Rate of Workers Enrolled in High-Deductible Health Plans Jumps for 8th Year in Row to Record 55.7%

Maine has the highest rate of private-sector workers enrolled in HDHPs, while Hawaii has the lowest rate. We also address who should — and shouldn’t — consider an HDHP.

by Jacqueline DeMarco, Lending Tree, Jan 30, 2023 (excerpts)

Key findings

55.7% of American private-sector workers were enrolled in high-deductible health plans (HDHPs) in 2021 — the highest on record and the eighth straight yearly increase. That rate is up 5.3% from 2020, 14.5% from 2017 and 83.7% from the low in 2013.

Maine had the highest rate of private-sector workers enrolled in HDHPs in 2021. In Maine, 76.2% of these workers were enrolled in HDHPs — the only state above 70.0%. Behind Maine were Tennessee (68.7%) and Nebraska (67.6%). None of these three states was among the top 10 in 2020.

Just 11.6% of private-sector workers in Hawaii were enrolled in HDHPs in 2021 — the lowest in the nation. The next closest states doubled (District of Columbia, 28.4%) and tripled (Alaska, 42.4%) that rate. Hawaii was also the lowest state in 2020 at 17.6%, with an almost identical gap with D.C.

Since 2017, the rate of private-sector workers enrolled in HDHPs jumped the most in Arkansas. 58.0% of Arkansas workers were enrolled in HDHPs in 2021, a 60.8% jump from 36.1% in 2017. Louisiana (57.2% increase) and New Jersey (45.4%) were next. Only six states saw decreases in this period, led by the District of Columbia (13.8%), South Dakota (7.3%) and New Hampshire (5.8%).

HDHP enrollment up for 8th straight year

As of 2021 (the most recent data available), 55.7% of American private-sector workers were enrolled in HDHPs. This record high represents an eighth consecutive annual increase in HDHP enrollments. The percentage is up 5.3% from 2020, 14.5% from 2017, 83.7% from 2013 and 62.6% from 2012….

some states have very low HDHP enrollment levels. In Hawaii, only 11.6% of private-sector workers were enrolled in an HDHP, followed by D.C. (28.4%) and Alaska (42.4%.) Hawaii also had the lowest HDHP enrollment in 2020 at 17.6%, and D.C. had an almost identical gap at that time.

Varying state laws on employer-sponsored health care plans can contribute to why some states such as Hawaii have low HDHP enrollment. According to a 2022 analysis from Becker’s Payer Issues, the passing of the Prepaid Health Care Act in 1974 in Hawaii led to the creation of an employer mandate for medical insurance coverage. This law also blocked employer efforts to save money — including the implementation of HDHPs.

Federal law also requires HDHPs to have larger out-of-pocket maximums and deductibles than Hawaii’s benchmark plan (the HMSA Preferred Provider Plan 2010). This can make it very difficult for Hawaiian employers to offer HDHPs to their employees.

Dating to 2012, Hawaii has been at the bottom eight times:

• 2013 (7.9%)
• 2014 (3.1%)
• 2015 (12.9%)
• 2016 (11.8%)
• 2017 (9.3%)
• 2019 (12.6%)
• 2020 (17.6%)
• 2021 (11.6%)

It was second-lowest in 2012 (14.4%) and not ranked in 2018….

read … Full Report