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Deductible Levels and Out-of-Pocket Limits

• Average general annual deductibles in these arrangements, as expected, are relatively high when compared to the average annual deductibles for health plans generally.
  
• • The average general annual deductible for single coverage is $1,442 in HDHP/HRAs and $2,011 in HSA qualified HDHPs (Exhibit 8.3). However, there is variation around these averages, particularly in the case of HSA qualified HDHPs, where 30% of covered workers are in a plan with a deductible amount between $1,050 and $1,499 and 63% of covered workers are in a plan with a deductible of $2,000 or more (Exhibit 8.5). Seventy-four percent of workers enrolled in HDHP/HRAs and 82% of workers enrolled in HSA qualified HDHPs are in a plan that does not require the deductible to be met before the plan pays for covered preventive services.
    
  • This year the survey was modified to collect additional information about family general annual deductible amounts. The survey asks employers whether the family deductible amount is (1) an aggregate amount (i.e., the out-of-pocket expenses of all family members are counted until the deductible is satisfied), or (2) a per person amount that applies to each family member (typically with a limit on the number of family members that would be required to meet the deductible amount). Due to this change, the amounts reported this year for family deductibles are not directly comparable to the amounts reported in 2005.
    
  • Average aggregate deductibles for family coverage are $2,985 for HDHP/HRAs and $4,008 for HSA qualified HDHPs (Exhibit 8.3). As with deductibles for single coverage, there is substantial variation among covered workers for their family coverage deductibles. Twenty-nine percent of covered workers in HSA qualified HDHPs have aggregate family deductibles between $2,100 and $2,999 and 38% have family aggregate deductibles of $5,000 or more (Exhibit 8.7).
    
  
  
• HSA qualified HDHPs are legally required to have a maximum out-of-pocket liability of no more than $5,250 for single coverage and $10,500 for family coverage, while HDHP/HRAs have no such requirement.
  
• • The survey collected out-of-pocket maximum liability data differently than in previous years. As with deductibles, the survey asks employers whether the family out-of-pocket maximum liability is (1) an aggregate amount that applies to spending by any covered person in the family, or (2) a separate per person amount that applies to spending by each family member or a limited number of family members. The survey also asks whether the value reported for the out-of-pocket maximum includes the plan deductible. Because of these changes, the amounts reported this year for family out-of-pocket maximums are not directly comparable to the amounts reported in 2005.
    
  • The average out-of-pocket maximum for covered workers in HDHP/HRAs with single coverage is $2,693, which is not significantly different from the average of $3,172 for HSA qualified HDHPs. Among those with family coverage who reported their out-of-pocket maximum as an aggregate amount that applies to spending by any covered person in the family, the average amounts are $5,230 and $6,017 respectively (Exhibit 8.3).
    
  • Only four percent of covered workers in HSA qualified HDHPs are in firms who report that the general annual deductible is not included in the out-of-pocket maximum, while 38% of covered workers in HDHP/HRAs work in firms who report that the deductible is not included in the out-of-pocket maximum.

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