Use of Health Savings Accounts Among US Adults Enrolled in High-Deductible Health Plans

Abstract

IMPORTANCE Health savings accounts (HSAs) can be used by enrollees in high-deductible health plans (HDHPs) to save for health care expenses before taxes. Expansion of and encouraging contributions to HSAs have been centerpieces of recent federal legislation. Little is known about how US residents who may be eligible for HSAs are using them to save for health care. OBJECTIVE To determine which patients who may be eligible for an HSA do not have one and what decisions patients with HSAs make about contributing to them.

Health Savings Plans and Disparities in Access to Care by Race and Ethnicity

“…Therefore, these findings may partly be due to employer contributions that decreased enrollee deductibles (23% of covered workers in an HSA-qualified HDHP receive employer contributions that reduce actual liability to <$1,000 when applied to deductibles). 10 Given that few adults with an HSA were able to afford healthcare savings in the last year, 34 studies investigating the differences by whether employers offer HDHPs with (and make contributions to) a health savings plan option are recommended.…”

Trends in high deductible health plan enrolment and spending among commercially insured members with and without chronic conditions: a Natural Experiment for Translation in Diabetes (NEXT-D2) Study

“…HSA-eligible and HRA-eligible HDHP members with chronic diseases consistently had higher OOP and higher total costs than members in nonaccount based HDHPs (online supplemental appendix 7), possibly because the accounts provide funds that lower barriers to utilisation and reduce the effective OOP cost of care through use of pretax dollars. However, another study found that more than half of the members with HSAeligible HDHPs do not contribute money to their HSA, 24 suggesting that HSA accounts may not actually reduce the OOP burden for the majority of HDHP members. Our finding that members with chronic diseases paid OOP for a lower share of total costs than healthier members Open access is because members with chronic diseases have much higher total costs and many high costs members hit their deductible and OOP max limits.…”

High-Deductible Health Plans and Health Savings Accounts

“…Kullgren and colleagues 1 found that higher-income respondents (ie, 250%-400% of the federal poverty level) were more likely to enroll in an HSA than lower-income respondents (<250% of the federal poverty level). 1 These enrollment differences may create a greater financial burden of out-of-pocket health care costs on lower-income families, but this study did not address that possibility. However, a recent study of low-income adults with multiple chronic conditions enrolled in employer-sponsored insurance found that almost half had a family out-ofpocket health care burden exceeding 20% of family disposable income, which was considerably higher than that of similar low-income adults in low-deductible or no-deductible plans.…”

“…Employers and policy makers may be able to increase HSA enrollment and savings by making the benefits of HSA participation more transparent and understandable, because this study found that HSA enrollees in the highest tertile of health insurance literacy were more likely to contribute to their HSA than those in the lowest tertile. 1 Even greater improvements might be realized if employers leveraged the important insight from behavioral economics that default options strongly influence participation rates. 6 If HSA enrollment and a monthly contribution at a fixed amount or percentage of income were the default options that employees had to opt out of, future HDHP enrollees may not experience the same outcomes of those in the 2016 sample from this study.…”

“…The work by Kullgren et al1 provides important insights about the discordance between HSA use by HDHP enrollees as intended by proponents and HSA use in the real world. More work is needed to make what appears to be a match made in heaven (HDHPs plus HSAs) work as expected in this imperfect real world that is filled with employees who may not be as rational as hoped.ARTICLE INFORMATION Published: July 17, 2020. doi:10.1001/jamanetworkopen.2020.11000 Open Access: This is an open access article distributed under the terms of the CC-BY License.…”