That's interesting data. Thanks for sharing it. In the 2017 snapshot, I'm surprised to see that HDHP plans are slightly more common for high-income families. I didn't expect that.

There's a missing variable here: What are the premiums? HDHPs are attractive to insurers (and by extension employers) because they increase employee sensitivity to healthcare costs and may lead to less wasteful spending. Advocates emphasized that the savings on premiums could be passed on employees as HSA contributions [1]. But as that chart shows, a quarter of Americans have an HDHP without an HSA, and at every point most HDHPs haven't come with an HSA. Are employers just keeping the premium savings? Or have rising healthcare costs meant that the savings haven't materialized?

[1]: https://www.wsj.com/articles/SB10001424052970204251404574342...

I imagine it's because it provides a way to sock away $7k each year in a retirement fund that can be invested in index funds and won't get taxed after 65 on qualified medical expenses making it more valuable than either traditional or Roth IRAs that get taxed on withdrawal and when you put the money in respectively. High-income families have the spare cash to do that, so for them it's a valuable investment vehicle.

My wife's employer covers our family under an HDHP. Our out of pocket cost is 0. Our plan requires us to have an HSA, though I don't thinkone is required to contribute to it. We contribute the max $ to our HSA each year.

A more traditional plan would run us about $4-5 thousand annually in payroll deductions. Most years we spend far less than our HSA contributions and can roll that money over year to year and even invest it. The one year she needed major surgery, we hit out OOP max and probably spent about $10,000 total from our HSA.

Probably our biggest risk exposure would be if one of us needed to take an expensive prescription since I don't think there is any annual limit on those costs.