The number of health savings accounts (HSAs) and health reimbursement arrangements (HRAs) increased to 5.7 million in 2010, according to a new report by EBRI. Assets in these account-based health plans increased to $7.7 billion in 2010.
ASSET LEVELS GROWING: In 2010, there was $7.7 billion in health savings accounts (HSAs) and health reimbursement arrangements (HRAs), spread across 5.7 million accounts. This is up from 2006, when there were 1.2 million accounts with $835.4 million in assets, and 2009, when 5 million accounts held $7.1 billion in assets.
AFTER LEVELING OFF, AVERAGE ACCOUNT BALANCE DROPS SLIGHTLY: Increases in average account balances leveled off in 2008 and 2009, and fell slightly in 2010. In 2006, account balances averaged $696. They increased to $1,320 in 2007, a 90 percent increase. Account balances averaged $1,356 in 2008 and $1,419 in 2009, 3 percent and 5 percent increases, respectively. In 2010, average account balances fell to $1,355, down 4.5 percent from the previous year.
AVERAGE ROLLOVER DECLINES, WHILE TOTAL ROLLOVERS INCREASE: Despite a decline in the average rollover amount in 2010, total assets being rolled over have been increasing. $4.2 billion was rolled over in 2010, up from $4 billion in 2009. The average rollover increased from $592 in 2006 to $1,295 in 2009, and fell to $1,029 in 2010. The percentage of individuals without a rollover decreased from 23 percent in 2006 to 10 per-cent in 2009 and increased slightly to 13 percent in 2010.
HEALTHY BEHAVIOR MEANS HIGHER ACCOUNT BALANCES AND HIGHER ROLLOVERS: Individuals who exercised, those who did not smoke, and those who were not obese had higher account balances and higher rollovers than those with less healthy behaviors. It was also found that individuals who used cost or quality information had higher account balances and higher rollovers compared with those who did not use such information. However, no relationship was found between either account balance or rollover amounts and various cost-conscious behaviors such as checking pricing before getting services or asking for generic drugs instead of brand names, among other things.
DIFFERENCES IN ACCOUNT BALANCES: Men have higher account balances than women, older individuals have higher account balances than younger ones, account balances increase with household income, and education has a significant impact on account balances independent of income and other variables.
DIFFERENCES IN ROLLOVER AMOUNTS: Men rolled over more money than women, and older individuals had higher rollover amounts than younger individuals. Rollover amounts increase with household income and education, and individuals with single coverage rolled over a higher amount than those with family coverage.
Accounts (millions) ) Accounts (millions) Figure The Other tha num 13, Typ Cost- ber o n Acc ine of C response to fo C peopl unt Ba ons oc v e ious Behavio e lances with rag th e— a rollover , by e last In for Various question r m s as w ulating acco —A num Cost-Conscious e, no statisticall ll as t berh of cost-consci unt e tota balanc lBehaviors, August 2010 leve y signi es f l of fo o icant as r persons us be sets di haviors bein fferwit ences g ro h were in lle ................................................. wer dividual d ex over has e fou amine co nd in verage an d to se bee ave n increas e i rage fd inpersons with account diividuals ng, alt hough ..... who 13 Figure 4 Figure 20 Figure 24 Figure 26 Figure 22 Figure 10 Figure 6 Figure 8 Figure 14 Figure 30 Figure 16 Figure 18 Figure 12 Figure 32 Account Balance Variation About the 2010 EBRI/MGA Consumer En Figure 2 gagement in Health Care Survey Figure 28 a b the balanc exhi family cover growth bit mor es betw slo eage, a co een wst-conscious ed in individu number o 2010al . sdecision fIn 2 who factors 00exh 6 maki Account Balances, , 5 ne ibit 00, ed eng 000 d th to be had hi in e cost-co consider divid gher ualn rollover s rolled scious decisio ed. by Whil Gender over amou e in $di nts than t ,n 302. 2007–2010 makin viduals with 9 mil g lion h beh ose (Fig aviors and tho fa who mily ure di covera 19 d not e ). B ge often have higher s yx e who 20 hibit such 09, di 3.1 d no a mit. llion Introduction Account Balances, Account Balances, Avera Account Balances, Rollo gRollo e HSA Rollo ver Amount, ver Amount, ver Amount, b or HRA b yy Gender and Ann u b Rollo al Household b y y Education, b b Plan y y Race Ag ver Amount, Ag T ee y ,, 2007–2010 pe 2007–2010 Combined, , 2007–2010 2007–2010 Income 2006–2010 , A 2007–2010 ugust 2010 Account Balances, Rollover Amount, Account Balances, b by y V Length arious Cost-Conscious of b Time y LeWith Account, vel of Ann Beha ual vior 2007–2010 s, 2010 Rollover Amounts, Among Individuals with Account References Account Balances, Rollover Amount, by Use of Cost by Leand Quality vel of Annual Information Figure 14, Account Balances, by Length of Time With Account, 2007–2010............................................................... 15 Rollover Amount, by Health Behavior and Health Status, 2010 Total Assets and Number of Adults Ages 21–64 This sectio The Employe n e ex Ben amines var efit Resea iation in rch Institut accoue nt (EBRI) and Mat balances and tren hewds i Green n thos wale ba d & Associates lances by a num (MGA) creat ber of differ ed thee Consum nt variabler es, Paul Fronstin is director of the Health Research and Education Program at the Employee Benefit Research Institute. Furthermore, indivi decision deductibles th duals ro maki $1,400 ll ng with r an those ed ove process. espect r n with early t To h single $4 wh e e billion. x ether pectatio covera an An i n was ge, an n d divi by 2 dual that t d th 01 asked 0 ey ar , 4 ho s m e who e st illion hisatutorily or h ex individuals rolle e hibit r doctor to reco al ed cost-consci lowed to mak d ovmmend a l er nearly o eus be higher havior $ contri e 4ss costly prescri .2 million. would hav butions, th The e a a ey pv tion high erage may er Individual Contribution, 2007–2010 for More than One Year, 2006–2010 $1,800 and Use of EmploW yer Contrib ellness Pr u ogram, tion, 2007–2010 August 2010 Employers firs $2,000 $1,800 $2,000 $1,400 $1,400 $1,400 t started offering account-based health plans in 2001, when a handful of employers began to offer health $3,000 $1,200 a b Fronstin, Paul. "The Use of Health Savings Accounts for Health Care in Retirement." EBRI Notes, no. 3 (Employee $1,200 With an HRA or HSA, 2006–2010 Engagement such as demo in graph Healt ics, inco h Care m Survey to e, health sta exam tus, health ine issues be surro haviors, and v unding conarious measur sumer-directees d hof cost-conscious d ealth care, including th ecision e cost of Figure This Issue Brief 15, Account Ba was written with assistance from lances, by Level of Annual Employ the Inser Contri titute’s rbutio esearn ch an , 2007–2010 d editorial staffs. .............................................. Any views expressed in ... 15 rollover i drug, rollover amou also use more it was ncrea fo nt than healt sed from und that t h car those $h e 5ose s 9 2 e who in rvices an asking for 20 did not 06 to $ d t e h a r 1 erefore x,hibit such e 295 commendati in hav 2009, be e hhavior igher o and t n ha costs. T . hen d The lo fe wer questions re ll t average accou his makes it o $1,029 in $1,295 gar 2 di d 0n fficu ing cost-cons 10 t ba (Figu lt to lances t rpre e 20 dh cious de i). c an those who t whether cision families making did not $1,288 reimbursem 35% ent arrangements (HRAs), empl $1,275 oyer-funded hYes e Yes alth plans No No that reimburse workers for qualified medical $1,400 $1,800 Benefit Resear $2,000 ch Institute, April 2010a $1,620 ): 2 -6. 2007 2008 2009 2010 January 2011 • No. 353 $9,000 $1,796 7 Male Female $1,766 $1,787 insurance, making an the cost of c d health engage are, ment. satisfaction Both twi he accou th healn th c t bala are, nce estimat satisfaction es with a and thhealt e statist h caical signific re plan, reanc asons for c e tests w hoosin ere g a this report$1,800 are those of the authors, and should not be ascribed to2007 the officers, 2008 trustees, or other 2009 $1,742 2010 sponsors of EBRI, 2007 2008 2009 2010 $1,890 (Fi were described a willgur have e 1 hi 3). $1,800 gh er or bove. lower In t ach count e seribalanc es of questions, no st es than individuatistically signi als. It was found that ficant differ indivi enc des wer uals with e foun family covera d (Figure 3ge 0).had $1,600 $1,028 2007 2008 2009 2010 $1,600 expenses. In 2004, employers were able to start offering health plans with he $1,026 alth savings accounts ( $2,563 HSAs), tax- Figure 16,$1,200 Account Balances, by Level of Annual Individu $1,525 al Contribution, 2007–2010 $1,161 ............................................ 31% .... 16 $1,526 $1,200 $1,200 $1,163 Yes No $1,166 $1,200 2007 $1,000 2008 2009 $992 2010 $1,139$1,643 The gene plan, remain rated fro and sour der m ces of of t a re his section gressio healthn i e n exami formation. quation nes vari tha tThe 2010 EB also controll ation in rollo R ed v I/MGA efor r amounts. how Cons lon u m gThe an er Eng $987 in estimates divi agem dual e has ha $986 nt i in t n Hea his section d a lth n H Care S RA or HSA, werurvey is e $989 also e m ployer 2007 2008 2009 2010 $1,775 EBRI-ERF, or their staffs. Neither 2007 EBRI 2008 nor EBRI 2009 -ERF lo 2010$976 bbies or takes positions on specific policy $974 proposals. EBRI ________. "Findings from the 2010 EBRI/MGA Consumer Engageme $1,608 nt in Health Care Survey." EB $1,130 $1,754 RI Issue $1,606 Brief, no. $1,386 in their $1,000 $1,800 account in August 2 $968010, while those with individual coverage had $1,456 (Figure 10). However, the $2,500 $1,000 $1,600 $962 $1,456 $951 $963 $1,536 $1,444 $1,577 $1,579 $960 exempt trusts or custodial $8,000 accounts that individuals can use to pay for health $948 care expenses $1,188 . $7,721.9 The theory $954 behind these 30% $928 $941 $937 4 $1,600 $1,200 $917 $1,386 6 Figure comparabl gene contributio rated fro 17, Length of Time With Length of Time With $1,600 Acc e n to s t m o fin o a re unt Ba the din account, gressio gs from lances n , by e individu the 2005, quation Account— Account— Rollover al co tha 2006, an Level, tn also controll tThe Not sur ributions le d 200 ngth 2007 p7– risingly, the to t 20 of t ed E10 h Be acco RI/Common for ime t ..................................................................................... how h lunt, a at an ength lon $908 g in w n of an d ealth dividual has time unuse indivi Fun that an ddual $1,646 d bal C has ha had th ance rol onsumerism in individual has e accou d a lover n Hamounts. RA or HSA, n Health t has had a an im Care n accou Unli em pact on ke the ployer nt 16 invites comment on this research. $1,034 $1,366 $901 350 (Employee Benefit Research Institut 2007 2008e, Dec 2009 ember 2010 2010b). $1,457 $1,029 average accou $1,400nt balance of individuals with family coverage declined between 2009 and 20 $1,023 10, while it was unchanged $1,400 $1,346 $1,351 $891 $1,453 $2,231 2007 2008 $1,496 2009 $883 2010 $1,000 $1,334 accounts is that by giving individuals more control over funds allocated for healt $7,094.8 h care services, t $1,013 h $1,321 ey will $999 spend the $867 $992 $1,301 6 $1,003 $1,000 $1,393 $1,600 2006 2007 2008 2009 2010 $995 $1,000 $1,441 $1,439 overall contributio Surveys, an rollover amou has a major i data o $1,000 nd t s t m n accou nts. T he opact on the 200 account, h8 a nt bala e a the nd nal 2 amount of ysis found th nces show and in 009 EBRI divi mo /MGA Consum n in dual aney in t persons Fi contributions gure the 3, acc holding 2 er0 Engagement 0 ount. 6 to the data ar an ac The account coun e not an in alysis foun t for o shown Health Ca . Like the det ne to for d th re two years ha the S at persons u di rvey. affer iled data e nt var wh d a on o hel n iables avera average accou d a beca g ne roll acco use over of unt for of t nt he $948 $1,368 $2,109 $1,000 $1,400 $7,000 $1,348 5.7 $1,000 for those wit $1,400 h individual coverage. Assets (millions) Fig money more responsibly, ure 18, Rollover Amounts, especially once th Among Individuals ey become more With $933 Account for educated ab More than out t On he a e Y ce tual ar, 20 price of h 06–2010 ealth servic ........................... es. 17 $921 $1,303 $927 $804 $927 $2,028 Sandman,25% David, Elisabeth Simantov, and Christina An. "Out of Touch: A $926 merican Men and the Health Care System" $1,400 $993 $800 $986 $1,334 $879 small samp balanc less than si $768 (Figur es, 2x le sizes. 0 e 0 months ha 31). 6 data for In com d a roll pn arison, those overs are average of not $holdin 694 shown ing thei for th an acc r ac e o co dif unt fo unt an feren r thr t varia d te he os to four be who les because years held a had a of small sam n accou n av nt at erage rollover ple least six mont sizes. of $1,213. hs but $1,200 $1,000 $800 23% $959 5 $2,000 $1,200 $956 $849 $867 $1,400 $834 $1,116 Furthermore, these accounts can $837 be used as tax-advantaged vehicles to save for health care expenses in retirement. (March 2000). Accounts (millions) $823 5.0 $1,166 $1,822 The 2010 survey was co $6,000 nducted within the United States betw $5,697.1 een August 8 and August 20, 2010, through a 14-minute $1,200 $1,073 $809 21% Figure Copyright Information: 19, Tot $1,200al Rollover Assets and Number of This report is cop $799 yrighted by the Adults Ag Employee Bene es 21–64 With a fit Research I Rollover, 2006–2010 nstitute (EBRI). It may be us ................................ ed 17 And those wit less than Health B a year ha h an account eha d $962 vi $806 ors and Health Status— (Figure at least $1,066 14). five ye In comparison, ars old had an Indivi in average rol duals dividuals who smoke have wit loh v an er of $1, account $1,206634. less money i for one to two n their ac years had an counts than average those $787 $800 $780 $1,727 $800 $800 $777 $757 $849 Health Savings Accounts and Health Reimbursement $1,200 Gender and $800 Age—Men rolled over more money than women. In 2010, men had a $1,667 n average rollover of ww w.commonwealthfund.org/~ $826/media/Fil $1,035es/Publications/Fund%20Report/2000/Mar/Out%20of% 19%20Touch%20%20 Internet surve Gender and 20% y. The natio Age— nMe al or n ha base ve hi sample gher acco was unt drabalanc wn from Syno es than vate’s onli women. By August 2 ne panel of I 0n 1tern 0, men et users had a who n average o have f $1,631 without permission but citation $717 $1,103 of the source is required. who of $1do not ,324. $1,000 $1,000 $1,200 T sh m ose with oke, but an the ac di count for fference thr is not statisticall ee to four y $992 ear y sign s had ificant an av (Figure 11 erage of $1, ). 822. Similarly, And those obese indivi with an duals ha account ve for at less $1,125 4 By 2009, 15 percent of employers with 10–499 workers and 20 percent of employers with 500 or more workers offered $600 $1,100 Figure 20,$1,000 Average H $800 $5,000 SA or HRA Rollover Amount, 2006–2010....................................................................... 4.2 ........... 19 $1,06 American 1 while w %20 ome Mn h en% ad $8 $651 20an $912 74 (F d%20t iguhe re 21 %2)0Health% . Average rol 20Care love %20 r am System/s ounts deacndman lined fo _r b outof oth me touch_3 n an 74 d w %2 ome 0pd nf..p df Arrangements: Assets, Account Balances, and Rollovers, $665 $882 agreed to $1,525 in Emplo their part $1,000icipate in HRA or yer an HSA d In research surveys. divid whileua wom l Co en ntr had Ove ibutio $1, $654 r 2 321 ns— ,00 0 ad (Fi Annua gure ults 4 l con () n. =2 Th tribution ,0is 07 may be ) ag amo es 2 due to unts from 1 -64 who h the in fact di ave h viduals that ealth men use have a insuranc strong less e health $600 1 money in least five year the $1,500 irs had an av account than $592 erage the no account nobese, balance of but the di $2, ff231. erence Inis 2009, not sta average accou tistically signn ifit ba cant. lances No stati fell by stically signi a much lafic rger ant $1,358 $694 $626 $607 EBRI E$1,000 mployee Benefit Research Institute Issue Brief (ISSN 0887 ?137X $1,356 ) is published monthly by the Employee Benefit Research Institute, either an HRA or HSA-eligible plan. $831 $831 As a result, these plans covered about 21 million people in 2010, representing $600 $588 $1,332 $1,324 Recommended C $1,000 itation: Paul Fronstin, “Health Savings Accounts a 14% nd Health Reimbursement Arrangements: Assets, (access$600 $600 ed December 2010). through care tha impact o an n n ove wo employer or men, rall rollov which e pu r a all $924 rchased m ows them ounts, wh dir to eer ctl maintain eas employer y from a a h carri igher acco er we contri 14% re dra butio unt nw s balance n do not random 14% (Sa have ly fro ndman, Sima a m statistically significant the Synovat ntov and An, Mar e sampl e e for ffect ch 2 t h on is base 000). Figure 1100 21, 13 15% Rollover Amount th St. NW, Suite 878,, by Gender, 2007–2010 Washington, DC, 20005-4051,.............................................................................. at $300 per year or is included as part of a membership subscription. .................. Periodi- 19 $800 $600 $903 2006–2010 $800 $800 dif amount for ference was individuals hol foun $4,000 d in acco dinunt g acco balanc unts e fby level or a longer of ex pe er riod o cise. In f time, divi a du sals who they ha ex d a erci much lar se have g an er aaverage verage accoun of $1,51 t 3 in 13% 13% 13% about 12 percent of the privately insured market (Fronstin 2010b). As the number of people with account 3 -based plans With respect to age, the oldest adults had the largest rollover amounts in 2010. Individuals ages 55 -64 had an cals postage rate paid in Washington, DC, and additional mailing offices. POSTMASTER: Send address changes to: EBRI Issue Brief, 1100 $ $800 Account Balan $600 $600ces, and Rollovers, 2006–2010,” EBRI Issue Brief, no. 353, January 2011. sample. Among rollover amou both Th $400 $400 is sample was men an nts. Ind dividua wom st en, acco lratifie s withd by gen an unt em baployer co lances i der, agncrea e, ntribution o regi sed on, betw income, f leen ess than 2 a007 nd rac $1,0 ane. d 0200 Th 0 ha e 9 d an response rat and t avera hen fe ge ll i e rn 2 o was 27.4 llover of 010. $ perc 956 ent , while (21 their ac balances. count, $800while those who do 11% not exercise have $1,239. 11% 13th St. N $800 W, Suite 878, Washington, DC, 20005-4 $3,037.0 051. Copyright 2011 by Employee Benefit Research Institute. All rights reserved. No. 353 F grows, total igure 22, R a olssets in these lover Amount, plans by Age will , 20 gro 07 w –2 as 010 well. ..................................................................................................... 20 average rollover of $1,166, compare10% d with $777 for individuals 21 -34 10%, $927 for individuals 35 -44, and $1,003 for By Paul Fronstin, Employee Benefit Research Institute $600 $400 $400 $962 $3,000 percent for those with $1,000 an the base sample or nat $600employer contribution of ional at l sample, east $1, and 38 000 hpercent for ad an avera th ge rollove e oversampl r of e $9 ). The m 59 (Figuargi re 32 n ). In of error contrast, for the 10% $600 9% 9% 9% $898 $400 $886 $400 $875 $400 $842 2.3 individuals 45 $600 -54 (Figure 22). Individuals ages 21 -34 experienced the largest decline in rollover amounts, dro 2 pping Report availability: This report is available on the Internet at www.ebri.org With respect to age, there is no difference in account balances for those below age 55; individuals ages 55 -64 had a 7% Figure 23, Rollover Amount, $600 $600 by Gender and Age Combined, 2010 ............................................................................ 20 To measur national individuals sampl Emplo e h whe o contribute e alth status, a y was er a ±2. nd In 2 d l percent. divid measure of self-r ess than ua A sum l Co $1,0 ntr 00 m ibutio ary of sa had an eport ns— ed h ave mAnnua p elrage alth e charact status l con rollover teribution risti w o as combin cs is pres f $7 amo 51, whil unts, wh ed ented in with e those w a measur ether Fronstin h o cont they come e in (2010b). ribute dicati fro d at ng w m the leas hether t $400 HRAs and HSAs are r $701elatively$694 new, but a growing percentage of the population has held them for a number of years. $400 $2,000 1.2 Endnotes $200 from $1,163 in 2009 to $777 in 2010. 5% higher account balances than younger individuals. Individuals 55 -64 had an average of $1,791 in their account, $400 $400 $581 an in employer $1,000 had an dividual (in t $200 hhe cas average rol ad one o e of f e bot igh lov h HRAs t chronic er of $1, EXECUTIVE an con 203, d Hd SAs a itions. difference ), or Whi from i le t th nat is statistic he dividif SUMMARY duals fere n (as ce ally sign they a in accou pply ifica nt bala to nt (Figure HSAs nces by only) 33 this m ). ha ve a s easure o trongf im hepact alth 5% The Employee Benefit Research Institute (EBRI) was founded in 1978. Its mission is to In 2006, 15 percent of the population with an HRA or HSA had held an account for less than six months, 42 percent for $400 Figure 24, Rollover Amount, by Race, 2007–2010 ................................................................................................... 21 $200 $200 $400 3% $200 1 The compare sample d wit $400 wh b as divided into etween $1,250 one an of t d $1,4 hree0 groups: t 0 for those hose under a with a consum ge 55 (Figer-dr ure 5 iven ). Th hea is lwas fou th plan nd (CDH deP), those spite the fact with that a high- $500 $200 $200 $835.4 status was small, it on overall account balanc was statistically sig es. Not sur contribute to prisin nificant. gly, th , to encourag e more money that e, and to enhanc is contribut e the developmen ed to an at of sound empl ccount, the high oy er th ee ben e efit $1,000 1 six months to a year, and 30 percent for one to two years (Figure 1). By 2010, 8 percent had held them for less than Whe n examining differences in rollovers for men and women by age, men ages 45 -54 have higher average rollover $200 See www.mercer.com/summary.htm?idContent=1364345. Who we are deductible older individua hea $200llth plan s use more h (HDHe P), a alth c nd those programs and so are on average than with trund public policy aditiona young l healer th cov through objective ones. er It age. is possibl Individu resear e that ol als wer ch and 0%der educati e assigned to th individuals on. EBRI is the only are sa e CDHP an ving d Figure 25, Rollover Amount, $200 by Annual Household Income, 2007–2010 .................................................................... 21 average account balance. For instance, individuals with an employer contribution of less than $1,000 had an average $200 $0 0% $200 $- six months, 19 percent for six months to a year, and 35 percent for one to two years. And as the length of time amounts than Conc Table of Contents lusio n women—th e same age. The average rollover for men was $1,138, while for women it was $898 (Figure $200 $0 private, nonprofit, nonpartisan, Washington, DC-based organization committed exclusively to 2 ASSET LEVEL HDHP group if they the mone Us y in e of $0 thS Healt e acco GROWING: Chec $0 had a kunt to h ed Inf deducti Chec ormation and use to ked pr In 2010, there was $7.7 billion in health savings b icle o e pay fChec at for l ke Prog ed health ast $1, rams T care alk 000 ed to ex — for Account pe Us innses i ed online dividual co balanc n retir Taverage or e lk es w ed to ment, erebut exami Dev $2,000 eloped thi accounts (HS s n could not ed for usi Ask family c ed for ng tA w be s) and health o varia As det overage. ked doc e 0rmine btor le s to To be d from 2006 2007 2008 2009 2010 In theory, a ra $0 ndom sample of 2,007 yields a $0 Less Than $100–$299 statistical prec $300–$499 $500–$999 ision of plus or $1,000–$1,499 minus 2.2 percentage points (with 95 percent $1,500–$1,999 $2,000 or More Don't Know account balance of $1,344, while those with an employer contribution of at least $1,000 had an average of $1,582 in $0 individuals ha $0 $0 ve these whether Les pl plan s T ans increases, han of s $50,000 ervice quality av rerage ating $50,000–$99,999 of accou doctor about nt bala cost nces sho tracking $100,000 doc uld torincrease about or Morebudget to as well. gener ic dr Dec ug lined to recommend Figure 23). A smalle 26, Rollover Amount, r difference between by Education, public men an poli d wom 2007–2010 cy reseearch n can ........................................................................... and also be educat seen ion on at other econom ages, ic securi with ty a a very nd em small differenc ployee benefi ................. t ises amon ues. 23 g Employers first started offeri$100 ng HRAs 2006 White, non- in 2001, a Hispanic 2007nd they were ab 2008le to start offerin 2009 g hM einor alth ity plans 2010 with HSAs in 2004. By Introduction .................................................................................................................. $0 $0 $0 ........................................ 4 $0 $0 High School Graduate or Less Some College, Trade or Business College Graduate or Some Graduate Degree measure a reimbursement arrangem as the survey. signed to th n Pr ine CDHP d ior researc ividual’s grengageme oup h h ents (HRA ,as foun they m nt in d th us s), spre t h al at, whi es alth car o have a ad across le H eSAs c . O n ac ne e count, such an be 5.7 million ac xamine used d to as a h w hether counts. save for ealth anhealt savin This individual h is up from 20 g care s account used co expe (H nses in r st and 06, when th SA) or equa hea tirem lity lth e ere were nt, they would cover 21–34 before getting doctor/hospital 35–44 treatment tool provided presc 45–54 ription manage health instead of 55–64 less costly confidence) of what the result Smokes Cigar s would be ettes if the entire population ages 21– Exercise 64 with Obese private health insur Health a Pr noblem*** ce coverage were their account $0 (Figure 15). Similarly, individuals who contributed less than $1,000 had an average account balance of EBRI’s membership includes a cross-section of pension funds; businesses; trade associations; $0 Source: EBRI/Commonwealth Fund Consumerism Sc in Health hool Care Survey, 2006–2007; Graduate Wor EBRI/MGkA Consumer Engagement in Health < 6 Months 6 Months to Year 1–2 Years 3–4 Years 5 or More Years those ages 55 -64. care careIndiv Les Less is dual Cov T T Male han $1,000 han $1,000 erage options and by health plan options and carF e ex $1,000 or $1,000 or amily F pens e male Cov es Mor er Mor age br e eand name prescription 2009, 15 percent of employers with 10–499 workers and 20 percent of those with 500 or more workers offered either Used Cost or Quality Info Used Wellness Program Figure 1.2 million ac information reimbursem are far from 27, Rollover Amount to en suffic counts with $ choose a t arran ientgement for t doct h, by at pur 835.4 million (HRA or. Th Pla p), e oth n ose Type, with be e a r cause of 2007–2010 in assets, examin rollover ed wh statu provi and ........................................................................... t eory constraint s 2009, tion her a that t n when indivi hey dual s place 5 million accounts held $7 can use to partici d onp co pa ate ntributio y for m d in a we en dica lllnes eve l .1 billion in assets. expenses or t ls relative s program, ................. to su he ch as 23 Sour Carc e Sur e: EBRI/Commonwe vey, 2008–2010. alth labor un Fund Cons ions; h umerism ealth in Health care prov Care Sur iders and insur vey, 2006–2007; EBRI/MG ers; government org A Consumer Engagement anizations; in Health and service firms. Care About the 2010 EBRI/MGA C 21–34 onsumer Engagement 35–44 in cost He s alth Care Survey co 45–54 .................................................................. 4 sts drug55–64 drug surveyed with complete accuracy. There are also other possible sources of error in all surveys that may be more serious than $1,1 This re 25, port whiex le amines HSA those who con antd HRA ribute assets, account d at least $1,000 bal haa d nces an avera , and rol ge ba lover amounts. lance of $1,75 It examin 4 (Figure 1 es t 6).h e types of SourcSour e: EBRI/Commonwe ce: EBRI/Commonwe alth Fal und Cons th Fund Cons umeris umer m in Health ism in Health Care Sur Care vey Sur , 2006 vey, 2007; EBRI/MG –2007; EBRI/MG AA Cons Cons umer umer Engagement Engagement in Health in Health Car Car e e 7 Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2010. Sour a ce: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2007; EBRI/MGA Consumer Engagement in Health Care an HRA or HSA-eligible SurHe vey alt , 2008 h reim –plan. 2010. bursem As a ent arran result, gement. these plans covered about 21 million people in 2010, representing about Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2007; EBRI/MGA Consumer Engagement in Health Care Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2007; EBRI/MGA Consumer Engagement in Health Care Sur Sour Sovurce ey Sur ce: , 2008 : vEB EBRI/Commonwe eyRI , 2008 –/C 2010. ommon –2010. wea alltth h Fund Fund Cons Consum umer erism ism in in Health Health Care Care Surv Surveey y, , 2007; EBRI/MG 2007; EBRI/MGAA Co Cons nsum umer er Engage Engagement ment in in Health Health Care Car Surv e ey, (a) ability to expected h one d take eseign alt ***Health their ac ed to h care spendi dir problem count ectly defined ng i with t improve as n fair r he em sho or tirement (Fronstin partici poor health uld t pants or one of hey c ’ healt eight han 2010 h, cge jo hronic i.e., a a health c ). bs. wei In onditions g div hti l duals o : Ass, nutrition, rthritis with ; asthma, emphy only a f stress manage slema or exible lung spendi diseas ment, or smok e; ng account (FSA) ing Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2007; EBRI/MGA Consumer Engagement in Health Care Survey, Race— Sur a v bey In con Sour , 2007 ce: – EBRI/Commonwe t 2010. rast to the fi alth nF d und Cons ings from umeris 20 m in Health 09, it was Care Sur fou veyn , 2007; EBRI/MG d that whites A Cons have umer low Engagement er rollover amou in Health Care nts than theoretical calc individuals like Sour ulations of sampling erro Sour ly to have an cc e: e: EBRI/Commonwe EBRI/MGA Cons HSA or HRA. al umer th F und Cons Engagement r. These include refusals to be intervie umer It then in Health ism in Health exami Care Sur Carn v e ey es di Sur , 2010. veyff , 2007; EBRI/MG erences and trends i A wed and other forms of nonresponse, the Consumer Engagement n accouin Health nt bala Car nces by e Assets and Account Ba Health r Healtheimbur savings lances sement account. ................................................................................................... arrangement. ............................... 5 Survey, 2008–2010. Figure 28, Rollover Amount, Survey, 2008–2010. by Health Behavior and Health Status, 2010 ................................................................. 24 Note: Sur 2008 vey 2006 –20 , 2008 10 data wer . –2010. e capped at $1,500 or more. canc Sour er; depr ce: EBRI/MG ession; diabetes A Cons; umer hear t attac Engagement k or other in Health heart dis Car eas e Sur e; high c vey, 2010. holesterol; or hypertension, high blood pressure or stroke. b AFTER LEVELING OFF, A 12 percent of 2008 the Sur –2010. privately vey, 2008–2010. inV sured market ERAGE AC (Fronstin COUNT B 2010b). ALANCE DROPS SLIGHTLY: Increases in average account Sour Sur Health s v cey e: , 2008 EBRI/MG avi– ng 2010. ac A c Cons ount.umer Engagement in Health Care Survey, 2010. EBRI’s work advances knowledge and understanding of employee benefits and their cessation pro were It wil not l be impo inclu gded in rtant to track ram, or the (b) a CD t HP grou health his tren risk assessment pro p. d over time. Curregnt ram, wh ly, account ere an balindivi ances are dual fi lo lls w out a and aquestion re therenaire fore investe and the d n in , in effects of ques minorities. On tion wording a average, minorities ha nd question d order, and scree a $1,130 rollover ning. While attempts are in 2010, while whites mad had a e to minimize these factors, it is $921 rollover (Figure 24). demographics, income, contribution levels, and engagement in an individual’s own health care using a regression Account Balance Variation ...................................................................................................................................... 7 importance to the nation’s economy among policymakers, the news media, and the public. It balances leveled off in 2008 and 2009, an The higher account balances among older individu d fell slightly in 2010. In 2006, acc als may also be due to the fact that they ount balances are allowed to make “catch- averaged $696. They Figure 29, Rollover Amount, by Use of Cost and Quality Information and Use of Wellness Program, 2010 ................... 24 consultation relatively safe w ivehicles suc th a medical h professional, as money mar ex kamines et funds. his or As her account healbalan th history to identi ces grow, the fypotential any existin to g in vest in mor or potential m e rie sky dical Furthermore, whites experienced a decline in their average rollover amount, while minorities experienced an increase. impossible to q equation. Rolu lover amounts antify the erro are t rs that may re hen exam sult from them. ined. does this by conducting and publishing policy research, analysis, and special reports on According to findings from the 2010 EBRI/MGA Consumer Engagement in Health Care Survey, there was $7.7 billion in What we do increased to Rollovers Because up” contri the ............................................................................................................................... buti base sample ons that i $1,320 in 200 ndivi (nduals 7, a 90 percent increase. ational sam under a ple ge ) i55 nclu are ded onl not allowe Account bal y 94 in d to dividual ma ances ke. However, s in a averaged $1,356 in 2008 and $1,4 CDHP, a the regression n oversampl .............................. 14 e equation of individuals cont 19 in rols for with a conditions, investment ve in order to hicles, such devel aso mutual p a pro fu gram nds for ear and stocks, w ly intervention. ill grow. In Th both cases, it e opportunities was foun for capita d th l a at i ppr ne divi ciation i duals nwh creas o e but employee benefits issues; holding educational briefings for EBRI members, congressional and Figure 3 30, Rollover Amount, by Various Cost-Conscious Behaviors, 2010 .................................................................. 25 HSAs and HRAs in 2010, spread across 5.7 million accounts. In 2006, there were 1.2 million accounts with $835.4 The term “assets” is used loosely as it relates to health reimbursement arrangements (HRAs). HRAs are typically set up as 2009, 3 percent and 5 perc CDHP individwas ual cont added. ributions, The ove and rsent increases, respectively thus wou ample inclu ld no ded t be 87 a 9 ifactor ndividuals i. n the In 2010, average acc wit observ h a CD eHP. In d differe an dditio ces. ount n to balances fell to $1,355 being stratified, the bas , down e Household Income— According to Figure 25, rollover amounts increase with household income. The average Conclusion .................................................................................................................... federal agency staff, and the news media; and sponsoring public opinion survey ...................................... 22 s on employee partici so do th pated in e opportunities a wellness pr for cogram ha apital losses, even amo d a higher aver nage acco g individuals unt bala withnce th high levels an those w of em hployer o did not. and in Thdivi e avera dualg e account million in assets, and by 2009, 5 million accounts held $ Fi 7.1 gu bill reion i 1 n assets. Total assets in the accounts have notional arrangements and exist only on benefit issues. paper. Employees may view the a EBRI’s Education and Rese ccount as arch Fund if money was actuall (EBRI-ERF) performs y being deposited the charitable, Figure 4.5 percent fr sample account 31, was al balan Rollover Amount, c so wei om the previous year e wasg $7 hte 66 d a by gen m by Length ong i der, ndivi . age, odu f Time als with education, With Acco less t region, han unt, 2007–2010 $50, income, 000 in and r house ......................................................... ace/ethn hold income, $ icity to reflect 860 among i the act nu div al iduals wit ....... 25 h balanc contributio e was $ ns. 1 ,536 among those who used cost and quality information to choose a doctor, and $1,348 among those References .......................................................................................................................................................... 27 a b 2 increased ea When examin ch ing dif year,f and in erences creases in in account educa average tiona balanc l, and es account scientif for men an bala ic func nc d ti es appe women ons of the Instit ar to hav by age, m ute. EBRI e leen a veled g-ERF es 21 off i is a tax-ex - n 2 340 ha 08ve an empt organizatio a higher d 2009, a and ccount n Length of Time With Figure 19 HRA or HSA, 2006–2010 into an account, but employers do not in proportions in the population ages 21–6 cur expenses associated with the arrang 4 with private hea Figure 27 Figure 21 Figure 15 Figure 13 Figure 23 Figure 11 Figure 33 Figure 17 Figure 25 Figure 5 Figure 9 lth insurance coverage. ement The CDHP until an employee incurs a claim. oversample was $50,000 -$99,999, and $1,224 among individuals with $100,000 or more in household income. Rollover amounts Figure 3 Figure 31 Figure 29 Figure 7 who did not use cost and quality information (Figure 12). Average account balances were similar by wellness program Figure 32, Rollover Amount, by Level of supported b Annual Em y contributions ployer Contribution, and grants. 2007–2010 .................................................. 26 Endnotes ............................................................................................................................................................ 27 AV balanc dropped slight ERAGE RO e than women ly in LLO 20 VER D ages 2 10. In E 1 20 CL -34. 06, IN a ES, The av ccoun WH t bala erage accou ILE TO nces ave TAL RO nt bala rage LLO d nce for m $6 VERS IN 96. They en was $1,441, whi CREASE: increased Despit to $1, le 320 e a d for in wo e 20 cline in the men it 07, an was d th$1,103 average en Total Rollo a ver Assets and Number b of Adults 45% Account Account Balances, Rollo Rollo Balances, ver Account Balances, Account Balances, ver Amount, Rollo Amount, Rollo Account Balances, Account Balances, Rollo b ver Amount, by ver Amount, y Health Beha V ver Amount, b arious y b Ann y Gender and Cost-Conscious b u y Rollo b al Household b y b y Plan y vior Education, b b b Gender yy y Ag Le Le ver and Health Status, Tvel of Ann y vel of Ann e Ag pe Le , 2007–2010 , ,2007–2010 e Combined, vel, 2007–2010 Income 2007–2010 Beha 2007–2010 u u al vior al , 2007–2010 s, 2010 A August ugust 2010 2010 Rollover Amount, by Length of Time With Account, 2007–2010 wei increase ghted d Rollovers for by gende those wit r, a —Like contri g he, i less than ncA ome, an vera butio $5 Rollo ge HRA n 0,0 d rac levels, rollov Account Balances, 0 ver Amount, 0e/eth in or HSA honicity. usehol er amounts M d income, fell Account Balances, by o Use of Cost and Quality re in by Race ar formatio e one of the bi fo , 2007–2010 n can r those with be fo 2006–2010 ggest un $d in 50,0 factors i (Fronstin 00 -$9 n avera 9,9 201 99 in househol g0b). e acc ount d 4 participation but the difference was not statistically significant. A regression equation is a statistical model that allows researchers to determine the effect of an independent variable on a $2,500 42% Ages 21–64 With a Rollover, 2006–2010 rollover am (Fi average gure 6 d) $1, $1,200 . $1,800 T ou 3 h56 in 20 nt in 2010, total assets be e differenc 08 an e betwee d $1,4n m 19 in 20 en a Individual Contrib Emplo ing rolled over 09. nd women In yer Contrib 2010, ca average n also have been in u ution, tio be se accou n, 2007–2010 2007–2010 en at a nt creasing ba glances fel es 35 . $4.2 billion was r -44l , but it to $1,3 is sm 55. aller, as olled over in men have an 2010, 41% Figure 33, Rollover Amount, by Level of Information Annual I and Use of ndividual Cont Weribution, llness Pr 2007–2010 ogram, 2010 .................................................. 26 balances. Individuals with less than a $1,000 rollover had an average account balance of $942 (Figure 17). In income, an $1,400 $1,200 d increased slightly for those w $1,142 ith $100,000 or more in household income. $3,500 $2,000 $1,600 $1,600 $2,000 $1,600 $2,000 EBRI Issue Briefs is a monthly periodical with in-depth evaluation of employee benefit issues Yes No dependent variable while holding the effect of all other independent variables constant. For this analysis, the amount of $1,140 $1,513 39% 2007 2008 2009 2010 up from $4 billion in 2009. average Whil 40%e pane accou l Inn ternet surv t balance of eys are $1,4 The av 96, nonran whi erage ldo e women m, studies rollover incr have hav eased fr an avera e demonstrated that om $5 ge account 92 in 2006 to $1,295 in 2009, and fell to $1,503 balanc suche surveys, when c of $1,334. The diff areful erenc ly design e in ed, $1,200 Yes No 2006 2007 2008 2009 2010 comparison, i Cost- $2,000 nC dividuals w onscious Behavio ith a rollover rs— of A num at leas ber t $1,000 of cost-consci had an av ous be erage accou haviors were nt bala exnce o amine f $2,773. d to see i f individuals who and trends, as well as critical analyses of employee benefit policies and proposals. EBRI $1,600 Our $4,500 7 2007 2008 2009 2010 $1,437 money an indiv idual has in an HRA or HSA is determined by $1,550 a number of factors. The regression equation allows researchers The number o $1,600f people with a rollover $1,425 as well as the total level of assets being ro $1,419 lled over have bee $1,778 n increasing. In $1,061 Education—Education has an impact on$1,036 rollover amounts independent of income and oth $1,774er variables, as they 36% $1,522 $1,029 in 201 account balan obtain results $1,800c comparabl 0. The per es betweeen men to centage of indiv random Maleand wo -Female digit me-n dial t iduals with disappears elephon ou e surv for those ages 55 t a rollov $1,507 eys. eTayl r decreased from 23 percent in 2006 to 1 or (2003), -64. for example, provides the result 0 s $1,800 $1,800 Notes is a monthly periodical providing current information on a variety $4,165.8 $1,385 of employee benefit $1,011 $1,729$1,382 $1,495 exhibit more cost-conscious $1,485 decision maki 2007 ng 2008 had higher 2009 account 2010 balances than $1,483 those who di $1,199 d not exhibit such a 2007 2008 2009 2010 $1,400 $1,400 $1,400 Yes $1,356 2007 No 2008 2009 2010 $1,355 $2,017 Figures 35% 2007 2008 2009 2010 to determine the strength of $1,200 each factor $1,421 independently. More information 2007 2008 2009 about th 2010 $3,975.7 e regr $1,429 ession equation is available upon 2006, 23 perc $3,000ent of individuals with an HR $1,320 A or HSA $1,424 did not roll over any money. By 2010, 13 percent did not have a 35% $1,000 $1,800 topics. EBRI’s 2007 2008 Pension Inv 2009 e2010 stment Report provides detailed financial information on the are controlled for in the regression equation that these estimates are $1,138 based on. Individuals $2,869 with a high school degree percent in 20 from a num $2,000 be09 and increased slightly to 13 percent in r of surveys that were conducted at the same time 2010. using the same questionnaires bo $1,134 th via telephone and publications $1,000 $4,000 $1,388 $1,717 $1,634 $1,019 $1,276 $1,385 $1,372 $1,385 $957 $1,599 decision making process. The e $1,006 xpectation was 2007 that i 2008ndivi2009 duals who 2010 exhibited cost-c $1,587$1,359 onscious behavior would have a $1,400 $1,350 $2,773 $1,400 $1,347 $1,332 Rollovers Figure 1, Length of Time With HRA or HSA, 2006–2010 $1,239 ........................................................................... $912 $1,558 6 ................ 4 $1,600 $1,600 universe of defined benefit, defined contribution, and 401(k) plans. EBRI Fundamentals of request from the author. rollover. Race— In 2006, Minorit 500,0 ies wit 00 indivi h HRAs duals rol or HSAs have led over $ 3 high 02.9 e m r acco illion. unt Furt bala hermore, by 2 nces tha $1,224 t whit 010, es w 4 ith t millio hese acco n indivi $1,531 d unts. On uals rolled $1,600 $1,547 or less have $1,000 an average rollover of $799, while those with a college degre $1,296 $1,208 e had $1,519 an average rollover of $ $1,791 $1,214 1,034, and online. He found that the use of demographic $1,048 weighting alone was sufficient to bring almost all of the results from the 30% $1,192 $1,582 higher average account balance th an those who did not exhibit such behavior. The questions regarding cost-conscious $932 $932 $874 $1,200 Employee Benefit Programs offers a straightforward, basic explanation of employee benefit $1,200 $1,600 $1,200 $864 $1,444 $1,222 $844 $1,442 30% $3,500 $846 2007 2008 2009 2010 $834 $2,494 HEA average, over There L $ is TH 4.2 bill mino no us Y BiE oe-it rities have n. HA The -or-lose VIOR M avera an -it r E g account ule associate ANS e rollover inc HI balan GHER AC dreased from $ c with e of $ HSAs, C 1O ,53 UN 1, as T BALA while 592 any mon in w 2hites NC 006 eE y l to S he AND ave an $1, ft in29 an HIG 5 i accoun accou n 2 H 00 ER R t bala n 9 an t at t O d t nce o LL he hen O end V f fe ERS $1 of the year ll to $ ,38 : Individuals wh 7 1,0 (Fig 29 ur in e 7). 201 0.o 5 28% 28% $1,203 those with a graduate degree had an average rollover $1,387 of $999 (Figure 26). online survey $1,000close to the replies $811 from the parallel telephone survey. H $1,100 e also found that in some cases propensity Figure 2, Total Assets and Number $2,500 A of A ssets (million dults s) Ages 21–64 With an HRA or HSA, 2006–2010 ........................................ 6 Individuals are $1,200 also able to roll over funds fr programs in the private om one HSA into and pub another HSA without subjecting lic sectors. The $1,460 EBRI Databook on Employee the distribution to incom $1,594 Benefits is a e and $1,378 decision maki $1,200 $1,400 $1,400 ng are as follows: $1,144 $1,400 5 $795 $1,403 26% $800 $2,292 5 exerci Both e automatically rolls sed, those xperienced a who did over declian ne d is not sm betw available in the een oke, and those who were 2009 and 2 fo0 llowi 10 $1,026 ; ho ng year. wever, not Em the ob ploy de ese h cline ers have a was l d higher accoun $898 a tr arger amon emendous g mi t balances amo norities. unt of and hi flexibgher ility in $800 $1,501 $1,279 $1,267 statistical reference work on employee benefit programs and work force-related issues. weighting $1,400 (meaning the propensity for a certain ty$1,344 pe of person to be online) reduced the $1,348 remaining gaps, but in other penalty taxes as long as the rollover does not exceed 60 days. Rollover contributions from Archer MSAs are also permitted. $1,500 $1,222 Accounts (millions) $1,232 $1,000 $3,000 $851 $1,219 24% $1,416 $1,405 $961 Figure It is expect 25% 3, Aver Typ $1,000 ed e of C age H that in oR v dividual A or erag HSA Account e— $1,397 s who a Individuals wit re given more contro Balances, 2006–2010 h single covera l over ge ha ...................................................................... fun d an ds al avera located for ge rollover of $1,036, health care servi wher ces wil eas t l becom h............. 6 ose wit e h $1,000 $1,386 $833 $1,213 $1,380 $1,022 $946 $800 $2,764.8 rollover designing h s than eal those with less h th plans that incorporate an ealthy behavior HRA. Leftover s. It was $1,165 $1,171 fun also found ds at the end of that individu each ye aar can ls who used be carried over to cost or quality the $1,000 $1,200 $1,160 $1,200 $1,323 $685 cases it did no In the last 12 months or sin t reduce the rce you join emaining gaps ed your curre . Perhapsnt h thee mo alth st plan, striking dif did you fere do any nce in demographics betwee of the following: n telephone $1,308 $1,200 $1,102 $1,198 $1,110 6 $1,000 $652 $1,091 $800 $2,000 $1,246 $860 family cover more cost con Household Income— age ha scious, especi d a $912 ally once th average Acco rollov rdin ey g to become more er (Fi Figur gure e 8, 2 account 7).educat Furthermor balances i ed aboe, ut the actual both ncrea ex se with peri price of h en house ced a d he e old alth cline income. services. However, in avera The ge roll avera over ge More information about the r $1,070 egression equation is available upon request from the author. $1,200 informati following year on h (at ad higher acc the employ oer’s unt bal dis Contact EBRI ca rnces and higher etion). Employers Publications, (2 rollover can, howev 02) 659-0670; s comp er,ared with th place restrict fax publication ose wh ions on t orders to o did not use such he amount that (202) 775-6312. 4 can be $723 20% $1,059 Figure 4, Account Ba $2,500 lances $1,102 , by Gender, 2007–2010 ................................................................................................. 8 and online surveys was the under-representation of minorities in online samples. 19% $988 20% $800 4.0 $766 19% amounts. no evi account ? Checked whet denc balan $1,000 e $600 $800 wce was as foun her my $958 $1, d to 16 su healt 6 among in pport t h plan Subscriptions to his wou divi with respect duals ld cover my car with EBRI to so less than Issue Bri me of the measures e or $5 medi efs 0,0 are included cation? 00 in househol as part of used in d income; this study EBRI $757 membership, or as part of $1,3 of0 cost-conscious 3 among individuals a $800 $600 $800 $1,083 $976 $974 $1,000 $1,051 $740 informati carried over. 7 o $1,000 n. However, no relationship was found between either account balance or rollover amounts and Orders/ $1,011 See www.mercer.com/summary.htm?idContent=1364345 $1,000 $800 $977 $696 $199 annual sub $750 scription $751 to EBRI Notes and EBRI Issue Briefs. Individual copies are available 16% Figure 5, Account Balances, by Age, 2007–2010 ...................................................................................................... 8 $600 behavior. with $50,00 I $1,000 n 0di -viduals $99,99 9, a who nd $ exercis 1,742 ed, thos among i e w ndivi ho did dua not ls with smoke, and th $100,000 or more. ose who Acc were ount b not obese ha alances increase d higherd accou for thn ose t $2,000 $647 15% various cost-c $600onscious behavior $830 s such as checking pricing before getting services or asking for generic drugs $1,500 3 ? Checked the price of a doctor’s visit, medication, or other health care service before I received care? $675 $800 $609 with prepayment for $25 each (for printed copies). Change of Address: EBRI, 1100 13th St. Health Beha $790 viors and Health Status—Individuals who smoke had lower rollover amounts than individuals 15% 3.1 $800 $600 $600 $767 $768 Assets and Account Balances Subscriptions balanc Overall, th with less than es an e $800 $800 d pe high $50, rcenta e00 r rol $560 $560 ge o 0 in lover ho f ins than those usehold dividuals incom wit h with a ro e; fe less hea llover ll for tha hose w lts increase hy be ith haviors. $5 d0,00 . InIt 0 2 -w 006, $9 as 9,9 2 also found 99, 3 pe arcent o nd staye that indivi f in ddivi the duals d same for t uals who use with an hose w HRA or d cost ith $600 $600 $600 $600 $544 $544 $ $597 instead of brand names, among other things. $800 NW, Suite 878, Washington, DC , 20005-4051, (202) 659-0670; fax number, (202) 775-6312; Figure 6, Account Balances, by Gender and Age Combined, August 2010 ................................................................... 9 2.8 who do not s 11 m %oke, but the difference is not statistically significant (Figure 28). Those who exercise had higher rollover $600 $400 $1,500 $400 ? Checked the quality rating of a doctor or hospital before I received care from them? or qua HSA di $10 Accordin 0,0lity i d 00 or g to not ro nfor more. findin ll over mation ha gs from Whi any mo le d high t hihgher ney e e 201 r-i account (Fi n e-m 0 EB come gur ail: e 1 RI/MGA Consum househol balanc subscriptions@ebri.o 8). Thes an e n ds m umbe d ay contribute e hig r En r not rol he rg ga r rol geme lMe lin over g o mbe nt high s, compared in H vrship Information: er any mo er amou ealth Car nt ne with t s to their e y fell Surv h to ose ey, ther Inquiries reg HSA 15 wh per o di s than lo e was cent i d not a $7. rding EBRI nwer use 20 7 0 -bill i7 n such , come ion in and $600 10% $991 $1,163.7 $600 9% 9% 2 $400 $959 10% $400 $942 amounts than $600 those who did not, but the difference was not statistically significant. Obese individuals had lower $1,000 $400 8%8% 8% Figure 7, Acco $400unt Balances, by Race, 2007–2010 ..................................................................................................... 9 $878 membership and/or contributions to EBRI-ERF should be directed to EBRI President/ASEC $600 DIFFERENC information. was 1 households, HSAs and HRA 6 perce t n h However, ES t in s e re in IN ACCOUNT B 20 gression 201 08. 0, spr no By equatio relationshi e200 ad 9, across 5.7 n 10 A contr Lp A perc w NCES: as foun o ent million ls for cont did Men have higher acc d not accou betw ributi ha een n ve a rol ts (F on l eith e igure vels a er acc lover, 2). no o d e and t In unt bal unt balanc d 2 ucatio hat i 00a 6nces than women, older individuals , the ncre nal e or rollover a attainment. re w sed sli ereg 1.2 htly t am T mil ounts an oh 13 lion acco e dif pfeere rcent d vari n unts ce ious n 2 in with 010. $400 $400 ? Talked to my $500 doctor about the prescription options and costs? $1,000 average rollov $400er amounts ($804) th Chairman Dallas an the nonobese Salisbur ($1, y026 at the ), a a statisti bove address, ( cally sign 202) 659-0670; ificant differ e-mail: ence.salisbur There y@ebri.org was no 3 $400 5% have higher account bal cost- Some of account $835.4 conscious b millio the balan $400 decrease nc in es e by assets, and by haviors such as checking hous in ta h eh nc e perc old i es th 20 ncome m enta an youn 09, ge o 5 m a f iger ones, ac individu y be llion acco prices due to be afore ls w unts hcigher io thout a g held $ unt bal ettin incom g7 servic rollove .1 ances increase with bil e lio households es, or asking fo r bet n in assets. ween be 20 ing 0r 6 household in an ge less like neric d 20 dr 07 m ly ug to take a scome, ins y be tead due to distributions and of br th and e $200 4% Figure 8, Account Balances, by Annual Household Income, 2007–2010 ..................................................................... 10 5% $400 $400 $200 1 3% statistically significant $200 difference in account balances by health status. $200 ? Talked to my doctor about other treatment optio 1.2 ns and costs? $200 $500 2% 2% 2% 2% names, amon educati fact that from the o the percenta acco n has a significan g oth unt. e (T r thi his is ge o ngs f i a t impact on . Future research shoul n ndivi emduals piricalwh qu acc o di estion th ount bal d not kno at da nces examine is worth explorin w wheth independent dif er th feren ey had a rol ces g as data bec of income betwele over or t n ian ndivi ome d other vari duals availa he amount associated with ible. n Hables. ) SAs and HRAs, and it $500 Editorial Bo $200ard: Dallas L. Salisbur $302.9 y, publisher; Stephen Blakely, editor. Any views expressed in this publication and those of the authors should $200 1% $200 $200 $200 Figure 9, Acco $200unt Balances, by Education, 2007–2010 ............................................................................................ 10 While total assets in the accounts have increased each year, increases in average account balances appear to have not be ascribed to the officers, trustees, members, or other sponsors of the Employee Benefit Research Institute, the EBRI Education and $0 $200 should a decreaseld so ex fro $200 m amine t 19 percent he impact that a to 13 percent. ccou In nt ba contrast, t lances ha hve on e decrease in the use the perc of health enta care ge of in services as in dividuals without dividuals co a ro ntin llover ue to 0.5 0% ? Used an Use of onli Healt ne cos h Inf t-trackin ormation and g tool provi Prog ded by my h rams— eRollover alth plan to amounts were also examined manage my health expensby wheth es? er an individual Research Fund, $0 or $0 Chec their k staffs. ed Chec Nothin ked pr g her ice ein is to be co Checked nstr Taued as an attem lked to Used online pt to aid or T hi alknder ed to the adoption Developed of any As pending le ked for gislat Asked doc ion, 0 tor re gulation, $0 DIFFERE levele d oEdu ff NC in 0c200 ES ation— 8, a IN R nd Education O dro LLOV ppeER AM d sli has a ghtly nO impact on i U n 2 NTS: 010. Men r I an ccount 20 o06, acco lled over m balanc unt es indep o bre money th alances av endenera t of i an women ged ncome an $696 ,(Fi an d oth gd older individuals ure er varia 3). They bles, as they $0 accumulate between 20 Less f 0 Tu 8 hnds in an a n 6d 20 Mon the t09 hsi c r ac 6 aM n b o counts. nte hs a tttr o Lib esu s t Ted han to a n in 1–c 2 Y reea ase rs in the perc 3– ent 4 Yage ears with a ro 5 or llover between More Years $500 a Don'tn K d $999, as now Figure 10, Acc $0ount Ba whetherlances plan , by of servPlan ice Typ quality r ea, 20 ting of 07 doc –20 tor about 10 ........................................................................................... cost-tracking doctor about budget to generic drug to recommend 12 used cost and $0 $0quality information to choose a doctor and whether he or she participated in a wellness program. It was or interpretative $0 rule, or as legal, 21–34 2006 accounting, actuarial, o 2007 r other such prof 35–44 essional advice. 2008 45–54 www. 2009 ebri.org 2010 55–64 $0 0 $0 $0 Smokes Cigarettes Exercise Obese Health Problem*** $0 ? Developed $0 $0 a would c budg ovet to m er before getting an 1 Y White, non- age my ear doctor hea H/is hos panic pital lth care treatment expens tool pr es? ovided prescription manage health Minority instead of less costly had higher rollover am are control increased to led $1 for in ,320 the regr in 2ounts than y 007,ession equatio a 90 perce oung nt er individuals. in n that crease these es . Accou timates Rollov nt bala e are n r am ces ave bounts increase with hou ased on. raged I $ndi 1,356 viduals in 20 with 08 and s a ehold income high $1 s ,41 chool 9 in 2 de and 009 gree , Less Than $50,000 Male $50,000–$99,999 $100,000 or More Female Declined 21–34 35–44 45–54 55–64 well as an increase amon High School 2006 g t Graduate hose wit or Lesh s a ro Some llover of at 2007 College, Trade or lea Bus st $2,0 ines2008 s 00. College G Between raduate 2 or0 Some 0 2009 9 and 2010, t Graduate Degr he perce 2010 ee ntage with a found individuals who care used cost and care Indiv Lesis dual Cov T qua han $1,000 lit ery informatio age options and n toby choose health plan a doctor had a options and car Fe ex amily $1,000 or hipens gher Cov es er Mor rollover age br eand name amount tha prescription n those $0 Less Than $1,000 $1,000 or More 1–2 YearLes s s Than $1,000 3–4 Years $1,000 or Mor 5 ore More Years Figure 11, Account Balances, by Health Behavior and H School ealth Status, AG urgust aduate Wor 2010 k ..................................................... 12 costs costs drug drug educati or less have 3 percent on, an an a d n d individuals with single c 5 percent average of inc$ r1 eases, respect ,219 in their overage rolled account, ively. Inwhil 2010 e those over a higher , the ave with rag a e accou college amount ndegr t b than alance ee those with family coverage. have fel $1, l to $1 519, ,35 and t 5, do hwn ose 4wit .5 h a Sourc Sour e: EBRI/Commonwe ce: EBRI/Commonwe alth F al und Cons th Fund Cons umerumer ism in Health ism in Health Care Sur Care Sur vey, 2006 vey, 2006 –2007; –2007; EBRI/MG EBRI/MG A Cons A Cons umerumer Engagement Engagement in Health in Health Source: EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2006–2007; EBRI/MGA Consumer Engagement in Health Care Survey, 2008– rollover of $1,500 -$1,999 fell from 6 Used Cos p t ore Q rc uality ent to Info 3 percent, while the percentage Used Wellnes with a ro s Progr llover o am f at least $2,000 fell ? EBR Asked for I Issue Brief a ge is rneric egistered in the U. drug instS. ead o Patent and T f a bran radem d nam ark Office. e dru I gS?SN: 0887 ?137X/90 0887 ?137X/90 $ .50+.50 Source: EBRI/MGA Consumer Engagement in Health Care Survey, 2010. who did not participate in such a program, although statistically the differences were not significant. The average Sour Sour ce: ce: EBRI/Commonwe EBRI/Commonwe altal h tF h und Cons Fund Cons umer umer ism ism in Health in Health Car Car e Sur e Sur vey vey , 2007; EBRI/MG , 2007; EBRI/MG A Cons A Cons umer umer Engagement Engagement in Health in Health Car Car e e Survey, Sour Sour ce: EBRI/Commonwe ce: EBRI/Commonwe alth al Fund Cons th Fund Cons umer umer ism is in Health m in Health Care Sur Care Sur vey, 2007; EBRI/MG vey, 2007; EBRI/MG A Cons A Cons umer umer Engagement Engagement in Health in Health Care Survey, 2010. Care Sur Care Sur vey, 2008 vey, 2008 –2010. –2010. *** Health Sourcpr e: oblem EBRI/Commonwe defined as fair alt h orF poor und Cons health umer or one ism of in Health eight chr Car onic e Sur health vey, 2007; EBRI/MG conditions: Arthritis A Cons ; asthma, emphy umer Engagement sema or in Health lung diseas Care; e gradu percent from ate degr tee h he Sour previous y ave ce: EBRI/Commonwe $1,55e8ar. (Figal ure th F 9 und Cons ). Only in umerism divi in Health dualCar s with e Surv a ey, 2007; EBRI/MG graduate degr A Cons ee umer ex Engagement perienced a in Health decline Care in their Sour Sourcce: e: EBRI/Commonwe EBRI/Commonweal altth h F Fund Cons und Consumer umeris ism m in Health in Health Car Care e Sur Survvey ey, 2007; , 2007; EBRI/MG EBRI/MGA A Cons Consumer umer Engagement Engagement in Health in Health Car Care e a Sour Sur 2008 avey ce: , 2008 –EBRI/Commonwe 2010.–2010. alth Fund Consumerism in Health Care Survey, 2007; EBRI/MGA Consumer Engagement in Health Care Survey, from Figure 31 perc H12, ealth r Acc eient 2008 mo buunt Ba Car Sour r– s to 21 perc 2010. ee Sur m cen e: EBRI/Commonwe v tlances ar eyr, 2008 angent. em –, by Use 2010. ent. alth F of Co und Cons st and Q umerism in Health ualityCar Information e Survey, 2007; EBRI/MG and Use A Cons of umer Well Engagement ness Program, in Health August Care 2010 ....... 13 Sour Health r ce: EBRI/MG eimbusement A Cons ac umer count. Engagement in Health Care Survey, 2010. rollover was $1,006 among those who used cost and quality information to choose a doctor, and was $932 among cancer Sur ; depr vey, 2008 ession; –2010. diabetes; heart attack or other heart disease; high cholesterol; or hypertension, high blood pressure or stroke. Survey, 2008–2010. Sur Survvey ey, 2008 , 2008––2010. 2010. b b ? Asked my Sour 2008doc c– e: 2010. EBRI/MG tor to recomm A Consumer Engagement end a lesin Health s costly pres Care Survcri ey, 2010. ption drug? Health savingSour Sur Health s s acco vc ey e: u , 2008 EBRI/MG n av t.ings –2010. acA count. Consumer Engagement in Health Care Survey, 2010. average account balance in 2010. those who did not use cost and quality information (Figure 29). © 2011, Employee Benefit Research Institute ?Education and Research Fund. All rights reserved. ebr ebr ebr A ebr ebr ebr ebr ebr ebr ebr res i.o i.o i.o i.o i.o i.o i.o i.o i.o i.oe ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 ebri.org Issue Brief • January 2011 • No. 353 rg rg rg rg rg rg rg rg rg rg arc Is Is Is Is Is Is Is Is Is Ish su su su su su su su su su su re e B e B e B e B e B e B e B e B e B e B pori ri ri ri ri ri ri ri ri ri rte e e e e e e e e e from ffffffffff • • • • • • • • • • J J J J J J J J J Jth a a a a a a a a a an n n n n n n n n n e E uary uary uary uary uary uary uary uary uary uary BR 20 20 20 20 20 20 20 20 20 20 I E 11 11 11 11 11 11 11 11 11 11 duca • No • No • No • No • No • No • No • No • No • No tion . 3 . 3 . 3 . 3 . 3 . 3 . 3 . 3 . 3 . 3 an 5 5 5 5 5 5 5 5 5 53 3 3 3 3 3 3 3 3 3 d R esearch Fund © 2011 Employee Benefit Research Institute 19 13 12 17 10 16 23 21 25 20 15 24 26 9 8 6 18 11 14 22 27 7 4 5 3 2 Assets (millions) Assets (millions) 15% 16% 10% 10% 9% 10% 8% 8% 7% 6% 8% 8% 9% 11% 11% 10% 5% 7% 6% 18% 20% 13% 12% 10%