Consumer-driven health plan members use fewer services, but pay higher out-of-pocket costs


A narrowly defined but growing health plan that supplements high-deductibles and out-of-pocket maximums with health savings accounts leads to lower overall healthcare costs than traditional plans, despite higher out-of-pocket costs for members.

A study released by the Health Care Cost Institute (HCCI) found that among consumer-driven health plans (CDHP), average per capita spending between 2010 and 2014, was more than $500 less than traditional plans like HMOs and PPOs, a gap that widened to more than $600 in the final year of the study. Likewise, utilization rates within CDPH plans were 9%-13% lower than traditional plans--an intended outcome of the plan’s structure that aims to reduce unnecessary services by transferring costs to the beneficiary.  

Despite lower utilization rates, the HCCI study found that CDHP members spent 1.5 times more in out-of-pocket expenses compared to those with traditional plans. On average, CDHP plan members were responsible for 25% of their medical costs, compared to 14% for those in traditional plans.

“As the costs of health care increase, consumer-driven health plans try to balance lower premiums with higher deductibles and higher limits on out-of-pocket spending,” HCCI Senior Researcher Amanda Frost said in an announcement. “As these types of plans grow in prevalence, it is important to look beyond premium dollars and also consider dollars spent directly on health care services.”

CDHP enrollment climbed from 15% of the insured population in 2010 to 27% in 2014, according to HCCI. Those statistics echo previous surveys that show CDHPs are taking on a larger share of the insured, coupled with higher satisfaction rates among CDHP members. Other studies have shown CDHPs can lead to sustained savings for large employers.