Has Enrollment in HSA-Eligible Health Plans Stalled?

February 2018
EBRI Issue Brief #441
Paperback, 14 pp.
PDF, 719 kb
Employee Benefit Research Institute, 2018

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Executive Summary

Both the number of health savings accounts (HSAs) and enrollment in HSA-eligible health plans have grown significantly since HSAs first became available in 2004. In 2017, enrollment estimates in HSA-eligible health plans vary considerably from 21.4 million to 33.7 million policyholders and their dependents. But there is one consistency between the enrollment estimates – most sources show that growth appears to have slowed in 2017, especially when looking at the market share of HSA-eligible health plan enrollment.

This Issue Brief examines trends in enrollment in HSA-eligible health plans. It compares surveys of individuals, employers, and health plans. It also puts enrollment trends in the context of the health policy environment.

• This Issue Brief examines the findings from five surveys.

  • Two surveys (conducted by EBRI/Greenwald & Associates and the National Center for Health Statistics (NCHS)) interview individuals with private health insurance obtained either through employment, directly from insurers, or through public exchanges.
  • Two surveys (conducted by Kaiser Family Foundation (KFF) and Mercer) interview employers to determine enrollment.
  • One survey (conducted by America’s Health Insurance Plans (AHIP)) polls insurance companies and obtains estimates for individuals with private health insurance either through employment, directly from insurers, or through public exchanges.

• Enrollment estimates for 2017 range from 21.4 million to 33.7 million individuals. AHIP, whose estimates generally are the lowest, has not released 2017 estimates yet. AHIP, EBRI/Greenwald & Associates, and NCHS estimates are in the low 20-million range, while KFF and Mercer estimates are in the lower 30million range. Surveys conducted by AHIP, EBRI/Greenwald & Associates, and NCHS cover the entire privately insured market, whereas those conducted by KFF and Mercer cover only employment-based health plans. Hence, the AHIP, EBRI/Greenwald & Associates, and NCHS estimates should be larger than those reported by KFF and Mercer, but the data show just the opposite.

• All of the surveys find substantial growth in HSA-eligible health plan enrollment since HSAs were established in 2004.

• The surveys consistently find that there was very little growth in HSA-eligible health plan enrollment from 2014 to 2017.

• Two studies focus on growth in the number of HSAs rather than enrollment growth in HSA-eligible health plans. Devenir collects data from about 100 HSA providers and tracks the number of accounts universally. It finds that the number of accounts increased from 16.8 million at the end of 2015 to 20 million at the end of 2016. The Employee Benefit Research Institute (EBRI) HSA Database, which contains 5 million HSAs as of the end of 2016, finds that most HSAs have been established relatively recently and this indirectly supports the notion that we should be seeing growth in enrollment in HSA-eligible health plans. Data from the EBRI HSA Database show that 21 percent of HSAs were established in 2016.