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The bright side of high-deductible health plans

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Satisfaction levels are rising among Americans enrolled in consumer-driven health plans (CDHPs), while they are declining among those in traditional health plans, according to a new report by the nonprofit Employee Benefit Research Institute (EBRI).

In particular, satisfaction rates for out-of-pocket costs appear to be trending downward among those with traditional coverage and upward for those with consumer-driven plans, according to the report.

CDHPs typically combine high-deductible health plans (HDHPs) with a tax-exempt health savings account (HSA) or health reimbursement arrangement (HRA) to help enrollees pay for out-of-pocket expenses.

A growing number of U.S. employers have adopted CDHPs over the past decade to provide employees with incentives to make cost-conscious decisions when selecting health care services and to limit unnecessary health care spending.

In EBRI's 2011 survey, individuals with a CDHP or HDHP had deductibles of at least $1,000 for individual coverage or $2,000 for family coverage in addition to an HSA or HRA with a rollover provision they could use to pay for medical expenses. The report, which incorporated earlier years of the survey, was published in the August 2012 EBRI Notes, “Satisfaction with Health Coverage and Care: Findings from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey.”

Key findings include the following:

Overall satisfaction with health plan: Overall satisfaction levels among CDHP enrollees increased from 37% to 52% between 2006 and 2009, although there was a drop in satisfaction rates between 2009 and 2010. Satisfaction rates increased from 43% to 46% between 2010 and 2011.

Satisfaction rates among traditional enrollees decreased in most years. Between 2006 and 2008 they slipped from 67% to 63% and, after increasing between 2008 and 2009, they fell from 66% to 57% between 2009 and 2011.

Out-of-pocket costs: Attitudes about out-of-pocket costs may explain some of the difference in overall satisfaction rates among enrollees in traditional plans, HDHPs and CDHPs. In 2011, 41% of traditional-plan participants were either extremely or very satisfied with out-of-pocket costs (for health care services other than for prescription drugs), while 16% of HDHP enrollees and 24% of CDHP participants were extremely or very satisfied. Satisfaction rates appear to be trending downward among those with traditional coverage and upward for those with a CDHP.

Access to doctors: Satisfaction levels with getting doctor appointments were high relative to other aspects of health care, regardless of plan type, yet some differences were found. In 2006, traditional-plan enrollees were more likely than CDHP enrollees to be extremely or very satisfied with their ability to get doctor appointments. However, between 2007 and 2010, differences were not statistically significant, and in 2011 CDHP enrollees were more likely than traditional-plan enrollees to be extremely or very satisfied with their ability to get doctor appointments. In 2011, 73% of CDHP enrollees were extremely or very satisfied with their ability to get doctor appointments, compared with 68% of traditional-plan enrollees.

Within those overall trends, EBRI noted a few divergent findings, such as that enrollees in CDHPs and HDHPs were less likely than those in traditional plans to recommend their health plan and to indicate a desire to stay with their current plan, if given an opportunity to switch. While their experience with high-deductible plans may be proving better than they expected, if given the option many still would prefer lower deductibles with the same or better coverage.

Stephen Miller, CEBS, is an online editor/manager for SHRM.

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