High-deductible health plans are popular among employers, but reports of adverse health and economic outcomes associated with such plans raise questions about how much saving they achieve after accounting for future health spending. Using a microsimulation model informed by national data from 2,160 employers and 48,300 individuals with employer-sponsored health insurance coverage, we estimated the cost to employers and members of transitioning from high-deductible to standard preferred provider organization health plans, both over the duration of employment and over the members’ life-course. The model accounted for the healthier profile of those typically selecting high-deductible plans, and the estimated cost and health implications of switching plans on common conditions including diabetes, cardiovascular disease and cancer. We found that switching away from high-deductible plans is expected to inconsistently affect employers due to the degree of Health Savings Account seed funding that can neutralize cost savings of high-deductible plans for some employers. Yet switching to preferred provider organization plans during employment would be expected to save Medicare after employment, due to averted long-term disease complications due to higher medication and preventive screening adherence on preferred provider plans than on high-deductible plans.

Sanjay Basu1,2,3*, Seth A. Berkowitz4, Russell S. Phillips1,5, Zirui Song1,6,7, Aaron Baum8, Bruce E. Landon1,5,6

1 Center for Primary Care, Harvard Medical School, Boston, Massachusetts

2 Research and Analytics, Collective Health, San Francisco, California

3 School of Public Health, Imperial College, London, United Kingdom

4 General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina

5 Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

6 Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts

7 Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts

8 Arnold Institute for Global Health, Mount Sinai School of Medicine, New York, New York

*[email protected]