Over the past decade employees have consistently registered higher overall satisfaction ratings for traditional health plans than their high-deductible counterparts. But the satisfaction gap is narrowing, according to a recent study by the Employee Benefit Research Institute.
The most likely reason is that people are gradually gaining a firmer grasp on how the plans actually are intended to work, and how they might prove to be less costly than the alternative, suggests Paul Fronstin, EBRIs director of Health Research and Education Program, and author of the study.
Even so, the percentage of employees reporting that they are very or extremely satisfied with their high-deductible health plan, at 37%, was still well below the 61% holding that opinion of their traditional plan. Also, satisfaction levels among employees covered by a consumer-driven health plan (a CDHP, essentially an HDHP lacking any accompanying savings vehicle such as an MSA or HSA), at 46%, are still substantially below the 61% figure.
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The data suggest that employers offering high deductible plans particularly those who have gone the full replacement route need to beef up their educational efforts, Fronstin suggests. Many employees focus more on the high deductible than their total outlay over the course of a year. Depending on the cost-sharing specifics, in many scenarios employees could wind up spending less with a high deductible plan than otherwise, Fronstin says.
Also, employees with access to HSAs often lack a full understanding of the tax benefits they offer, or how they can be used as long-term savings vehicles, he adds.
Still, the 37% extremely or very satisfied ratings for HDHPs follows a pattern of steady, albeit slow, rising satisfaction levels. In 2005, the first year of the survey was taken, only 29% registered high satisfaction levels.
Mixed reviews
Also, the relatively low overall HDHP and CDHP satisfaction levels obscure far higher levels of contentment with particular aspects of their plans. For example, high satisfaction with quality of health care received was registered by 56% of those covered by HDHPs, 66% of those in CDHPs and 68% in traditional plans.
The pattern was similar when employees were asked to rate ease of getting a doctor appointment and choice of doctors.
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None of the three plan types elicited a majority of survey respondents registering high satisfaction with out-of-pocket costs. Predictably, employees covered by HDHPs and CDHPs gave their lowest ratings on this question.
Survey data released did not distinguish results by such employee demographic factors as age or health status. When high deductible plans became widely offered a decade ago, many observers predicted they would appeal primarily to younger and healthier employees.
However, according to Fronstin, that pattern did not emerge. A lot of older employees chose them because they generally are better paid than the younger ones, and were less worried about covering a high deductible, he says.
That meant that they could look beyond the deductible and focus on other facets of the plan design that they found more appealing than those in their alternative plan choices, whether it be lower basic cost-sharing on monthly premiums, greater wellness benefits or perhaps a better provider network.
ACAs uncertain impact
The Affordable Care Act does not yet appear to have prompted a surge in employers shifting to high deductible plan designs, Fronstin says, although there could be an uptick as employers grapple with the prospect of facing the 40% excise tax in 2018. He added, however, that a cloud hangs over high deductible plans that feature HSAs.
Employer contributions to employees HSAs would be counted toward the valuation of the benefit for purposes of calculating whether an excise tax liability exists. What remains unclear, however, is whether employees own payroll-deducted HSA contributions would also be folded into that calculation.
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While there would be little logic to that approach, pre-ACA rules require that those amounts be included in overall plan cost figures reported to the IRS, according to Fronstin. The IRS has hinted that in as-yet unpublished regulations, it might require that those employee dollars be included for excise tax calculation purposes.
Even if that ultimately does not happen, Fronstin predicts many employers that sponsor HDHPs will drop contributions to HSAs to minimize their exposure to the excise tax. Should that occur, future employee satisfaction surveys likely would not show a large jump in employee satisfaction levels.
