Cost-sharing is key to choosing traditional plans, HDHPs and HSAs, say employees

Although employees weigh a number of factors when making benefits decisions, cost remains the overriding factor.

“It’s clear that inflation is really having a long-term impact on Americans’ sense of financial security,” said Kerry Sette, vice president of consumer insights and research for Voya Financial. “Although inflation has leveled off, deflation has not really occurred. We aren’t keeping up with those already high prices. Many people are putting off health care, especially in high-deductible health plans. As an industry, we need to be concerned about what that means for the future of health care costs if they are delaying much-needed health care today.”

Sette joined the Employee Benefits Research Institute for an online discussion of findings from the 2023 Consumer Engagement in Health Care Survey.

“Many employees this year thought their workplace benefits were going to cost them more,” she said. “As a result, they wanted to maximize what they could get from their employer across both their health benefits and wealth benefits. We found that employees need and want more support.”

Sara Rubinstein, director of health care for Greenwald Research, analyzed employee attitudes about everything from open enrollment to plan selection and use.

“Overall satisfaction with open enrollment is relatively high, especially regarding the ease of selecting their health plan and the information available,” she said. “But one thing to keep in mind is that satisfaction with the affordability of health plans is down this year compared to last year. This is true regardless of plan type, both those with a traditional health plan and those with a high-deductible health plan.”

Most enrollees don’t spend a lot of time on health plan choices:

• 23% of those in high-deductible plans and 21% in traditional plans spent between five and 29 minutes deciding.
• Those in traditional plans (21%) were far more likely than those in high-deductible ones (13%) to take no action and were automatically enrolled.
• Only 6% of high-deductible enrollees and 5% of those in traditional plans spent more than five hours.

“People are generally satisfied with the amount of time they have to make a decision, with the overall process and the materials provided to help them make that decision,” Rubinstein said.

Which aspects of plans do enrollees consider very or somewhat important in their current choice of plan?

• Good network of physicians and hospitals, 98%
• Low out-pocket costs when visiting a doctor, 98%
• Lower premium cost, 98%
• Prescription drug coverage, 96%
• Specific coverage included in plan, 87%
• Simple to understand, 87%

“Traditional plan enrollees value lower cost-sharing more, while high-deductible health plan enrollees value a low premium more, which makes sense, given the plan they are on,” she said. “Most people have at least some choice when it comes to choosing their plan. Only one-third of traditional and one-fourth of high-deductible enrollees said they had no choice.”

Overall plan satisfaction is fairly high, although employees in traditional plans expressed higher levels of satisfaction. “This is really driven by cost sharing,” Rubinstein said. “High-deductible plan members expressed dissatisfaction with the level of out-of-pocket spending.”

The survey asked respondents who had been on their plan for at least two years whether and how it had changed. Seven in 10 said it was about the same, 18% said it was better and 10% said it was worse.

Rubinstein identified health savings accounts as a key area where employers can have an impact.

“The main reason for employees opening an HSA is to take advantage of employer contributions and to save for future expenses,” she said. “Most employees are using it to pay for current or recent out-of-pocket expenses. There seems to be an opportunity for more education, which might help close the knowledge gap.”

Sette agreed.

Related: The young workforce is driving consumerization of health care and the demand for HSAs

“We see some big opportunities for HSAs,” she said. “Knowledge generally is getting better. Employer contributions seem to be an anchor and are the main reason why employees have an HSA. Another great finding is that six in 10 employees said they are saving for future health care expenses, and the same percentage view it as a savings account.

“If employers are not offering an HSA, I am not sure what they are waiting for.”