High-Deductible Health Plans in Rural and Urban Populations: Outpatient Utilization and Out-of-Pocket Costs

This policy brief explores rural-urban differences in High-Deductible Health Plan (HDHP) enrollment, subsequent healthcare utilization, and out-of-pocket (OOP) costs.

Key Findings:

• HDHP enrollment was uncommon. Rural residents were slightly less likely to enroll than urban residents across all demographic groups.
• Switching plans influenced utilization. Compared to those who did not change healthcare plans, switching from a Traditional plan to a HDHP was associated with a larger reduction in 2022 outpatient visits for both rural and urban residents. Moving from a HDHP to a Traditional plan was associated with a smaller reduction in 2022 outpatient visits for both rural and urban residents.
• HDHPs increased OOP costs. Rural residents with lower outpatient utilization faced modestly higher costs than urban residents, while urban residents with the highest utilization incurred modestly higher costs than rural residents.