High-Deductible Health Plan Enrollment Increased From 2006 To 2016, Employer-Funded Accounts Grew In Largest Firms

Area of Science:

• Health Economics
• Employee Benefits
• Health Insurance Policy

Background:

• Employers are adopting high-deductible health plans (HDHPs) to manage rising health insurance premiums.
• HDHPs shift more financial responsibility to employees for healthcare costs.

Purpose of the Study:

• To analyze trends in HDHP enrollment from 2006 to 2016.
• To investigate how HDHP characteristics vary by employer size.
• To assess the availability of employer-funded accounts and plan choices within HDHPs across different firm sizes.

Main Methods:

• Utilized data from the Medical Expenditure Panel Survey-Insurance Component for private-sector establishments in 2006 and 2016.
• Examined HDHP enrollment, employer-funded accounts, non-HDHP options, and deductible levels.
• Categorized firms by size (e.g., fewer than 25 employees, 1,000+ employees).

Main Results:

• In 2016, 78% of HDHP enrollees in the smallest firms (under 25 employees) lacked employer-funded accounts, versus 35.2% in the largest firms (1,000+ employees).
• HDHP enrollees in larger firms generally experienced more favorable plan offerings, including better access to supplementary accounts and potentially lower out-of-pocket costs.
• Significant heterogeneity exists in HDHP design and associated employee protections based on firm size.

Conclusions:

• Workers in larger firms enrolled in HDHPs often have superior benefits and financial protections compared to their counterparts in smaller firms.
• The trend towards HDHPs may exacerbate disparities in healthcare access and affordability based on employer size.
• Policymakers and employers should consider the varying impact of HDHPs across different firm sizes to ensure equitable employee benefits.