NCHS Data Brief ■ No. 317 ■ August 2018 

High-deductible Health Plan Enrollment Among Adults 

Aged 18–64 With Employment-based Insurance Coverage
	

Robin A. Cohen, Ph.D., and Emily P. Zammitti, M.P.H. 

increasing family income level
	 

Key findings 

Data from the National 

Health Interview Survey 

● From 2007 through 2017, 

enrollment in high-deductible 

health plans (HDHPs) with a 

health savings account (HSA) 

(4.2% to 18.9%) and without 

an HSA (10.6% to 24.5%) 

increased among adults aged 

18–64 with employment-based 

coverage, while enrollment in 

traditional plans decreased. 

● In 2017, among adults aged 

18–64 with employmentbased coverage, there were 

no differences in the types of 

health insurance plan by sex. 

● Enrollment in an HDHP 

with an HSA was higher among 

adults aged 30–44 (21.0%) 

than among those aged 18–29 

High-deductible health plans (HDHPs) are health insurance policies with 

higher deductibles than traditional insurance plans. Individuals with HDHPs 

pay lower monthly insurance premiums but pay more out of pocket for 

medical expenses until their deductible is met. An HDHP may be used with 

or without a health savings account (HSA). An HSA allows pretax income to 

be saved to help pay for the higher costs associated with an HDHP (1). This 

report examines enrollment among adults aged 18–64 with employmentbased private health insurance coverage by plan type and demographic 

characteristics. Approximately 60% of adults aged 18–64 have employmentbased coverage (2). All estimates in this report are based on data from the 

National Health Interview Survey (NHIS). 

Keywords: health insurance • private plan • National Health Interview Survey 

Among adults aged 18–64 with employment-based coverage, 

the type of coverage has changed over the past decade. 

Figure 1. Percentage of adults aged 18–64 with employment-based coverage, by type of private 

coverage and year: United States, 2007–2017 

 

 

 (16.8%) and 45–64 (18.4%). 

● Enrollment in HDHPs 

with an HSA increased with 

 

and educational attainment, 

whereas the percentage enrolled 

in traditional plans and HDHPs 

without an HSA decreased. 

 

 

 

1

Significant linear decrease from 2007 through 2017 (p < 0.05).
 2

Significant linear increase from 2007 through 2017 (p < 0.05).
 

NOTES: HDHP is a high-deductible health plan. HSA is a health savings account. Estimates are based on household 

interviews of a sample of the civilian noninstitutionalized population. Due to rounding, percentages may not add up to 100 

within each year. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db317_table.pdf#1.
 

SOURCE: NCHS, National Health Interview Survey, 2007–2017.
 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

Centers for Disease Control and Prevention
 

National Center for Health Statistics
 

 
NCHS Data Brief ■ No. 317 ■ August 2018

●		 Among adults aged 18–64 with employment-based coverage, the percentage enrolled in a 

traditional plan decreased from 85.1% in 2007 to 56.6% in 2017 (Figure 1). 

●		 The percentage enrolled in an HDHP without an HSA increased from 10.6% in 2007 to 

24.5% in 2017 among adults aged 18–64 with employment-based coverage. 

●		 Among adults aged 18–64 with employment-based coverage, the percentage enrolled in an 

HDHP with an HSA increased from 4.2% in 2007 to 18.9% in 2017. 

Among adults aged 18–64 with employment-based coverage, enrollment in 

plan type varied by age but not by sex. 

●		 Among adults aged 18–64 with employment-based coverage, there was no difference in the 

type of health insurance plan by sex (Figure 2). 

●		 Among adults aged 18–64 with employment-based coverage, those aged 18–29 (16.8%) 

and 45–64 (18.4%) were less likely to be enrolled in an HDHP with an HSA than those aged 

30–44 (21.0%). There were no differences by age in the percentages enrolled in an HDHP 

without an HSA or in a traditional plan. 


 

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1

Significantly different from those aged 30–44 (p < 0.05).
 

NOTES: HDHP is a high-deductible health plan. HSA is a health savings account. Estimates are based on household interviews of a sample of the civilian 

noninstitutionalized population. Due to rounding, percentages may not add up to 100 within each sex and age group category. Access data table for Figure 2 at: 

https://www.cdc.gov/nchs/data/databriefs/db317_table.pdf#2.

SOURCE: NCHS, National Health Interview Survey, 2017.
 

Figure 2. Percent distribution of adults aged 18–64 with employment-based coverage, by sex, age group, and type of 

private coverage: United States, 2017 
NCHS Data Brief ■ No. 317 ■ August 2018

As family income level increased, enrollment in HDHPs with an HSA 

increased, while enrollment in HDHPs without an HSA decreased. 

●		 In 2017, among adults aged 18–64 with employment-based coverage, enrollment in 

traditional plans decreased with increasing family income, from 59.9% among those with 

incomes of 138% of the federal poverty level (FPL) or less to 55.5% among those with 

incomes greater than 400% FPL (Figure 3). 

●		 Enrollment in HDHPs without an HSA decreased from 32.2% among those with incomes of 

138% FPL or less to 22.6% among those with incomes greater than 400% FPL. 

●		 Enrollment in HDHPs with an HSA increased from 7.9% among those with incomes of 

138% FPL or less to 22.0% among those with incomes greater than 400% FPL. 

Figure 3. Percent distribution of adults aged 18–64 with employment-based coverage, by family income and type of 

private coverage: United States, 2017 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Significant linear decrease with increasing family income level (p < 0.05).
 2

Significant linear increase with increasing family income level (p < 0.05).
 

NOTES: HDHP is a high-deductible health plan. HSA is a health savings account. FPL is federal poverty level, which is based on the ratio of the family’s income in 

the previous calendar year to the appropriate poverty threshold as defined by the U.S. Census Bureau. Estimates are based on household interviews of a sample 

of the civilian noninstitutionalized population. Due to rounding, percentages may not add up to 100 within each family income level. Access data table for Figure 3 

at: https://www.cdc.gov/nchs/data/databriefs/db317_table.pdf#3.
 

SOURCE: NCHS, National Health Interview Survey, 2017.
 

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NCHS Data Brief ■ No. 317 ■ August 2018

As educational attainment increased, enrollment in HDHPs with an HSA 

increased, while enrollment in traditional plans and HDHPs without an HSA 

decreased. 

●		 In 2017, among adults aged 18–64 with employment-based coverage, enrollment in 

traditional plans decreased from 61.1% among those with less than a high school education 

to 54.3% among those with a bachelor’s degree or higher (Figure 4). 

●		 Enrollment in HDHPs without an HSA decreased with increasing educational attainment, 

from 28.2% among those with less than a high school education to 21.8% among those with 

a bachelor’s degree or higher. 

●		 Enrollment in HDHPs with an HSA increased with increasing educational attainment, from 

10.7% among those with less than a high school education to 23.9% among those with a 

bachelor’s degree or higher. 

Figure 4. Percent distribution of adults aged 18–64 with employment-based coverage, by educational attainment and type 

of private coverage: United States, 2017 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Significant linear decrease with increasing educational attainment (p < 0.05).
 2

Significant linear increase with increasing educational attainment (p < 0.05).
 

NOTES: HDHP is a high-deductible health plan. HSA is a health savings account. Estimates are based on household interviews of a sample of the civilian 

noninstitutionalized population. Due to rounding, percentages may not add up to 100 in each educational attainment category. Access data table for Figure 4 

at: https://www.cdc.gov/nchs/data/databriefs/db317_table.pdf#4.
 

SOURCE: NCHS, National Health Interview Survey, 2017.
 

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NCHS Data Brief ■ No. 317 ■ August 2018

Summary 

Enrollment in HDHPs with and without HSAs among adults aged 18–64 with employment-based 

coverage increased from 2007 through 2017. Sociodemographic and socioeconomic factors were 

associated with enrollment in HDHPs with and without HSAs among adults aged 18–64 with 

employment-based coverage. In 2017, adults aged 30–44 were more likely to be enrolled in an 

HDHP with an HSA than those aged 18–29 and 45–64. However, no differences by age were 

observed for enrollment in HDHPs without an HSA or traditional plans. More highly educated 

and affluent adults were more likely to be enrolled in an HDHP with an HSA and less likely to 

be enrolled in a traditional plan or an HDHP without an HSA than their less educated and less 

affluent counterparts. 

More than 60% of adults aged 18–64 in the United States obtain their private health insurance 

coverage through the workplace (2). The change in HDHP enrollment has been faster among 

those with employment-based coverage than among those with directly purchased coverage (3). 

NHIS will continue to monitor the different types of private health insurance, and NHIS data can 

be used to examine further differences according to plan type. 

Definitions 

Employment-based coverage: Private insurance originally obtained through a present or former 

employer, union, or professional association. 

Family income level: Categories are based on the ratio of the family’s income in the previous 

calendar year to the appropriate poverty threshold (given the family’s size and number of 

children), as defined by the U.S. Census Bureau. 

Health savings account (HSA): A tax-advantaged account or fund that can be used to pay medical 

expenses. HSAs may only be used by those with an HDHP. These plans are also referred to as 

consumer-directed health plans. The funds contributed to the account are not subject to federal 

income tax at the time of deposit. HSA funds roll over and accumulate from year to year if not 

spent. HSAs are owned by the individual. Funds may be used to pay qualified medical expenses 

at any time without federal tax liability. HSAs may also be referred to as health reimbursement 

accounts, personal care accounts, personal medical funds, or choice funds. The term “HSA” in 

this report includes accounts that use these alternative names. These accounts differ from flexible 

spending accounts (FSAs). FSAs are accounts offered by some employers to allow employees 

to set aside pretax dollars of their own money for their use throughout the year to reimburse 

themselves for their out-of-pocket expenses for health care. With this type of account, any money 

remaining in the account at the end of the year, following a short grace period, is lost to the 

employee. Some FSAs allow a small amount of the money to roll over into the next calendar year. 

High-deductible health plan (HDHP): For persons with private health insurance, a question was 

asked regarding the annual deductible of each private health insurance plan. HDHP was defined 

in 2015 through 2017 as a private health plan with a deductible of at least $1,300 for self-only 

coverage and $2,600 for family coverage. The deductible is adjusted annually for inflation. For 

2013 and 2014, the annual deductible was $1,250 for self-only coverage and $2,500 for family 

coverage. For 2010 through 2012, the annual deductible was $1,200 for self-only coverage and 

$2,400 for family coverage. For 2009, the annual deductible was $1,150 for self-only coverage 

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NCHS Data Brief ■ No. 317 ■ August 2018

and $2,300 for family coverage. For 2007 and 2008, the annual deductible was $1,100 for selfonly coverage and $2,200 for family coverage. 

Private health insurance: Includes persons who had any comprehensive private insurance plan 

(including health maintenance and preferred provider organizations). These plans include those 

obtained through an employer, purchased directly, purchased through local or community 

programs, or purchased through the Health Insurance Marketplace or a state-based exchange. 

Private coverage excludes plans that pay for only one type of service, such as accidents or dental 

care. 

Traditional health plan: For persons with private health insurance, a question was asked regarding 

the annual deductible of each private health insurance plan. A traditional plan was defined as a 

private health plan with an annual deductible less than the HDHP threshold for the given year. 

Data source and methods 

NHIS is a nationally representative survey of the civilian noninstitutionalized U.S. population 

that is conducted continuously throughout the year by the National Center for Health Statistics 

(NCHS). NHIS is an in-person interview conducted in the respondent’s home. In some instances, 

follow-up to complete the interview is conducted via telephone. 

NHIS is designed to yield a nationally representative sample, and these analyses used weights to 

produce national estimates that are representative of the civilian noninstitutionalized population 

of the United States. Point estimates and the corresponding variances were calculated using 

SUDAAN software (4) to account for the complex sample design of NHIS. All estimates in this 

report meet NCHS standards of reliability as specified in “National Center for Health Statistics 

Data Presentation Standards for Proportions” (5). Linear trends by year, family income level, and 

educational attainment were evaluated using logistic regression. Differences between percentages 

were evaluated using two-sided significance tests at the 0.05 level. 

Data analysis for 2017 was based on information collected on 46,688 adults aged 18–64 in the 

NHIS Family Core component. Visit the NHIS website at: https://www.cdc.gov/nchs/nhis.htm for 

more information about the design, content, and use of NHIS. 

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NCHS Data Brief ■ No. 317 ■ August 2018

About the authors 

Robin A. Cohen and Emily P. Zammitti are with the National Center for Health Statistics, 

Division of Health Interview Statistics. 

References 

1. United States Government Accountability Office. Consumer-directed health plans: Early 

enrollee experiences with health savings accounts and eligible health plans. GAO–06–798. 

Washington, DC. 2006. 

2. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Longterm Trends in Health. Hyattsville, MD. 2017. 

3. Cohen RA, Zammitti EP. High-deductible health plans and financial barriers to medical care: 

Early release of estimates from the National Health Interview Survey, 2016. National Center 

for Health Statistics. 2017. Available from: https://www.cdc.gov/nchs/data/nhis/earlyrelease/ 

ERHDHP_Access_0617.pdf. 

4. RTI International. SUDAAN (Release 11.0.01) [computer software]. 2013. 

5. Parker JD, Talih M, Malec DJ, Beresovsky V, Carroll M, Gonzalez Jr JF, et al. National 

Center for Health Statistics Data Presentation Standards for Proportions. National Center for 

Health Statistics. Vital Health Stat 2(175). 2017. Available from: https://www.cdc.gov/nchs/data/ 

series/sr_02/sr02_175.pdf. 

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NCHS Data Brief ■ No. 317 ■ August 2018

       

 

 

   

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Suggested citation 

Cohen RA, Zammitti EP. High-deductible 

health plan enrollment among adults aged 

18–64 with employment-based insurance 

coverage. NCHS Data Brief, no 317. 

Hyattsville, MD: National Center for Health 

Statistics. 2018. 

Copyright information 

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated. 

National Center for Health 

Statistics 

Charles J. Rothwell, M.S., M.B.A., Director 

Jennifer H. Madans, Ph.D., Associate 

Director for Science 

Division of Health Interview Statistics 

Stephen J. Blumberg, Ph.D., Director 

Robin A. Cohen, Ph.D., Acting Associate 

Director for Science 

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ISSN 1941–4927 Print ed. 

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DHHS Publication No. 2018–1209 

CS294879