Employer and Worker Contributions to Health Reimbursement Arrangements and Health Savings Accounts, 2006-2014

This paper presents findings from the 2014 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS), as well as earlier surveys, examining the availability of health reimbursement arrangements (HRAs) and health-savings-account (HSA)-eligible plans (consumer-driven health plans, or CDHPs). It also looks at employer and individual contribution behavior. According to the 2014 CEHCS, 15 percent of the population was enrolled in a CDHP, representing about 26 million individuals with private insurance. Among the 15 percent of individuals enrolled in a CDHP, 57 percent (or 9.3 million) had an HRA or had opened an HSA, while 43 percent were enrolled in an HSA-eligible health plan but had not opened an HSA. The percentage of workers reporting that their employers contribute to the account decreased in 2014 for the first time since 2009. Workers’ contributions to their HSAs decreased slightly in 2014. The survey found a correlation between health engagement and individual contributions to an HSA. Those defined as being engaged in their health reported that they did at least one of the following: checked whether their health plan would cover their care or medication; checked the price of a doctor’s visit, medication, or other health care service before receiving care; checked the quality rating of a doctor or hospital before receiving care; talked to their doctor about prescription options, costs, other treatment options and costs; used an online cost tracking tool provided by their health plan to manage health expenses; developed a budget to manage health care expenses; asked for a generic drug instead of a brand name drug; or asked their doctor to recommend a less costly prescription drug. It was found that individuals with some engagement with the health care system contributed higher amounts to their HSA than those with no engagement