Satisfaction Levels Up for CDHPs, Down for Traditional Plans

By Stephen Miller, CEBS September 6, 2012

Concerning Americans' overall satisfaction with employer-provided health coverage, traditional-plan enrollees were more likely than consumer-directed health plan (CDHP) enrollees to be extremely or very satisfied with the overall plan. However, satisfaction levels have been trending up among CDHP enrollees, and trending down among traditional-plan enrollees, according to a new report by the nonprofit Employee Benefit Research Institute (EBRI).

In particular, satisfaction rates for out-of-pocket costs appear to be trending downward among those with traditional coverage and upward for those with consumer-driven plans, according to surveys conducted annually by EBRI and Matthew Greenwald and Associates.

CDHPs typically combine high-deductible health plans (HDHPs) with a tax-exempt health savings account (HSA) or health reimbursement arrangement (HRA) to help enrollees pay for out-of-pocket expenses. (See the SHRM Online article "Consumer-Driven Decision: Weighing HSAs vs. HRAs.")

A growing number of U.S. employers have adopted CDHPs over the past decade to provide employees with incentives to make cost-conscious decisions when selecting health care services and to limit unnecessary health care spending.

In EBRI's 2011 survey, individuals with a CDHP had deductibles of at least $1,000 for individual coverage or $2,000 for family coverage in addition to an HSA or HRA they could use to pay for medical expenses. The report was published in the August 2012 EBRI Notes, Satisfaction with Health Coverage and Care: Findings from the 2011 EBRI/MGA Consumer Engagement in Health Care Survey.”

Key findings included the following:

  • Overall satisfaction with health plan. Overall satisfaction levels among CDHP enrollees rose from 37 percent to 52 percent between 2006 and 2009, although there was a drop in satisfaction rates between 2009 and 2010. Satisfaction rates increased from 43 percent to 46 percent between 2010 and 2011.
    Meanwhile, satisfaction rates among traditional enrollees decreased in most years. Between 2006 and 2008 they slipped from 67 percent to 63 percent and, after increasing between 2008 and 2009, they fell from 66 percent to 57 percent between 2009 and 2011.
  • Out-of-pocket costs. Attitudes about out-of-pocket costs may explain some of the difference in overall satisfaction rates among enrollees in traditional plans and CDHPs. In 2011, 41 percent of traditional-plan participants and 24 percent of CDHP participants were extremely or very satisfied with out-of-pocket costs (for health care services other than for prescription drugs). But satisfaction rates appear to be trending downward among those with traditional coverage and upward for those with a CDHP.
  • Access to doctors. Satisfaction levels with getting doctor appointments were high relative to other aspects of health care, regardless of plan type, yet some differences were found. In 2006, traditional-plan enrollees were more likely than CDHP enrollees to be extremely or very satisfied with their ability to get doctor appointments. However, between 2007 and 2010, differences were not statistically significant, and in 2011 CDHP enrollees were more likely than traditional-plan enrollees to be extremely or very satisfied with their ability to get doctor appointments.
    In 2011, 73 percent of CDHP enrollees were extremely or very satisfied with their ability to get doctor appointments, compared with 68 percent of traditional-plan enrollees.

Despite rising satisfaction levels with CDHPs, EBRI noted that CDHP enrollees remained less likely than those in traditional plans to recommend their health plan and to indicate a desire to stay with their current plan if given an opportunity to switch. While their experience with high-deductible plans combined with tax-advantaged spending accounts may be proving better than they expected, if given the option many still would prefer lower deductibles with the same or better coverage.

Stephen Miller, CEBS, is an online editor/manager for SHRM.

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