Growing number of workers enrolling in high-deductible health plans – InsuranceNewsNet
(Washington, DC) – The Employee Benefits Research Institute (EBRI) today released a brief titled “Recent Trends in Out-of-Patient Out-of-Pocket Cost Sharing,” revealing that the cost share out-of-pocket benefits increased from 17.4% in 2013 to 19% in 2019. This result appears to be due to the growing number of workers enrolling in plans with higher deductibles. The study analyzed data from more than 45 million patients covered by employer-sponsored health care plans.
“We found out-of-pocket spending increased between 2013 and 2019 overall. Interestingly, this appears to be driven by the growing adoption of plans with higher deductibles, not changes in cost sharing. In fact, when we separated the study by individual plan types, such as High Deductible Health Plans (HDHPs), Preferred Provider Organizations (PPOs), or Health Maintenance Organizations (HMOs), we we found that the share of out-of-pocket expenses for patients in these plans either declined or remained stable,” explained Jake Spiegel, Research Associate, EBRI.
Key findings from the study include:
• The share of out-of-pocket expenses paid by patients with employer-sponsored health plans fell from 17.4% in 2013 to 19% in 2019, before a pandemic-related decline to 16.4% in 2020.
• However, disaggregating the data by type of health plan reveals a more nuanced story: for most plan types, the share of expenses paid by patients remained stable or decreased slightly. The increase in the share of expenses paid out of pocket observed between 2013 and 2019 seems to be due to the growing number of workers enrolling in plans with higher deductibles.
• Between 2013 and 2019, out-of-pocket spending for outpatient services grew faster ($470 to $631) than out-of-pocket spending for inpatient services ($109 to $127). Out-of-pocket spending on prescription drugs decreased over this period (from $158 to $148).
• Patients’ health status affects their out-of-pocket expenses. For example, the median patient with high cholesterol had higher expenses than patients in general ($882 versus $205) and paid a higher share of their expenses (16.9% versus 16.2%).
“Employers face a tension between controlling the net impact of healthcare costs and helping workers achieve financial well-being. For one thing, employers are more frequently implementing financial wellness programs as a way to improve the financial well-being of their employees. On the other hand, in an effort to combat increases in health care costs, employers often look to increasing their health plan deductible, which could offset the positive impact of any financial wellness initiative. said Spiegel.
The study leveraged the IBM® Marketscan® Commercial Claims and Encounters database of member enrollment information, as well as medical (inpatient and outpatient) and pharmaceutical claims. For this analysis, claims data from 2013 to 2020 was examined. Overall, the analytic dataset contains records on more than 45 million patients who were continuously enrolled in an employer-sponsored health plan for at least one year between 2013 and 2020. In total, the Database patients accounted for $998 billion in claims between 2013 and 2020, covering inpatient and outpatient consultations as well as prescription drug claims.
The full brief, “Recent Trends in Out-of-Patient Cost Sharing,” can be viewed by visiting https://www.ebri.org/oop-costsharing.
This brief was supported by a grant from the FINRA Investor Education Foundation and was produced by the EBRI Center for Health Benefits Innovation Research, which receives funding from Aon, Blue Cross Blue Shield Association, FINRA Investor Education Foundation, ICUBA, JP Morgan Chase, Pfizer and PhRMA.
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