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News Items, by Subject

Health plan costs - misc

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Health Plan Trends (PDF)
11 pages. "[E]mployers are increasingly focused on cost control options that don't involve automatically shifting costs to employees. These options include encouraging cost-effective treatment venues, narrow networks, reference-based pricing and centers of excellence.... [This article reviews] ... [1] Issues affecting medical care and costs; [2] Strategies employers use to control health plan costs." (Marsh & McLennan Agency LLC)
Managing and Monitoring High Cost Claimants Is Top Benefits Strategy for Employers
" '[M]anaging and monitoring high cost claimants' is the top health benefits strategy that US employers will be focusing on for the next five years. More than three quarters (77%) of US employers with 500 or more employees said this strategy was 'very important' or 'important' ... The rapid rise in high cost claims is most likely a key driving force behind this strategic prioritization by employers." (Mercer)
The High Cost of Healthcare: Patients See Greater Cost-Shifting and Reduced Coverage in Exchange Markets 2014-2018 (PDF)
28 pages. "[1] Health plan networks have grown increasingly narrow ... [2] Non-subsidized exchange marketplace premiums have increased faster relative to other markets, such as employer-sponsored insurance and Medicare Advantage, since 2014; [3] Deductibles and maximum out-of-pocket limits (MOOPs) have grown across all payers ... [4] [C]ost-sharing for services after the deductible has remained relatively constant ... [5] Federal and state rules around network adequacy have not kept pace with the growing patient burden." (Avalere, for Physicians for Fair Coverage [PFC])
Insurers Offer Tools to Dig Into Health Costs
"Three of Michigan's largest health insurers developed various software and support tools that provide employers with detailed reports on how their workforces spend health care dollars and where they access care.... 97 percent of human resource practitioners believe they need better tools to evaluate health care cost and use data to make better decisions on benefit plans." (Crain's Detroit Business)
CMS Halts ACA Risk Adjustment Transfers
"CMS' decision presents two sets of issues for payers. One is an immediate question of cash flow for payers that were expecting to receive, in some cases, millions of dollars in payments ... for example, one Florida insurer was set to receive $666 million ... Longer term, for payers, the decision creates a large amount of uncertainty about the viability of remaining in the ACA markets." (PwC)
Ways and Means Reports Out Eleven Health Care Bills After a Two-Day Markup
"The bills reported out of the Ways and Means Committee ... deal with the following topics. [1] Delay of the implementation of the Cadillac Tax.... [2] Broadening of Qualified Medical Expense definition.... [3] Increase HSA contribution limits.... [4] Expand eligibility for HSAs ... [5] HSA 'housekeeping' issues.... [6] Modification of the ACA premium tax credit." (Employers Council on Flexible Compensation [ECFC])
Medicare Billing Overhaul to Transform Documentation, Expand Telehealth
"Rather than continuing to comply with documentation guidelines from the 1990s, practitioners would be able to choose to document [Evaluation and Management ('E&M')] visits based on time spent with the patient or on their own medical decision-making.... Rather than having to re-document information from past visits, practitioners would have more options to simply review and update existing documentation. Physicians would further be allowed to simply review and verify certain medical records that staff members or the patient entered." (HealthLeaders Media)
Health Care Cost Control: Where Do We Go From Here?
"Markets could be improved with stronger financial incentives for individuals to select higher-value providers and services and by making more information available to patients about the value of alternative treatments and sites of care.... Options for limited price regulation could take the form of price ceilings on commercial plan services based on a percentage of Medicare rates -- say 175 percent.... [E]mployers must take a far more aggressive role. This could include increasing the use of benefit design that rewards consumers for selecting cost-effective providers and therapies." (Health Affairs)
[Opinion] Telemedicine: Does It Measure Up to the Hype?
"Along comes the idea of a face-to-face online appointment with a real doctor who can diagnose and prescribe medications or refer to an appropriate care level.... [At] around $49 per visit I thought uptake would be rapid. I was wrong again as I look at 1-5% employee utilization rates. So what happened?" (Frenkel Benefits)
[Opinion] Freezing Risk-Adjustment Payments Will Cause More Instability in the Individual and Small-Group Insurance Markets
"The court ruled in February that the formula is arbitrary and capricious because CMS did not adequately justify key assumptions. The court left open that the formula may be allowed, if justified through notice and comment rulemaking.... CMS could have waited for the court to issue an opinion on a motion to reconsider the decision ... then appeal and request a stay to keep the formula in place through the appeals process. Reversal on appeal may not be a long shot given that a court in Massachusetts upheld the formula in a similar case." (The Commonwealth Fund)
[Guidance Overview] Recent New Jersey Legislation Affects Out-of-Network Health Services
"If a [self-insured plan subject to ERISA] opts in, its members would not be balance billed for out-of-network charges for emergency care in excess of the deductible, copayment, or coinsurance amount applicable to in-network services, and the plan can take advantage of the act's binding arbitration provisions. The opt-in plan must provide each primary insured with a health insurance identification card indicating that the plan has elected to be subject to the act." (Morgan Lewis)
A New Twist in the Ongoing Out-of-Network Provider Lawsuit Saga
"Perhaps the most interesting part of this case relates to the claim that the plan used an improper reference pricing model ... The Hospital cited the FAQs under ACA which provide that reference pricing cannot be used as a subterfuge for otherwise prohibited limitations ... Specifically, a 2016 FAQ provides that a plan using a reference price without ensuring adequate access at that price will not be considered to have established a network for purposes of Section 2707(b) of the Public Health Service Act which relates to cost-sharing requirements and permissible MOOPs. The court found this argument somewhat convincing and declined to dismiss this claim." [Salinas Valley Memorial Healthcare Sys. v. Monterey Peninsula Horticulture, Inc., No. 17-7076 (N.D. Cal. May 31, 2018)] (Kilpatrick Townsend)
House Committee Contemplates Bill That Would Reduce Employer Health Benefit Costs
"Among one of the bills considered is legislation ... [which] would provide retroactive relief from the ACA's employer mandate from 2015 through 2018 and delay for one additional year (until 2023) the 40% Cadillac Tax." (PLANSPONSOR)
[Opinion] Ways and Means Bills Would Expand HSA Tax Breaks, Weaken Insurance Marketplaces
"The House Ways and Means Committee is marking up several bills this week that would raise contribution limits for [HSAs] and expand the allowable uses of these accounts, at a cost of $41 billion over ten years ... The bills also include other problematic provisions providing premium tax credits to people who buy plans offered outside the [ACA] marketplaces and delaying the ACA's excise tax on high-cost plans ... In all, the bills would cost $92 billion over the next decade[.]" (Center on Budget and Policy Priorities)
Is Panic Over Risk Adjustment Loss Much Ado About Nothing?
"The loss of the risk adjustment payments that healthcare insurers depend on to remain profitable under the [ACA] could be another devastating blow that drives them away from the marketplace and further increases premiums.... The problem could be fixed by changing the payment formula CMS uses, without any legislation or regulatory maneuvers." (HealthLeaders Media)
Proposal Could Save Pre-Retirees Over $4,600 Per Year on Health Insurance Premiums
"According to an analysis of H.R. 6311 ... pre-retiree adults ages 55 to 64, who typically pay the highest premiums in the individual market, could save an estimated $384 per month, or $4,608 a year by purchasing a copper plan instead of a bronze plan." (eHealth)
Health Plan Costs Rose Significantly for Small Employers in 2017
"Employers across the board saw health plan costs rise for a variety of reasons, but employers with less than 500 workers were especially vulnerable to cost effects ... The survey attributed the cost increases to a number of factors, namely expensive new treatment options and a rapidly aging population. A new cost driver is the slow rise of uninsured patients, which ticked up in 2017 and is likely to lead to providers shifting the costs of uncompensated care onto employer health plans[.]" (HealthLeaders Media)
[Opinion] Thoughts On Risk Adjustment
"[T]he Trump Administration has temporarily suspended all payments and collections of RA until the lawsuit is resolved.... [T]his is something that could have been avoided and fixed by the prior administration.... They could have issued interim rules to circumvent the problem. They could have adjusted the 2017 Notice of Benefit and Payment Parameters that were rushed through in late 2016 to mitigate the problem too. But they didn't." (InsureBlog)
Insurer: ACA Risk Payments Use 'Flawed' Methodology
"Health Connections' CEO Marlene Baca said the [CMS suspension of risk-adjustment payments] was a positive development for both the company and the industry, particularly for small insurers who had been penalized by the program.... A CMS report released Monday showed New Mexico Health Connections would have had to pay a net sum of about $5.6 million[.]" (
[Guidance Overview] Sections 4980H(a) and 4980H(b) Penalty Amounts Set for Historic Increase in 2019
"The Code explains that the original $2,000 amount associated with the section 4980H(a) penalty and the original $3,000 amount associated with the section 4980H(b) penalty would be adjusted for calendar years beginning after 2014 ... [T]he correct numbers to use when calculating the potential section 4980H penalties for 2019 are: Section 4980H(a) penalty amount = $2,500; Section 4980H(b) penalty amount = $3,750. The penalty amounts have increased significantly compared to 2018." (Accord)
Frozen ACA Risk Adjustments Would Hit Some Insurers Harder Than Others
"In the event that the delay in 2017 risk-adjustments becomes permanent, Kaiser Pemanente stands to gain the most ... [The] company was expected to owe $928 million for 2017 ACA risk adjustments. Molina Healthcare came in second, owing $853 million. Centene and Fidelis ranked third, owing $689 million.... On the opposite end of the spectrum, the biggest losers would be Anthem, which expects to receive $522 million; Blue Cross Blue Shield of Florida, which expected to receive $618 million; Health Care Service Corp., which expected to receive $640 million; and Blue Shield of California, which expected a $696 million payout." (HealthLeaders Media)
CMS Summary Report on Permanent Risk Adjustment Transfers for the 2017 Benefit Year (PDF)
36 pages. "A total of 654 issuers participated in the risk adjustment program for the 2017 benefit year, of which 628 received a risk adjustment transfer, and 27 received a default risk adjustment charge in at least one risk pool.... Risk adjustment transfers as a percent of premiums slightly decreased compared to the 2016 benefit year.... Amount of paid claims is strongly correlated with risk adjustment transfers.... Risk scores overall declined by approximately 5 percent in the individual non-catastrophic risk pool and 6 percent in the small group risk pool." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Opinion] The Health Insurance Marketplaces Likely Will Survive
"[P]remiums in every state have increased since 2015, but in about half of states, enrollment has also increased, and there is no apparent relationship between premium increases and enrollment changes. Overall, enrollment has not declined substantially, so it does not appear that large numbers of healthy people are exiting the Marketplaces, and the concern that self-sustaining premium increases will lead to discontinuation of the Marketplaces is not warranted." (The JAMA Network)
[Opinion] Blue Cross Blue Shield Association Statement on Risk Adjustment Payment Freeze
"Without a quick resolution to this matter, this action will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices. It will undermine Americans' access to affordable coverage, particularly for those who need medical care the most." (Blue Cross and Blue Shield Association)
Latest In ACA Risk Adjustment Litigation
"CMS states that it is seeking a 'quick resolution' in the case but is, in the meantime, prohibited from collecting or making payments under the current risk adjustment methodology for 2014 to 2018. (Risk adjustment payments for 2019 are not at issue; the payments for 2017 were not expected until the fall of 2018.)" (Katie Keith, in Health Affairs)
Want to Fix Health Care? Start with Employers
"Focusing on improving outcomes and lowering costs for employer-insured workers will be a quicker path than trying to reform the pharmaceutical or health insurance industries ... because employers are increasingly desperate to stem their rising costs, so have a vested interest in making care more efficient and less wasteful." (CNBC)
United States District Court Ruling Puts Risk Adjustment on Hold
"On February 28, 2018, the United States District Court for the District of New Mexico issued a decision invalidating use of the statewide average premium by [CMS] in the risk adjustment transfer formula established under section 1343 of the [ACA] for the 2014-2018 benefit years ... In light of a contrary decision by the United States District Court for the District of Massachusetts, the government moved the New Mexico district court to reconsider its decision, and CMS is currently awaiting the court's ruling.... The New Mexico district court's ruling currently bars CMS from collecting or making payments under the current methodology[.]" (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Court Allows Provider to Proceed With Claim That Plan Violated Cost-Sharing Limit
"The hospital asserted that the plan essentially established a reference price when it reimbursed all of the hospital's services at 140% of Medicare's allowed charge. Because the plan's network did not include any hospitals or otherwise ensure access to hospitals that would accept the reference price, the hospital contended that the plan was required to count out-of-pocket expenses for charges over the reference price toward the maximum annual cost-sharing limit[.]" [Salinas Valley Memorial Healthcare Sys. v. Monterey Peninsula Horticulture, Inc., No. 17-7076 (N.D. Cal. May 31, 2018)] (Thomson Reuters / EBIA)
[Guidance Overview] IRS Releases ACA Affordability Rates for 2019
"For 2019, the required contribution percentage has increased to 9.86% (up from 9.56% in 2018). This means that if an employee's share of the premium for employer-provided coverage in 2019 is more than 9.86% of his or her household income, the coverage is not considered affordable for that employee and the ALE may be liable for a penalty if that employee obtains a premium tax credit through a Marketplace." (The Wagner Law Group)
CMS Marketplace Reports Show Increases In Subsidy-Eligible Enrollees, Effectuated Enrollment Rate
"10.6 million individuals effectuated their coverage for February 2018 ... a higher proportion of marketplace enrollees received premium subsidies relative to 2017; and those who selected a plan during the 2018 open enrollment period were more likely to effectuate their coverage compared to 2017. Premium affordability, however, remains a concern, and CMS devotes an entire report to documenting a decline in individual market enrollment among consumers who are not eligible for advance premium tax credit (APTC)." (Health Affairs)
Questions to Ask Your Health Benefits Broker to Make Sure the Price Is Right
"Just as in retirement plans, in the health benefits market there can be conflicts of interests between providers that drive up costs for employers and employees and result in decisions being made that are not in the best interest of participants.... [If] employers ask, 'What kind of commissions and bonuses do you receive from carriers, in total?' they will learn what kind of incentives are driving broker and adviser underlying decisions." (PLANSPONSOR)
Doctors, Hospitals Received $8.4B in Payments from Drug Companies Last Year
"Doctors and teaching hospitals received $8.4 billion in payments from drug companies in 2017 ... The 2017 payments included nearly $4.7 billion in research related payments, $2.82 billion in non-research-related payments and more than $927 million representing ownership or investment interests held by physicians or their immediate family members," (FierceHealthcare)
The Exchanges Trends Report 2018 (PDF)
12 pages. "Data from the call center shows that the consumer satisfaction rate remained at an all-time high -- averaging 90 percent -- throughout the entire Open Enrollment period. This is up from 85 percent last year. 63 percent of uninsured consumers who have visited Federal platform Exchanges in the past year indicate they didn't purchase a health plan through the Federal platform because the health insurance premium was too expensive, which is up from 52 percent from the end of last year's Open Enrollment Period." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
Trends in Subsidized and Unsubsidized Individual Health Insurance Market Enrollment (PDF)
"Average monthly enrollment in individual market plans decreased by 10 percent between 2016 and 2017 at the same time premiums increased by 21 percent. Most of the decrease in enrollment between 2016 and 2017 occurred among people who did not receive APTC subsidies.... 10 states experienced declining individual market enrollment between 2015 and 2016.... The decline in the non-APTC portion of state markets grew larger and more widespread between 2016 and 2017." (Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS])
[Opinion] Federal Subsidies for Employer-Based Coverage Expected to Total $3.7 Trillion Between 2019 and 2028
"It will cost the federal government $685 billion this year to subsidize health insurance for people under 65. Of that, $272 billion will go to those with some form of employer-sponsored coverage.... [CBO] says net subsidies for those covered by employers will total $3.7 trillion over the 2019-2028 period.... For those with employer-based coverage, the subsidies are not direct but come in the form of untaxed benefits.... The CBO estimates that a monthly average of 158 million Americans (about 58% of the population under age [65] have employer-based insurance this year. That's expected to decline to 154 million (or 55% of the population) by 2028." (Managed Care)
Moda Decision Affecting Risk Corridor, CSR Litigation; Sen. Alexander Pushes for Sec. 1332 Waiver Flexibility
"As expected given the stakes, Moda Health Plan has indicated that it will appeal the Federal Circuit's decision. In the meantime, other litigation over risk corridor payments -- which had been stayed pending the Federal Circuit's decision -- can proceed. There are currently two additional cases on risk corridor payments before the same panel of judges on the Federal Circuit." (Katie Keith, in Health Affairs)
What's Driving Health Care Costs?
"Based on data from 2015, there was no association between an increase in population-based [value-based payment (VBP)] and slowing of health care costs in a given market.... The question of 'what type of competition' in a market may be more important than 'how much' competition.... Lower-cost markets appear to benefit from organized mechanisms, including state-sponsored or endorsed reporting agencies, for more transparent sharing of information on provider quality and costs." (Health Affairs)
Is a Benefits Captive Right for Your Company?
"A benefits captive pools self-funded employers together to save on stop-loss insurance ... which could cut claim minimums by half -- from $50,000, which would be out of reach for many employers, to a much more manageable $25,000, for example. Individual employers take on risk below the minimum, and then transfer risk to the captive above that amount. Sharing risk is attractive to employers; however, this only makes sense if each member of the benefits captive is working equally hard to mitigate risk and keep claims low. There are a few ways to do this." (Corporate Synergies)
North Carolina Creates Solvency Fund to Pay Down Unfunded Employee Benefit Liabilities
"The Unfunded Liability Solvency Reserve Act creates a reserve that will be funded through several sources, including General Assembly appropriations, overflows from the state's rainy day fund, or savings from refinancing of general obligation bonds. Between pension and health care, the state has $50 billion in unfunded liabilities, $35 billion in health care alone. The solvency fund is believed to be the only one of its kind in the nation[.]" (Pensions & Investments)
The Economic Cost of Disease
"Originally released in 2015 ... [this] study provided an assessment of the cost of absenteeism, presenteeism, and early withdrawal from the workforce.... This year ... the study has been updated to capture the costs associated with workforce withdrawal for informal caregiving. The findings are alarming, showing a 7.7% loss in GDP in 2015, projected to rise to 8.6% of lost GDP by the year 2030." (U.S. Chamber of Commerce)
'Holy Cow' Moment Changes How Montana's State Health Plan Does Business
"60 hospitals ... accounted for 43% of employee healthcare costs.... [T]he state decided it would pay an average of 234% of Medicare rates -- a level of payment that hospitals indicated they would accept and an amount the state calculated would allow an efficient hospital to deliver high-quality care and still profit.... Two years in, the state calls the effort a success, saving $15.6 million this year over the estimate of what it would have paid without the change." (FierceHealthcare)
[Opinion] Reasons Why Employers -- And New Ventures -- Won't 'Disrupt' U.S. Healthcare
"Employer Sponsored Insurance (ESI) isn't the product of intelligent system design. In fact, there's no clinical, fiscal or moral argument to support this unique financing model at all.... Whatever the business of private industry ... unless they are literally in the business of healthcare, the vast majority have no specific healthcare domain expertise ... Unlike Medicare or Medicaid, ESI ... supports inelastic healthcare pricing because it is literally whatever the market will bear based on group purchasing dynamics.... ESI -- and the employment process known as open-enrollment -- is arbitrarily tied to our annual tax calendar, but that has no correlation or applicability to how healthcare actually works." (Dan Munro, in Forbes)
How Employers Are Working to Combat the Opioid Epidemic
"[E]mployers have addressed [the opioid epidemic] through innovative plan design and outreach.... Developing best practices ... Tighter controls on opiod prescriptions ... Comprehensive patient education ... Attention to drug prescription and interaction guidelines ... Collaboration with physical and mental health care providers." (American Benefits Council)
CalPERS Adopts 2019 Health Rates
"The CalPERS Board of Administration [has] approved health care rate and plan changes for 2019 that include an average 1.16 percent overall premium increase, marking the lowest health premium increase CalPERS has negotiated in over two decades.... Overall rates for seven of the nine HMO plans will be less than the 2018 rates.... A pilot program for reference-pricing pharmaceuticals will begin ... The PERS Select Basic PPO plan will adopt a value-based insurance design." (California Public Employees' Retirement System [CalPERS])
When to Consider Becoming Self-Insured
"Initially, the thought of not having a fixed premium, and being liable for unknown employee medical claims, may seem a little scary. However, if done right, this kind of strategy can help you reap financial rewards." (Fidelity Health Marketplace)
Planning for Health Care Costs in Retirement (PDF)
24 pages. "Some research on health care costs in retirement estimates these expenses as a lifetime lump sum.... [A] better planning framework considers these costs as annual expenses personalized to an individual's health status, coverage choices, retirement age, and loss of any employer subsidies. For a typical 65-year-old woman, the Mercer-Vanguard model predicts an annual health care expense of $5,200 in 2018.... Half of individuals will incur no long-term care costs -- but there is a small but meaningful risk that costly care will be required for multiple years[.]" (Vanguard)
Healthcare's Next Cost Challenge: Tackling Rising Fees by Providers and Facilities
"The annual rate of growth in employer medical costs has plateaued at about 6%, which is half the rate of growth seen a decade ago, thanks largely to the rise of high-deductible health plans. However, squeezing cost reductions from reduced utilization that come with high-deductible plans may have played itself out, ... which means that employers and health plans looking to slow cost growth will have to focus on medical pricing." (HealthLeaders Media)
Unwieldy Health Costs Often Stand Between Teachers and Fatter Paychecks
"Many teachers ... have traditionally accepted a trade-off: In exchange for relatively low salaries, they could expect relatively generous benefits, including pensions and low- or no-cost health premiums. But in an era of $100,000-a-year drugs and government budget cuts, school districts are struggling to find the money to keep up their end of the bargain ... Many cash-strapped school boards, cities and legislatures view health care benefits as an unpredictable budget-buster." (Kaiser Health News)
HHS Secretary Pressed by Senate Committee on Administration's Drug Pricing Plan
"[HHS Secretary Alex Azar] outlined the strategies in the President's blueprint and argued, 'We have begun to take action on each of them already.'... He cited creating incentives for lowering list prices set by drug companies, better negotiating for Medicare Part B and D, stopping drug companies who are unfairly blocking competition, and curbing out-of-pocket costs by ensuring that patients pay the lower-cost drug option." (HealthLeaders Media)
Appeals Court Finds Insurers Not Entitled to Risk Corridor Payments
"The court agreed with the Trump administration that insurers are not owed any money, because congressional Republicans passed legislation that required the program to be budget neutral.... Dozens of other insurers have filed similar lawsuits over the risk corridors. All told, insurers say the government owes them nearly $12 billion." [Moda Health Plan, Inc. v. U.S., No. 2017-1994 (Fed. Cir. June 14, 2018)] (The Hill)
Insurers Not Owed Risk Corridor Payments
"The Federal Circuit concluded that Section 1342 does obligate the government to make full risk corridors payments. However, this obligation was temporarily suspended by subsequent appropriations riders that required HHS's risk corridors payments to be budget neutral (meaning that HHS could pay out no more than it received in risk corridors payments). The court found that Congress intended to cap risk corridors payments in this way via the appropriations process, even though it did not amend the underlying statute, Section 1342." [Moda Health Plan, Inc. v. U.S., No. 2017-1994 (Fed. Cir. June 14, 2018)] (Katie Keith, in Health Affairs)
[Guidance Overview] Repeal of the Michigan Health Insurance Claims Tax
"On June 11, 2018, Governor Snyder signed a series of bills that repeal the Michigan Health Insurance Claims Assessment (HICA) tax. But the repeal is conditioned on federal approval of the HICA tax's replacement.While all employer-sponsored group health plans benefit from HICA tax repeal, the true winners will be self-funded group health plans and their third-party administrators (TPAs)." (Miller Johnson)
The Effects of Actuarial Value Changes on New Yorkers with High-Cost Medical Needs
"Under the expanded AV threshold, insurers could sell plans with lower premiums but with higher cost sharing to compensate.... In New York, ... the AV threshold change did not adversely affect individuals with high-cost conditions. However, ... other factors such as New York's unique Marketplace requirements, the state's basic health plan and Medicaid expansion, and drug pricing and coverage changes may have mitigated the impact of the new AV threshold flexibility." (Health Affairs)
Insurers Can Continue Silver Loading for 2019
"[I]nsurers will not be prohibited from using silver loading to make up for the loss of cost-sharing reduction (CSR) payments -- at least for 2019. [HHS] Secretary Azar made these remarks during a hearing before the House Education and Workforce Committee. These comments resolve at least one point of uncertainty for 2019, but Secretary Azar did not rule out banning silver loading in the future." (Health Affairs)
PCORI Fee Due July 31, 2018
"The PCORI fee for a plan year is due by July 31 of the calendar year immediately following the last day of such plan year. Because the PCORI fee only applies to plan years (and policy years) ending before October 1, 2019, the final PCORI fee payment for sponsors of calendar year plans (for the 2018 plan year) will be due by July 31, 2019." (Conduent)
Drivers of 2019 Health Insurance Premium Changes (PDF)
9 pages. "Key drivers include the underlying growth in health spending, which will increase premiums relative to 2018. The termination of funding of the CSRs has led to different strategies for building the cost into premiums, and insurers may need to make adjustments for 2019 rates." (American Academy of Actuaries)
Migraine Impacts Employers in Both Health Care Spend and Lost Productivity
"[F]rom 2011 to 2015, employees treated for migraine had higher health care costs on average than employees without migraine treatments -- a difference of about $2,000 per year. Employees treated for migraine also had an average of 2.2 more sick days per year, at a cost of almost $600 in wages and benefits.... Employees who take short-term disability leave for migraine miss an average of 38 work days per episode--an economic loss to their employer of about $10,400." (Integrated Benefits Institute)
Behind the Numbers 2019: Healthcare and Medical Cost Trends (PDF)
38 pages. "[T]hree factors inflating medical cost trend in 2019: [1] Care anywhere and everywhere.... [2] Provider megamergers.... [3] Physician consolidation and employment.... Three factors are tempering the spending increases. [1] Flu impact.... [2] Care advocacy.... [3] High-performance networks.... HRI projects medical cost trend to be 6 percent in 2019 ... The net growth rate in 2019, after accounting for benefit design changes such as higher co-pays and narrow provider networks, is expected to be 5.5 percent." (PwC)
Employers Hope to Shield Employees from Increased Health Coverage Costs
"Employers continue to be focused on bringing overall costs down by designing medical plans with tighter provider networks, and drug plans with restrictive brand name formularies. But most large employers are trying to avoid raising deductibles and shifting more costs to employees, and planning to absorb the higher costs." (CNBC)
[Guidance Overview] Association Health Plans, Part 4
"If the proposed rule were issued in its current form, AHPs would be forced to quote basically the same rates for all member employers, and commercial carriers would quote unhealthy large employer groups at higher rates than healthy groups ... Large employer groups with higher-than-average claims would have a financial incentive to join AHPs, and healthier-than-average-groups with lower costs would inevitably choose to purchase health insurance from commercial carriers.... AHPs would then be required to increase premiums across the board, diminishing the ability to attract even moderately healthy groups, resulting in further market segmentation and destabilizing the AHP marketplace." (Benefits Bryan Cave)
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