Impact of High Deductible Health Plans on Rural Populations

High deductible health plans (HDHPs) have become an increasingly prevalent form of private insurance coverage in the U.S. These plans typically have lower premiums but require members to pay thousands of dollars out-of-pocket before coverage kicks in. Rural residents may be disproportionately enrolled in HDHPs, and little research has evaluated the impact of HDHPs on access, treatment patterns, costs, and outcomes specifically for rural populations.

Investigators used Merative MarketScan commercial insurance claims data to analyze differences in utilization, spending, and care patterns between rural members enrolled in HDHPs compared to traditional plans. Rural residents were identified using metropolitan statistical areas. Outcomes included trends in the utilization rates of preventive services, care delays, medication adherence, out-of-pocket spending, avoidable emergency department visits, and hospitalizations before and after HDHP growth.

This analysis was one of the first studies to assess the effects of HDHP penetration on commercially insured individuals in rural areas. Findings can inform policy design efforts to balance HDHP cost containment through impacting health access and outcomes tailored to rural residents.

Publications

• High-Deductible Health Plans in Rural and Urban Populations: Outpatient Utilization and Out-of-Pocket Costs
  Policy Brief
  Rural and Underserved Health Research Center
  Date: 08/2026
  This policy brief explores rural-urban differences in High-Deductible Health Plan enrollment, subsequent healthcare utilization, and out-of-pocket costs.