As millions of working Americans open their employer’s health care packets this month, many will be encountering a new option: high-deductible plans linked to health savings accounts that come loaded with tax benefits.
They’re attracting workers who want lower premiums and a tax-free way to save for retirement. But they’re not for everyone, which is why some consumer groups are alarmed by their growing presence in the health care market.
In the past six years, the number of workers covered by these health savings account plans has quadrupled, from 5 percent in 2007 to 20 percent this year, according to a 2013 Kaiser Family Foundation survey.
“More companies are offering them as a choice, and in some cases, they’re the only choice,” said Paul Fronstin, director of health research and education for the Employee Benefit Research Institute in Washington, D.C.
Experts say the reason is simple: Employers are trying to cut expenses after years of inflating health care costs that only recently started to ease. And some are motivated by a looming “Cadillac tax” under the federal Affordable Care Act, which in 2018 will start penalizing companies offering health plans that are considered too generous.
In return for lower premiums, consumers who sign up for these plans agree to pay much more out of their own pockets before their insurance coverage kicks in. In 2014, the minimum deductible for a qualifying HSA plan is $1,250 for an individual, and $2,500 for a family. Maximum out-of-pocket costs are $6,350 for a single person and $12,700 for a family.
Other than high deductibles, the most notable feature of the new plans are the so-called health savings accounts, or HSAs, which were authorized by Congress in 2003 as part of a massive Medicare overhaul. Similar to a 401(k), the HSA is a take-it-with-you, tax-free savings account that’s used to cover your out-of-pocket medical expenses.
To make HSAs especially appealing, the plans offer multiple tax advantages for contributions and withdrawals. The money can even be rolled over for retirement.
“There’s clearly an incentive on the part of employers to offer these,” said Maribeth Shannon, program director with the California Healthcare Foundation. “Some of it’s financial. Some of it’s philosophical. There are a lot of employers who feel employees should have a little skin in the game, a little more responsibility for the health care costs they consume.”
It’s part of sweeping trend toward “consumer-driven” health care, an approach that government and employers are embracing as a way to tamp down health care costs by encouraging individuals to be more in control of their health care behaviors and choices.
The growth of HSAs has prompted concern among some consumer advocates who worry such plans will cause people to forgo needed medical care because they can’t afford the high deductibles.
“We’ve actively opposed them and regret they’re in federal law,” said Beth Capell, a lobbyist for Health Access, a consumer advocacy group based in Sacramento, Calif.
Capell and other critics say HSAs are financially risky for low-income consumers and are primarily beneficial for healthy, wealthier people.
“They work best for those who need health care the least or those with higher incomes,” said Capell. “They work less well if you’re sick and if you’re poor. If you make $25,000 a year and your out-of-pocket limit is $6,000, that’s a lot of money to pay in cash. If something bad happens, do you have the money in the bank to pay for your health care?”
In a 2006 study, the Kaiser Family Foundation said that many low-income families would not benefit from HSAs, primarily because they wouldn’t be able to utilize the tax benefits and couldn’t absorb the higher out-of-pocket costs.
Earlier this month, a study released in the New England Journal of Medicine found a “startling” lack of research on how high-deductible health plans affect health outcomes, such as diabetes control, cancer survival, heart conditions and mortality.