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High Deductible Health Plan Enrollees Consider Cost and Quality of Care

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A recent study of individuals with private health insurance coverage shows participants with high-deductible health plans (HDHPs) are more likely to consider health care cost and quality when selecting care.

The 14th annual Consumer Engagement in Health Care survey, sponsored by the Employee Benefit Research Institute (EBRI) and Greenwald & Associates, looks at consumer engagement and value-based health insurance design. Participants include individuals with private health insurance coverage through an employer, purchased directly from a carrier, or purchased through a government exchange. The majority (85 percent) were covered through an employer-sponsored plan.

Consumer Actions

Survey findings show HDHP enrollees:

  • Have many characteristics equated with financial stability (higher education, employed full time, in very good health)
  • Are more likely to seek cost information than traditional plan enrollees
  • Are more likely than traditional plan enrollees to exhibit cost-conscious behaviors (e.g., checked plan coverage for care or medication, checked quality rating of doctor or hospital before receiving care, talked to their doctors about treatment and prescription options and cost, asked a doctor to recommend less costly prescriptions, used an online cost-tracking tool provided by the plan, or developed a budget to manage health care expenses)
  • Are more likely to delay care than traditional plan enrollees
  • Are more likely to have and participate in wellness programs than traditional plan enrollees


According the Center of Disease Control (CDC) the percent of persons under the age of 65 with private health insurance enrolled in a HDHP is 46 percent in 2018 compared to 17.4 percent in 2007. In comparison, the percent of TRS ActiveCare participants electing ActiveCare-1HD is 62 percent. Like other employers, most districts offer employees with HDHPs the option of participating in a health-savings plan.

Other Assistance

With so many staff participating in TRS ActiveCare’s HDHP, districts may want to explore things to help employees make health decisions based on need rather than cost. Things like medical gap insurance, a supplemental insurance plan that provides a cushion for those insured by HDHP to make procedures and prescriptions more affordable, could be added to a district’s benefits offerings to help address these issues.

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April Mabry
April Mabry
Best Practices: Salary Notification Letters

April Mabry oversees HR Services training services, member library products, and the HRX newsletter. She has provided HR training and guidance to Texas public schools  since 1991. Mabry was a classroom teacher for 11 years in Texas and Michigan.

Mabry has a bachelor’s degree in education from the University of Michigan and certification as a professional in human resources (PHR) and is a SHRM-CP.

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TASB HR Services supports HR leadership in Texas schools through membership offerings in specialized training, consulting, and other services.
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