three-quarters (75 percent) The deductibles 2014 EBR (at least I/Green $1,2 wal5 d0 & Associates Co in 2014) and tax-pref nsumer En erregag d saving ement s or sp in He end alth Care ing accounts Surveythat (CEHCS work ) ers a founn d co d thntinu eir famil ed slow ies educational, and scientifFigure 18 ic functions of the Institute. EBRI-ERF is a tax-exempt organization Figure 17, Percentage of Individuals Reporting That They Would Probably Participate in Employer Wellness Program, Don't know if have deductible Figure 2 Figure 14 Figure 16 Figure 10 Figure 12 Figure 8 Figure 4 Figure 6 Both individuals and employers are allowed to contributFigure 20 e to an HSA. Contributions are excluded from taxable income if traditional tradition plan enro al plan to exhibit llees to report t a hnumber of cost-con at they visited health pl sciou ans’ s behavior websites to l s. Sp eecifically, th arn about the ose in a CDHP ir plans; used o were more ther money was actually being deposited into an account, but an employer does not incur expenses associated with the deductible or a deductible that was below current thresholds for HSA tax preference. Health Plan Choice Decisions .............................................................................................................................. 8 10 of CDHP enrollees participated in a health-risk assessment, compared with 58 percent of traditional-plan enrollees Percentage of supported by co Indiv ntributions iduals and g Reporting rants. That They Would can use to pay their out-of-pocket health care expenses. A handful of employers first started offering CDHPs in 2001 growth in by Var consumer-dr ious Financial I iven health ncent pla ives and Ty ns (CDHPs): pe of Healt 15 percent h Plan, of th 2014 e popul ................................................................. ation was enrolled in a CDHP. Enrollment in .. 17 The specific question was: Does your employer offer any of the following wellness programs? A number of other surveys tr Distribution ack enrollm of Indiv enit in C dualD sHPs. A Covem red by erica’s He Priv alt ate Health h Insurance Insurance, Plans (AHIP) found that 17.4 million Employ Reasons Employ Familiarity Informed Decision Making for er Number for Offers W er Offers Not Tof y pes of Participating With Consumer-Dri Y ellness Program, Cash ears Cost Cov Incentiv eInformation red in Employ eby or by v Current Health Rew e n Ty er' Health Plans, 2014 Sought, pe ard s Plan of W Health for ellness Health Participating Choice, Plan, Plan, 2014 Program Interest in Using an App for a Smartphone or Tablet, made by the employer and deductible from adjusted gross income if made by the individual. The maximum annual websites to learn about their choices; and that they consulted with an insurance broker to understand plan choices. arrangem likely than th ent until an ose emplo with tr yee in aditional coverage to say curs a claim. By contrast, if that they had checked whether the employer sets up the HRA on the plan would cover a funded basis, the Probably Participate in Employer Wellness Program, by 6 Various (Figure 13). About one-half (53 perce nt) of CDHP enrollees participated in a health-promotion program, compared with Availability and Use of Cost Information .............................................................................................................. 8 high with -healt deduct h rei ible m he bursement alth plan a s rrangem (HDHPs) was 11 perc by ents Ty (HRAs). In pe of Health ent. 2004, em Overall, 26 Plan, ployers 2005 milli ?on 2014 were able to individuals with private start offering h ine surance wer alth plans wit e h people 3. Do you have a specia were enrolled in an A m HSA-eli in o l ng account or f Wellness Program, Those gible hby eOffered alth by by by und you Health-Related Function, 2014 T T plan Ty y ype of pe of pe in but A J of can use to pay for medical expenses? The accounts m aNot nuary Health Health Health ong Participating W 201 o Plan, Plan, Plan, rkers Whose 4, w 2014 2014 2014 hich a in cProgram, coEmploy unted forer 2014 about 10 percent of the 70% Because the base sample (national sample) included only 294 individuals in a CDHP and 237 individuals with an HDHP, contribution is $3,300 for self-only coverage and $6,550 for family coverage in 2014. HDHP ecare; a nrolleess were ked f less l or a generic d ikely thanr tra ug instead ditional plan of a brand nam enrollees to have e; talked t talked to o th fr eir doctor iends, family, a s about prescript nd colleagues a ion optio bout ns employer incurs the full expense at Cost-Sharing 2 the time of Incentiv the con es tribution, and Ty eve pe n of Health Plan, 2014 if an employee has not incurred any expenses. EBRI Issue Briefs Extremely or very familiis a monthly ar Somewh at periodi familiarcal with Not too in or no -depth t at alevalu l familia artion of employee benefit issues ? Health-risk assessment, where you answer a questionnaire and then a medical professional examines your health Figure 44 perc18, ent o Per f centage of In traditional-pladividuals n enrollees. Repor Nearly fo ting That ur-fifth They s (7 Wou 7 percent) ld Probab of ly Part CDHP enro icipatellees partici in Employer pat Well ed in ness Pro a biomet gram, ric 100% health savings 50% accounts (HSAs). Offers W By (Among 2014, ellness 27 individuals seeking cost percent o Program, by f employers Ty wit pe h information) 1 of 0–4 Plan, 99 wor 2014 kers and 48 percent of employers enrolle Participat d in aion in CDHP. Wellness Pr (Among ograms those w ............................................................................................ ho never used an App for a Smartphone or Tablet) ........................ 11 are sometimes referred to as Health Savings Accounts (HSAs), Health Reimburseme a b c nt Accounts population with private health insurance. Mercer found that 23 percent of workers with employment-based coverage 80% an oversample of individuals with a CDH and trends P or, as HDHP well as Tradi was a tiona crit l dde icHDH al d. The anal P ys es CDH ove of Prsample employee b inclu enef ded 1,1 it polici 65 individuals with es and proposals. EBRI a CD HP the plans; attended a meeting where choices were explained; consulted with their employer’s HR staff about choices; and costs; checked the price of a service before getting care; asked a doctor to recommend less costly Our by Various Cost-Sharing Incentives and Type of Health Plan, 2014 3 ............................................................. 43% 17 histo 90% ry to identify any co 92% nditions you may have or that you might be at risk of developing. 91% 7 a screening, co 80% mpared with 60 percent of traditional-plan enrollees. b c 45% with 500 or more workers offered either an HRA- or HSA-eligible plan. (HRAs), Personal care a Visited health plans' webccounts, Per site to learn about their s p onal medical funds, or lT ar ns aditonal HDHP CDHPChoice funds, and are different from 52%* were covered To be eligible for an by a CDHP HSA, a in n 2014. individu The Nat al may not ional Health be enroll In ed aterview Su in other rvey (NHIS health covera ) fou ge, n such as d that 12 a spo percent of in use’s plan, diviunl duals ess Patient Use of Technology ..................................................................................................... Notes is a monthly periodical providing curr b cent information on a variety ............................... 15 of employee benefit HRAs can be thought of as providing “first-dollar” coverage until funds in the account are exhausted. Leftover funds at and 741 indivi 90%duals a with an HDHP, resulting in a 20 total sa 05 2006mple 2007(base 2008 pl20 us oversample 09 2010 2011) of 20 1, 12 45 209 for 13 20 50% the C 14 DHP group and 48% asked hprescription ealth 60 45% % plans to sen s; talked to 86%d 86% information their doctor in the mai s about other l; and also wer treatment opti e less likely to hav ons and costs; developed a budget to e talked to their doctor or other You can make changes on your ow Tradi n tional HDH 28% P CDHP 33% Traditional Prescription drug 44% The 2014 CEHCS continue 14%d to find that C 20%DHP enrollees were more cost conscious in 62% their decision making than those in 8 84% 69% employer-provided Flexible Spendin topics. EBRIef g Accounts. is a weekly rou ndup of EBRI r 69% esearch and insights, as well 48% as updates on 68% 70% 82% a c that pl with private publications an is als insurance wer o a high-dedu e covered ctible hea by a CDHP lth plan. However, in 2014, whi indivi le 24 duals bperc are ent were allowed to h covered by ave suppleme an HDHP (without ntal coverage anwi HSA). thout Very Interested Somewhat Interested 67% Not Interested the end of eac ? Pro 80%grams fo h yearr impro can be ving yo carried over to ur health, like fo the follo r weight lo wing year (at th ss, walking o e employer’s r other exercise, discretion), nutrition, allo stress mana wing employees gement, to Figure 978 for19, the Per HD centage of In HP group. Afdividuals ter factorRepor ing outt the ing That base Tradi Th sa ti66% ona ey Used a mple—th l HDHPn e App More 29 CDH 4 individu P Than als w Oin th a C ce for a DHP Sma and th rtphone or e 237 inTa dividuals blet, health professional about the plans. 37% Conclusion .................................................................................................................... CDHP en manage h rollees were ealt also m h care e ore like xpenls y tha es; and u n traditio sednal-pla an online n enro cost-tracking tool provided by the heal llees to report that their em...................................... 15 ployer offerth plan. ed a cash 65% Employers have been interested in surve briny gin s, studi g aspects es, litig oation f co,ns leg umer islation and r engagement into health plans for many egulation affecting employee benef 53%it plans, while years. As far traditional 70 pla % ns. CDHP enrollees were 78% more likely to use resources to pick their 64% health plan and more like 9 ly to use cost 80% 52%* 27%* Talked to friends, family, colleagues about the plans 40% Office visit 51% a hi Thegh Kaiser deducti Family Fou ble for suc ndat h th ion (K ings as vision FF) found that care, dental 20 perc c ent of are, spec work ific ers wer diseases, and in e enrolled in surance t a CDHPh iat n 201 pays a fi 4. xed amount by Various Health-Related Purposes and Type of Health Plan, 2014 ............................................................ 18 accumulate smoking cessation, and so on. funds over time, and, in pri 74% nci74% ple, creating the key incentive for individuals to make 40% health care purchases with an HDHP—there were 1,450 individuals in the sample with traditional health coverage. 48% 60% EBRI’s Blog supplements our regular publications, offering commentar 60% y on questions incentive or reward for participating in a 72% wellness program. Just over three-fifths (63 percent) reported a cash incentive 63% information back as 1978, 50 before % they a gettin dopted g 59% he Sec. 125 cafet alth care serve ices. CDHP ria plans a enrollees nd flexible s wer pen e more likely th ding accounts an traditional (FSAs). More -plan recently, enrollemplo ees to take yers 12 Appendix—Methodology Yes .......................................................................................................... 58% ............................. 19 70%60% 47%* 61% 50% per day (or other period) for 60% hospital 46%* ization. Individuals 60% enrolled in Medicare are not eligible to make HSA ? There is also some evidenc rece e that ived from adults i news 56% n reporters a CDHP we , polic re more likely ymakers, and others than th 34%* . The ose in EBRI Databook a traditional on Employee plan to be responsibly. 70 Employers can % You d place restrictio o n De ot h ntal av ce en are ough time ns on th to participat e amo e unt that can be carried over. 30% 65%* Availability and Use of Cost Information 27% 33% or reward for 35% participating in the health-risk assessment; one-half (53 percent) reported a cash incentive or reward for 60% 63%* 58% 43% have begun to take a Attended broa a meetde ing whe r view re your of cho cons ices wer umer e e explain ned gagement in health 17% care. * Some employers have introduced more advantage o No f various we 57% llness programs, such as health-risk assessments, health-promotion pro 57% grams, and biometric 33% ? Biometric screenings, which are measurements or blood work to determine your health status including blood Figure 20, Interest in Using 61% an App Benefits for a Sis martphon a sta 56% tistice or al refer Tablet, by ence work on em Health-Related ployee ben Function, efit programs and work force-related 2014 ........................... 18 Length of Time in Health Plan 42% In ad contributio ditionn to s, bein although th g stratifey ied, th are a e b ble to wit ase sample hdraw mon was also we ey from the HSA ighted by gen for quali der, age, fied m education, edical 37%* expenses and certa region, income, 55% an in d Definitions ................................................................................................................... 33% ....................................... 21 engaged in their choice of health plan. Specifically, those in a CDHP were more likely than those with participatin 60% g in a health-promotion program, and two-thirds (65 percent) reported a cash 42% incentive or reward for a The incentives of CDHPs ar Lae b o desi r radio gne logyd to promote heightened sensitivity to cost in individual’s decisions about their screenin workplacgs. In Not sure e wel addition, lness prog fin ram ancial i s, usually i ncentn ive th se form mattered mo of healre th-to C risk assessments or DHP enrollees thb an to iometric screenings. Emp traditional-pla 52%n enrollees. loyers have 11 1350% issues. 30%* pressure, 60% cholesterol, weight, height, etc. 40% 40% 55% Distributions from an HRA for qualified medical expenses are made on a tax-favored basis. Since unused funds are race/ethnicity 30% to reflect the actual proportions in the population ages 21–64 with private health insurance coverage. The premiums. survey fo An und that t individual he also amount of may not time mak individu e an HSA co als hantribution ve been in if a C heD or she is HP was shor 25% claim ter than ed as a th de e ti pen me others dent on a hav noth e been er traditional coverage to say that they had attended a meeting wher 53%* e health plan choices were explained; 36% 52% Consumer-Driven Health Plans (CDHPs) ............................................................................................................ 21 biometric50 scre % Co enin nsultg ed w (Fi ithg yo ur ure em 14). ployer T 's H he m R staff aabo in reasons e ut you choicesnrollees participat 16% ed * were to improve or maintain health (Figure 51% 32% 35% health often provi care. d Y ed fina et the ncial ability t inceo n make i tives to i nform ncrease worker ed decision pa s is rthighly de icipation in pen sd uent ch programs. on th 47% e extent A feto whic w employers have h people have intro access duced b 26%* 50% 39% Outpatient procedure/surgery 26%* 35%* allowed to roll HDH over, an P 10% employee is a 20%ble to accumulate funds over time. An 66%employer can allow a former employee to pers The CDHP on’s ta an x rd HDHP ov eturn. You d o nersamples ot need it becauwere se you a w ree alight readyed by healthy gender, 19% age, income and rac 29% e/ethnicity, using the demographic enrolle 11 d in tra 50% ditional coverage. Among individuals with traditional coverage, 19 percen 40% t had been in their plan for three consulted with their employer’s human resources (HR) staff about health plan choices; and were more 50% In theory, a random sample of 2,000 yields a statistical precision of plus or minus 2.2 percentage points (with 95-percent 15). CDH P enrollees were more likeContact EBRI ly than traditio Publications, (2 nal 45% plan enro02) 659-0670; llees to report t fax publication hat they parti orders to cipated to r (20e2duce ) 775-6312. to usefu Health S l in 25 a for % 40 vings Accounts % mation. .................................................................................................................................. 21 private health insurance exchanges. These programs give workers more choices for health coverage and more 23%* 37% use any leftover money in the HRA to continue to cover qualified medical expenses. 27% Funds can be used for out-of- profile of the CDHP and HDHP respondents to the omnibus survey described below. a to four years 30%and 45 percent for five or more years. This compared with 21 percent and 30 percent, respectively, likely to have consulted with an insur Vision care ance broker to understand plan choices. 21%* a Subscriptions to EBRI Issue Briefs are included as part of EBRI membership, or as part of a Used other websites to learn about your choices 21% 38% 34%* confidence) of what the result 40% s would be if the entire population ages 21–64 with private health insura T Tr rn adi adi ce coverage were ti tiona onall premiums, while they were less likely to report that they participated to improve 33% their health. Otherwise, there were no 20% transparency regarding coverage choices and the costs associated with each choice. Health Reim Orders/ bursement Arrangements ............................................................................................................... 22 40% 40% 20% 28% Individuals who have reached age 55 and are not yet enrolled in Medicare may make catch-up contributions. In 2014, a 35% 35% 19% pocket expenses and premiums for insur $199 annual sub ance, lonsg cription -term to care, EB 24%* RI Not COBReA, s and and r EBRI Issue etiree heBrie alth fsbe . Change of nefits. An Address: employer i EBRI, s not among peo 20p %le in a CDHP (Figure 4). While still lower than the 18% percentage of individuals with traditional coverage, the 23%* 33% The survey asked if participants tried to find the cost of health care services before getting care and found that CDHP Whil surveyed with e panel I 30n % complete accur ternet surveys are a 22%* cy. There are nonrandoalso other poss m, studies havible sources of error in al e demonstrated that such l surveys that ma surveys, when c y be areful more serious than ly designed, differences by plan type. Inpatient surgery 24% 32% 32% 17% 31% 31% b b 17% $1,0 To e0 ffici 0 catch ently -iup co dentify ntributio Tres he pr pog on rn adents who wo m i was s not allow 1100 13th St. NW, Suite 878, Washington, convenie ent d. The lyuld qua located catch forlify for you-up contribution the C 15% DHP and HDHP ov 12% is not in DC, 20005-4051, (202) 659-0670; fax number, 27%dexed ersample to infls, the stud ation. y used Ipsos’ References ............................................................................................................................... 30% 30% ........................... 22 requir ?ed to m The survey al ake the un so finds used balanc that CDHP enrolle e available to a es wer worke er w moh re likely than tr en 22% he or she leaves adition . al-plan enrollees to take 29% number of people with a CDHP and the length of time they have been enrolled in a CDHP have been increasing. In Subscriptions Consulted with an insurance broker to understand your choices 24%* HDH HDHP P 30% enrollees an 30 20 %% d HDHP enrollees were more likely than traditional plan enrollees to report that they tried to find cost theoretical calc This Issue Brief 30% ulations of sampling erro presents findings from r. These include refusals to be intervie the 2014 EBRI/Greenwald & Associates Consu wed and other forms of nonresponse, the mer Engagement in Health Care obtain results comparable with random-digit-dial telephone surveys. Taylor (2003), for example, provided the results (202) 775-6312; e-mail: 15%subscriptions@ebri.org Membership Information: Inquiries 15% 19%* omnibus survey of more than 40,000 online panel mem 12%bers who met the study’s criteria (having private insurance and Physical therapy/rehabilitation services advantage of various wellness programs, such as health-risk assessments, health-promotion programs, as 2014, 30 percent of CDHP enrollees reported that they had been 19% in the health plan at least five years, up from 20 per- Endnotes The survey als ...................................................................................................................... o asked respondents their reasons for not participating in their employer’s welln ...................................... 23 ess program. About 20% regarding EBRI membership and/or contributions to EBRI-ERF should be directed to EBRI Survey (CEHC information (Figure S). This 9). C stuD dH y was P enro base llees d an ond tra an onli ditional ne su pl rve an en y of 3 rolle ,88es w 7 pre ivate re equa ly insur lly led adu ikely to lts ages 2 have found inform 1 -64 thata was tion from effects of ques from a numbetion wording a r of surveys th nat wer d question order, and scree e conducted at the sa ning. me time While attempts using the same are m que ade to minimi stionnaires bo ze these factors, it is th via telephone and c Distributions from an HSA can be made at any time. An individual need not 22% be covered by a high-deducti c ble health plan being ages 20 21 %–64). The following three questions w 10% ere used in the omnibus survey running from July 14 to Aug. 1, CDH CDHP P 17% well as biometric screenings. In addition, financial incentives mattered more to CDHP enrollees than to 20% Asked health plans to send you information in the mail 16%* Major reason cent in 2006 (Figure c 5). President Dallas 6% Salisbury at the above address, (202) 659-0670; e-mail: salisbury@ebri.org 10% Alternative medical care 15% 15% 60 percen 20 t re % sponded that they did not participate because they could make changes on their own (Figure 16): 28 per- various sources. HDHP enrollees were less likely than traditional plan enrollees to have found information from a health des impossible to igned to pr CDH ovide quantify the P nationalerrors th ly repr 39%* esat m entati ave data y result re from them. garding t 17%he 25%* growth of 18% CDHPs and high 35%* -deduct 17% 13%ible health plans online. He found that the use of demographic weighting alone was sufficient to bring almost all of the results from the to withdra10 w% money from the HSA (although he or she must have been covered by a high-deductible health plan at the You just do not know enough about the program 9% 27% 11% 11% 11% 2014, to identify likely CDHP and HDHP respondents: 15% traditional-plan enrollees. 9% 9% 9% 10% 12% 13% 8% 8% cent cited this as a major reason, and 33 percent cited it as 7% a minor reason for not participating. Lack of time was the 10% 7% 12% (HDHPs) an plan’s printed d tmaterials. Oth he impact of te hrwise, H ese plans a DHP nd consum and traditio er e nal 7%ngagement plan enrolle mes wer ore genera e equa lly lly l on the ikely to 7% behavi Mi have noor and attitu r reas fo on und informat des of ion online survey close to the r Menta eplies l health c from th are e paralle 7% l telephone survey.15% He also found that in some cases propensity 5% 11% 5% 11% time the funds were placed in the HSA). Distributions are excluded from taxable income if they are used to pay for Editorial Bo 10% ard: Dallas L. Salisbury, publisher; Stephen Blakely, editor. Any views expressed in this publication and those of the authors should 12 5% 14% 10%* Talked to your doctor or 9% other health professional 9% about the plans 3% 3% Figures References Permitted insurance also includes workers’ compensation, tort liabilities, and liabilities related to ownership or the use of 8% 8% 8% 10% second-most-popular reason for not participating, with 27 percent r14% eporting it as a major reason, and 33 percent from various s not be ascribed to the officers, ources. trustees, members, or other sponsors of the Employee Benefit Research Institute, the EBRI Educ c ation and adults with private health insurance coverage. The sample was ra b ndomly drawn from Ipsos’ online panel of more than Familiarity With CDHP wei ghting (meaning the propensity for a certain ty 9% pe of person to be online) reduced the remaining gaps, but in other qualified medical expenses as defined under Internal Revenue Code (IRC) Sec. 213(d). Distributions for premiums for 0% 0% Out of network care 9% propResear erty (ch Fund, such as auto 0% or their mo staffs. bile insurance) Nothing herein is to be co . nstrued as an attempt to aid or hinder the adoption of any pending le c gislation, regulation, Figure 1, YPremium Incr ou are worried that yo eases Among Employers ur employer will know your personalWith heal 10% th 10 or More Em b ployees, Worker Earnings and Inflation, Fronstin, Paul. Consumer-Driven Healt a h Benefits: A Continuing Evolution? Washington, DC: Employee Benefit Research reporting it as a minor reason. About one-half (48 percent) did not participate because they were already healthy 0% 0% 775,000 Internet usersHe who alth rT have is radi k as tiona sess agr l ment eed to participate 0% He i alt n rese 10% h prom HDH 10 oti arc on % P pr h sur ogram 25% v 20 eys. This sur % 30% vey used Biom 40etr %CDH ic s a cP rba eense sample 50 ing % 60 of % 1,981 to cases it did not reduce the remaining gaps. Perhaps the most striking difference in demographics between telephone Reduced drug cost sharing Increased drug cost sharing Reduced office visit cost sharing Increased office visit cost sharing the Consoli The survey fo datund ed Om that mos nibus B t peo udget R ple wit econcil h a CDHP iation Act were of fa 1m 985 iliar (CO with BRA it. ), Two-t long-t hirds erm car (64 percent e insuran ) of t ce, h he ose wit alth insuranc h a CDe HP while 0% 10in %formation20% 30% 40% 50% 60% 70% 80% 90% 100% or interpretative rule, or as legal, accounting, actuarial, or other such professional advice. www.ebri.org Less He Talt hah r n O isn k as e Yse ear ssment 1-2 Years Health promotion program 3-4 Years Biometric s 5 Yea creen rs o ing r More 1988–2014 ............................................................................................................................................... 6 0% 0% 10% 20% 30% 40% 50% 60% Among individuals who sought cost information, CDHP and traditional plan enrollees were equally likely to have sought Institute, 2002. (19 percent reported it as a major reason, and 29 percent reported it as a minor reason). For the most part, there were 13 draw incidence rates for people with CDHPs and HDHPs, and the base sample was complemented with an additional and online surveys was the under-representation of minorities in online samples. receiving unemployment compensation, and insurance while eligible for Medicare other than for Medigap, are also tax were extr Only Medicare emel Source: EBR y, very, or so N enrollees ages 65 and older a utritio I/C nommonw Exer ealth Fund cis mewhat e C W onsum ei famil ghterismi in H Ge ar wit ne ealth C re allowed to p ral ha it re Surv P (Fi rices ey g for , ure 2005 ? a P6). 2007; EBR ry insura ices In co for I/Gnce pr reenw nt Merast, 34 diald calemiums from a & Associates Ba perc lance o Ce f ons nt of umer Con ntac in Engagement HSA. A Medic tdividua Make in H l an s with ealth C aare re enrollee under Ch traditio eck nal Source: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2014. Source: Source: Source: EBR EBR EBR I/G I/G I/G reenw reenw reenw ald & Associates ald & Associates ald & Associates C C C onsum onsum onsumer er er Engagement Engagement Engagement in H in H in H ealth C ealth C ealth C a a a re Surv re Surv re Surv ey ey ey , , , 2014. 2014. 2014. cost informati a on on Source: EBR a ran I/Greenw ge of ald & Associates health car Consum e services er Engagement (Fi in H g ealth C ure a1 re Surv 0). In ey, most instances, H 2014. DHP and traditional plan enrollees Surv Source: Source: ey in, 2008 forma EBR EBR ? tio 2014. I/G I/G n reenw reenw prog ald & Associates ald & Associates rams managem C Consum onsumer ent er he Engagement Engagement alth pres in H in H crealth C ealth C iption a are Surv re Surv other ey ey, , 2014. 2014. claims HSA or health plan's appointment provider no differenceTs in t EBR raditional = I Issu he He answer ealth Brief plan w is r s to this seri ith egister no deductible ed in the U. or es of <$1,250 (indiv S. Patent and T questio idual), <$2,500 (family ns radem by p arlk an ty Office. ) in 2014. pe. ISSN: 0887 ?137X/90 0887 ?137X/90 $ .50+.50 a aa 0% 10% 20% 30% 40% 50% 60% 70% random oversample T Tr raditional = aditional = of t H Health ealth hes plan w plan w e two iith th no no gro deductible deductible ups. or or <$1,250 (indiv <$1,250 (indiv More spec iidual), <$2,500 (family dual), <$2,500 (family ifically, the oversamp ) in ) in 2014. 2014. les were: 1) those with either an HRA or an T araditional = Health plan with no deductible or <$1,250 (individual), <$2,500 (family) in 2014. a ba a free. coverage were extr age 65 cannot use an HSA to pay insur This mea Traditional = n Ts that raditional = emely, very, or somewh Health distributions used to Health plan w plan w ith no ith deductible no deductible aor nce <$1,250 (indiv or premiums. pay M <$1,250 (indiv at famil idual), <$2,500 (family edi iar idual), <$2,500 (family care with Part A or a C ) in DHP, 2014. ) in B, 2014. and 30 Medicar percent e Advan oft individu age plana premiums, and th ls with an HDHP w e ere Figure 2, Distribution HDHP = High-deduc T Tr raditional = aditional = of In H Health ealth tib plan w plan w di le health viduals Cov iith th no no plan or deductible deductible d w iet iths deduc or e or in red <$1,250 (indiv <$1,250 (indiv tible forma $1,250+ (indiv by Privat tion iidual), <$2,500 (family dual), <$2,500 (family drug idual), $2,500+ (fam e H s e me alth I dical c ) in ) in n asuranc rily e 2014. 2014. ), not his HSA-eligible in tor e y, by Type o HRA 2014. * f cu Health stomer Plan, 2005-2014 hours .............. 6 ________. “H b b ealth Savings Accounts and Other Account-Based Health Plans.” EBRI Issue Brief, no. 273 (Employee b HDHP = High-deduc HDHP = High-deductib tiblle e health health plan plan w wiith th deduc deductible tible $1,250+ (indiv $1,250+ (indiviidual), $2,500+ (fam dual), $2,500+ (fam ily ily), not ), not HSA-eligible in HSA-eligible in 2014. 2014. b b b HDHP = High-deduc b tible health plan with deductible $1,250+ (individual), $2,500+ (family), not HSA-eligible in 2014. c HDHP = High-deductible health plan with deductible $1,250+ (individual), $2,500+ (family), not HSA-eligible in 2014. HDHP = High-deduc HDHP = High-deduc HDHP = High-deduc tibltib tib e health lle e health health plan plan plan with w w iideduc th th deduc deduc tible tible tible $1,250+ (indiv $1,250+ (indiv $1,250+ (indiv idual), $2,500+ (fam iidual), $2,500+ (fam dual), $2,500+ (fam ily), not ily ily), not ), not HSA-eligible in HSA-eligible in HSA-eligible in 2014. 2014. 2014. CDHP = Consumer-driven health plan with deductible $1,250+ (individual), $2,500+ (family), with HRA, HSA, or HSA-eligible in 2014. c c c service CDHP = Cons CDHP = Consum umer-driv er-driven en health health plan plan w wiith deduc th deductible tible $1,250+ (indiv $1,250+ (indiviidual), dual), $2,500+ (fam $2,500+ (family ily), w ), wiith th HRA, HRA, HSA, HSA, or or HSA-eligible in HSA-eligible in 20 2014. 14. HSA, including CDHP = Cons c individu um aer-driv ls th en at wer health plan e enroll with deduc ed tible in a $1,250+ (indiv n HSA idual), -eligi $2,500+ (fam ble health ily), w plan, but ith HRA, HSA, or ha HSA-eligible in d not op 20ene 14. d the HSA, and 2) those c c c employee shar CDHP = Cons e of CDHP = Cons the umer-driv pr umemi er-driv en health u en m for health plan w plan emp ith deduc with deduc loyment-based tible $1,250+ (indiv tible $1,250+ (indiv idual), re idual), $2,500+ (fam tiree $2,500+ (fam health ily), w ily ith ), w benefits ar HRA, ith HRA, HSA, HSA, or HSA-eligible or e a HSA-eligible in llowed on in 2014. 2014. a tax-free basis. familiar with * a Source: Differenc CDHP = Cons CDHP = Cons CDHP. EBR e betw I/G um um een HDHP/CDHP reenw er-driv er-driv ald & Associates en en health health plan and T plan w w C riaditional ionsum th deduc th deduc er is tible tible Engagement statis $1,250+ (indiv $1,250+ (indiv tically s in H ignific ealth C iidual), dual), ant at a$2,500+ (fam $2,500+ (fam re Surv the p =ey 0.05 , 2014. ily ily or better. ), w ), wiith th HRA, HRA, HSA, HSA, or or HSA-eligible in HSA-eligible in 20 2014. 14. Benefit Research Institute, September 2004). * * Source: Differenc Differenc EBR e e betw betw I/Greenw een HDHP/CDHP een HDHP/CDHP ald & Associates and T and T Consum r raditional aditional er Engagement is is s st tatis atistic tica ally llyin H s siignific gnific ealth C ant ant a at at re Surv the p the p ey = = 0.05 0.05 , 2014. or better. or better. * Difference between HDHP/CDHP and Traditional is statistically significant at the p = 0.05 or better. * Difference between HDHP/CDHP and Traditional is statistically significant at the p = 0.05 or better. * Difference between HDHP/CDHP and T raditional is statistically significant at the p = 0.05 or better. * Asked of CDHP only. © 2014, Employee Be nefit Research Institute ?Education and Research Fund. All rights reserved. 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 Brie e e e e e e e e e e effffffffffff • December • December • December • December • December • December • December • December • December • December • December • December 2014 • No. 407 2014 • No. 407 2014 • No. 407 2014 • No. 407 2014 • No. 407 2014 • No. 407 2014 • No. 407 2014 • No. 407 2014 • No. 407 2014 • No. 407 2014 • No. 407 2014 • No. 407 20 21 15 19 23 22 11 4 2 3 8 5 A monthl ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org ebri.org y resea Issue Issue Issue Issue Issue Issue Issue Issue Issue Issue rch report f Brief Brief Brief Brief Brief Brief Brief Brief Brief Brief • • • • • • • • • • r December December December December December December December December December December om the EBRI Education and Re 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 • • • • • • • • • • No. No. No. No. No. No. No. No. No. No. 407 407 407 407 407 407 407 407 407 407 search Fund © 2014 Employee Benefit Research Institute 16 12 17 14 18 13 10 7 9 6