Health Savings Accounts, High-Deductible Plans Jump 18%

Some 13.5 million Americans had health savings account/high-deductible health plans in 2012, an increase of 18% from 2011, according to the latest annual census from America’s Health Insurance Plans, an industry lobbying group.

The large group market, which dominates HSA/HDHP enrollment, grew by 26% to 7.9 million members. The individual and small group markets posted enrollment gains of 5% to 2.5 million members and 9% to 3 million, respectively.

Employers are attracted to HSAs and high -deductible health plans as a way to control burgeoning healthcare costs, explains Larry Boress, president and CEO of the Midwest Business Group on Health. HSAs and CDHPs allow employers to “develop their healthcare budget once a year. They know what that line item cost will be.

The consensus is that employees with controlled spending amounts are more likely to be prudent buyers, cost compare for healthcare services, and spend less.

A recent Aetna study of its HealthFund plans supports that contention. HealthFund members spent 7% less overall on healthcare costs but received more preventive care from their primary care physicians and preventive screenings than members with traditional PPOs.

AHIP has conducted the census survey since 2004 when HSAs first appeared. The first census recorded only one million HSAs. Membership has steadily increased and has tripled since 2007.

Among the census findings:

• An estimated 51% of all HSA/HDHP enrollees in the individual market (including dependents covered under family plans) are less than 40 years old.
• Lives covered by an HSA/HDHP are evenly split between males and females.
• PPOs are the most popular HSA/HDHP product
• States with the highest portion of HSA enrollees are Vermont (20%), Minnesota (14%), and Montana (12%).
• States with the lowest proportion of HSA enrollees were Alabama (1.3%), West Virginia (1.8%), and New Mexico (2%).

What accounts for the differentiation among states is unknown. Robert Zirkelbach, spokesman for AHIP, explains that while there could be a number of reasons, including the number of large employers in a given state, the exact cause is beyond the scope of the survey.

The census includes responses from 97 health insurance companies. It does not include coverage associated with health reimbursement arrangements (HRAs), which are most commonly offered in the large-group market.

For the first time, the census takes a look at the consumer decision support tools available with HSAs/CDHPs and the online availability of those tools. According to the findings, 93% of companies offer access to HSA information to track spending and 95% offer online access to that information.

Health information is provided by 97% of companies; healthcare cost information, such as negotiated rates from procedures and drugs, is offered by 84% of the companies.