40% of adults enrolled in high-deductible insurance plans

A recent survey shows an increasing number of adults were enrolled in health plans with deductibles above $1,300 for individual plans and $2,600 for family coverage in 2016 as more employers turn to plans with higher out-of-pocket costs.

This shift away from lower deductibles has been seen for several years since the Affordable Care Act was signed into law. According to estimates from the National Health Interview Survey, the percentage of adults aged 18 to 64 enrolled in high-deductible health plans (HDHPs) has increased from 28.5 percent in 2011 (24 percent in employer-sponsored HDHPs, 4.5 percent in directly-purchased HDHPs) to 40.6 percent in 2016 (34.9 percent in employer-sponsored HDHPs, 5.7 percent in directly-purchased HDHPs).

Most employer-based plans still have “traditional” deductibles, but enrollment in those plans has steadily decreased from 67.2 percent in 2011 to 54 percent in 2016. Among the smaller population covered by directly-purchased private coverage, HDHP enrollment was already the norm in 2011 (covering 51.1 percent of those in directly-purchased plans). That share went up to 55.1 percent in 2013, then declined to 51.2 percent by 2016.

The report also said customers in HDHPs are more likely to report having problems paying medical bills. 15.5 percent of adults aged 18-64 said they had problems paying in the past 12 months, compared to 10.3 percent of those in lower-deductible plans. Among those who purchase their plans directly, there wasn’t a significant difference on this question for traditional plan customers (15.9 percent said they had problems paying medical bills in past year) and those in HDHPs (16.1 percent had trouble paying bills).

Similarly, HDHP enrollees were more likely to report they put off or didn’t get medical care due to cost concerns (9.2 percent) than those in traditional plans (5.2 percent), with the greatest share seen in those with a directly-purchased HDHP (13.3 percent).

The report also examined differences in income amongst HDHP and traditional plan customers, both in the employer-based market and those who directly purchased plans. For those covered through an employer, the income distribution was similar no matter what kind of plans they received. For the directly-purchased market, however, higher-income customers were more likely to have a high-deductible plan, with 49.8 percent of those customers purchasing a HDHP having income above 400 percent of the federal poverty level.

“Therefore, factors other than income may contribute to the differences seen in financial barriers to health care between those with employment-based HDHPs and those with traditional plans,” the report concluded.