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Health Savings Accounts - US - June 2012

With healthcare costs continuing to rise, both employers and employees are constantly looking for ways to control them. Consumer Driven Health Plans (CDHPs), of which Health Savings Accounts (HSAs) are one type, are becoming an increasingly popular way to do just that. Paired by law with High Deductible Health Plans, HSAs offer participants an option to put tax-free money away in an account specifically earmarked for healthcare.

Where HSAs offer an additional advantage over other CDHPs, however, is that whatever money is put into the account can be saved from year to year, and even used as retirement savings. The increasing need for consumer-driven health insurance is making banks, insurance companies, financial advisors and employers look at the market differently, and is changing the way they position themselves to consumers. In addition, new healthcare provisions scheduled to go into effect in 2014 will open up opportunities for these firms.

What you need to know:

  • How is the increasing cost of healthcare affecting the popularity of HSAs?
  • How much did and will the provisions of the Patient Protection and Affordable Care Act affect the HSA market?
  • How is the new consumer-driven perspective on health plan consumption changing the way companies position themselves?
  • Where is the potential for growth in the HSA industry?
  • What HSA features are most important to HSA participants, as well as to people who could be HSA participants but have chosen not to be?

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Table of contents

  1. Scope and Themes

      • What you need to know
        • Data sources
          • Consumer study data
            • Advertising creative
              • Abbreviations
                • Companies mentioned in this report:
                • Executive Summary

                    • The market
                      • HSA enrollment increasing
                        • Figure 1: Total HSA enrollment (in millions), 2001-11
                      • Smaller firms lead the way in enrollment
                        • Figure 2: Percentage of firms offering HSA-qualified HDHPs, by firm size, 2010
                      • Age distribution of enrollees
                        • Figure 3: Age distribution of people covered by HSAs/HDHPs, individual market,
                      • Companies, brands, and innovation
                        • Competitive landscape
                          • Brand positioning is evolving, and innovation is key
                            • Market drivers
                              • Impact of healthcare legislation
                                • Potential for greater competition in the healthcare industry
                                  • The consumer
                                    • Consumer accessibility to HSAs
                                      • Figure 4: Accessibility of HSAs for respondents, June, 2012
                                    • Employer contributions increase attractiveness of HSAs
                                      • Figure 5: Interest in having an HSA, by household income, June 2012
                                    • Only a third are contributing the maximum
                                      • Figure 6: Amount contributed to HSA, by gender and income, June 2012
                                    • Preferred type of institution
                                      • Figure 7: Institution preferred by those who have HSAs available to them, June 2012
                                    • Importance of HSA features and benefits
                                      • Figure 8: Importance of HSA features and benefits, by gender, June 2012
                                    • How HSA funds are invested
                                      • Figure 9: How HSA funds are invested, by household income, June 2012
                                    • Plans for paying medical expenses in retirement
                                      • Figure 10: Plans for paying future medical expenses, by age, June 2012
                                    • What we think
                                    • Issues in the Market

                                        • What are the growth opportunities in the market?
                                          • Regulatory impact on HSAs
                                            • Technology is key to innovation
                                              • Increased competition in the industry
                                              • Insights and Opportunities

                                                  • Key points
                                                    • Employers can help increase participation
                                                      • Young employees are unaware of HSA availability
                                                        • Younger people represent a huge opportunity
                                                          • Positioning HSAs as useful for retirement
                                                              • Figure 11: Average HSA account balances, 2006-10
                                                            • Questions about future legislation
                                                            • Inspire Insights

                                                              • Inspire Trend: “The Decline of Deference”
                                                                • Inspire Trend: “A Simple Balance for Health”
                                                                • Market Size

                                                                  • Key points
                                                                    • HSA enrollment continues to grow
                                                                      • Figure 12: Total enrollment in HSAs, 2005-11
                                                                    • Many who are eligible are still not enrolling
                                                                      • Number of firms offering HSAs continues to grow
                                                                        • Figure 13: Percentage of firms that offer health benefits that offer HSAs, 2005-11
                                                                        • Figure 14: Percentage of employers offering a consumer-driven health plan, 2011-12
                                                                      • Employees at small firms more likely to enroll in HSA
                                                                        • Figure 15: Percentage of covered workers enrolled in HSA-Qualified HDHP, 2010
                                                                    • Competitive Context

                                                                      • Key points
                                                                        • Pricing
                                                                          • Figure 16: Average annual total, employer and worker premium contributions for covered workers for single and family coverage, by type of plan, 2011
                                                                        • Enrollment by state
                                                                          • Figure 17: HSA enrollment by state
                                                                      • Segment Performance

                                                                        • Key points
                                                                          • Large group plans are the fastest-growing segment
                                                                            • Figure 18: HSA/HDHP enrollment (covered lives), March 2005-January 2011
                                                                            • Figure 19: Percentage of lives covered by an HSA/HDHP, by market type, March 2005 to January 2011
                                                                          • HSA age distribution
                                                                            • Figure 20: Age distribution of people covered by HSAs/HDHPs, individual market, October 2008 vs. January 2011
                                                                        • Marketing Channels

                                                                          • Key points
                                                                              • Figure 21: Type of institution preferred for existing HSA, by gender, June 2012
                                                                              • Figure 22: Institution preferred by those who have HSAs offered to them, June 2012
                                                                              • Figure 23: Type of institution preferred for existing HSA, by household income, June 2012
                                                                              • Figure 24: Institution preferred by those who have HSAs offered to them, by household income, June 2012
                                                                          • Market Drivers

                                                                            • Key points
                                                                              • HDHP/SOs are fastest-growing type of healthcare plan
                                                                                • Figure 25: Distribution of health plan enrollment for covered workers, select years, 1988-2010
                                                                                • Figure 26: Distribution of health plan enrollment for covered workers, by firm size, 2010
                                                                                • Figure 27: Distribution of health plan enrollment for covered workers, by region, 2010
                                                                              • Healthcare reform may make HSAs more attractive
                                                                                • Healthcare costs keep rising
                                                                                  • Figure 28: National health expenditures per capita and as a percent of GDP, 2000-10
                                                                                  • Figure 29: Average annual health insurance premiums for family coverage, 2001 and 2011
                                                                                • Growth in small businesses
                                                                                    • Figure 30: Percent of banks experiencing “moderately stronger” demand for commercial and industrial loans from small firms, January, 2012
                                                                                  • Changing demographics will increase HSA account balances
                                                                                    • Incentives to participate in wellness programs
                                                                                    • Leading Companies

                                                                                      • Key points
                                                                                        • Largest banks
                                                                                          • Figure 31: Largest HSA banks, by number of accounts in 2011
                                                                                        • Bank of America
                                                                                          • J.P. Morgan
                                                                                            • Cigna
                                                                                              • Aetna
                                                                                              • Innovation and Innovators

                                                                                                • Key points
                                                                                                  • Technology is at center of innovative educational efforts
                                                                                                    • Optum ™
                                                                                                      • Castlight Health
                                                                                                        • Healthper
                                                                                                          • UNB Healthcare Services
                                                                                                            • Aetna
                                                                                                            • Marketing Strategies

                                                                                                              • Key points
                                                                                                                • Print advertising
                                                                                                                  • Figure 32: Blue Cross Blue Shield of Montana, print advertisement, 2011-12
                                                                                                                  • Figure 33: Aetna print advertisement, 2011
                                                                                                                • Direct mail advertising
                                                                                                                  • Figure 34: Unitedhealthcare direct mail advertisement, 2011
                                                                                                                  • Figure 35: Blue Cross Blue Shield Florida, direct mail advertisement, 2012
                                                                                                                  • Figure 36: Highmark direct mail advertisement, 2012
                                                                                                                • Online and email advertising
                                                                                                                  • Figure 37: Wells Fargo email advertisement, 2011
                                                                                                                  • Figure 38: Health1 One email advertisement, 2012
                                                                                                                  • Figure 39: Chase email advertisement, 2011
                                                                                                              • The Consumer – HSA Ownership

                                                                                                                • Key points
                                                                                                                  • Most people aren’t offered an HSA
                                                                                                                      • Figure 40: Accessibility to an HSA, by gender, June, 2012
                                                                                                                    • Youngest employees most likely to be unaware of HSA availability
                                                                                                                        • Figure 41: Accessibility to an HSA, by age, June 2012
                                                                                                                        • Figure 42: Accessibility to an HSA, by race/Hispanic origin, June 2012
                                                                                                                    • The Consumer – Interest in Opening an HSA

                                                                                                                      • Key points
                                                                                                                        • Employer contributions make some difference
                                                                                                                          • Figure 43: Interest in having an HSA, by gender, June 2012
                                                                                                                          • Figure 44: Interest in having an HSA, by age, June 2012
                                                                                                                        • Higher earners are looking for employer contributions
                                                                                                                          • Figure 45: Interest in having an HSA, by household income, June 2012
                                                                                                                          • Figure 46: Interest in having an HSA, by race/Hispanic origin, June 2012
                                                                                                                      • The Consumer – HSA Amount Contributed and Preferred Investments

                                                                                                                        • Key points
                                                                                                                          • More people contribute less than maximum, but women more likely to contribute as much as possible
                                                                                                                              • Figure 47: Amount contributed to HSA, by gender, June 2012
                                                                                                                              • Figure 48: Amount contributed to HSA, by income, June 2012
                                                                                                                            • Most HSA funds are invested conservatively
                                                                                                                                • Figure 49: How HSA funds are invested, by age, June 2012
                                                                                                                                • Figure 50: How HSA funds are invested, by household income, June 2012
                                                                                                                            • The Consumer – HSA Benefits

                                                                                                                              • Key points
                                                                                                                                • The ability to keep money from year to year is the most important benefit
                                                                                                                                    • Figure 51: Importance of HSA features and benefits, by gender, June 2012
                                                                                                                                  • HSA features more important to people under age 55
                                                                                                                                      • Figure 52: Importance of HSA benefits, by age, 2012
                                                                                                                                      • Figure 53: Importance of HSA benefits, by income, June 2012
                                                                                                                                  • Consumer – Plans for the Future

                                                                                                                                    • Key points
                                                                                                                                      • Younger people are not depending on Medicaid for the future
                                                                                                                                          • Figure 54: Plans for paying future medical expenses, by age, June 2012
                                                                                                                                        • Income plays a role in the plan
                                                                                                                                            • Figure 55: Plans for paying future medical expenses, by household income, June 2012
                                                                                                                                            • Figure 56: Plans for paying future medical expenses, by race/Hispanic origin, June 2012
                                                                                                                                        • Appendix—Trade Associations

                                                                                                                                          Companies Covered

                                                                                                                                          • Aetna Inc.
                                                                                                                                          • Bank of America Corporation
                                                                                                                                          • Centers for Medicare & Medicaid Services
                                                                                                                                          • CIGNA Corporation
                                                                                                                                          • Federal Deposit Insurance Corporation
                                                                                                                                          • First Horizon National Corporation
                                                                                                                                          • JPMorgan Chase & Co
                                                                                                                                          • Wells Fargo & Company

                                                                                                                                          Health Savings Accounts - US - June 2012

                                                                                                                                          £3,174.67 (Excl.Tax)