2016 survey of health savings account – high … survey of health savings account – high...

FEBRUARY 2017

2016 Survey of Health Savings Account – High Deductible Health Plans

2 ahip.org | [email protected] /ahip @ahipcoverage


KEY TAKEAWAYS

As of January 2016, 59 plans reported nearly 20.2 million HSA/HDHP enrollees, up from 19.7 million in 2015. Plans participating in both the 2015 and 2016 surveys saw a net increase of 648,000 enrollees (3.4 percent).

Preferred Provider Organizations (PPOs) were the most popular HSA/HDHP product type, accounting for 66 percent of enrollment. Similar to 2015, large group plans accounted for over three-fourths of all enrollment.

The majority of companies reported offering members online access to HSA account information and consumer decision-support tools, such as health education, treatment cost information, physician-specific information, and personal health records.

Summary

An annual survey conducted by America’s Health Insurance Plans (AHIP) of U.S. health insurance companies offering health savings account/high-deductible health plans (HSA/ HDHPs), shows that enrollment in HSA/HDHPs totaled approximately 20.2 million, as of January 2016. By contrast, enrollment was 19.7 million in 2015. Of those plans participating in both the 2015 and 2016 surveys, total enrollment grew by 3.4 percent. Enrollment numbers stratified by by product type and by market type remained in-line with previous years. Overall, results from this year’s study underscore the continued growth in the HSA/HDHP market.



Market Overview

Health savings account (HSA) plans give consumers incentives to manage their own health care costs. They accomplish this by coupling a tax-favored savings account used to pay medical expenses with a high-deductible health plan (HDHP) that meets certain requirements for deductibles and out-of-pocket expense limits.1 The funds in the HSA are owned by the individual and may be rolled over from year to year.

HSAs were authorized by the Medicare Prescription Drug Improvement and Modernization Act of 2003 and entered the market in January 2004. Since

then, AHIP has conducted an annual survey of health insurance plans to monitor and report on the HSA/ HDHP health insurance market.

As summarized in Table 1, as of January 2016, nearly 20.2 million people were enrolled in HSA/HDHPs. This represents an overall increase of approximately 468,000 enrollees since January 2015. However, there was a net increase of roughly 648,000 HSA/HDHP enrollees among the 52 insurers that participated in both the 2016 and 2015 surveys. These 2016 findings are consistent with the steadily increasing prevalence of HSA/HDHPs observed over the past decade (Figure 1). See Appendix B for additional details.

Table 1: HSA-Qualified High-Deductible Health Plan Enrollment, January 2016

Total HSA-Qualified HDHP Enrollment 20,164,930

Total Covered Lives — Individual Market 1,894,133

Total Covered Lives — Small-Group Market 2,113,133

Total Covered Lives — Large-Group Market 13,902,214

Total Covered Lives — Uncategorized* 2,255,470 *Three respondents did not report their total enrollment broken-out by market type

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2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Figure 1: HSA-Qualified High-Deductable Health Plan Enrollment, 2005-2016



Consistent with previous years (Figure 2), the majority of enrollees were in the large group market (78 percent, n=13.9 million), with all remaining enrollees about evenly split between the small group and individual markets. Since 2005, the proportion of HSA/HDHP enrollees in the large group market has been steadily increasing to about three-fourths of total HSA/HDHP enrollment today.

As shown in Figure 3, similar to 2015, the most respondents in 2016 reported HSA/HDHP total plan enrollments between 100,001 and 1,000,000 (41 percent, n=24).2 This is an increase over 2015, when 36 percent of insurance plans reported total HSA/HDHP enrollments in the hundreds of thousands. Other enrollment levels were similar to last year’s results. Lastly, in terms of enrollment by

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Figure 2: Percentage of Individuals in the Commercial Health Insurance Market Covered by an HSA-Qualified High-Deductible Health Plan, by Market Type, 2005-2016

Individual Small Group Large Group



product type, the majority of enrollees had a PPO (66 percent, n=8.4 million) followed by an HMO/POS (31 percent, n=3.9 million) product. A variety of other product types made up the remaining 3 percent (n=0.4 million) of enrollees.

Individual Market

1.9 million people were enrolled in HSA/HDHPs purchased in the individual market in January 2016. However, three respondents were not able to categorize their HSA/HDHP enrollment by market. Thus, it is possible that actual individual market enrollment was slightly higher than 1.9 million.

Group Market

As of January 2016, insurers offering HSA/HDHP products in the small-group market reported enrollment of 2.1 million. In general, small-group coverage was defined by responding companies as coverage offered by employers with 50 or fewer employees.

Large-group HSA/HDHP coverage accounted for 13.9 million people. Though, of the plans that were able to report HSA/HDHP enrollment by market in 2016, 78 percent percent of enrollees were in the large group market, as was the case in 2015. Generally large group coverage was

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Figure 3: Percent of Companies Reporting HSA-Qualified High-Deductible Health Plan Enrollment,

by Enrollment Level, 2012-2016

2012 (95) 2013 (91) 2014 (80) 2015 (64) 2016 (59)



defined as policies offered by employers with 50 or more employees.

Approximately 2.3 million enrollees were considered “uncategorized” as three plans provided total enrollments and did not provide a breakout of their HSA/HDHP total enrollment by market type.

Enrollment by Age

This year, 40 insurers were able to provide information on the ages of their HSA/HDHP enrollees, including dependents if covered under a family plan. As shown below in Figure 4, approximately 21 percent of HSA/HDHP enrollees were under the age of 18; 11 percent were 18-24 years; 30 percent were 25-44 years; the majority at 35 percent were 45-64 years; and only 3 percent were age 65 and older.

Consumer Decision-Support Tools for HSA/HDHP Enrollees

Many health insurers offering HSA/HDHPs have created online tools to help members manage their HSA accounts online. Such accounts allow members to access information about their health conditions, medical services, health care costs (e.g., negotiated rates for procedures and drugs), and quality of health services in their area.

Figure 5 illustrates responses from 52 health insurers that answered survey questions regarding consumer decision-support tools offered to their HSA/HDHP enrollees. Ninety-eight percent of respondents offered enrollees access to health and wellness resources. Eighty-seven percent gave enrollees access to information on their health savings account,

and 67 percent supplied them with their personal health record.

Seventy-five percent of respondents also provided healthcare cost information. Beyond information on personal accounts and healthcare costs, insurers also supplied HSA/HDHP enrollees with information on providers. Ninety-six percent of respondents supplied enrollees with information on provider networks, 60 percent provided physician specific quality data, and 67 percent provided hospital specific quality data.

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Figure 4: Age Distribution of HSA/HDHP Enrollees,

January 2016

0-17 18-24 25-44 45-64 65+



State and US Territory Enrollment

Fifty-three insurers reported enrollment by state and US territory for 14.3 million lives with HSA/HDHP coverage as of January 2016 (Figure 6). States with the largest reported HSA/HDHP enrollment levels were Illinois

(1,351,691), Texas (1,707,591), Minnesota (908,711), Ohio (801,198), and Florida (711,485). See Appendix B for additional details.

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Provider Network Information

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Figure 5: Percentage of Health Insurers Providing Access to Consumer Decision-Support Tools, January 2016



Conclusion

HSAs have enjoyed consistent growth since they were originally offered to consumers in 2005. They provide an attractive, consumer-friendly, savings option for employees, employers and individuals looking for help in making health care more affordable. With nearly 20.2 million lives covered, and continued enrollment growth expected in the coming years, HSAs and high deductible health plan insurance products represent another vital option for Americans looking to manage their health care needs. As Congress considers proposals to improve health care choices, enable more personal control and flexibility, and reduce costs to consumers, HSAs must be part of the discussion.



Endnotes

1 For 2015, the minimum annual deductible for self-only HSA/HDHP

coverage is $1,300, and the maximum out- of- pocket limit is $6,450.

For family HSA/HDHP coverage, the minimum deductible is $2,600,

and the maximum out-of- pocket limit is $12,900. For 2016, the

minimum annual deductible for self-only HSA/HDHP coverage is

$1,300, and the maximum out-of-pocket limit for self-only is $6,550.

For family HSA/HDHP coverage, the minimum deductible is $2,600 and

the maximum out-of-pocket limit is $13,100. These amounts are

indexed annually for inflation. Accessed 11/17/2016 at

http://www.irs.gov/pub/irs-drop/rp-14- 30.pdf and

http://www.irs.gov/pub/irs-drop/rp-15- 30.pdf.

2 Results for responding companies are reported by grouping data from

all subsidiaries into one unit, regardless of the number of subsidiaries

or number of states where the company does business.

AHIP would like to thank the health plans that participated in this year’s survey.

Acknowledgments

Related Topic


Appendix A

Methodology

A data collection instrument was developed by AHIP to ascertain total enrollment, premiums, and other information on HSA/HDHPs as of January 2016. The instrument was developed using Qualtrics software (Qualtrics, Provo, UT), and was emailed to 97 AHIP member and non-member companies believed to sell HSA- eligible high-deductible health plans.

Data collection occurred from February 2016 through January 2017. Fifty-nine health insurance companies responded, yielding a 61 percent response rate.

Fifty-six responding companies reported HSA/ HDHP enrollment in the individual, small-group, and large-group markets. Three companies provided total HSA/HDHP enrollment only, as they were unable to give detailed information on each market.

We analyzed the data to examine national trends in enrollment, distribution of enrollment by state/U.S. territory, and individual versus group markets. In addition, we analyzed changes in enrollment for plans that responded in 2015 and 2016. Six companies could not provide their HSA/HDHP enrollment by state/U.S. territory, representing approximately 5.6 million enrollees.

Thirty-six responding companies provided information on average monthly premiums at the state level, representing 7.2 million enrollees. For this report, premium data were not published for states that had fewer than four companies in a state contributing premium data.

Data Limitations

AHIP did not receive participation in the annual census from all health insurers that sell HSA/HDHP insurance coverage or administer HSA/HDHP coverage for self-insured group health plans. This census does not include coverage associated with health reimbursement arrangements (HRAs), which are most commonly offered in the large-group market. Further, while the rate of response was similar to that of the 2015 census, AHIP did not receive responses from every health plan that participated in 2015.

Identifying trends over time is most accurate when using data from the same responders. For this study, 51 of the 59 health insurers that responded to the 2016 census also participated in the 2015 study. Eight insurers were new respondents to the 2016 study. Thirteen insurers reporting data in 2015 did not participate in 2016. Three of the 13 non-responders no longer service HSA/HDHPs, and one was purchased by another non-responding company. Excluding the three insurers that no longer service HSA/HDHPs, the remaining non-responders accounted for 0.5 million lives in the 2015 census. Such changes in the respondent population for 2016 may have resulted in an understatement of the total HSA/HDHP enrollment for this year’s report.

Additionally, not all insurers were able to provide data broken out by state or market type, and three could provide only total enrollment in their HSA/HDHPs. We believe the census understates the number of individual purchasers choosing HDHP plans with HSAs because market-specific data are unavailable for certain states reported in this study.


Appendix B

Table 2: HSA-Qualified High-Deductible Health Plan Enrollment, March 2005 to January 2016

Date Individual Small-Group

Large-Group

Other Group Uncategorized Total

Mar 2005 556,000 147,000 162,000 88,000 77,000 1,031,000

Jan 2006 855,000 510,000 679,000 247,000 878,000 3,168,000

Jan 2007 1,106,000 1,057,000 2,044,000 291,000 34,000 4,532,000

Jan 2008 1,502,000 1,816,000 2,777,000 13,000 10,000 6,118,000

Jan 2009 1,832,000 2,429,000 3,752,000 0 0 8,013,000

Jan 2010 2,053,000 2,970,000 4,986,000 0 0 10,009,000

Jan 2011 2,358,497 2,779,208 6,299,460 0 0 11,437,165

Jan 2012 2,470,840 3,019,347 7,939,023 0 72,865 13,502,075

Jan 2013 2,029,646 2,590,037 9,597,759 0 1,237,631 15,455,075

Jan 2014 1,974,895 2,505,931 12,813,021 0 749,177 17,368,764

Jan 2015 2,042,520 2,294,590 15,357,063 0 3,102 19,697,275

Jan 2016 1,894,113 2,113,133 13,902,214 0 2,255,470 20,164,930


Appendix B

State/Territory Enrollment

Alabama 62,867 Alaska 28,818 Arizona 296,519 Arkansas 74,462 California 709,106 Colorado 307,466 Connecticut 318,065 DC 33,705 Delaware 25,311 Florida 711,485 Georgia 379,389 Hawaii 354 Idaho 58,702 Illinois 1,351,691 Indiana 281,018 Iowa 193,955 Kansas 71,267 Kentucky 153,519 Louisiana 190,118 Maine 106,180 Maryland 390,838 Massachusetts 261,183 Michigan 148,411 Minnesota 908,711 Mississippi 34,891 Missouri 211,477 Montana 91,675 Nebraska 173,582 Nevada 65,230 New Hampshire 94,317 New Jersey 541,837 New Mexico 32,648

State/Territory Enrollment

New York 703,454 North Carolina 183,628 North Dakota 20,174 Ohio 801,198 Oklahoma 120,333 Oregon 120,031 Pennsylvania 407,456 Rhode Island 13,213 South Carolina 76,381 South Dakota 34,051 Tennessee 527,030 Texas 1,707,591 Utah 163,958 Vermont 52,930 Virginia 428,677 Washington 410,064 West Virginia 19,948 Wisconsin 227,138 Wyoming 15,034 Guam 19 Northern Marina Islands 0 Puerto Rico 164 US Virginia Islands 145 American Samoa 5

Table 3: Total HSA/HDHP Enrollment By State/Territory, January 2016*

* Six of fifty-nine responding health insurers did not breakout their HSA/HDHP enrollments by U.S. State/Territory.Also, 79 HSA/HDHP covered lives are missing from thistable. They either resided outside of the U.S.States/Territories, or a U.S. State/Territory could not beidentified for them.


Appendix B

State/ Territory Single Family

Alabama $366.74 $745.47 Alaska — — Arizona $332.61 $743.95 Arkansas $494.44 $994.64 California $481.53 $1,270.46 Colorado $443.40 $1,096.73 Connecticut $526.99 $1,388.22 DC $470.77 $1,391.69 Delaware $500.95 $1,172.54 Florida $445.18 $940.04 Georgia $445.29 $1,113.91 Hawaii — — Idaho $357.96 $903.83 Illinois $426.78 $1,005.00 Indiana $482.39 $1,204.68 Iowa $410.08 $913.19 Kansas $432.89 $1,135.81 Kentucky $394.64 $1,016.87 Louisiana $435.37 $1,028.06 Maine $420.93 $1,020.80 Maryland $378.55 $1,014.18 Massachusetts $373.57 $1,033.04 Michigan $345.14 $740.93 Minnesota $438.67 $545.11 Mississippi $459.73 $956.49 Missouri $415.19 $1,016.04 Montana — — Nebraska $449.90 $1,024.15 Nevada $380.49 $993.50 New Hampshire $529.37 — New Jersey $430.49 $1,197.34 New Mexico — —

State/ Territory Single Family

New York $446.50 $1,096.90 North Carolina $420.12 $945.85 North Dakota — — Ohio $430.85 $1,088.29 Oklahoma $434.89 $1,026.70 Oregon $301.61 $1,081.97 Pennsylvania $397.59 $976.39 Rhode Island — — South Carolina $425.75 $853.56 South Dakota $463.96 $1,053.28 Tennessee $427.79 $1,016.98 Texas $406.94 $972.94 Utah $306.02 $901.40 Vermont $443.48 — Virginia $397.63 $1,009.96 Washington $384.06 $965.99 West Virginia $498.55 $1,127.03 Wisconsin $466.82 $1,119.02 Wyoming $555.06 —

Monthly premium data were weighted by plan enrollments by state. Premium information were excluded if fewer than four companies reported premium data for a state. Not all plans could provide their premiums by state; however, for plans covering single individuals, survey participation ranged from four plans (DC, DE, ME, MA, NH, SD, and WV) to eleven plans (WI). For family coverage, survey participation ranged from four plans (AL, DC, DE, ID, ME, MA, NV, OR, SD, WA, and WV) to ten plans (WI).

Table 4: Average Monthly Premiums, HSA/HDHP, January 2016*


Appendix B

Glossary

Enrollee An individual covered under an insurance policy, including dependents.

Small-Group Market The market for health insurance offered to small businesses, usually 1-50 employees.

Large-Group Market The market for health insurance offered to large businesses, usually 50 or more employees.

Individual Market The market for health insurance offered to individuals and not through an employer.

Health Insurance Plan A health insurance plan pays for medical services through premiums collected from the insured. Health plans offer many different insurance products. (See Insurance Product.)

Insurance Product Describes the type of insurance plan, e.g. Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), HSA-Eligible/High-Deductible Health Plan (HSA/HDHP), and Point-of-Service (POS).

Insurance Policy In the individual market, policies are held by individuals. In the group market, policies are held by employers. Employees covered under group plans receive certificates of coverage.

Single Coverage Health insurance that covers one person.

Family Covereage Health insurance that covers more than one person.

2016 survey of health savings account – high … survey of health savings account – high...

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