RWJF-Health Affairs Policy Brief: High Deductible Health Plans

This health policy brief from the Robert Wood Johnson Foundation and Health Affairs focuses on the increasing number of high deductible health plans (HDHPs) being offered through the health insurance marketplaces established through the Affordable Care Act (ACA). In 2015, almost 90 percent of enrollees in ACA marketplaces selected a HDHP, with deductibles of at least $1,300 for an individual and $2,600 for a family. The maximum out-of-pocket limit in a HDHP was $6,450 for an individual and $12,900 for a family. However, when consumers are enrolled in a qualified HDHP, they can open a Health Savings Account (HSA) to set aside tax-preferred money to help pay for medical expenses, including their deductibles. In 2015, this contribution was limited to $3,350 per year for an individual, and $6,650 for a family. Meanwhile, in the employer group market, nearly one-quarter of workers were enrolled in a HDHP in 2015, up from 4 percent in 2006.

Section 2713 of the ACA requires all health plans to cover a set of preventive services without imposing any form of cost sharing, including a deductible. Services covered by this provision include those that have earned an “A” or “B” rating from the U.S. Preventive Services Task Force such as disease screenings, routine immunizations, and counseling for drug and tobacco use. Enrollees in HDHPs should be able to access these services without having to meet their deductible.

This policy brief examines early evidence that HDHPs have reduced spending, as well as the risks that they may pose for some consumers who might avoid filling prescriptions and obtaining necessary care because of costs. A number of studies have shown that in- creasing consumers’ share of costs reduces their care use. But evidence is mixed on the health impact of this reduction.  The research so far also seems to indicate that high deductibles and out-of-pocket expenses reduce use of necessary as well as unnecessary care, particularly in specific populations. There is evidence that there is an adverse impact in health outcomes on low-income patients and those with chronic conditions. Moreover, families with HDHPs who have family members with chronic conditions also have higher levels of financial burden, with nearly half reporting problems paying medical bills or other bills because of health care costs. These impacts need to be further studied and considered as the use of HDHPs continues to gain prominence in health insurance markets.

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