Health Savings Accounts and Account-Based Health Plans: Research Highlights

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1 Health Savings Accounts and Account-Based Health Plans: Research Highlights July 2012 SUMMARY Health savings accounts (HSAs) were first authorized by the 2003 Medicare Modernization Act. HSAs are intended to be used in conjunction with qualified high-deductible health plans (HDHPs) defined as those with minimum deductibles of $1,200 for single coverage and $2,400 for family coverage in 2012 (unchanged from 2011). Consumers, family members, and employers can make deposits into a tax-favored account (up to annual limits) for qualified medical expenses. Funds not withdrawn for qualifying health expenses can remain in the account and be rolled over annually to build savings for future health-related costs. HSA plans and similar health reimbursement arrangement (HRA) plans generally make up the broad category of consumer-directed health plans (CDHPs). Unlike HSAs, HRAs are held by employers and are not usually portable if an employee leaves the firm. This brief report is an update of the November 2011 AHIP Center for Policy and Research publication, Health Savings Accounts and Account-Based Health Plans: Research Highlights, and gives an overview of current research and statistics on the market for account-based health plans (ABHPs). ENROLLMENT The number of people with HSA/HDHP coverage rose to more than 13.5 million in January 2012, up from 11.4 million in January 2011, approximately 10 million in January 2010, 8 million in January 2009, and 6.1 million in January 2008 (see Figure 1). (AHIP Center for Policy and Research, May 2012) Between January 2011 and January 2012, the fastest growing market for HSA/HDHP products was large-group coverage. The large-group market represented approximately 59 percent of all HSA/HDHP enrollment in January 2012, up from 55 percent of HSA/HDHP enrollment in January 2011 (see Figure 2). (AHIP Center for Policy and Research, May 2012) America s Health Insurance Plans, Center for Policy and Research 1

2 Among adults ages with private insurance in 2011, 15.8 million 13.1 percent of the commercial health insurance market were enrolled in consumer-directed health plans (CDHPs) account-based (HSA or HRA) highdeductible health plans or an HSA-eligible HDHP, but had not yet opened an account. That figure rose to approximately 21 million people when the enrollees children were counted. (Employee Benefit Research Institute, December 2011) Twenty-six (26) percent of enrollees in CDHPs were enrolled in their plans for 3 4 years, and 21 percent were enrolled for 5 or more years. Among traditional plan enrollees, the figures were 18 percent and 44 percent, respectively. (Employee Benefit Research Institute, December 2011) Based on data collected for nearly 13.5 million lives with HSA/HDHP coverage as of January 2012, the states with the largest reported HSA/HDHP enrollment levels were: California (1,001,943); Texas (755,432); Illinois (717,384); Ohio (662,999); and Florida, which had 539,778 covered lives (see Figure 3). State market penetration ranged from less than 1 percent in Hawaii to 20 percent in Vermont (see Figure 4). (AHIP Center for Policy and Research, May 2012) AVAILABILITY OF ACCOUNT-BASED HEALTH PLANS Among firms offering health benefits in 2011, 18 percent offered an HSA-qualified HDHP, an increase of eleven percentage points since 2007, and a sixteen percentage point increase since 2005 (see Figure 5). (Kaiser Family Foundation, 2011) According to the U.S. Bureau of Labor Statistics, HSA/HDHPs are proving to be an important lower-cost option to help both employers and employees get a handle on increasing health care costs. Between 2005 and 2010, the percentage of workers which had access to an HSA grew from 5 percent to 14 percent (see Figure 6). (U.S. Bureau of Labor Statistics, April 2011) Of all employers with 500 or more employees, 32 percent offered a CDHP in 2011, a 9 percentage point increase over Forty-seven (47) percent of firms with more than 10,000 employees offered a CDHP; the CDHP offer rate among small employers (with employees) was much lower, but still grew from 16 percent in 2010 to 20 percent in (Mercer, 2012) In 2010, 44 percent of employees in small businesses chose HSA/HDHP options when offered a choice among those and other types of coverage. This result varied slightly, depending on group size: 49 percent for firms with 10 or fewer employees; 45 percent for firms with 11 to 25 workers; and 40 percent for firms with 26 to 50 workers. (America s Health Insurance Plans, July 2011) POPULATION The gender distribution of HDHP enrollees has been evenly split each year between 2005 and percent female and 50 percent male. However, enrollees in CDHPs were more likely to be female (56 percent, versus 44 percent male) in both 2010 and (Employee Benefit Research Institute, April 2012) America s Health Insurance Plans, Center for Policy and Research 2

3 In January 2012, 49 percent of all HSA/HDHP enrollees in the individual market (including dependents covered under family plans) were age 40 or over; 51 percent were under age 40. Specifically, 26 percent of enrollees were younger than 20 years of age; 25 percent were between the ages of 20 and 39; 18 percent were between the ages of 40 and 49; and 31 percent were 50 years of age or older (see Figure 7). (AHIP Center for Policy and Research, May 2012) Between and in 2011, there was no significant difference in the percentage of CDHP enrollees with children, compared to those in traditional health plans. In and 2009, CDHP enrollees were less likely to be married than those with traditional coverage. (Employee Benefit Research Institute, April 2012) A 2009 study in which responding banks used a geo-coding technique to estimate the income characteristics (in 1999 dollars) of their HSA accountholders found that: - 3 percent of HSA accountholders lived in lower income neighborhoods, which had median incomes less than $25,000; - 46 percent lived in lower-middle income neighborhoods, with median incomes between $25,000 and $50,000; - 34 percent lived in middle-income neighborhoods, which had median incomes between $50,000 and $75,000; - 12 percent lived in upper-middle income neighborhoods, with median incomes between $75,000 and $100,000; and - 5 percent lived in higher-income neighborhoods, with median incomes above $100,000 (see Figure 8). (America s Health Insurance Plans, May 2009) HEALTH STATUS A 2010 study by Cigna comparing its CDHP, Choice Fund, and traditional plans showed that CDHP enrollees are in better control of their chronic health issues and were more engaged in their care. For example, CDHP enrollees were 21 percent more likely to participate in disease management programs than those with traditional coverage. The study also found slower growth of health costs among CDHP enrollees (see Figure 9). (Cigna, October 2010) According to a 2012 study of employersponsored health plans, about 10 percent of employers say account-based health plan (ABHP) enrollees are better at reducing lifestyle risks than those enrolled in non-abhps. (Towers Watson/National Business Group on Health, 2012) Enrollees in CDHPs are about as likely to have a health problem as enrollees in traditional health plan products (50 percent versus 53 percent, respectively). Health problem was defined as fair or poor health, or having one of eight chronic conditions: arthritis; asthma, emphysema, or lung disease; cancer; depression; diabetes; heart attack or other heart disease; high cholesterol; or hypertension, high blood pressure, or stroke. (Employee Benefit Research Institute, April 2012) CONSUMER-SUPPORT TOOLS AND ENROLLEE ENGAGEMENT CDHP enrollees were more likely than traditional plan enrollees to seek provider cost and quality from sources other than the health plan. Specifically, 1 in 3 CDHP enrollees sought such America s Health Insurance Plans, Center for Policy and Research 3

4 information, compared with about 1 in 4 traditional plan enrollees. (Employee Benefit Research Institute, December 2011) An Aetna study of 2.3 million members showed that CHDP enrollees were more engaged in their healthcare than traditional PPO plan members. Specifically, CDHP enrollees used online tools more than twice as often and were about 4 percent more likely to take certain actions considered to be indicators of engagement e.g., use mail order Rx, preventive medical and dental, call the 24 hour nurse line. (Aetna, 2011) According to an Aetna study of its members, CDHP households (HRA and HSA) generated 20 percent fewer alerts indicating gaps in care than traditional PPO plan members. Enrollees in the HSA-qualified HDHP plan showed 30 percent fewer gaps in care, compared to the traditional plan members studied. (Aetna, 2011) Many health plans offering HSA-qualified HDHPs have created online consumer-support tools for their enrollees (see Figure 10). Additionally, other tools are offered by the responding health plans to assist HSA/HDHP enrollees with their needs in managing their health care and health care expenses, including: health risk assessments, health coaching, bill payment tools, and mobile applications ( apps ). (AHIP Center for Policy and Research, May 2012) CDHP enrollees were more likely than traditional plan enrollees to report access to health risk assessments and health promotion programs. (Employee Benefit Research Institute, December 2011) Eleven (11) percent of CDHP enrollees used a smartphone or tablet apps to access their medical claims history, compared with 6 percent of traditional plans and HDHPs not associated with an account (HSA or HRA). (Employee Benefit Research Institute, December 2011) PREVENTIVE CARE Ninety-one (91) percent of employees with HSA/HDHP group coverage in 2011 were provided first-dollar coverage for preventive care. (Kaiser Family Foundation, 2011) A study of employers offering ABHPs in 2012 found ABHP enrollees were in most cases were just as, if not more likely, to seek recommended preventive care, reduce lifestyle risks, and avoid unnecessary care than their counterparts in traditional health plans (see Figure 11). While the study concluded ABHPs were out-performing traditional health plans in many respects, specifically with respect to the use of inappropriate care and non-emergent ER use, it also stated there are significant gaps in measurement of employee behavior data. (Towers Watson/National Business Group on Health, 2012) A study of plan enrollees showed that members with either HRA or HSA plans utilized screenings for cervical, prostate and colorectal cancers, as well as mammograms and immunizations at a higher rate than traditional PPO plan enrollees. Compared with traditional PPO plan enrollees with diabetes, diabetics in CHDP plans had higher rates of diabetes-related tests and screenings (see Figure 12). (Aetna, 2011) America s Health Insurance Plans, Center for Policy and Research 4

5 An actuarial monograph on consumer-driven health (CDH) plan studies indicates that CDH plan enrollees with chronic conditions use more preventive services than similar patients enrolled in a traditional health plan in some cases up to 23 percent more than traditional plan enrollees. This was attributed to the fact that most CDH plans provide such care at no charge. The studies also showed: - Enrollees in CDH plans with chronic conditions received recommended care at comparable or higher rates than traditional plan enrollees; - CDH plan enrollees use fewer inpatient services, and have lower emergency room and acute care spending; - Enrollees in consumer-directed plans use more generic drugs a behavior change which results in lower costs without reductions in quality of care; - An increased incidence of physicians following evidence-based care protocols. (American Academy of Actuaries, May 2009) CDHP members with chronic conditions congestive heart failure, high blood pressure and high cholesterol had similar medication adherence rates as PPO enrollees. CDHP members used generic drugs at higher rates. (Aetna, 2011) PREMIUMS Average annual premiums for HSA-qualified HDHP Plans as reported in a 2011 Kaiser Family Foundation survey were $4,427 for single coverage and $12,655 for family coverage. The Kaiser survey reported that average premiums for HDHP/HRA plans were $5,227 for single coverage and $14,909 for family coverage. In contrast, the average premium for non-savings account plans was $5,565 for single coverage and $15,363 for family coverage (see Figure 13). (Kaiser Family Foundation, 2011) The AHIP census on HSA-eligible plans in January 2012 reported average monthly premiums of $361 for single coverage and $896 for family coverage in the small-group market. (AHIP Center for Policy and Research, May 2012) ACCOUNT INFORMATION A study released by UnitedHealthcare and Optum Bank shows that lower-income members open health savings accounts at a greater rate than do higher income groups with an average income in the mid-$50,000 range. The report indicated that account adoption rates are highest among those earning less than $25,000 (see Figure 14). (United Healthcare, 2008) The average age of HSA accountholders at three banks studied in 2010, was 43.0 years. Approximately 16 percent of accountholders were age 20 29; 25 percent were age 30 39; 27 percent were in age 40 49; 23 percent were age 50 59; and 9 percent were age 60 and older. (America s Health Insurance Plans, December 2010) A 2011 Kaiser Family Foundation study found that 69 percent of employees with employersponsored HSA/HDHPs received contributions to the accounts from their employers. Among those accounts receiving employer contributions, the average contribution was $886 for individuals and $1,559 for families. Note: For HSA-qualified high deductible health plans (HDHPs), the America s Health Insurance Plans, Center for Policy and Research 5

6 average annual total employer contribution (premium plus HSA contributions) for covered workers was $4,723 for single coverage and $11,138 for family coverage (see Figure 15). (Kaiser Family Foundation, 2011) An Aetna study of 2.3 million enrollees found that those with HSAs were more likely to accumulate funds, when compared to HRA members. Nearly all HSA members rolled over some of their account while the majority of HRA members used their entire fund in (Aetna, 2011) A fund administrator snapshot of HSAs in 2011 showed that: on average, 65 percent of accounts had an annual contribution and 43 percent of accounts had a distribution every month in 2011; the average annual contribution was $530 more than the average annual distribution; and 74 percent of accountholders contributed more than they spent during the year. (J.P. Morgan Chase, 2011) A January 2012 Devenir survey of the top 50 HSA providers found that the number of health savings accounts continued to grow and now totals nearly 6.8 million accounts a year-overyear increase of 20 percent from December 2010 to December (Devenir, 2011) According to a study of HSA and HRA accounts between 2006 and 2011, both average account balances and total assets have increased. While total assets grew steadily over that period, average account balances leveled off in 2008, dropped slightly in 2010, and then increased in In 2011, nearly half (46 percent) of all HRAs and HSAs had balances above $1,000; 22 percent had balances of $3,000 or more (see Figure 16). (Employee Benefit Research Institute, January 2012) Between 2006 and 2011, both the percentage of individuals with a rollover and the average rollover amount have increased. In 2006, 23 percent of individuals with an HRA or HSA did not roll over any money, but by 2011, that figure had dropped to 13 percent. Likewise, the average rollover amount increased from $592 in 2006 to $1,206 in 2011 (see Figure 17). (Employee Benefit Research Institute, January 2012) A 2009 study in which responding banks used a geo-coding technique to estimate the income characteristics of their HSA accountholders found that although accountholders in all neighborhood income ranges used their HSAs, those in higher income ranges tended to make larger deposits and withdrawals. For example, during calendar year 2007: - Accountholders residing in areas with median incomes between $25,000 and $50,000 (in 1999 dollars) experienced average HSA inflows (personal deposits, employer contributions and interest earnings) of $1,401 and average outflows (personal spending and fees) of $ Accountholders in neighborhoods with median incomes between $75,000 and $100,000 (in 1999 dollars), that had average HSA inflows of $2,083 and average outflows of $1,320. (America s Health Insurance Plans, May 2009) America s Health Insurance Plans, Center for Policy and Research 6

7 FIGURES Figure 1. Growth of HSA-Qualified High-Deductible Health Plan Enrollment, Covered Lives (Millions), March 2005 to January 2012 March January January January January January January January Individual Small Group Large Group Other Group Other Sources: AHIP Center for Policy and Research (May 2012). Note: Companies reported enrollment in the large- and small-group markets according to their internal reporting standards, or by state-specific requirements for each state. The Other Group category contains enrollment for companies that could not break down their group membership into large- and small-group categories within the deadline for reporting. The Other category was necessary to accommodate companies that were able to provide information on the total number of people covered by HSA/HDHP policies, but were not able to provide a breakdown by market category within the deadline for reporting. Figure 2. Percentage of Individuals in the Commercial Health Insurance Market Covered by an HSA-Qualified High- Deductible Health Plan, by Market Type, March 2005 to January 2012 March % 17% 19% January % 25% 33% January % 25% 49% January % 30% 45% January % 30% 47% January % 30% 50% January % 24% 55% January % 22% 59% Individual Small Group Large Group Sources: AHIP Center for Policy and Research (May 2012). Note: Columns may not sum to 100 percent due to rounding. America s Health Insurance Plans, Center for Policy and Research 7

8 Figure 3. Number of Lives Covered by HSA-Qualified High-Deductible Health Plans, by State, January 2012 Below 40,000 40,000 to 139, ,000 to 269, ,000 and Above Source: AHIP Center for Policy and Research (June 2012). Figure 4. Lives Under Age 65 Covered by HSA-Qualified High-Deductible Health Plans as a Percent of Total Commercial Health Plan Enrollment, by State, January 2012 Below 4 Percent 4 to 6 Percent 6 to 8 Percent 8 Percent and Above Source: AHIP Center for Policy and Research (June 2012). America s Health Insurance Plans, Center for Policy and Research 8

9 Figure 5. Percentage of Firms Offering HDHP/HRAs and/or HSA-Qualified HDHPs, % 7% 2% 3% 3% 4% 1% 2% 2% 6% 7% 12% 18% 4% 7% 13% 11% 15% HDHP/HRA HSA-Qualified HDHP HDHP/HRA or HSA-Qualified HDHP Source: Kaiser Family Foundation (2011) Figure 6. Percent of Private Industry Workers with Access to Health Savings Accounts, Figure 7. Age Distribution of People Covered by HSA- Qualified High-Deductible Health Plans, Individual Market, January % 14% % % % % 5% 6% 8% 8% Source: U.S. Bureau of Labor Statistics (April 2011). Figure 8. Distribution of HSA Accountholders Census Tract Median Household Incomes (Thousands of 1999 Dollars), 2008 $25 $50 46% $50 $75 34% % Source: AHIP Center for Policy and Research (May 2012). Notes: Most enrollees in the 0 19 age group were dependents covered under family plans. Figure 9. CDHP versus Traditional Plan Medical Cost Trend Reduction Hypertension Diabetes Joint Disease Overall Choice Fund Less than $75 $100 More than $25 12% $100 3% 5% Source: AHIP Center for Policy and Research (May 2009). Source: Cigna (2010). -21 America s Health Insurance Plans, Center for Policy and Research 9

10 Figure 10. Consumer Decision-Support Tools Available to HSA-Qualified High-Deductible Health Plan Enrollees, January 2012 Account transactions and balances 95% Health education information 98% Hospital-specific quality data 93% Physician-specific quality data 86% Physician-specific information 97% Health care cost information 85% Personal Health Records 91% Source: AHIP Center for Policy and Research (May 2012). Figure 11. Health Behaviors and Outcomes for Employees and Dependents Enrolled in an ABHP Compared to Non- ABHP Enrollees Getting recommended preventive screening procedures Having an annual physical Using ER for non-emergent conditions Avoiding inappropriate care Participating in healthy lifestyle activities Reducing biometric risks (e.g., blood pressure, cholesterol) Reducing lifestyle risks (e.g., BMI, tobacco use, exercise) 15% 14% 11% 13% 19% 15% 17% 11% 16% 23% 27% 26% 29% About the Same Better in ABHP Source: Towers Watson/National Business Group on Health (2012). America s Health Insurance Plans, Center for Policy and Research 10

11 Figure 12. Difference in Percent of Eligible Household Utilization Rates for Preventive Cancer Screenings, Diabetic Screenings and Immunizations, CDHP versus Traditional PPO Enrollees Mammogram Screening Source: Aetna (2011). Cervical Cancer Screening Immunizations Colorectal Cancer Screening Prostate Cancer Screening Diabetic Hemoglobin A1C Test Diabetic Lipid Screening Diabetic Microalbumin Test Figure 13. Average Annual Premium for Employer-Sponsored Health Benefits, HSA Plans Compared to All Plan Types, $9,101 $12,892 $10,396 $13,591 $11,683 $13,979 $12,655 $15,363 Single HSA Single All Family HSA $3,527 $4,769 $3,829 $4,902 $4,233 $5,136 $4,427 $5,565 Family All Source: Kaiser Family Foundation (2011). Note: In 2010, "All" includes non-hdhp/so plans. Figure 14. Health Savings Account Adoption Rates, by Income, 2008 Figure 15. Average Annual Employer Health Savings Account Contributions, % 56% 52% 50% $806 $1,294 $1,139 $2,067 $1,000 $1,640 $858 $1,546 $886 $1,559 Under $25k $25k to $50k $50k to $100k $100k and Above Source: United Healthcare/Optum Bank (2008) Individuals Families Source: Kaiser Family Foundation (2011). America s Health Insurance Plans, Center for Policy and Research 11

12 Figure 16. Distribution of Health Reimbursement Account or Health Savings Account Balances, % 12% 14% 16% 13% 12% 11% 12% 15% 15% 12% 12% 12% 9% 6% 7% 8% 5% 8% 9% 11% 16% 9% 6% 7% 7% 18% 20% 18% 9% 11% 9% 11% % Don't Know $3,000 or More $2,000 to $2,999 $1,500 to $1,999 $1,000 to $1,499 $500 to $999 $200 to $499 Less than $200 Nothing 13% 8% 7% 9% 22% Source: Employee Benefit Research Council (January 2012). Note: Columns may not sum to 100 percent due to rounding. Figure 17. Rollover Amounts, Among Individuals with Account for More than One Year, % 7% 9% 9% 13% 0% 19% 15% 16% 7% 9% 11% 8% 8% 8% 9% 6% 8% 14% 5% 14% 9% 11% 11% 11% 6% 14% 5% 7% 3% 18% 20% 31% 21% 13% 13% 8% 8% 6% 8% 9% 25% 13% 12% 13% 15% Don't Know $2,000 or More $1,500 to $1,999 $1,000 to $1,499 $500 to $999 $300 to $499 $100 to $299 Less than $100 Nothing Source: Employee Benefit Research Council (January 2012). Note: Columns may not sum to 100 percent due to rounding. America s Health Insurance Plans, Center for Policy and Research 12

13 ACRONYMS CDHP. A consumer-driven, or consumer-directed, health plan is a health plan with a high deductible that is coupled with a tax-preferred health payment account either an HRA or HSA. The IRS defines HDHPs as health plans with minimum deductibles of $1,200 for single coverage and $2,400 for family coverage in (Note: For bullets citing EBRI reports, the deductible value is at least $1,000 for individuals and $2,000 for families.) HDHP. A high-deductible health plan is a health plan with a high deductible. The IRS defines HDHPs as health plans with minimum deductibles of $1,200 for single coverage and $2,400 for family coverage in (Note: For bullets citing EBRI reports, the deductible value is at least $1,000 for individuals and $2,000 for families.) HSA-Qualified HDHP. A health savings account-qualified high-deductible health plan (HSA/HDHP) is a health plan with a deductible of at least $1,200 for individuals and $2,400 for families in 2012 that is coupled with a tax-preferred health savings account (HSA). HSA. A health savings account is a tax-preferred account used to pay for qualified health care expenses, which is paired with a high-deductible health plan. HSAs are owned by the individual and are portable, and balances roll over from year to year. HRA. A health reimbursement arrangement is an employer-funded health plan used to reimburse employees for qualified health care expenses. HRAs are often paired with a high-deductible health plan, but can also be used as a standalone employee benefit, or coupled with traditional comprehensive health coverage. HRAs are owned by the employer, who sets specific policies including balance rollover. ABHP. Account-based health plans includes all health plans with a deductible which are associated with either an HRA or an HSA. ACKNOWLEDGEMENTS Data for this report were compiled and prepared for publication by Kelly Buck, Deputy Director at AHIP's Center for Policy and Research. Assistance was provided by Research Analyst Jessica Collins and Research Intern Sabrina Tangchaiburana. For further information, please contact Jeff Lemieux, Senior Vice President at AHIP s Center for Policy and Research, at or visit our website at Content and Design AHIP All Rights Reserved: AHIP 2012 America s Health Insurance Plans, Center for Policy and Research 13

14 REFERENCES Aetna, 2011 Aetna HealthFund Consumer-Directed Plans Continue to Reduce Health Care Costs for Employers: Plans also encourage members to take a more active role in their health care Eighth Annual Aetna HealthFund Study AHIP Center for Policy and Research, December 2010 An Analysis of Health Savings Account Balances, Contributions, and Withdrawals in 2009 AHIP Center for Policy and Research, May 2009 Estimated Income Characteristics of HSA Accountholders in 2008 AHIP Center for Policy and Research, May 2012 January 2012 Census Shows 13.5 Million People Covered by Health Savings Account/High-Deductible Health Plans (HSA/HDHPs) AHIP Center for Policy and Research, July 2011 Small Group Health Insurance in 2010: A Comprehensive Survey of Premiums, Consumer Choices and Benefits American Academy of Actuaries, May 2009 A Public Policy Monograph: Emerging Trends on Consumer-Driven Plans Cigna, 2010 CIGNA Choice Fund Experience Study, Summary of Key Findings October 2010 Devenir, 2012 Health Savings Accounts Surpass $12.4 Billion Accounts in 2011 Devenir Investments Press Release Employee Benefit Research Institute (EBRI), December 2011 Issue Brief Number 365: Findings from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey Employee Benefit Research Institute (EBRI), January 2012 Issue Brief Number 367, Health Savings Accounts and Health Reimbursement Arrangements: Assets, Account Balances, and Rollovers, Employee Benefit Research Institute (EBRI), April 2012 Notes Volume 33, Number 4, Characteristics of the Population with Consumer-Driven and High-Deductible Health Plans, America s Health Insurance Plans, Center for Policy and Research 14

15 REFERENCES (Continued) J.P. Morgan Chase, 2010 Health Savings Accounts: 2010 Program Snapshot Kaiser Family Foundation & Health Research Educational Trust, 2011 Employer Health Benefits 2011 Annual Survey Mercer, 2012 National Survey of Employer-Sponsored Health Plans Towers Watson/National Business Group on Health, 2012 Performance in an Era of Uncertainty: 17 th Annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care United Healthcare, 2008 Health Savings Accounts: A year-long look at adoption, usage and funding patterns U.S. Bureau of Labor Statistics, April 2011 Program Perspectives Volume 3, Issue 4, High Deductible Health Plans: A growing option in private industry America s Health Insurance Plans, Center for Policy and Research 15

16 PREVIOUS PUBLICATIONS ON HEALTH SAVINGS ACCOUNTS FROM THE AHIP CENTER FOR POLICY AND RESEARCH The reports listed below can all be found at the AHIP Center for Policy and Research website, Health Savings Accounts and Account-Based Health Plans: Research Highlights This report highlighted publicly available research and statistics from a variety of sources on the market for account-based health plans. January 2011 Census Shows 11.4 Million People Covered by Health Savings Account/High- Deductible Health Plans (HSA/HDHPs) (Revised ). The 2011 AHIP census of U.S. health insurance carriers showed that the number of people covered by HSA/ HDHPs totaled 11.4 million in January An Analysis of Health Savings Account Balances, Contributions, and Withdrawals in This report is a comprehensive study of financial activity in HSAs. Data collected from three large banks contain detailed account information of more than 1.2 million HSA accounts open as of December 31, January 2010 Census Shows 10 Million People Covered By HSA Qualified High-Deductible Health Plans The 2010 AHIP census of U.S. health insurance carriers showed that the number of people covered by HSA/HDHPs totaled 10.0 million in January January 2009 Census Shows 8 Million People Covered By HSA Qualified High-Deductible Health Plans The 2009 AHIP census of U.S. health insurance carriers showed that the number of people covered by HSA/HDHPs totaled 8.0 million in January Estimated Income Characteristics of HSA Accountholders in As a follow up to AHIP s February 2009 report, A Preliminary Analysis of Health Savings Account Balances, Contributions and Withdrawals 2007 & January June 2008, five bank trustees of health savings accounts used a geo-coding technique to estimate the income characteristics of those HSA account-holders, which allows analysis of account balances, inflows and outflows by income range. A Preliminary Analysis of Health Savings Account Balances, Contributions and Withdrawals 2007 & January June A comprehensive study of financial activity in HSAs from five large banks, this report shows detailed account information of more than 1.1 million HSA accounts open as of June 30, January 2008 Census Shows 6.1 Million People Covered by HSA/High-Deductible Health Plans The 2008 AHIP census of U.S. health insurance carriers market showed continued growth in HSA-qualified HDHP coverage, especially in the small-group market. This was the first report in the series to include a breakdown of HSA/HDHP enrollment by state. America s Health Insurance Plans, Center for Policy and Research 16

17 Most HSA Plans Provide First-Dollar Coverage for Recommended Preventive Care Analysis of a 2007 survey of health plans showed that most HSA/HDHP policies being purchased in the market provided coverage for recommended preventive services, as allowed under Internal Revenue Service (IRS) rules, without requiring enrollees to first meet their plan deductibles ( first-dollar coverage). Number of HSA Plans Exceeded One Million in March A census of AHIP members shows HSA/HDHP enrollment doubled to over one million in six months, and the number of companies reporting enrollment in HSA/HDHP products more than tripled during the same period, from 29 companies in September 2004 to 99 companies in March January 2007 Census Shows 4.5 Million People Covered by HSA/High-Deductible Health Plans The 2007 AHIP HSA census showed that HSA/HDHP enrollment continued to grow from the previous year in both the Individual and Group Markets. Overall enrollment was 4.5 million in January 2007, up by 1.3 million from 3.2 million in January HSAs and Account-Based Health Plans This report highlighted publicly available research and statistics from a variety of sources on the market for account-based health plans available to the public as of June Health Savings Accounts Off to a Fast Start in the Individual Market This was the first AHIP report on HSA/HDHPs aimed at monitoring and reporting on the emerging HSA/HDHP health insurance market, and analyzed data from two surveys conducted in June and September It reported on data submitted by 29 companies, showing 438,000 people covered by HSA/HDHPs in September January 2006 Census Shows 3.2 Million People Covered By HSA Plans The 2006 AHIP HSA census showed that the number of people covered by health savings accounts/high-deductible health plans (HSA/HDHPs) was almost 3.2 million in January 2006, more than triple the HSA/HDHP coverage of about one million reported in March Guide to Health Care Spending Accounts Answers to frequently asked questions about HSAs, HRAs, FSAs, and MSAs, based on guidance issued by the U.S. Treasury Department and the IRS as of June America s Health Insurance Plans, Center for Policy and Research 17