One trend in health plan design that has continued to gain popularity is consumer-driven health care, including defined-contribution health plans intended to make employees more conscious and responsible for the cost of their health care. In its simplest form, the employer provides a fixed sum for the employee to buy insurance on his or her own. Under another scheme, the employer provides a voucher for a fixed sum per year for health coverage and allows the employee to choose from an array of less- to more-expensive plans.

Hybrid defined-contribution plans combine a high-deductible plan with a tax-exempt medical expense savings account that could cover the deductible, copayments, or the cost of out-of-network care. Another type of plan provides a fixed sum for routine care and a high-deductible insurance plan to cover major illnesses.

Currently, health savings accounts (HSAs), health reimbursement arrangements (HRAs), and medical savings accounts (MSAs) are the three types of tax-favored consumer-directed plans that have legal authorization. While HSAs and MSAs require coverage under a high-deductible health plan (HDHP), HRAs are also frequently coupled with an HDHP.