Surveys suggest a slowdown in HSA-eligible health plan enrollment growth

Health insurance benefits form
A review of various surveys indicates there’s been very little enrollment growth in HSA-eligible health plans between 2014 and 2017. (Getty/michaelquirk)

Enrollment growth in health savings account-eligible health plans, once robust, appears to be slowing down, according to a new issue brief.

The brief (PDF), produced by the Employee Benefit Research Institute, examines the findings from five different surveys that tracked HSA-eligible health plan enrollment. 

The surveys vary in their estimates of HSA-eligible health plan enrollment, ranging from 21.4 million to 33.7 million policyholders and their dependents as of 2017. However, a common finding among most of them is that there’s been very little enrollment growth in those types of plans from 2014 to 2017.

That’s significant, because those surveys also indicated there had been substantial growth in HSA-eligible health plan enrollment since HSAs were first established in 2004.

So what might be causing enrollment growth in those plans to slow down? The brief suggests several possible explanations:

  • Recent minimal increases in health insurance premiums, combined with low unemployment, may have caused employers to hold off on moving to HSA-eligible health plans.
  • Employers may be holding back from adopting HSA-eligible health plans because of the potential drawbacks. For example, recent research found they’re associated with a reduction in appropriate preventive care and medication adherence. 
  • Employers may want flexibility to exempt more services from a plan’s deductible than solely preventive services, which isn’t possible under current IRS rules. A recently proposed bill, however, would change those rules to let high-deductible health plans that are paired with HSAs cover chronic disease prevention and treatment on a pre-deductible basis. 

Two other surveys, meanwhile, found evidence of recent growth in the number of HSAs—a finding that seems to conflict with the lack of enrollment growth in HSA-eligible plans. As for why that is, the brief says there might be a large number of HSAs that are no longer affiliated with an HSA-eligible health plan. After all, people can keep an HSA after dis-enrolling from the plan it’s affiliated with, though they can only draw from it and not contribute to it.