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 will use 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 will be identified using metropolitan statistical areas. Outcomes will include 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 will be 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.