Health Plans Brace for HSA, HRA Headaches

Margaret Dick, for HealthLeaders Media, March 2, 2011

Although a huge number of health savings accounts and health reimbursement accounts have been created that hold a record amount of assets, a study indicates that on an individual consumer level, high balances are not being maintained in these accounts. And there is little if any evidence that high deductible health plans are leading health consumers to make smarter healthcare choices.

According to research by the Washington, D.C.-based Employee Benefit Research Institute, from 2006 to 2010 the number of HSA and HRA accounts increased by nearly fivefold, from 1.2 million accounts to 5.7 million accounts. A record amount of total assets, $7.7 billion, was stashed in those HSAs and HRAs in 2010. Just four years ago account assets totaled just $834.5 million.

Meanwhile, average account balances are a mixed bag. From 2006 to 2007 they almost doubled,  increasing from $696 to $1,320 but since then the increases have been more modest. In 2010 the average account balance dipped below 2008 levels to $1,355.

As for cost-comparison shopping, although it was widely expected that HDHPs would lead consumers to shop more carefully, EBRI reports that there is almost no relationship between HSA/HRA account balances or rollover amounts and price checking for healthcare services.

Cost-conscious behaviors such as checking if the health plan covers care, price comparing before a service is rendered, discussing lower-cost treatment options, or even something as simple as asking a pharmacist for the generic drug instead of the brand name one have not produced the expected uptick in account balances.

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