2016 Survey of Health Savings
Account – High Deductible
Health Plans
FEBRUARY 2017
2016 Survey of Health Savings Account – High Deductible Health Plans
KEY TAKEAWAYS
As of January 2016, 59 plans reported
nearly 20.2 million HSA/HDHP enrollees,
up from 19.7 million in 2015. Plans
participating in both the 2015 and 2016
surveys saw a net increase of 648,000
enrollees (3.4 percent).
The majority of companies reported
offering members online access to HSA
account information and consumer
decision-support tools, such as health
education, treatment cost information,
physician-specific information, and
personal health records.
Preferred Provider Organizations (PPOs)
were the most popular HSA/HDHP product
type, accounting for 66 percent of
enrollment. Similar to 2015, large group
plans accounted for over three-fourths of
all enrollment.
Summary
An annual survey conducted by America’s Health Insurance Plans (AHIP) of U.S. health insurance
companies offering health savings account/high-deductible health plans (HSA/ HDHPs), shows that
enrollment in HSA/HDHPs totaled approximately 20.2 million, as of January 2016. By contrast, enrollment
was 19.7 million in 2015. Of those plans participating in both the 2015 and 2016 surveys, total
enrollment grew by 3.4 percent. Enrollment numbers stratified by by product type and by market type
remained in-line with previous years. Overall, results from this year’s study underscore the continued
growth in the HSA/HDHP market.
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2016 Survey of Health Savings Account – High Deductible Health Plans
Figure 1: HSA-Qualified High-Deductable
Health Plan Enrollment, 2005-2016
22,000,000
20,000,000
18,000,000
16,000,000
14,000,000
12,000,000
10,000,000
8,000,000
6,000,000
4,000,000
2,000,000
2005
2006
2007
2008
2009
Market Overview
Health savings account (HSA) plans give
consumers incentives to manage their own
health care costs. They accomplish this by
coupling a tax-favored savings account used to
pay medical expenses with a high-deductible
health plan (HDHP) that meets certain
requirements for deductibles and out-of-pocket
expense limits.1 The funds in the HSA are owned
by the individual and may be rolled over from year
to year.
HSAs were authorized by the Medicare Prescription
Drug Improvement and Modernization Act of 2003
and entered the market in January 2004. Since
2010
2011
2012
2013
2014
2015
2016
then, AHIP has conducted an annual survey of
health insurance plans to monitor and report on
the HSA/ HDHP health insurance market.
As summarized in Table 1, as of January 2016,
nearly 20.2 million people were enrolled in
HSA/HDHPs. This represents an overall increase
of approximately 468,000 enrollees since
January 2015. However, there was a net increase
of roughly 648,000 HSA/HDHP enrollees among
the 52 insurers that participated in both the
2016 and 2015 surveys. These 2016 findings
are consistent with the steadily increasing
prevalence of HSA/HDHPs observed over the
past decade (Figure 1). See Appendix B for
additional details.
Table 1: HSA-Qualified High-Deductible Health Plan
Enrollment, January 2016
Total HSA-Qualified HDHP Enrollment
20,164,930
Total Covered Lives — Individual Market
1,894,133
Total Covered Lives — Small-Group Market
2,113,133
Total Covered Lives — Large-Group Market
13,902,214
Total Covered Lives — Uncategorized*
2,255,470
*Three respondents did not report their total enrollment broken-out by market type
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2016 Survey of Health Savings Account – High Deductible Health Plans
Consistent with previous years (Figure 2), the
majority of enrollees were in the large group
market (78 percent, n=13.9 million), with all
remaining enrollees about evenly split between
the small group and individual markets. Since
2005, the proportion of HSA/HDHP enrollees in
the large group market has been steadily
increasing to about three-fourths of total
HSA/HDHP enrollment today.
As shown in Figure 3, similar to 2015, the most
respondents in 2016 reported HSA/HDHP total
plan enrollments between 100,001 and
1,000,000 (41 percent, n=24).2 This is an
increase over 2015, when 36 percent of
insurance plans reported total HSA/HDHP
enrollments in the hundreds of thousands. Other
enrollment levels were similar to last year’s
results. Lastly, in terms of enrollment by
Figure 2: Percentage of Individuals in the Commercial Health
Insurance Market Covered by an HSA-Qualified HighDeductible Health Plan, by Market Type, 2005-2016
2016
11
2015
10
2014
11
2013
12
78
12
78
14
74
14
2012
18
18
22
2011
21
2010
20
2009
68
59
24
55
30
23
2008
25
2007
26
2006
50
30
47
30
45
25
49
42
2005
25
33
64
0
10
20
30
17
40
Individual
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50
Small Group
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60
70
19
80
90
100
Large Group
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2016 Survey of Health Savings Account – High Deductible Health Plans
Figure 3: Percent of Companies Reporting HSA-Qualified
High-Deductible Health Plan Enrollment,
by Enrollment Level, 2012-2016
2012 (95)
2013 (91)
2014 (80)
2015 (64)
2016 (59)
41
36
32
28
29
29
30
28
29
27
27
25
24
17 17
13 13
9
9
8
7
5
8
6
3
Up to 10,000
10,001 to 50,000
50,001 to 100,000
product type, the majority of enrollees had a PPO
(66 percent, n=8.4 million) followed by an
HMO/POS (31 percent, n=3.9 million) product. A
variety of other product types made up the
remaining 3 percent (n=0.4 million) of enrollees.
Individual Market
1.9 million people were enrolled in HSA/HDHPs
purchased in the individual market in January
2016. However, three respondents were not
able to categorize their HSA/HDHP enrollment by
market. Thus, it is possible that actual individual
market enrollment was slightly higher than 1.9
million.
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100,001 to 1M
More than 1M
Group Market
As of January 2016, insurers offering HSA/HDHP
products in the small-group market reported
enrollment of 2.1 million. In general, small-group
coverage was defined by responding companies
as coverage offered by employers with 50 or
fewer employees.
Large-group HSA/HDHP coverage accounted for
13.9 million people. Though, of the plans that
were able to report HSA/HDHP enrollment by
market in 2016, 78 percent percent of enrollees
were in the large group market, as was the case
in 2015. Generally large group coverage was
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5
2016 Survey of Health Savings Account – High Deductible Health Plans
defined as policies offered by employers with
50 or more employees.
Approximately 2.3 million enrollees were
considered “uncategorized” as three plans
provided total enrollments and did not provide
a breakout of their HSA/HDHP total enrollment
by market type.
Figure 4: Age Distribution
of HSA/HDHP Enrollees,
January 2016
3%
Enrollment by Age
21%
This year, 40 insurers were able to provide
information on the ages of their HSA/HDHP
enrollees, including dependents if covered
under a family plan. As shown below in Figure
4, approximately 21 percent of HSA/HDHP
enrollees were under the age of 18; 11 percent
were 18-24 years; 30 percent were 25-44
years; the majority at 35 percent were 45-64
years; and only 3 percent were age 65 and
older.
Consumer Decision-Support Tools
for HSA/HDHP Enrollees
Figure 5 illustrates responses from 52 health
insurers that answered survey questions
regarding consumer decision-support tools
offered to their HSA/HDHP enrollees. Ninetyeight percent of respondents offered enrollees
access to health and wellness resources.
Eighty-seven percent gave enrollees access to
information on their health savings account,
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11%
30%
0-17
Many health insurers offering HSA/HDHPs have
created online tools to help members manage
their HSA accounts online. Such accounts allow
members to access information about their
health conditions, medical services, health care
costs (e.g., negotiated rates for procedures and
drugs), and quality of health services in their
area.
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35%
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18-24
25-44
45-64
65+
and 67 percent supplied them with their
personal health record.
Seventy-five percent of respondents also
provided healthcare cost information. Beyond
information on personal accounts and
healthcare costs, insurers also supplied
HSA/HDHP enrollees with information on
providers. Ninety-six percent of respondents
supplied enrollees with information on provider
networks, 60 percent provided physician
specific quality data, and 67 percent provided
hospital specific quality data.
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2016 Survey of Health Savings Account – High Deductible Health Plans
Figure 5: Percentage of Health Insurers Providing Access to
Consumer Decision-Support Tools, January 2016
Physician Specific Quality Data
60
Personal Health Record
67
Hospital Specific Quality Data
67
Healthcare Cost Information
75
Health Savings Account Information
87
Provider Network Information
96
Health/Wellness Resources
98
0
20
40
60
80
100
120
State and US Territory Enrollment
Fifty-three insurers reported enrollment by state
and US territory for 14.3 million lives with
HSA/HDHP coverage as of January 2016
(Figure 6). States with the largest reported
HSA/HDHP enrollment levels were Illinois
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(1,351,691), Texas (1,707,591), Minnesota
(908,711), Ohio (801,198), and Florida
(711,485). See Appendix B for additional
details.
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2016 Survey of Health Savings Account – High Deductible Health Plans
Conclusion
HSAs have enjoyed consistent growth since they were originally offered to consumers in 2005. They
provide an attractive, consumer-friendly, savings option for employees, employers and individuals looking
for help in making health care more affordable. With nearly 20.2 million lives covered, and continued
enrollment growth expected in the coming years, HSAs and high deductible health plan insurance
products represent another vital option for Americans looking to manage their health care needs. As
Congress considers proposals to improve health care choices, enable more personal control and flexibility,
and reduce costs to consumers, HSAs must be part of the discussion.
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2016 Survey of Health Savings Account – High Deductible Health Plans
Endnotes
Acknowledgments
1 For 2015, the minimum annual deductible for self-only HSA/HDHP
AHIP would like to thank the health plans
that participated in this year’s survey.
coverage is $1,300, and the maximum out- of- pocket limit is $6,450.
For family HSA/HDHP coverage, the minimum deductible is $2,600,
and the maximum out-of- pocket limit is $12,900. For 2016, the
Related Topic
minimum annual deductible for self-only HSA/HDHP coverage is
$1,300, and the maximum out-of-pocket limit for self-only is $6,550.
For family HSA/HDHP coverage, the minimum deductible is $2,600 and
the maximum out-of-pocket limit is $13,100. These amounts are
indexed annually for inflation. Accessed 11/17/2016 at
http://www.irs.gov/pub/irs-drop/rp-14- 30.pdf and
http://www.irs.gov/pub/irs-drop/rp-15- 30.pdf.
2 Results for responding companies are reported by grouping data from
all subsidiaries into one unit, regardless of the number of subsidiaries
or number of states where the company does business.
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Appendix A
Methodology
A data collection instrument was developed by AHIP to ascertain total enrollment, premiums, and other
information on HSA/HDHPs as of January 2016. The instrument was developed using Qualtrics software
(Qualtrics, Provo, UT), and was emailed to 97 AHIP member and non-member companies believed to sell
HSA- eligible high-deductible health plans.
Data collection occurred from February 2016 through January 2017. Fifty-nine health insurance
companies responded, yielding a 61 percent response rate.
Fifty-six responding companies reported HSA/ HDHP enrollment in the individual, small-group, and largegroup markets. Three companies provided total HSA/HDHP enrollment only, as they were unable to give
detailed information on each market.
We analyzed the data to examine national trends in enrollment, distribution of enrollment by state/U.S.
territory, and individual versus group markets. In addition, we analyzed changes in enrollment for plans
that responded in 2015 and 2016. Six companies could not provide their HSA/HDHP enrollment by
state/U.S. territory, representing approximately 5.6 million enrollees.
Thirty-six responding companies provided information on average monthly premiums at the state level,
representing 7.2 million enrollees. For this report, premium data were not published for states that had
fewer than four companies in a state contributing premium data.
Data Limitations
AHIP did not receive participation in the annual census from all health insurers that sell HSA/HDHP
insurance coverage or administer HSA/HDHP coverage for self-insured group health plans. This census
does not include coverage associated with health reimbursement arrangements (HRAs), which are most
commonly offered in the large-group market. Further, while the rate of response was similar to that of the
2015 census, AHIP did not receive responses from every health plan that participated in 2015.
Identifying trends over time is most accurate when using data from the same responders. For this study,
51 of the 59 health insurers that responded to the 2016 census also participated in the 2015 study. Eight
insurers were new respondents to the 2016 study. Thirteen insurers reporting data in 2015 did not
participate in 2016. Three of the 13 non-responders no longer service HSA/HDHPs, and one was
purchased by another non-responding company. Excluding the three insurers that no longer service
HSA/HDHPs, the remaining non-responders accounted for 0.5 million lives in the 2015 census. Such
changes in the respondent population for 2016 may have resulted in an understatement of the total
HSA/HDHP enrollment for this year’s report.
Additionally, not all insurers were able to provide data broken out by state or market type, and three could
provide only total enrollment in their HSA/HDHPs. We believe the census understates the number of
individual purchasers choosing HDHP plans with HSAs because market-specific data are unavailable for
certain states reported in this study.
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Appendix B
Table 2: HSA-Qualified High-Deductible Health Plan Enrollment,
March 2005 to January 2016
Date
Individual
SmallGroup
LargeGroup
Other
Group
Uncategorized
Total
Mar 2005
556,000
147,000
162,000
88,000
77,000
1,031,000
Jan 2006
855,000
510,000
679,000
247,000
878,000
3,168,000
Jan 2007
1,106,000
1,057,000
2,044,000
291,000
34,000
4,532,000
Jan 2008
1,502,000
1,816,000
2,777,000
13,000
10,000
6,118,000
Jan 2009
1,832,000
2,429,000
3,752,000
0
0
8,013,000
Jan 2010
2,053,000
2,970,000
4,986,000
0
0
10,009,000
Jan 2011
2,358,497
2,779,208
6,299,460
0
0
11,437,165
Jan 2012
2,470,840
3,019,347
7,939,023
0
72,865
13,502,075
Jan 2013
2,029,646
2,590,037
9,597,759
0
1,237,631
15,455,075
Jan 2014
1,974,895
2,505,931
12,813,021
0
749,177
17,368,764
Jan 2015
2,042,520
2,294,590
15,357,063
0
3,102
19,697,275
Jan 2016
1,894,113
2,113,133
13,902,214
0
2,255,470
20,164,930
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Appendix B
Table 3: Total HSA/HDHP Enrollment By State/Territory, January 2016*
State/Territory
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
DC
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
ahip.org |
Enrollment
State/Territory
62,867
28,818
296,519
74,462
709,106
307,466
318,065
33,705
25,311
711,485
379,389
354
58,702
1,351,691
281,018
193,955
71,267
153,519
190,118
106,180
390,838
261,183
148,411
908,711
34,891
211,477
91,675
173,582
65,230
94,317
541,837
32,648
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New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Guam
Northern Marina Islands
Puerto Rico
US Virginia Islands
American Samoa
Enrollment
703,454
183,628
20,174
801,198
120,333
120,031
407,456
13,213
76,381
34,051
527,030
1,707,591
163,958
52,930
428,677
410,064
19,948
227,138
15,034
19
0
164
145
5
* Six of fifty-nine responding health insurers did not break
out their HSA/HDHP enrollments by U.S. State/Territory.
Also, 79 HSA/HDHP covered lives are missing from this
table. They either resided outside of the U.S.
States/Territories, or a U.S. State/Territory could not be
identified for them.
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Appendix B
Table 4: Average Monthly Premiums, HSA/HDHP, January 2016*
State/
Territory
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
DC
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
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Single
Family
$366.74
—
$332.61
$494.44
$481.53
$443.40
$526.99
$470.77
$500.95
$445.18
$445.29
—
$357.96
$426.78
$482.39
$410.08
$432.89
$394.64
$435.37
$420.93
$378.55
$373.57
$345.14
$438.67
$459.73
$415.19
—
$449.90
$380.49
$529.37
$430.49
—
$745.47
—
$743.95
$994.64
$1,270.46
$1,096.73
$1,388.22
$1,391.69
$1,172.54
$940.04
$1,113.91
—
$903.83
$1,005.00
$1,204.68
$913.19
$1,135.81
$1,016.87
$1,028.06
$1,020.80
$1,014.18
$1,033.04
$740.93
$545.11
$956.49
$1,016.04
—
$1,024.15
$993.50
—
$1,197.34
—
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State/
Territory
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Single
Family
$446.50
$420.12
—
$430.85
$434.89
$301.61
$397.59
—
$425.75
$463.96
$427.79
$406.94
$306.02
$443.48
$397.63
$384.06
$498.55
$466.82
$555.06
$1,096.90
$945.85
—
$1,088.29
$1,026.70
$1,081.97
$976.39
—
$853.56
$1,053.28
$1,016.98
$972.94
$901.40
—
$1,009.96
$965.99
$1,127.03
$1,119.02
—
Monthly premium data were weighted by plan enrollments by
state. Premium information were excluded if fewer than four
companies reported premium data for a state. Not all plans
could provide their premiums by state; however, for plans
covering single individuals, survey participation ranged from
four plans (DC, DE, ME, MA, NH, SD, and WV) to eleven plans
(WI). For family coverage, survey participation ranged from
four plans (AL, DC, DE, ID, ME, MA, NV, OR, SD, WA, and WV)
to ten plans (WI).
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Appendix B
Glossary
Enrollee
An individual covered under an insurance policy,
including dependents.
Small-Group Market
The market for health insurance offered to small
businesses, usually 1-50 employees.
Large-Group Market
The market for health insurance offered to large
businesses, usually 50 or more employees.
Individual Market
The market for health insurance offered to
individuals and not through an employer.
Health Insurance Plan
A health insurance plan pays for medical services
through premiums collected from the insured.
Health plans offer many different insurance
products. (See Insurance Product.)
Insurance Product
Describes the type of insurance plan, e.g. Health
Maintenance Organization (HMO), Preferred
Provider Organization (PPO), HSA-Eligible/HighDeductible Health Plan (HSA/HDHP), and Pointof-Service (POS).
Insurance Policy
In the individual market, policies are held by
individuals. In the group market, policies are held
by employers. Employees covered under group
plans receive certificates of coverage.
Single Coverage
Health insurance that covers one person.
Family Covereage
Health insurance that covers more than one
person.
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