	Background

Consumer-directed health plans generally include three components: a  health plan with a high deductible, a savings account—such as an HSA—to  pay for health care expenses, and enrollee decision-support tools. There are several  types of savings accounts that may be associated with consumer-directed  health plans, with HSAs being among the most prominent. Financial Features of HSA-Eligible Plans Differed From Those of Traditional Plans, but Covered Services Were Similar

HSA-eligible plans had lower premiums, higher deductibles, and higher  out-of-pocket spending limits than traditional plans in 2005. Our illustration of enrollees’ potential health care costs—including  premiums, deductibles, and other out-of-pocket costs for covered  services—for the three employers’ 2005 health plans we reviewed showed  that HSA-eligible plan enrollees would incur higher annual costs than PPO  enrollees for extensive use of health care, but would incur lower annual  costs than PPO enrollees for low to moderate use of health care. HSA-Eligible Plan Enrollees Had Higher Incomes than Comparison Groups, but Data on Age Differences Were Inconclusive

HSA-eligible plan enrollees generally had higher incomes than comparison  groups. Moreover, 51 percent of tax filers reporting HSA contributions had an  adjusted gross income of $75,000 or more, compared with 18 percent of all  tax filers under age 65. Additionally, two of the three employers we reviewed and  eHealthInsurance reported that HSA-eligible plan enrollees had higher  incomes than did traditional plan enrollees in 2005. Just Over Half of Enrollees and Most Employers Contributed to HSAs, and These Funds Were Used to Pay for Medical Care and to Accumulate Savings

Just over half of HSA-eligible plan enrollees and most employers  contributed to HSAs. About 55 percent of HSA-eligible plan enrollees  reported HSA contributions in 2004, according to our analysis of data  obtained from IRS and a publicly available survey. About two-thirds of employers offering HSA-eligible plans  contributed to their employees’ HSAs in 2005, according to two national  employer health benefits surveys. Account holders used HSA funds to pay for medical care and to  accumulate savings. About 45 percent of tax filers reporting an HSA  contribution in 2004—made by themselves, their employers, or others on  their behalf—also reported withdrawing funds in 2004. About 55 percent of tax filers reporting  HSA contributions in 2004 withdrew no money from their account in 2004. Focus Group Participants Were Generally Satisfied with HSA-Eligible Plans, but Would Not Recommend Them to All Consumers

HSA-eligible plan enrollees who participated in our focus groups at the  three employers we reviewed generally reported positive experiences with  their plans. Few participants researched the cost of hospital or physician services  before obtaining care, although many participants researched the cost of  prescription drugs. Most participants reported that they would not recommend HSA-eligible  plans to all consumers. Most participants would recommend the plans to healthy  consumers, but not to those who use maintenance medication, have a  chronic condition, have children, or may not have the funds to meet the  high deductible. Few of the HSA-eligible plan enrollees who participated in our focus  groups researched cost before obtaining health care services.
Why GAO Did This Study

Health savings accounts (HSA) and the high-deductible health insurance plans that are eligible to be coupled with them are a new type of consumer-directed health plan attracting interest among employers and consumers. HSA-eligible plans constitute a small but growing share of the private insurance market, and the novel structure of the plans has raised questions about how they could affect enrollees' health care purchasing decisions and costs. This statement is based on GAO's August 2006 report entitled "Consumer-Directed Health Plans: Early Enrollee Experiences with Health Savings Accounts and Eligible Health Plans" (GAO-06-798). In this report, GAO reviewed (1) the financial features of HSA-eligible plans in comparison with those of traditional plans, such as preferred provider organizations (PPO); (2) the characteristics of HSA-eligible plan enrollees in comparison with those of traditional plan enrollees or others; (3) HSA funding and use; and (4) enrollees' experiences with HSA-eligible plans.

What GAO Found

HSA-eligible plans had lower premiums, higher deductibles, and higher out-of-pocket spending limits than did traditional plans in 2005, but both plan types covered similar services, including preventive services. For the three employers' health plans GAO reviewed to illustrate enrollees' potential health care costs, GAO estimated that HSA-eligible plan enrollees would incur higher annual costs than PPO enrollees for extensive use of health care, but would incur lower annual costs than PPO enrollees for low to moderate use of health care. HSA-eligible plan enrollees generally had higher incomes than comparison groups, but data on age differences were inconclusive. In 2004, 51 percent of tax filers reporting an HSA contribution had an adjusted gross income of $75,000 or more, compared with 18 percent of all tax filers under 65 years old. Two of the three employers GAO reviewed, the Federal Employees Health Benefits Program, and a national broker of health insurance also reported that HSA-eligible plan enrollees had higher incomes than traditional plan enrollees in 2005. Just over half of all HSA-eligible plan enrollees and most employers contributed to HSAs, and account holders used their HSA funds to pay for medical care and accumulate savings. About 55 percent of HSA-eligible plan enrollees reported HSA contributions to the Internal Revenue Service in 2004, and about two-thirds of employers offering HSA-eligible plans contributed to their employees' HSAs. About 45 percent of tax filers reporting 2004 HSA contributions also reported that they withdrew funds in that year, and 90 percent of these funds were withdrawn for qualified medical expenses. The other 55 percent of those reporting HSA contributions did not withdraw any funds from their HSA in 2004. HSA-eligible plan enrollees who participated in GAO's focus groups generally reported positive experiences, but most would not recommend the plans to all consumers. Few participants reported researching cost before obtaining health care services, although many researched the cost of prescription drugs. Most participants were satisfied with their HSA-eligible plans and would recommend them to healthy consumers, but not to those who use maintenance medication, have a chronic condition, have children, or may not have the funds to meet the high deductible.