Getting the lowest health insurance premiums remains what is most important to Americans when choosing a health insurance plan, according to a survey by Insurance.com.
In hopes of improving health plan satisfaction, health insurance companies and employers have improved health care provider networks, added services and removed obstacles like referrals to specialists in health plans, but most Americans still care most about the cost of health insurance premiums.
Insurance.com commissioned a survey of 1,942 Americans and asked respondents about health care costs and high deductible health plans. The survey found that:
- 35% of respondents said that low premiums are most important when choosing a health plan.
- 23% said they chose their plan because of the preferred providers available in the plan.
- 17% said low deductibles are most important.
- 13% selected breadth of services as number one.
- 4% chose not needing a referral, such as in a Preferred Provider Organization (PPO) health plan, as what’s most important.
The results show that cost is a main factor. The way a health insurer designs a plan and the network of providers are not as important as the amount you pay,” says Michelle Megna, managing editor of Insurance.com. “For years, insurance companies and employers have tried to figure out ways to improve health plan designs when it appears low premiums remain most important item to consumers.”
HDHPs: Most cost-effective option
One of the biggest changes to health insurance plan design over the past decade has been the introduction (and subsequent rise) of high deductible health plans. High deductible health plans offer members low premiums, but that comes with the individual having to pick up a greater portion of health care services costs because of the high deductible.
The idea behind HDHPs is to contain health care costs by transferring more of the costs for health care services to the consumer while offsetting it with lower premiums. The cost structure is most beneficial when paired with greater consumer education and a Health Savings Account, in which employers contribute to help the individual pay for the higher deductible.
HDHPs have become popular options for employers and are now second only to PPOs in percentage of Americans enrolled in the health plan. Kaiser Family Foundation said about one-third of health plans are HDHPs in its 2017 Employer Health Benefit Survey.
Our survey found that 37 percent of respondents in the survey have a HDHP, which is slightly more than the figure cited by the Kaiser Family Foundation (28 percent).
Respondents’ reasons for selecting a HDHP:
- 45% chose an HDHP because it was the most cost-effective option.
- 37% said it made more sense for their situation.
- 16% said their employer only gave them an HDHP choice.
HDHPs: Most not saving money
Though many chose an HDHP because of cost, respondents said having an HDHP didn’t actually save them money. In fact, 62 percent said health care costs increased in a HDHP compared to their previous plan. Thirty percent said their health care costs decreased.
A key part of HDHPs is the idea of creating better health care consumers. In fact, HDHPs are often called Consumer Driven Health Plans (CDHPs) because the idea is to educate the health care consumer so he/she can make better health care decisions (and save money in the process). We found HDHPs have mixed results.
Most respondents said they are getting more information from their health insurer (63 percent) and doctors (61 percent) to make them better health care consumers. Sixty percent said they shop around for health care services, which is a positive response for HDHPs.
However, only 41 percent of respondents said they now consider themselves better health care consumers.
Related >> Guide to Health Plans
HDHPs: Putting off care
Those who question the benefit of HDHPs warn that the higher deductibles could cause people to put off care, which could cause problems down the road both in terms of cost and health.
Likewise, our survey found people with a HDHP are putting off care – 64 percent of respondents said they delayed care because they didn’t want to pay the high deductible.
Megna says health insurers and employers will need to make sure they are implementing plans and programs that actually don’t cost more money in the long run.
“The bottom line is that people are still looking for the lowest costs possible, which means HDHPs will continue to be a popular option for individuals looking to pay the least upfront costs possible. As HDHPs become more prevalent, however, health insurance companies and employers will need to make sure that members aren’t putting off necessary care and then have to pay much more down the road,” she adds.
HDHPs: How high is the deductible?
How high are the deductibles in an HDHP? Most respondents said their deductibles are between $1,501 and $2,000, while 20 percent said it’s more than $2,000, and 8 percent said it’s less than $1,500. (In 2018, the minimum HDHP deductible allowed by the IRS is $1,350 for individuals and $2,700 for families. The maximum out-of-pocket is $6,650 for individuals and $13,300 for families).
An important piece of an HDHP is its associated HSA, which allows members to contribute pre-tax money to an account that can be used for health care costs. Employers often also contribute to these accounts.
Respondents contribute the following amounts to their HSAs:
- 38% said they contribute between $1,001 and $2,000 to an HSA annually
- 30% put in $500-$1,000
- 14% put it $2,001 to $3,000
- 5% contribute more than $3,000
Our survey also found that employers are contributing to these accounts:
- 32% said their employer contributes between $500 and $1,000
- 31% of respondents’ employers put in between $1,001 and $2,000
- 16% get nothing
- 8% get less than $500
- 3% receive more than $3,000
HDHPs: Mixed survey results
Megna points out there are positives for health insurers and employers in the survey results. Some people realize they are being supplied information to make them better health care consumers – and they are shopping for the most cost-effective health care. The vast majority said they are contributing to an HSA, and their employers are providing money in the HSA to help pay for care.
The downside is that a large percentage said they have put off care because of high deductibles, and they don’t feel like they are any better health care consumers -- despite the greater education coming from health insurers and doctors.
“The results are definitely mixed for HDHPs. People feel there is more information out there to help them become better health care consumers, but they still don’t feel it’s helping. They are shopping around more for their health care, which should make health plans and employers happy, but they should also be worried that so many appear to be putting off care because they don’t want to pay the high deductible,” says Megna.
Insurance.com commissioned OP4G to survey nearly 2,000 people nationwide in June 2016.