Enrollees Lack Basic Health Plan and HSA Knowledge. Can Employers Help?
By: Sara Rubinstein
4/3/2025
Our 20th Annual Consumer Engagement in Health Care Survey (CEHCS) was conducted during open enrollment season in the fall of 2024. Through a new addition of presenting a series of True or False statements to gauge true understanding of aspects of an employee’s health insurance plan, we found that employees don’t understand as much as they think they do.
There is a Gap in Understanding Health Plans
Overall, nearly 9 in 10 enrollees feel they understand the health plans offered to them. Additionally, 56% are extremely or very satisfied with the ease of understanding the terms of their coverage, with an additional 3 in 10 somewhat satisfied.
However, when asked the True or False questions about their health plans, actual understanding varied. Overall, about half (48%) answered 3 or 4 correctly. Enrollees generally understand deductibles and monthly premiums but are confused about out-of-pocket maximums and different prescription pricing. High Deductible plan members fared better, with 63% answering at least 3 out of the 4 statements correctly, compared to 44% of Traditional plan members.
Those with a household income under $50,000, those younger than age 45, urban dwellers, and men were more likely to answer these statements incorrectly than their counterparts. Those who purchased their health plan directly rather than through an employer and those more satisfied with their plan were also more likely to answer incorrectly.
HSAs are Often Confused with FSAs
Though reported familiarity with consumer driven health care plans remains high (66% of Traditional plan members and 76% of High Deductible plan members are at least somewhat familiar), other results suggest otherwise. When we asked why those offered a Health Savings Account (HSA) but did not open one why they did not open it, a top reason was disliking the “use-it-or-lose-it” rule, which does not apply to HSAs.
We also asked a series of True or False statements about Health Savings Accounts. We found that HSA literacy is worse than overall health plan literacy. Overall, only a quarter answered 3 or 4 correctly. Enrollees generally understand that an HSA can pay for expenses in retirement and about half know you don’t lose it if you leave your job. But fewer know the funds can be invested in mutual funds or that you cannot open one regardless of plan type. Not surprisingly however, High Deductible plan members were more likely to answer correctly, though knowledge is still low, with 32% correctly answering at least 3 out of the 4 statements correctly compared to 22% of Traditional plan members.
Those with a household income under $50,000, women, and those without a college degree were less knowledgeable about HSAs, as well as those in worse overall and mental health.
Employers Can Help Bridge the Gap
As we’ve seen in previous years of this survey, most enrollees spend less than two hours deciding on their health plan during open enrollment, including half who spend less than an hour.
Employees may not be giving their health plan selection the attention it needs. They generally feel satisfied with their selection process, including 62% who report feeling very or extremely satisfied with the information available to help them understand their choices. And we saw earlier that they felt they understood their choices well. Yet, we see a disconnect as they answer basic questions about their plans and coverage incorrectly.
Employers have an opportunity to do more to help their employees with their selection. Hopefully in the future, we’ll see employees spend more time choosing the right plan for them, leading to a higher level of knowledge of what their plan options cover and how they work.
About the Survey
The Consumer Engagement in Health Care Survey (CEHCS) is a survey of privately insured adults conducted by the Employee Benefit Research Institute (EBRI) and Greenwald Research, an independent research firm. The survey has been conducted annually since 2005. The CEHCS provides reliable national data on the growth of consumer-driven health plans and high-deductible health plans and their impact on the behavior and attitudes of health care consumers.
Organizations supporting this year’s study include Blue Cross Blue Shield Association, CareFirst, Cigna, HealthEquity, Inc., Inspira Financial, Johnson & Johnson, Segal, TIAA, and Wex.
The 2024 survey of 2,011 individuals was conducted using Dynata’s online research panel between Oct. 24 and Nov. 25, 2024. All respondents were between the ages of 21 and 64. The national sample is weighted by gender, age, income, ethnicity, education, and region to reflect the actual proportions in the population.
Major findings from the research are available here.
