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Health plan costs - misc

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Administration Plans to Require Hospitals to List 'Shoppable' Prices
"Hospitals could be required to provide prices in an 'easy-to-read, patient-friendly format' before they provide services to patients under rules that will be proposed in an executive order signed by President Donald Trump.... [HHS] Secretary Alex Azar said the order would 'put American patients in control and address the fundamental drivers of high American healthcare costs.' " (FierceHealthcare)
New Executive Order May Make More Health Care Prices Public
"The White House will release an executive order Monday afternoon intended to require insurance companies, doctors and hospitals to give patients more information about precisely what their care will cost before they get it.... Exactly what information hospitals and insurers will have to disclose is not specified in the executive order ... White House officials said the details would be worked out during the rule-making process. Hospitals and insurance companies are likely to lobby to make any disclosures as general as possible." (The New York Times; subscription may be required)
U.S. Supreme Court Takes Up Insurers' $12 Billion Obamacare Dispute
"The U.S. Supreme Court on Monday agreed to decide whether the federal government must pay insurers $12 billion under an Obamacare program aimed at encouraging them to cover previously uninsured people after the healthcare law was enacted in 2010. The justices will hear an appeal by a group of insurers of a lower court ruling that Congress had suspended the government's obligation to make the payments. The insurers have argued that the ruling would allow the government to pull a 'bait-and-switch' and withhold money they were promised." [Maine Community Health Options v. U.S., Nos. 17-2395 (Fed. Cir. Jul. 9, 2018; cert. granted Jun. 24, 2019)] (Reuters)
[Guidance Overview] Health Care-Related Expiring Provisions of the 116th Congress, First Session
44 pages. "This report describes selected health care-related provisions that are scheduled to expire during the first session of the116th Congress (i.e., during calendar year 2019).... This report generally focuses on two types of health care-related provisions ... The first type of provision provides or controls mandatory spending, meaning that it provides temporary funding, temporary increases or decreases in funding ... or temporary special protections that may result in changes in funding levels ... The second type of provision defines the authority of government agencies or other entities to act, usually by authorizing a policy, project, or activity. Such provisions also may temporarily delay the implementation of a regulation, requirement, or deadline, or establish a moratorium on a particular activity." [Report R45781, June 21, 2019] (Congressional Research Service [CRS])
More Work Needed to Shift Health Care Spending from Low-Value to High-Value Care
"[S]pending growth on the five frequently-cited, low-value services remained mostly flat (slower than the growth in total health care spending). Meanwhile, spending on the high-value services increased only moderately, with spending on three of the analyzed services ... growing faster than total health care spending. Though this is moving in the right direction, there is much more work to be done." (Altarum Institute)
President Trump to Issue Executive Order on Health Care Price Transparency
"The order will direct federal agencies to initiate regulations and guidance that could require insurers, doctors, hospitals and others in the industry to provide information about the negotiated and often discounted cost of care ... Consumers and employers will benefit because pulling back the secrecy around the prices will allow them to shop for lower cost care and benefits, advocates say. But industry groups including hospitals and insurers have balked at the idea, saying it could cause costs to climb if some businesses learn competitors are getting bigger discounts." (The Wall Street Journal; subscription may be required)
Awaiting the Supreme Court on Risk Corridors
"We may learn the Supreme Court's decision on June 24. If the Court accepts the appeal, the case would be considered during the next term, which begins in October and runs through summer 2020.... If the Supreme Court does not accept the appeal, the case would be over and insurers would not recoup the more than $12 billion in unpaid risk corridor payments.... [T]his would likely have implications for litigation over unpaid cost-sharing reduction payments (CSRs) and could bolster the conclusion that insurers are entitled to these payments." (Katie Keith, in Health Affairs)
With Expected 6% Rise in Health Costs, 2020 May Be Year of 'Activist' Employer
"Employers' desire to more effectively manage healthcare spend previously meant shifting more and more costs to employees. However, continuing that trend is untenable ... and both employers and employees report dissatisfaction with high-deductible health plans." (FierceHealthcare)
Medical Cost Trend: Behind the Numbers 2020 (PDF)
"PwC's Health Research Institute (HRI) projects a 6 percent medical cost trend in 2020, a slight uptick over the past two years. After figuring in health plan changes, such as increased employee cost sharing and network and benefit changes, HRI projects a net growth rate of 5 percent.... Between 2020 and 2027, retail drug spending under private health insurance is projected to increase at a rate of 3 percent to 6 percent a year ... Obesity and Type 2 diabetes continue to produce high rates of hypertension and cardiovascular disease.... Nearly 75 percent of employers offer mental health disease management programs. Anytime access is expanded, costs will go up in the short term." (PwC)
An Examination of Surprise Medical Bills and Proposals to Protect Consumers from Them
"[This analysis uses] claims data from large employer plans to estimate the incidence of out-of-network charges associated with hospital stays and emergency visits that could result in a surprise bill.... For people in large employer plans, 18% of all emergency visits and 16% of in-network hospital stays had at least one out-of-network charge associated with the care in 2017." (The Peterson-Kaiser Health System Tracker)
Stop-Loss Coverage by the Numbers
"Two primary diagnoses accounted for more than 40% of all claims of $1 million or more in 2018 ... Average stop-loss premium increases have been higher at lower specific deductible policy levels in recent years. Most plans that bid or renewed their stop-loss insurance stayed with the incumbent insurer." (Segal Consulting)
Senate HELP Committee Hearing: Lower Health Care Costs Act
June 18 hearing on Draft Bill. Page includes video of hearing along with links to testimony by: [1] Sean Cavanaugh, Aledade; [2] Benedic N. Ippolito, American Enterprise Institute; [3] Elizabeth Mitchell, Pacific Business Group on Health; [4] Tom Nickels, American Hospital Association; [5] Frederick Isasi, Families USA; [6] Marilyn Bartlett, Office of the Montana State Auditor. (Committee on Health, Education, Labor and Pensions, U.S. Senate)
Senate HELP Committee Releases Sweeping Legislative Package Targeting Health Care Costs
"Entitled the 'Lower Health Care Costs Act,' the Draft Bill ... takes aim at so-called 'surprise' balance medical bills ... The Draft Bill also proposes a number of measures addressing prescription drug costs, price transparency, and certain public health initiatives.... [T]he efforts to address surprise balance billing have the most widespread support ... Congress could conceivably pass some form of surprise balance billing relief on a stand-alone basis." (Groom Law Group)
Senators Agree Surprise Medical Bills Must Go -- But How?
"Two years, 16 hearings and one massive bipartisan package of legislation later, a key Senate committee says it is ready to start marking up a bill next week designed to contain health care costs. But it might not be easy since lawmakers and stakeholders at a final hearing [on June 18] showed they are still far apart on one simple aspect of the proposal. That sticking point: a formula for paying for surprise medical bills[.]" (Kaiser Health News)
CalPERS Announces Increase in Average Health Care Premiums for 2020
"The CalPERS Pension and Health Benefits Committee [on June 18] approved the health plan rates for 2020, at an overall average premium increase of 4.65 percent. The action also included two health plan changes." (California Public Employees' Retirement System [CalPERS])
[Guidance Overview] Agencies Expand HRA Availability to Provide Coverage
"The final regulations, which will become effective January 1, 2020, provide for two new types of HRAs.... [1] Excepted Benefit HRAs ... There are four requirements that must be satisfied under the regulations for an HRA to qualify as an excepted benefit HRA ... There are no special notice requirements for excepted benefit HRAs, although they will be subject to ERISA's disclosure requirements.... [2] Individually Integrated HRAs ... Current regulatory guidance prohibits employers from offering HRAs that reimburse employees for the cost of individual health coverage ... The regulations ... remove that prohibition if [certain requirements] are satisfied." (The Wagner Law Group)
[Opinion] The Cadillac Tax: It's Time To Kill This Policy Zombie
"[P]olicy makers should incentivize employers to strengthen rather than cut their support for workers' and dependents' health insurance. Lawmakers increasingly realize the need to change direction, as suggested by the bipartisan majority of House members and more than a third of the country's senators who are now co-sponsoring 2019 legislation that would repeal the Cadillac tax. Abundant evidence shows the need for this change." (Stan Dorn, in Health Affairs)
Texas Is Latest State to Attack Surprise Medical Bills
"Texas is now among more than a dozen states that have cracked down on the practice of surprise medical billing.... Under the new law, insurance companies and medical providers can enter into arbitration to negotiate a payment -- and state officials would oversee that process." (Kaiser Health News)
[Official Guidance] Text of CMS Potential HHS-HCC Updates for Risk Adjustment Program (PDF)
51 pages. "The HHS risk adjustment model uses patient diagnoses and demographic information ... to predict plan liability for medical and drug spending.... [This paper describes the CMS] methodology for reviewing and restructuring the HHS-HCC classification to incorporate ICD-10 diagnosis codes, using the 2016 and 2017 benefit years masked enrollee-level External Data Gathering Environment (EDGE) claims data[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Guidance Overview] CMS Releases 2020 Medicare Part D Benefit Parameters
"Increases in the standard benefit parameters range from approximately 4.8% to 5.9%, with the OOP threshold increasing by 24.5%. Plan sponsors that want to remain qualified for the employer retiree drug subsidy will have to determine if their 2020 prescription drug coverage is at least actuarially equivalent to the standard Medicare Part D coverage." (Buck)
[Opinion] U.S. Chamber Letter to Senators on the Lower Health Care Costs Act
"[T]he Chamber strongly supports efforts to protect patients from surprise bills while providing certainty for payers and employers. Equally important, any solution should preserve and encourage market-based negotiations." (U.S. Chamber of Commerce)
[Opinion] Trump Administration Gets Smart on Pre-Existing Conditions
"The final rule ... enhances portability by allowing employers to give their workers a (tax-free) contribution to an HRA, so employees can buy the plan that works best for them. If there's any difference between the employer's contribution and the total premium -- for instance, an employer contributes $300 per month, and the worker selects a plan with a $350 monthly premium -- the worker can pay the difference on a pre-tax basis, so long as he purchases the plan outside of the Obamacare exchanges. Best of all, because employees own the plans and not the employer, they can keep their coverage when they change jobs." (The Federalist)
Final Rules Ease Restrictions on Health Reimbursement Arrangements
"The changes aim to ease mostly small and mid-size employers' ability to subsidize health coverage and include guardrails to protect the individual market. For larger employers, the rules create interesting opportunities to subsidize on a tax-favored basis individual health insurance for certain cohorts of employees -- such as part-timers -- who may not currently be eligible for their employer's group health plan." (Mercer)
[Opinion] The Trump Administration's Newest Health Care Rule
"A broad shift to HRAs could resemble the movement in retirement benefits from defined benefit pensions to 401(k) plans, where employers make fixed contributions instead of promising a set benefit for years in the future. A similar change in health coverage would give businesses more predictable costs while shifting the risk of higher healthcare expenses onto workers. It's all about money and determining or deflecting risk." (Business Forward)
Larger HSA Balances Result in Increased Use of Health Care Services and Spending (PDF)
"The average HSA balance more than doubled between 2014 and 2016 among enrollees with employee-only coverage.... Individuals with $3,000 or more in their HSA at the beginning of the year made an additional 50 visits to primary care physicians and specialists per 100 plan enrollees. Their spending was about $20 higher for primary care office visits and $28 higher for specialist visits. Spending associated with outpatient services was $551 higher." (Employee Benefit Research Institute [EBRI])
Providers Push Arbitration Approaches Used in Some State Surprise-Bill Laws
"As healthcare industry advocates and legislators clashed over draft federal legislation to end such billing disputes, both sides highlighted state experiences they viewed as bolstering their preferred approach. The major differentiator among state laws and competing federal proposals remains the method used to determine provider payment." (Healthcare Financial Management Association [HFMA])
States Continue to Make Efforts to Lower Health Care Prices Paid by Private Insurers
"States, which can often legislate more rapidly and with more flexibility than the federal government, can thus serve as important laboratories to inform federal action. [This article discusses] approaches states are taking: [1] targeted price regulation, [2] promoting competition, and [3] investing in alternative payment models." (The JAMA Network)
Senate Package Targets Healthcare Costs, Surprise Medical Bills
"A broad array of proposed reforms aims to lower drug prices, increase transparency, foster greater electronic exchange of health information and improve public health. The provisions targeting surprise medical bills and drug prices join a growing list of similar proposals in Congress." (Mercer)
House Energy and Commerce Committee Hearing: No More Surprises -- Protecting Patients from Surprise Medical Bills
Page includes video of the hearing, along with Memorandum from Chairman Pallone to the Subcommittee on Health, opening statement from Chairman Pallone, and opening statement of Subcommittee Chair Eshoo, along with testimony from: [1] Sonji Wilkes, Patient Advocate; [2] Sherif Zaafran, MD, FASA, Physicians for Fair Coverage; [3] Rick Sherlock, Association of Air Medical Services; [4] James Gelfand, The ERISA Industry Committee; [5] Thomas Nickels, American Hospital Association; [6] Jeanette Thornton, America's Health Insurance Plans; [7] Claire McAndrew, Families USA; and [8] Vidor E. Friedman, MD, FACEP, American College of Emergency Physicians. (Energy & Commerce Committee, U.S. House of Representatives)
Recent Trends in Stop Loss Claims
"The largest single Sun Life claim was $7.5 million and the largest injectable drug claim was $1.8 million. Injectable drugs account for 9.2% of the total cost of large cost claims. Cancer claims continue to dominate with almost 27% of claims paid. In 2018, 85% of policies have had some reimbursement, with 51.9% of employers submitting at least one cancer claim." (Frenkel Benefits)
[Opinion] American Benefits Council Letter to Senate HELP Committee on Lower Health Care Cost Act (PDF)
"[T]he Council supports the use of the benchmark payment methodology ... [T]he use of the in-network guarantee could materially disrupt the ability of plans and issuers to negotiate with potential network providers ... The Council believes that the use of a mandatory [independent dispute resolution] process would continue to impose on plans and issuers -- as well as providers -- significant administrative inefficiencies, unnecessary costs, and unpredictable outcomes." (American Benefits Council)
Considerations for the Self-Insured Health Plan Sponsor When Negotiating a Trend Guarantee in Your Next TPA Selection
"Provider discount analyses are generally thought to do a reasonable job of estimating the expected change in discount upon switching TPAs, but there are several caveats to consider when interpreting the results ... Though employers may intuitively expect that the use of [medical] trend guarantees will make the analysis simpler (i.e., take the bidding TPA that guarantees the lowest trend), there are many issues to consider for the self-funded employer ... TPAs offering trend guarantees will also attempt to control their exposure via reference to [certain listed] issues[.]" (Milliman)
Can the World's Biggest Companies Save Health Care?
"Can the frictionless consumer experience we now have in banking, retail, and entertainment be achieved in health care? Can the data generated by our digital devices -- combined with greater penetration of electronic health records (EHRs) -- lead to better patient outcomes and improved efficiencies? ... Aligning incentives could improve clinical trials ... Consumers could become more closely connected to their health data ... Web searches could lead to patient-specific insight." (Deloitte)
[Opinion] Employer Coalition Comments on Senate HELP Health Costs Draft Legislation (PDF)
"We support the draft proposal to prohibit balance billing for all emergency services.... We support requiring providers to give patients receiving scheduled care written and oral notice at the time of scheduling about the provider's network status and any potential charges for out-of-network care ... We believe the best option for resolving surprise medical bills is through a benchmark payment system.... We support the proposition that all providers in an in-network facility must accept the in-network rate.... We oppose the utilization of an arbitration system to settle payment disputes." (Partnership for Employer-Sponsored Coverage [PESC])
[Opinion] Surprise Billing: No Surprise in View of Network Complexity
"[T]he current debate has largely missed two other important problems related to provider networks: inaccurate provider directories and inadequate provider networks. These problems are inherently complex, harder to turn into news stories, and defy simple solutions. Yet, they also affect a much larger number of Americans' financial and physical well-being than does surprise billing." (Simon F. Haeder, David L. Weimer, and Dana B. Mukamel, in Health Affairs)
Health Care Cost-Mitigation Options for Large Employers
"[1] Value-based care, utilizing alternative payment models ... [2] High-performance but narrower networks ... [3] Direct contracting and reference-based pricing ... [4] Adoption of direct primary care or worksite clinics ... [5] Pharmaceutical procurement strategies ... [6] Defined control of J-coded medications and infusions." (CBIZ)
Plan Sponsors Say Educating Employees About HSAs Is Top Concern
"A quarter of organizations encourage or offer additional education to employees who do not contribute to the HSA or only contribute a nominal amount. The average participant contribution in 2018 was $2,595 and the average account balance at the end of 2018 was $5,239. The vast majority of responding organizations (85.6%) offer investment options for HSA contributions, though three-quarters require a minimum balance of at least $1,000 to invest assets beyond money market funds or cash." (Plan Sponsor Council of America [PSCA])
Effects of Alternative Insurer Responses to Discontinued Federal Cost-Sharing Reduction Payments: Broad Loading as an Alternative to Silver Loading
"Under a scenario in which CSR payments are restored, the authors estimate that the total number of insured and the number of individual market enrollees would fall relative to the status quo, but that enrollment would be higher than under a broad loading scenario.... Broad loading leads to higher premiums for bronze, gold, and platinum plans and decreases premiums for silver plans relative to silver loading. With broad loading, nonsilver plans with relatively few enrollees must pay CSR costs formerly covered by silver plans with many more enrollees. That means the per capita cost increases for the former are relatively large, while the per capita savings of the latter are relatively small." (RAND Corporation)
[Official Guidance] Text of CMS Change to Risk Adjustment Holdback Policy for the 2018 Benefit Year and Beyond (PDF)
"Beginning with the 2018 benefit year and beyond, there are two new aspects to the HHS-operated risk adjustment program that can be appealed: risk adjustment data validation (RADV) results and the high-cost risk pool (HCRP) transfers.... CMS is finalizing the proposed change and, beginning with the 2018 benefit year, will release the holdback amounts without regard to any pending appeals and make any necessary post-calculation adjustments in the event an appeal is successful." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Official Guidance] Text of CMS Memo on 2016 HHS-RADV Results (PDF)
23 pages. "The 2017 benefit year HHS-RADV results will be used to adjust 2018 benefit year risk adjustment plan liability risk scores, resulting in an adjustment to 2018 benefit year risk adjustment transfer amounts. This memo ... contains an overview of the HHS-RADV error rate methodology, a summary of the 2017 benefit year HHS-RADV results, and information to assist issuers in understanding their results. On August 1, 2019, CMS anticipates releasing a report reflecting how these results will adjust 2018 benefit year risk adjustment transfers."
  • Appendix A: Program Benchmark Metrics 2017 Benefit Year HHS-RADV [XLSX]
  • Appendix B: Estimated 2018 RA Market Weighted Average Risk Score Adjustment from 2017 RADV [XLSX]
  • Appendix C: Estimated 2017 RA Market Weighted Average Risk Score Adjustments from 2017 HHS-RADV (Exiting Issuers) [XLSX]
  • Appendix D: 2017 Benefit Year HHS-RADV HCC Group Definition [XLSX]
(Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Can Our Health Plan Require Cost-Sharing for Out-of-Network Lactation Counseling?
"As preventive services, prenatal and postnatal lactation support, counseling, and equipment rental must be covered without cost-sharing ... [P]articipants must be able to access required preventive services from in-network providers.... [If] a plan's network does not include a provider who offers a particular preventive service, the plan must cover the service without cost-sharing when performed by an out-of-network provider." (Thomson Reuters / EBIA)
Health Plan Deductibles Triple in 10 Years
"Between 2008 and 2018, the deductibles in employer health plans more than tripled -- growing much faster than earnings.... [Deductibles] now exceed $3,000 for individuals and $5,000 for families in the highest-deductible plans. Add to that a 50 percent hike in premiums during that time. Some 156 million people get health insurance through work ... They blame rising medical costs on insurers and pharmaceutical companies -- and not their employers and healthcare providers[.]" (Squared Away Blog, by the Center for Retirement Research at Boston College)
Bill Would Require Health Benefit Brokers to Disclose Compensation
"The Lower Health Care Costs Act was introduced by Sen. Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash. The bill takes aim at a number of issues, including surprise medical bills, high drug prices and public health problems. The bill also would create more transparency around pharmacy benefit managers to ensure they are passing along discounts on drugs to customers." (
Administration Preparing Executive Order on Health-Cost Disclosure
"President Trump is expected to release an executive order as early as next week to mandate the disclosure of prices in the health-care industry ... The order could direct federal agencies to pursue actions to force a host of players in the industry to divulge cost data ... The administration is also looking at using agencies such as the Justice Department to tackle regional monopolies of hospitals and health-insurance plans over concerns they are driving up the cost of care[.]" (The Wall Street Journal; subscription may be required)
Network Matching: An Attractive Solution to Surprise Billing
"One solution to most instances of surprise billing is to simply eliminate the possibility of being treated by an out-of-network emergency, ancillary, or similar clinician at an in-network facility.... [O]ne approach ... would require these facility-based clinicians to contract with every health plan that the facility at which they practice accepts (or alternatively, choose to secure payment from the hospital rather than insurers)." (The Brookings Institution)
How Much U.S. Households with Employer Insurance Spend on Premiums and Out-of-Pocket Costs: A State-By-State Look
"The median, or midpoint, of annual household spending on employer insurance premium contributions ranged from $500 (Hawaii) to $3,400 (South Dakota) in 2016-2017. In 11 states, households in the top 10 percent of spending on premium contributions paid $9,000 or more.... Median annual out-of-pocket spending on medical care ranged from $360 (Hawaii) to $1,500 (Nebraska). In four states, households in the top 10 percent of out-of-pocket expenses spent $7,000 or more on these items.... The median amount spent on both premiums and out-of-pocket costs ranged from $1,500 (Hawaii) to $5,540 (South Dakota)." (The Commonwealth Fund)
Are Surprises Ahead for Legislation to Curb Surprise Medical Bills?
"[P]policymakers agree on the need to take patients out of the middle of the fight over charges, but crafting a legislative solution will not be easy. A hearing of the House Ways and Means health subcommittee [on May 21] quickly devolved into finger-pointing as providers' and insurers' testimony showed how much they don't see eye to eye.... As Congress weighs how to address the problem, here's a guide to the bills and what to watch." (Kaiser Health News)
House Ways and Means Committee Hearing: Protecting Patients from Surprise Medical Bills
May 21 hearing. Testimony from: [1] The Honorable Katie Porter (D-CA); [2] The Honorable Cathy McMorris Rogers (R-WA); [3] James Patrick Gelfand, ERISA Industry Committee (ERIC); [4] Tom Nickels, American Hospital Association (AHA); [5] Jeanette Thornton, America's Health Insurance Plans (AHIP); [6] Dr. Bobby Mukkamala, American Medical Association (AMA). (Committee on Ways and Means, U.S. House of Representatives)
Breaking Down the Bipartisan Senate Group's New Proposal to Address Surprise Billing
"[A] bipartisan group of senators [has] released new legislation to address surprise medical bills ... by prohibiting balance billing for categories of services where surprise bills commonly arise and prescribing an initial payment from insurers tied to median in-network rates, with the option for providers or insurers to initiate an arbitration process to challenge this rate. By tying automatic payment to the insurer's median in-network rate ... the [STOP Surprise Medical Bills Act] could reduce health care costs as well, although the existence of arbitration as a backstop makes that uncertain." (Health Affairs)
Health Insurance Inflation Hits Highest Point in Five Years
"The Consumer Price Index for health insurance in April spiked 10.7% over the previous 12 months--the largest increase since at least April 2014 ... In contrast, the other categories that make up the medical care services index -- professional services and hospital and related services -- rose 0.4% and 1.4% in April, respectively. The CPI for medical care services in April rose 2.3%, while overall inflation increased 2% year over year." (Modern Healthcare Online; free registration required)
[Opinion] End Surprise Billing in Healthcare, But Do It Carefully
"An appropriate solution should reflect the geographic differences in the cost of services, consider the rates established by the private market for these services, and increase predictability for employer plan sponsors.... The U.S. Chamber's recommended solution is to create a benchmark that allows issuers to reimburse facility-based [Emergency room physicians, Radiologists, Anesthesiologists, and Pathologists (ERAP) doctors] for out-of-network services based on the median in-network reimbursement for that same service." (U.S. Chamber of Commerce)
Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029
12 presentation slides. "In an average month for each year during that period, between 240 million and 242 million such people are projected to have health insurance, mostly from employment-based plans.... Net federal subsidies for insured people will total $737 billion in 2019 ... That annual sum is projected to reach $1.3 trillion in 2029.... Medicaid and the Children's Health Insurance Program account for between 40 percent and 45 percent of the federal subsidies, as do subsidies in the form of tax benefits for work-related insurance." (Congressional Budget Office [CBO])
Private Insurance Payments to California Hospitals Average More Than Double Medicare Payments (PDF)
"For the 10 percent of California hospitals with the highest ratio of private to Medicare payments, private insurance payments average 364 percent of Medicare and 255 percent of cost; for the 10 percent with the lowest ratio, the average is 89 percent of Medicare and 89 percent of cost." (WestHealth Policy Center)
Some Dayton, Ohio Hospitals Charge Triple What Medicare Pays
"Miami Valley Hospital ... charged private health plans 295 percent of what Medicare paid for the same outpatient services. Kettering Medical Center ... charged private insurers 287 percent of what Medicare paid for outpatient services." (Dayton Daily News)
Opioid Prescriptions Drop Sharply Among California State Workers
"Insurance claims for opioids ... decreased almost 19% in a single year among the 1.5 million Californians served by [CalPERS].... Most notably, doctors reduced the daily dose and duration of opioid treatment: The number of new users who were prescribed large doses dropped 85% in the first half of 2018 compared with the same period in 2017, while new users prescribed more than a week's supply dropped 73%[.]" (Kaiser Health News)
[Opinion] Why Employers Pay Too Much for Health Care
"[As] recently as 2000, private payers were paying only 10% more than Medicare. Since then, the gap has been growing by leaps and bounds. What makes this especially surprising is that it has happened at a time when employers have been getting increasingly aggressive about controlling health care costs. So, what's going wrong? And who's to blame?" (John C. Goodman, in Forbes)
Observations on the Employer Stop-Loss Market: 2019 Survey (PDF)
"[T]he stop-loss market stands at approximately $20 billion in premium... [W]hile premium is relatively evenly spread across deductibles ranging from $75,000 to $500,000, a significant number of policies are sold with deductibles below $75,000, and some with deductibles as high as $1 million." (Milliman)
Savings Medicare Beneficiaries Need for Health Expenses in 2019: Some Couples Could Need as Much as $363,000
"For a 50 percent chance of having enough to cover health care expenses in retirement, a couple with median prescription drug expenses needs $183,000 in savings. For a 90 percent chance of having enough, the couple needs $301,000 in savings. At the extreme -- a couple with drug expenses at the 90th percentile throughout retirement who wants a 90 percent chance of having enough money for health care expenses in retirement by age 65 -- targeted savings are $363,000 in 2019. This $363,000 amount is lower than the nearly $400,000 required in 2018[.]" (Employee Benefit Research Institute [EBRI])
Deductible Relief Day: How Rising Deductibles Are Affecting People with Employer Coverage
"Over time, as deductibles have increased, Deductible Relief Day has fallen later in the year, meaning enrollees have to wait longer to receive the financial protection of their coverage. Ten years ago, Deductible Relief Day fell two months earlier in the year, on March 18, 2009. Back in 2009, the average deductible was $533 for a single person, but has since risen by over 150% to $1,350 in 2018." (The Peterson-Kaiser Health System Tracker)
[Guidance Overview] A Closer Look at the Medicare Advantage Telehealth Flex Rule
"Medicare has long been an enigma for the telehealth community. With limited coverage options, arcane and complex rules, and the threat of massive fines and penalties for missteps, telehealth providers have understandably avoided involvement in Medicare.... Although these barriers remain for Original Medicare, the [Bipartisan Budget Act of 2018] removed these obstacles for Medicare Advantage plans starting in Plan Year 2020." (Morgan Lewis)
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