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.


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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.

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