Big companies make up largest group of HSA customers

When health savings accounts and high-deductible plans first entered the market, they were sold mostly to individuals buying their own coverage.

By Emily Berry — Posted Aug. 9, 2012

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Until recently, physicians could count on patients who worked for big manufacturers, retailers and other giant corporations to have access to traditional PPO-style health coverage.

Enrollment in high-deductible plans paired with health savings accounts — sometimes called consumer-directed plans — was growing rapidly. Initially, the plans turned out to be most attractive to people who had to purchase their own coverage.

For a variety of reasons, that enrollment picture has shifted. Large businesses now are the most dominant customers for consumer-directed health plans.

There were 13.5 million people enrolled in high-deductible plans with HSAs in January, up from 11.4 million in January 2011, according to the most recent enrollment figures published in July by health insurance trade group America’s Health Insurance Plans. Large group enrollees make up 59% of that figure, compared with 55% in 2011 and 19% in 2005 (link).

The demographic shift could affect physicians, because research has shown that people enrolled in high-deductible plans tend to skip or delay care, even preventive care that is covered at no out-of-pocket cost to them.

Among all Americans with employer-sponsored coverage, an estimated 17% were enrolled in high-deductible plans with health savings accounts in 2011, according to the Kaiser Family Foundation (link).

A study by the RAND Corp. published in May found that pushing that percentage to 50% would save $57 billion per year, in part because of lower demand for health care, which might be problematic if patients forgo preventive care (link).

More large employers are expected to shift to high-deductible plans, said Roy Ramthun, who helped shape health care policy as a White House adviser under President George W. Bush. He helped the U.S. Treasury Dept. implement health savings accounts after they were enacted into law in 2003.

“Some of them might have wanted to wait to have other people try it first,” said Ramthun, president of HSA Consulting Services, based in Washington. “Once they saw this was not going to be a fad, and that it was working & for the right reasons, most have embraced it as one of the go-to strategies for getting health care costs under control.”

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Big business moves to big deductibles

Enrollment in high-deductible plans once was dominated by individuals buying their own coverage, but enrollees typically now work for large companies. As the number of people with high-deductible plans with HSAs has risen, so has the share of the enrollment made up of workers at large companies. Data are from January of each year except for 2005, when data were from March.

Year Individual Small group Large group Total reported enrollment
2005 64% 17% 19% 1.0 million
2006 42% 25% 33% 3.2 million
2007 26% 25% 49% 4.5 million
2008 25% 30% 45% 6.1 million
2009 23% 30% 47% 8.0 million
2010 20% 30% 50% 10.0 million
2011 21% 24% 55% 11.4 million
2012 18% 22% 59% 13.5 million

Note: Percentages may not add to 100%, due to rounding

Source: “Health Savings Accounts and Account-Based Health Plans: Research Highlights,” America’s Health Insurance Plan Center for Policy and Research, May (link)

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