Press Release

For Immediate Release Contact


Sue Ducat
Director of Communications
(301) 841-9962

High-Deductible Health Plans

A new policy brief from Health Affairs and the Robert Wood Johnson Foundation looks at high-deductible health plans (HDHPs), in which the annual deductible is $1,300 for an individual and $2,600 for a family. An estimated 25 percent of Americans with employer-sponsored health coverage are enrolled in HDHPs, as compared to 4 percent a decade ago. In the Affordable Care Act (ACA) Marketplaces, almost 90 percent of individual plan enrollees select HDHPs. Some policy makers believe HDHPs could reduce health care spending, since consumers paying directly for their care will be more cognizant of costs. This brief examines early evidence that HDHPs have reduced spending and risks they pose for some consumers, who might avoid filling prescriptions and obtaining other necessary care because of costs.

Topics covered by this policy brief include:
  • What's the background and the law? This section of the brief describes the parameters of HDHPs and how they have evolved since 2001 when consumer-driven health plans were first offered by employers. The brief explains the role of the ACA in creating actuarial value tiers for all nongrand-fathered plans sold in the Marketplaces, as detailed in Section 2713 of that act, and clarifies how certain services rated with an "A" or "B" by the US Preventive Services Task Force will be completely covered by HDHPs before an enrollee has to meet his or her deductible.

  • What's the debate? The central debate over HDHPs is whether or not they reduce health care costs and use in a way that could negatively affect health. The brief provides some of the key research on that issue. One analysis, for example, published in 2013 by the American Journal of Managed Care, found significantly decreased medication adherence for patients with chronic conditions in HDHPs. Another study concluded that some enrollees in HDHPs are likely to reduce preventive care use because they are unaware that these procedures may be free or low cost.

  • What's next? The brief describes new plans being introduced, such as value-based insurance design plans, which charge patients less for higher-value treatments. Some ten million Americans have delayed purchasing Marketplace coverage, citing affordability. To motivate this group, policy makers have proposed cheaper "copper" plans, with even higher deductibles. These proposals are timely: Health care spending is again rising, meaning that HDHP prevalence will likely continue to increase.