High-deductible health plans: a brief history

While the introduction of the Affordable Care Act’s (ACA) Health Insurance Marketplace plans in 2014 has accelerated the trend of more Americans with employer-based plans having HDHPs, the number of such plans was already increasing before then-from 5% in 2007 to 20% in 2013, according to a 2014 survey from the Kaiser Family Foundation.

“There is significant year-over-year growth in the number of employers switching to or adding these benefit offerings and employees choosing them,” says Ki Park, MBA, practice area head managed markets, Symphony Health Solu

tions. In fact, 44% of employers will only be offering high-deductible options over the next three years.

Taking a closer look at the statistics, in employer-based plans, specifically, 81% of members had a deductible in 2013, up from 52% in 2003, according to a Commonwealth Fund report, “State Trends in the Cost of Employer Health Insurance Coverage, 2003-2013.”  “Over that period, the average per person deductible more than doubled, increasing by 146%,” says Sara Collins, PhD, vice president for Health Care Coverage and Access, The Commonwealth Fund.

In terms of the growth and size, the share of privately insured adults with deductibles that are in the range of $1,000 to $3,000 rose from 7% in 2003 to 27% in 2014, according to a Commonwealth Fund report, “The Problem of Underinsurance and How Rising Deductibles Will Make It Worse.” The share with very high-deductible plans, those of $3,000 or more, climbed to 11% in 2014, up from 1% in 2003.

In the health insurance marketplace, close to 60% to 80% of plans are HDHPs. These deductibles tend to be higher than those of HDHPs offered through employer-sponsored insurance, says Amelia M. Haviland, PhD, Carnegie Mellon University, Pittsburgh.