Employer and Worker Contributions to Health Reimbursement Arrangements and Health Savings Accounts, 2006-2013

Abstract

This paper presents findings from the 2008-2013 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS) as well as the 2006 and 2007 EBRI/Commonwealth Fund Consumerism in Health Care Surveys. It examines the availability of health reimbursement arrangements (HRAs) and health savings account (HSA)-eligible plans (consumer-driven health plans, or CDHPs). It also looks at employer and individual contribution behavior. According to the 2013 CEHCS, 11.8 million adults ages 21-64 (9.7 percent of the U.S. population) were enrolled in a plan with an HRA or HSA. An additional 9.3 million reported that they were in an HSA-eligible plan but had not opened such an account. Thus, overall, 21 million adults ages 21-64 with private insurance, representing 17.3 percent of that market, were either in a CDHP or an HSA-eligible plan but had not opened the account. When their children were included, 26.1 million individuals with private insurance, representing 15 percent of the market, were either in a CDHP or an HSA-eligible plan. Seven out of 10 workers (71 percent) with an HRA or HSA reported that their employers contributed to the account in 2013. Workers with employee-only coverage dropped their contributions, but those with family coverage kept their contribution levels steady. The report found a correlation between health engagement and individual contributions to an HSA. Those defined as being engaged in their health reported that they did at least one of the following: checked whether their health plan would cover their care or medication; checked the price of a doctor’s visit, medication, or other health care service before receiving care; checked the quality rating of a doctor or hospital before receiving care; talked to their doctor about prescription options, costs, other treatment options and costs; used an online cost tracking tool provided by their health plan to manage health expenses; developed a budget to manage health care expenses; asked for a generic drug instead of a brand name drug; or asked their doctor to recommend a less costly prescription drug. It was found that individuals with some engagement with the health care system contributed higher amounts to their HSA than those with no engagement.

The PDF for the above title, published in the February 2014 issue of EBRI Notes, also contains the fulltext of another February 2014 EBRI Notes article abstracted on SSRN: “IRA Withdrawals, 2011.”

Keywords: Account-based health plans, Consumer-driven health care, Consumer-driven health plans (CDHPs), Employment-based benefits, Health insurance coverage, Health reimbursement arrangements (HRAs), Health savings accounts (HSAs), High-deductible health plans (HDHPs)

JEL Classification: I1, I11, J32