Enrollment in High-deductible Health Plans Among People Younger Than Age 65 With Private Health Insurance: United States, 2019-2023.

Abstract

Objective: This report provides a comprehensive look at enrollment in high-deductible health plans (HDHP), including consumer-directed health plans (CDHP) among privately insured people younger than age 65.

Methods: Data from the 2019 through 2023 National Health Interview Survey were used to examine enrollment in HDHPs and CDHPs among people younger than age 65 with private health insurance. CDHPs are HDHPs with an associated health savings account or health reimbursement account. All estimates are presented by sex, age group, race and Hispanic origin, family income, family educational attainment, level of urbanization, and source of private coverage.

Results: In 2023, among privately insured people younger than age 65, 41.7% were enrolled in an HDHP. Enrollment increased from 40.3% in 2019 to 43.3% in 2021, followed by a decrease to 41.7% in 2023. Among people with employment-based coverage, enrollment in an HDHP increased from 40.2% in 2019 to 43.4% in 2021, followed by a decrease to 41.9% in 2023. For people with directly purchased coverage, enrollment in an HDHP increased from 44.3% in 2019 to 47.0% in 2020, followed by a decrease to 43.1% in 2023. Generally, White non-Hispanic people were the most likely to be enrolled in an HDHP. Black non-Hispanic and Hispanic people were the least likely to be enrolled in an HDHP. Enrollment in an HDHP increased with family income and family educational attainment. In 2023, 19.5% of people younger than age 65 with private health insurance were enrolled in a CDHP. Enrollment characteristics of people with CDHPs mirrored those of people with HDHPs overall. However, children were more likely to be enrolled in an CDHP plan than adults ages 18-64. People with employment-based coverage were nearly four times more likely to be enrolled in a CDHP than their counterparts with directly purchased coverage.