Additional Preventive Care Benefits Permitted Under High-Deductible Health Plans: A Game Changer?

EBRI Director of the Health Research and Education Program Paul Fronstin has been in the habit of saying — for many years now — that allowing additional preventive care benefits to be provided by high-deductible health plans (HDHPs) — such as insulin for diabetics — could be a game changer for the growth of such plans and similarly for health savings accounts (HSAs).

In a recent Issue Brief, Fronstin showed how growth in the number of HSAs and enrollment in HSA-eligible health plans appear to have been slowing. Examining data from EBRI/Greenwald & Associates, the National Center for Health Statistics, Kaiser Family Foundation, Mercer, and America’s Health Insurance Plans, Fronstin found that all of the surveys noted substantial growth in HSA-eligible health plan enrollment since HSAs were established in 2004. At the same time, the surveys also consistently found slower growth in HSA-eligible health plan enrollment more recently (since 2016).

Several factors may have been holding back growth in HSA-eligible health plan enrollments: the delay in the Cadillac tax, recent low health insurance premium increases, and low unemployment may have caused employers to hold off on plans to move to HSA-eligible health plans. In addition, research findings indicate that growth in HSA-eligible health plan enrollments may also be held back because what constitutes an HSA-eligible health plan does not provide employers their desired level of flexibility around the design of the health plan — specifically, the flexibility to provide benefits prior to when the minimum deductible for that year is satisfied.

gamechangerThat game changer may now be here. Last week, effective July 17, 2019, the U.S. Treasury Department and the Internal Revenue Service issued Notice 2019-45, which allows certain preventive care benefits to be permitted before an HDHP’s deductible is met. These include certain treatments not only for diabetes but for asthma, heart disease, hypertension, and other chronic conditions.

The 2018 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey supports the “game changer” theory.  According to that survey, HDHP enrollees are more likely to seek cost information than traditional plan enrollees and are more likely than traditional plan enrollees to exhibit cost-conscious behaviors. Specifically, HDHP survey respondents say that they have:

  • Checked whether the plan would cover care or medication (55 percent HDHP vs. 41 percent traditional).
  • Checked the quality rating of a doctor or hospital before receiving care (41 percent HDHP vs. 33 percent traditional).
  • Asked for a generic drug instead of a brand name (41 percent HDHP vs. 32 percent traditional).
  • Talked to their doctors about prescription options and costs (40 percent HDHP vs. 29 percent traditional).
  • Talked to their doctors about other treatment options and costs (37 percent HDHP vs. 31 percent traditional).
  • Asked a doctor to recommend less costly prescriptions (31 percent HDHP vs. 22 percent traditional).
  • Used an online cost-tracking tool provided by the health plan (25 percent HDHP vs. 14 percent traditional).

The Consumer Engagement in Health Care Survey further found that HDHP enrollees are more likely than traditional plan enrollees to report that they have major financial concerns, despite the fact that HDHP enrollees have higher incomes than traditional plan enrollees.  The report concludes that: “Concerns over the financial wellbeing of workers may be what’s holding employers back from adopting HDHPs more broadly.”

EBRI will continue to track the growth in HDHPs and in HSAs using its Consumer Engagement in Health Care Survey and its database of over 6 million HSAs to understand to what extent the new regulation truly is a game changer for such plans.

About ebriorg
President and CEO, EBRI

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