Survey finds differences between HDHP, traditional health-plan enrollees

The percentage of the population with a high-deductible health-care plan (HDHP) has continued to rise, according to a new survey report.

In 2019, 15 percent of privately insured adults had a plan that was associated with either a health reimbursement arrangement (HRA) or health savings account (HSA), collectively known as consumer directed health plans (CDHP). The figure is up from 14 percent in 2018 and 13 percent in 2017, per the survey data.

At the same time, another 13 percent had a high-deductible health plan that was not associated with either an HRA or HSA. That number is up from 11 percent in both 2018 and 2017.

The numbers come from the annual Consumer Engagement in Health Care Survey (CEHCS). The Employee Benefit Research Institute (EBRI), a private, nonpartisan, nonprofit research group, and Greenwald & Associates, a full-service market research firm, released the survey report on Dec. 20. Both EBRI and Greenwald & Associates are based in Washington, D.C.

CEHCS is aimed at examining consumer engagement in health care and health-insurance decisions. Now in its 15th year, the annual CEHCS provides “reliable national data on the growth of consumer-driven health plans and high-deductible health plans and their impact on the behavior and attitudes of health care consumers,” according to EBRI. 

HDHP vs traditional plans

When it comes to choice of health plan, most people focus on the network of health-care providers, easy access to health care, low out-of-pocket costs, prescription-drug coverage, low premiums, and simple to understand, and specific coverage included in the plan. 

The provider network and access to health care were ranked higher in importance than lower cost of premiums or low out-of-pocket costs. 

Generally, traditional health-plan enrollees and HDHP enrollees rank these aspects of health care in the same order, with one exception: Traditional plan enrollees report that low out-of-pocket costs for doctors’ visits are more important, EBRI said. Of lesser importance is low cost of premiums when selecting a plan. However, HDHP enrollees report that low premiums are more important than low out-of-pocket costs when selecting a plan.

“It is clear that HDHP enrollees value low premiums over low out-of-pocket costs, while traditional plan enrollees value low out-of-pocket costs over low premiums,” said Paul Fronstin, director of EBRI’s health research and education program and co-author of the report. “It is therefore not surprising that traditional plan and HDHP enrollees behave differently when it comes to their health care.”

Consumers enrolled in an HDHP were more likely than those with traditional health-insurance coverage to say that they had checked whether the plan would cover care or medication; checked the quality rating of a doctor or hospital before receiving care; checked the price of doctor’s visits, medication or other service before receiving care; talked to their doctors about other treatment options and costs; talked to their doctors about prescription options and costs; used an online cost-tracking tool provided by the health plan; and developed a budget to manage health care expenses; or declined a medical procedure because of costs.

In addition, when it comes to prescription-drug use, those in an HDHP were more likely than those with traditional coverage to have asked for a generic drug instead of a brand name or asked their doctor to recommend a less costly prescription drug. 

Generational differences

Attitudes toward health care differ by generational cohort as well, the survey found. Baby Boomers were more likely than Generation Xers and Millennials to have a primary care provider. 

Baby Boomers are much more likely than Millennials to strongly agree that they are comfortable telling their primary care provider about any health issue that they may have, that it is important that their doctor knows them and their medical history personally, that it’s important that their primary care provider is aware of all of the other medical care that they receive, and that they see their own primary care provider at every visit.

About the survey

The 2019 survey of 2,068 individuals was conducted online using Dynata/ResearchNow’s online research panel between Aug. 26 and Sept. 20, 2019. All respondents were between the ages of 21 and 64, EBRI said. 

The national sample is weighted by gender, age, income, ethnicity, education, and region to reflect the actual proportions in the population. The CDHP and HDHP samples are weighted by gender, age, income, and ethnicity.

The survey was underwritten by Benefit Wallet, Blue Cross and Blue Shield Association, HealthEquity, Inc., National Rural Electric Cooperative Association, Prudential Financial (NYSE: PRU), and UMB Financial (NASDAQ: UMBF).