Good satisfaction with health plans, but out-of-pocket costs could be hurting HDHPs

Consumers are largely satisfied with their health plans, and most say they have a choice of plans, according to a new survey released by the Employee Benefits Research Institute (EBRI).

Results from the 2023 Consumer Engagement in Health Care Survey were released on Feb. 22, using data from Greenwald Research Consumer Engagement in Health Care Survey (CEHCS). The CEHCS survey results showed plans receiving relatively high marks in several areas, however, there was some decline in high deductible health plan (HDHP) enrollment.

“This year’s survey really shows strong evidence that people overall are satisfied with their health insurance. Satisfaction levels are steady.  We see no majority is complaining and that is key to understanding market needs,” said Paul Fronstin, Ph.D., director of Health Benefits Research at EBRI.

Consumers report ease in selection of plans

The report polled just over 2,000 people in October through December of last year. It found that most respondents were covered by their employer’s health plan (60%) or a spouse’s plan (24%). Results showed that 8% of respondents bought insurance directly from a health insurance company, and 7% purchased a plan through the Affordable Care Act exchanges.

The report noted that 68% of traditional plan enrollees (non-HDHP) said that their plan had a deductible; this was a 60% increase in this category from 2022.

Health plan selection saw high levels of satisfaction—90% said they were either extremely or very satisfied (63%) or somewhat satisfied (28%) with the ease of selecting their plan. They were also satisfied with the information available for choosing their plan (59% extremely/very satisfied, 31% somewhat satisfied), and approximately 90% were extremely, very, or somewhat satisfied with the amount of time they had to make a decision and the materials provided by their employer.

However, only half (49%) said they were extremely or very satisfied with the availability of affordable health plans. In that category, 33% said they were somewhat satisfied, and 18% said they were not too, or not at all, satisfied.

Overall satisfaction may be hurt by cost sharing

The overall satisfaction report for health plans showed some variation. For traditional plans, 62% said they were extremely or very satisfied with their health plan overall. For HDHP enrollees, that number was 46%.

When asked if they were satisfied with the health care costs they paid out-of-pocket, respondents were less satisfied: 47% of traditional plans said extremely or very satisfied, and 26% of HDHP enrollees said the same. For traditional plans 22% said they were not too, or not at all satisfied with out-of-pocket costs; 42% of HDHP plan enrollees said they were not satisfied with out-of-pocket costs.

Prescription drug costs also saw higher dissatisfaction: the satisfied/not satisfied numbers for traditional plan members was 58% and 12%, with 30% saying somewhat satisfied. For HDHP enrollees, those numbers were 42% satisfied, 24% not satisfied, and 34% somewhat satisfied.

Related: HDHP enrollment sees 2% drop, study finds employees have more choices

The report observed that lower satisfaction among HDHP enrollees appeared to be driven by these cost-sharing numbers. The report noted that HDHPs that were not paired with a health savings account (HSA) fell from 12% to 9% between 2022 and 2023. That number had reached 15% in 2020.

The report also suggested that enrollees could use more guidance on HSAs. It noted that 47% of HSA account holders said they would be more likely to accumulate and invest unused funds if they were provided an annual review of their HSA balance, and 35% said they would be more likely to accumulate and invest unused funds if information about the account benefits and how it works were sent to them via email.

“Employers have an opportunity to educate their employees on HSAs. Many account holders feel having more information would make them more likely to invest their unused funds. For non-account holders, interest remains high when shown important product features,” said Lisa Greenwald, CEO of Greenwald Research.