A health risk assessment (HRA) is a questionnaire that collects information about your health habits, personal history, and current symptoms to identify risk factors you can actually change. It’s one of the most common tools in workplace wellness programs and preventive healthcare, used by employers, insurers, and Medicare to flag potential health problems before they become serious. The goal isn’t diagnosis. It’s a starting point for understanding where your health stands and what steps might improve it.
What an HRA Typically Asks
Most health risk assessments cover a consistent set of topics, though the specific questions vary depending on who’s administering them. You’ll typically answer questions about tobacco use, physical activity, nutrition, alcohol consumption, stress levels, and sleep. Many also ask about your family medical history, current medications, and whether you’ve had recommended screenings like colonoscopies or mammograms.
For Medicare beneficiaries receiving an Annual Wellness Visit, the Centers for Medicare and Medicaid Services requires a more detailed assessment. That version collects demographic data, a self-assessment of your overall health status, and screens for psychosocial risks like depression, loneliness, social isolation, stress, and fatigue. It also asks about your ability to handle daily tasks on your own, from dressing and bathing to managing medications, handling finances, and preparing meals. These functional questions help providers spot early signs of decline that might otherwise go unnoticed between visits.
Starting in 2024, comprehensive risk assessment tools used in certain Medicare plans must also include questions about housing stability, food security, and access to transportation. These social factors have a measurable impact on health outcomes, and asking about them helps connect people with resources they might not have thought to request.
Where You’re Likely to Encounter One
The two most common settings for HRAs are the workplace and the doctor’s office. Employers frequently include them as part of wellness programs, often tied to health insurance. Your company might ask you to complete one during open enrollment or as a condition for earning a wellness incentive. In clinical settings, your primary care provider may use one during an annual checkup or, for Medicare patients, during the Annual Wellness Visit.
Some health insurers also send HRAs directly to members, either online or by mail. The results feed into personalized recommendations, like suggesting a smoking cessation program or a diabetes prevention class.
How Workplace Incentives Affect Participation
Left to their own choice, most employees skip the HRA. A U.S. Department of Labor analysis found that without incentives, the median participation rate was just 20 percent. Offering a financial reward roughly doubled that to 40 percent. The most effective motivator, by a wide margin, was a penalty for not participating: employers using surcharges saw median participation climb to 73 percent.
The size of these incentives varies considerably. The median annual reward an employee could earn was $189, though some multi-year programs offered up to $3,500. On the penalty side, the median surcharge was $312, with some programs charging as much as $2,600 over multiple years. One large employer introduced a $600 surcharge specifically for smokers who declined a cessation program and for employees eligible for disease management who chose not to participate.
What Happens After You Complete One
Once you finish an HRA, you typically receive a summary of your risk factors along with recommendations. This might include suggestions to increase physical activity, schedule an overdue screening, or enroll in a chronic disease management program. In clinical settings, the results become part of your medical record and can shape an individualized care plan your provider develops with you.
The CDC has described this as the “HRA Plus process,” which goes beyond the questionnaire itself to include follow-up activities and ongoing monitoring of progress toward health goals. The idea is that the assessment alone isn’t enough. It needs to connect you with specific, evidence-based programs that help you actually make changes. The CDC framework also emphasizes that HRAs and their follow-up interventions should be culturally and linguistically appropriate and accessible to people with disabilities.
Do HRAs Actually Change Behavior?
The honest answer is: modestly, at best. A study published in Health Affairs compared people who completed an HRA with a similar group that wasn’t offered one. Completers increased their monthly office visits by about 3 percent and filled slightly more prescriptions (a 4 percent increase). Cervical cancer screening rates went up among those who took the assessment. But emergency room visits didn’t change, and participation in disease management programs for chronic conditions showed no significant increase.
That last finding is notable. Simply telling someone they’re at risk for a chronic condition and providing general information about treatment doesn’t appear to be enough to get them into a structured management program. The assessment identifies the risk, but bridging the gap between awareness and action requires more sustained support.
Accuracy and Limitations
Because HRAs rely on what you report about yourself, their accuracy depends on your memory and honesty. Research comparing self-reported health data with medical records has found inconsistent agreement between the two. People tend to report higher rates of most chronic conditions than what shows up in billing records, with the exception of cancer. Recall bias is a real concern: you might forget a diagnosis, misremember when symptoms started, or not realize that a condition you were told about years ago still applies.
This doesn’t make HRAs useless, but it means they work best as screening tools rather than definitive assessments. They flag areas worth investigating, not confirmed diagnoses. A provider who reviews your HRA results should follow up with clinical measurements, lab work, or further evaluation when something looks concerning.
Privacy Protections for Your Responses
HRA data is protected health information, which means it falls under HIPAA’s privacy and security rules. But there’s an additional layer of protection that many people don’t know about. The Genetic Information Nondiscrimination Act (GINA) places strict limits on what health plans can ask in an HRA, particularly around genetic information and family medical history.
Here’s the key rule: if an employer or insurer offers a reward for completing an HRA, that assessment cannot ask for genetic information, including family medical history. A plan can include family history questions on an HRA, but only if no incentive is attached to completing it and the request isn’t made before or during enrollment. If the HRA might incidentally collect health information that touches on genetics, it must explicitly state that genetic information should not be provided. Any genetic details submitted despite that warning fall under an “incidental collection” exception, but they still cannot be used for underwriting, which includes determining eligibility, setting premiums, or adjusting deductibles.
These rules exist because the definition of “underwriting purposes” is broad. It covers not just traditional pricing decisions but also changes to cost-sharing tied to wellness program activities. So a plan that adjusts your deductible based on HRA completion is still engaged in underwriting under the law, and GINA’s genetic information restrictions apply.
Getting the Most From Your HRA
Answer honestly. The assessment is only as useful as the information you put into it. If you underreport alcohol use or skip the questions about stress and mood, the resulting recommendations won’t reflect your actual situation. If the HRA is part of a workplace program, your employer generally receives only aggregate data about the workforce, not your individual answers.
Pay attention to the follow-up. The value of an HRA isn’t in the questionnaire itself but in what happens next. If your results flag elevated risk for diabetes or cardiovascular disease, that’s information you can bring to your next medical appointment. If your employer offers coaching, nutrition programs, or subsidized gym memberships as part of the wellness program, those resources exist specifically because HRA data showed employees could benefit from them. The assessment opens a door, but walking through it is up to you.