This year, 19 percent of workers with insurance from an employer were enrolled in a high-deductible plan, more than double the percentage from just three years ago, according to the Kaiser Family Foundation. And these plans now have edged out HMOs as the second-most-popular option offered by U.S. employers, benefits consultant Aon Hewitt reports.
Studies suggest that these plans reduce health care costs at least initially.
"They are seeing a savings. The question is why and if it's sustainable," said Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute. "The jury is still out."
With employers seeing health care costs rise year after year, though, more are willing to try high-deductible plans. Some employers are beginning to make this their only choice.
High-deductible plans sprang up in the late 1990s, partly in response to the public revolt against health maintenance organizations, which were seen as limiting access to needed care, according to a report released last month by the Robert Wood Johnson Foundation.
Health savings accounts started to appear in 2004. Employees can contribute untaxed money into this account and use it later to pay deductibles and other medical expenses. About one-third of employers add money to workers' accounts, according to an Aon Hewitt survey.
For 2013, the most that can be contributed to a health savings account is $3,250 for an individual and $6,450 for those with family coverage.
Any money unused at the end of the year remains in the account, where it can earn interest or be invested. When employees leave the company, they can take the money with them.
Health savings accounts are different from flexible spending accounts, another popular option in which employees set aside money for health expenditures but the cash must be spent annually or it's forfeited.
Under federal rules, plans paired with a health savings account must have a deductible next year of at least $1,250 for an individual and twice that for family coverage. Kaiser reported this year that the average deductible for a plan with a health savings account was $2,190 for an individual, and $4,068 for a family.
Some plans will pick up the full cost of coverage once the deductible is met, while others require workers to pay a certain percentage of their medical bills until they hit a cap. Next year, the maximum out-of-pocket expense will be $6,250 for an individual and twice that for families.
Some employers offer a health reimbursement arrangement instead, which follows different rules. The employer contributes money annually on behalf of workers, and the company keeps any balance left over once employees leave.
High-deductible plans often are called consumer-directed health plans, a name that implies patients will question their doctors on whether a test is really necessary or insist on generics over brand-name drugs.
Initial surveys suggest the plans do change behavior somewhat although maybe not as intended.
The RAND Corp. reported in a study released last year that compared to others, consumers spent on average of 14 percent less on health care the first year that they switched to a high-deductible plan.
Most of the savings comes from people going to the doctor less often, while the rest came from consumers managing their care, such as asking for generic drugs, said Amelia Haviland, an associate professor at Carnegie Mellon University and an author of the RAND study.
One troubling sign: The study found that consumers in high-deductible plans cut back on preventive care, such as childhood vaccinations and cancer screenings, even when these services were fully covered by insurance. The study concluded that there may be confusion over the plans.
That could signal problems in the future.
"It might seem like you have lower costs in one year," said Cheryl Fish-Parcham, deputy director of health policy for the advocacy group Families USA. "Your employees haven't used services that year. It doesn't mean that their health didn't get worse. You might have higher costs showing up down the line."