HSA and FSA Users Access Care More Often, Report Shows

National attention to consumer-directed health care increased following the enactment of the Medicare Prescription Drug Improvement and Modernization Act of 2003, which established tax-advantaged health savings accounts (HSAs). As a result, enrollment in consumer-directed health care products has increased over the past several years. Consumer-directed health care enables clients to have more control over when and how they access care, what types of care they use, and how much they spend on health care services.

According to a recent report by the National Center for Health Statistics, there is a strong correlation between the type of health plan a client purchases and their utilization of their plan. Below, see some of the key findings of the report, which may help you and your client determine which plan is best for them. The study examined types of private health plans and their association with utilization and access to health care services for adults ages 18 to 64 years in 2007 and 2008.

• In 2007-2008, 18 percent of adults aged 18-64 years with private health insurance were enrolled in an HDHP, including 5 percent who were enrolled in a CDHP.
• Four out of five adults aged 18-64 years with private health insurance were enrolled in a traditional health plan, including 68 percent without an FSA and 14 percent with an FSA.
• Adults aged 18-64 years enrolled in an HDHP-only or an HDHP + FSA were more likely to report unmet medical or prescription drug needs due to cost than adults enrolled in a traditional health plan with or without an FSA.
• • Seventeen percent of adults aged 18-64 years enrolled in an HDHP + FSA and 16.6 percent enrolled in an HDHP-only had an unmet medical or prescription drug need due to cost compared with 9.7 percent of adults aged 18-64 years enrolled in a traditional health plan without an FSA. Adults enrolled in a traditional plan + FSA were less likely to have unmet medical or prescription drug needs (7.6 percent) compared with adults enrolled in a traditional health plan only. Twelve percent of adults aged 18-64 years enrolled in a CDHP had an unmet medical or prescription drug need.
• Adults aged 18-64 years with either an FSA or an HSA were more likely to get an influenza vaccination than those without an FSA or an HSA.
• • The percentage of adults aged 18-64 years with private health insurance who received an influenza vaccination in the past 12 months was highest among those enrolled in a traditional plan + FSA (37.5 percent), an HDHP + FSA (36.3 percent), or a CDHP (33.6 percent). Adults aged 18-64 years covered by either a traditional plan only (26.7 percent or an HDHP-only (25.8 percent) had lower rates of receiving an influenza vaccination in the past 12 months.
• Adults aged 18-64 years with either an FSA or an HSA were more likely to have contact with an eye doctor than those without an FSA or an HSA.
• • The percentage of adults aged 18-64 years with private health insurance who had seen or talked to an eye doctor in the past 12 months was highest among those enrolled in a HDHP + FSA (52.2 percent), a traditional plan + FSA (48.2 percent), or a CDHP (45.4 percent). Adults aged 18-64 years covered by either a traditional plan only (36.4 percent) or an HDHP-only (36.8 percent) had lower rates of having contact with an eye doctor in the past 12 months.
• Adults aged 18-64 years with an FSA were more likely to have had contact with a medical specialist within the past year than those without an FSA.
• • The percentage of adults aged 18-64 years with private health insurance who had contact with a medical specialist in the past 12 months was highest among those who had a traditional plan + FSA (30.8 percent) or an HDHP + FSA (34.6 percent). Adults aged 18-64 years with a traditional plan only had the lowest rate of contact with a medical specialist in the past 12 months (23.9 percent).
  • The percentage of adults aged 18-64 years who had at least one contact with a dentist in the past 12 months ranged from 68 percent among those enrolled in an HDHP-only plan to 82.5 percent enrolled in a traditional plan + FSA. Almost 71 percent of adults aged 18-64 years enrolled in a traditional plan only had contact with a dentist in the past 12 months.
• Most privately insured adults aged 18-64 years had a usual source of medical care. The percentage who had a usual source of medical care ranged from 87.7 percent among those enrolled in an HDHP-only plan to 92.5 percent among those enrolled in a traditional plan + FSA.
• The percentage of adults aged 18-64 years who had at least one contact with a doctor or other health care professional in the past 12 months ranged from 83.8 percent among those enrolled in an HDHP-only to 89.8 percent for those enrolled in an HDHP + FSA.

Although HDHPs and CDHPs still comprise a relatively small share of the private health insurance market, their market share has increased. The use of FSAs has also increased. Privately insured adults aged 18-64 years with HDHPs were more likely to experience unmet medical and prescription drug needs compared with individuals enrolled in traditional health plans and CDHPs. For privately insured adults aged 18-64 years, having either an FSA or an HSA was associated with increased health care utilization for influenza vaccination, dental visits, and eye doctor visits, which are services typically paid out of pocket by consumers.