Dive Brief:

• Health plans with a health savings account (HSA) option seem to be losing popularity with plan enrollees, says the Employee Benefits Research Institute, citing results from five separate surveys: EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, Kaiser Family Foundation, National Center for Health Statistics, Mercer and America’s Health Insurance Plans. 
• Growth in HSA-eligible health plans has declined since 2007, from a high of 70%, down to 12% and then to 0% in 2017. Paul Fronstin, director of EBRIs Health Research and Education Program, says employers might be holding off moving to HSA-eligible plans because of inflexible plan design and because of economic factors, such as increases in premiums and record-low unemployment.
• EBRI makes a distinction between surveys that focus on HSA-eligible health plan enrollment and those that focus on the growth in the number of HSA accounts.  Although some surveys might show growth in the number of HSA accounts, some HSAs aren't funded and some have no contributions at all, suggesting that some people with HSAs have unenrolled from HSA-eligible health plans.

Dive Insight:

Employers have opted for innovation in plan design to hold down healthcare costs, but plan design has recently met its limits in how much it can help employers save, experts have told HR Dive. However, HSAs are sometimes perceived as being mostly for better-paid employees.

Other surveys have shown that HSAs and high deductible health plans, often paired together, remain popular with millennials, who also appear to be better at saving for retirement than other generational cohorts.

But while the plans are meant to lower premium costs due to the higher deductible, as well as encourage employees to become better consumers of their own healthcare, such expectations can backfire if employers don't also offer proper education in how the plans work. Employees can easily become overwhelmed by the choices offered at open enrollment, and even afterward may not fully understand the plan they each chose. Employers have a responsibility to educate before, during and after open enrollment if they want employees to actually engage with their benefits offerings — and not be shocked by a surprise medical bill down the road.