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    The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders if their organization has seen more patient payments with health savings accounts (HSAs) due to increased high-deductible plans. The majority of respondents (59%) indicated yes, they have seen an increase in these payments, 19% have not and the remaining 22% were unsure. This poll was conducted on Feb. 12, 2019, with 803 applicable responses.

    Many respondents elaborated on the impact of high-deductible plans on medical practices and patient care. One respondent said, “It now sets expectations that patients will pay a portion of the deductible at time of service” to help improve collection of patient payments. Another participant outlined how their organization has adjusted: “We collect $60 from each patient who has a high deductible plan if they have not met the deductible … Then we bill, and if necessary, collect the difference …This helps with cash flow.”

    Data from the National Health Interview Survey describe the change in high-deductible health plans and HSAs from 2007 to 2017:

    • Enrollment in high-deductible health plans (HDHPs) with a health savings account (HAS) increased from 4.2% to 18.9% among adults 18–64 with employment-based coverage. Likewise, it increased from 10.6% to 24.5% for those without an HSA in that age group. Conversely, enrollment in traditional plans decreased.
    • Enrollment in an HDHP with an HSA was higher among adults 30–44 (21.0%) than among those 18–29 (16.8%) and 45–64 (18.4%).
    • Enrollment in HDHPs with an HSA increased as family income level and educational attainment increased; whereas, the percentage enrolled in traditional plans and HDHPs without an HSA decreased.

    Of those who indicated that they have not seen an increase in these payments, the most common response was that the patients they see cannot afford to pay their deductibles, so the respondents’ practices will not collect them. Due to high deductible plans, others said that their patients use payment plans, instead of FSAs or HSAs.

    A recent article on ValuePenguin explains why it is difficult for patients to get HSAs. According to IRS rules, many patients with high-deductible health plans do not fit the criteria to receive an HSA. “In actuality, few are HSA-eligible, because the IRS specifies …that ‘except for preventive care, [the] plan may not provide benefits for any year until the deductible for that year is met.’ That means that a slightly more generous plan, which pays for any portion of things like prescription drugs or specialist visits or an X-ray (with or without a co-pay or co-insurance) before the deductible is met is not HSA-eligible”. That said, practices may not have seen an increase in HSAs due to patients receiving extra assistance when paying for their high-deductible health plans.

    MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. See results of other polls and information on how to participate in MGMA Stat.


    • Cohen, R. A. (2018, August). High-deductible Health Plan Enrollment Among Adults Aged 18–64 With Employment-based Insurance Coverage. Accessed from:
    • Why Most People with High-Deductible Health Plans Can’t Get a Health Savings Account (HSA). Accessed from:



    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit Polls will be sent to your phone via text message.

    Erica Betz
    Project Analyst

         Sarah Taylor
    Project Assistant   

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