Summary
The Employee Benefit Research Institute (EBRI) published a new
research report today finding an increase in use of three of the seven
medical services and prescription medications by enrollees in
HSA-eligible plans compared with non-HSA-eligible plans. The report,
“The Impact of Expanding Pre-Deductible Coverage in HSA-Eligible Health
Plans on Use of Health Care Services,” is an analysis based upon IRS
Notice 2019-45 which
allows health savings account (HSA)-eligible health plans the
flexibility to cover 14 medications and other health services used to
prevent the exacerbation of chronic conditions prior to meeting the plan
deductible.
In fact, a 2021 EBRI survey found that 76% of
employers with 200 or more employees increased the number of drugs and
services covered pre-deductible in HSA-eligible health plans as a result
of IRS notice 2019-45. The new EBRI study used claims data to
quantify the effect of expanding pre-deductible coverage on the use of
health care services.
Key findings in the research report include:
- Between 2018 and 2021, there was an increase in the use of three of the seven medical services in HSA-eligible plans compared with non-HSA-eligible plans. Use of low-density lipoprotein (LDL) testing, hemoglobin A1C (HbA1C) testing and retinopathy screening increased by a larger percentage among enrollees in HSA-eligible plans compared with those health plans not targeted by this policy change, suggesting that the IRS notice and resulting employer adoption contributed to increased use of these services.
- Use of selective serotonin reuptake inhibitors
(SSRIs), statins and angiotensin-converting enzyme (ACE) inhibitors
increased by a larger percentage among enrollees in HSA-eligible plans
compared with those health plans not targeted by this policy change,
suggesting that the IRS notice and resulting employer adoption also
contributed to increased use of these prescription drugs.
“The
fact that we do not see a change in patient use of all targeted
services and prescription drugs as a result of the IRS notice is not
surprising. It may take time for enrollees to learn that their health
plan has changed coverage for certain preventive services, despite
employers’ best efforts to inform enrollees of a plan design change that
is considered an improvement in benefits. Also, use of some health
services may not have changed because many employers substituted
copayments and/or coinsurance for deductibles,” explained Paul Fronstin,
director, Health Benefits Research, EBRI. “Yet, the appropriate level
and type of cost sharing is something employers are likely to wrestle
with. Prior EBRI research found that employers would exclude additional
preventive services from deductibles if allowed by the IRS. Employers
recognize the benefits to their workers and themselves of higher use of
preventive services, but managing the cost of expanding access to those
services is also a consideration.”
To view the complete
23-page research report, “The Impact of Expanding Pre-Deductible
Coverage in HSA-Eligible Health Plans on Use of Health Care Services,”
visit
www.ebri.org/publications/research-publications/issue-briefs/content/the-impact-of-expanding-pre-deductible-coverage-in-hsa-eligible-health-plans-on-use-of-health-care-services.
This
study was conducted through the EBRI Center for Research on Health
Benefits Innovation, with the funding support of Aon, Blue Cross Blue
Shield Association, Independent Colleges and Universities Benefits
Association, JPMorgan Chase & Co., Pfizer and PhRMA.
The
Employee Benefit Research Institute is a non-profit, independent and
unbiased resource organization that provides the most authoritative and
objective information about critical issues relating employee benefit
programs in the United States. For more information, visit www.ebri.org.
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(MEDIA NOTE: Journalists interested in receiving “all-access” credentials to the EBRI research database should email dresner@ebri.org).