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All News > Health Plan Costs

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Transforming Employee Health Benefits Through Self-Funding: A Case Study
The Alliance Link to more items from this source
Nov. 29, 2022

"For most companies, health care is the second or third largest expense after wages. Through self-funding, Walker Forge reduced their all-in health care spend per employee to 28% below the national average and their pharmacy spend is about one-third of the national average per employee. While most employers have seen an upwards of 7% increase in average inflation each year, through self-funding, Walker Forge has been able to keep their premiums flat for four years."

Tags: Health Plan Costs  •  Health Plan Design  •  Prescription Drug Costs

What Does the Great Unwinding Mean for Employer-Based Health Plans?
InsuranceNewsNet.com Link to more items from this source
Nov. 28, 2022

"[T]he federal government is expected to stop purchasing and distributing vaccines for free as early as January 2023. Pharmaceutical companies are expected to set new prices for the commercial market. Plans need time to fully negotiate costs with manufacturers, pharmacies and wholesalers. Administration oversight and action will be important to avoid inflated costs. A clear picture of frequency of vaccines and boosters will be key in supporting effective price negotiations."

Tags: Coronavirus (COVID-19)  •  Health Plan Administration  •  Health Plan Costs  •  Health Plan Design

Annual Enrollment Period Snapshot: Medicare Costs and Trends (PDF)
eHealth Link to more items from this source
Nov. 23, 2022

"$7 is the average monthly premium for Medicare Advantage plans selected by Medicare beneficiaries in the first half of the Annual Enrollment Period for 2023 coverage ... $31 is the average monthly premium for Part D plans ... up from $21 the year before ... 8% of Medicare Advantage enrollees express satisfaction with their coverage, and most say they could not afford more costly alternatives like Medicare Supplement."

Tags: Health Plan Costs  •  Medicare

California Aims to Maximize Health Insurance Subsidies for Workers During Labor Disputes
Kaiser Health News Link to more items from this source
Nov. 22, 2022

"Freezing health insurance benefits is a common tactic in a labor dispute because without them, workers might be more easily persuaded to concede to management's demands. But California lawmakers are giving an edge to strikers.... [E]ligible workers will have their premiums covered as if their incomes were just above the Medicaid eligibility level. The state would factor in the worker's federal subsidy and cover the difference."

Tags: Health Plan Costs

Surprise Billing Final Regs Issued (PDF)
Husch Blackwell Link to more items from this source
[Guidance Overview]
Nov. 17, 2022

"The final regulations focus on ... [1] The factors that an IDR entity should consider when making a payment determination as part of the IDR process; [2] The requirements for an IDR entity's written decision; and [3] The disclosures by plans and issuers regarding the qualifying payment amount (QPA) to address 'downcoding'.... The final regulations are applicable with respect to items or services provided or furnished on or after October 25, 2022, for plan years beginning on or after January 1, 2022."

Tags: Health Plan Administration  •  Health Plan Costs

Inflation Causing Americans to Skimp on Critical Health Care Expenses
InsuranceNewsNet.com Link to more items from this source
Nov. 17, 2022

"As food insecurity deepens, Americans are also struggling to pay for critical health care expenses. Many have cancelled or postponed plans in the past 12 months to see a specialist (14%), take a prescribed medication (10%) or get an annual physical (11%) due to high inflation, the survey said. And almost one-fifth of Gen Z (17%) and millennials (19%) have cancelled or postponed plans in the past 12 months to see a mental health professional."

Tags: Health Plan Costs  •  Health Plan Design

With Price Transparency in the Limelight, How Much Are Patients Really Paying?
HealthLeaders Media Link to more items from this source
Nov. 16, 2022

"Using the average hourly earnings of residents of each state from the U.S. Bureau of Labor Statistics, researchers were able to calculate the number of hours of work required to pay off the bill for an average hospital stay. Oregon was the least affordable state, requiring residents to work 646 hours to pay for the average hospital stay. It was followed by Utah (600 hours), New Mexico (581 hours), Ohio (581 hours), and California (572 hours)."

Tags: Health Plan Costs

Amazon Launches Virtual Health Service for Common Problems Such as Allergies and Acne
Washington Examiner Link to more items from this source
Nov. 15, 2022

"Amazon Clinic will offer users virtual care related to 20 common health conditions such as allergies, acne, and hair loss. The clinic would then guide users to purchase the products through Amazon's interface or local stores and clinics."

Tags: Health Plan Costs  •  Health Plan Design

Text of CMS ICHRA Employer Lowest Cost Silver Plan Premium Look-Up Table and Data Dictionary (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS] Link to more items from this source
[Official Guidance]
Nov. 15, 2022

"The [CMS] Center for Consumer Information & Insurance Oversight (CCIIO) publishes the Individual Coverage Health Reimbursement Arrangement (ICHRA) Employer Lowest Cost Silver Plan (LCSP) Premium Look-up Table [XLSM] to help stakeholders access individual market Qualified Health Plans (QHPs) LCSP premium data by geographic location."

Tags: HRAs  •  Health Plan Costs

Text of IRS Notice 2022-59: Updated PCORTF Fee Payable for 2022 by Insured and Self-Insured Health Plans (PDF)
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
Nov. 14, 2022

"The applicable dollar amount ... for policy years and plan years that end on or after October 1, 2022, and before October 1, 2023, is $3.00. The increase from the prior applicable dollar amount is calculated by multiplying $2.79 (which is the adjusted applicable dollar amount for policy years and plan years ending in the previous Federal fiscal year) by the percentage increase of the projected per capita amount of National Health Expenditures published by HHS on March 24, 2022."

Tags: Health Plan Administration  •  Health Plan Costs

California Stockpiles Penalties from Uninsured Residents Instead of Lowering Care Costs
Kaiser Health News Link to more items from this source
Nov. 14, 2022

"Nearly three years after California started fining residents who don't have health insurance, the state has not distributed any of the revenue it has collected ... State finance officials have estimated that the revenue collected via the penalty in its first three years, from 2020 through 2022, will total about $1.3 billion."

Tags: Health Plan Costs  •  Local Regulation

ACA Numbers and Limits 2014-2023 (PDF)
Kaufman & Canoles, P.C. Link to more items from this source
[Guidance Overview]
Nov. 14, 2022

Chart includes detailed breakdown of applicable dollar limits for: [1] Applicable Large Employer (ALE) Shared Responsibility Penalty (IRC Section 4980H, Forms 1094-C and 1095-C); [2] Premium Tax Credits (IRC Section 36B, Form 8962); [3] Group Health Insurance Reforms (IRC Section 9815 & Section 4980D, Form 8928); [4] Qualified Small Employer Health Reimbursement Account (QSEHRA) Contribution Limits (IRC Section 9831(d)); [5] Health Savings Accounts (IRC Section 223, Form 8889).

Tags: HSAs  •  Health Plan Administration  •  Health Plan Costs

2023 Premium Tax Credit Quick Reference Chart (PDF)
Kaufman & Canoles, P.C. Link to more items from this source
[Guidance Overview]
Nov. 14, 2022

11 pages. "[1] Locate line where estimated 2023 household income & household size intersect. [2] First column shows household percentage of Federal Poverty Line. [3] Second column shows percent of household income required as contribution towards purchase of second lowest cost Silver coverage in Marketplace. [4] 'CSR AV' column shows resulting Actuarial Value after Cost Sharing Reductions applied. [5] 'Monthly contribution' = contribution percent x household income, divided by 12."

Tags: ARPA  •  Health Plan Costs

Most and Least Expensive States for Health Care, Ranked
Forbes Advisor; subscription may be required Link to more items from this source
Nov. 11, 2022

"Health care costs averaged over $10,000 per person in 2020, but the exact amount varied by state. [Forbes] compared all 50 states and the District of Columbia across 11 key metrics using data from the Kaiser Family Foundation ... South Dakota topped the list of states with the most expensive health care, while Michigan is the cheapest."

Tags: Health Plan Costs

The Pandemic and Inflationary Impact on the Health Care System
Medical Economics Link to more items from this source
Nov. 11, 2022

"The onset of COVID-19 prompted a surge in demand for clinical health services. At the same time, the extenuating circumstances of the pandemic limited physical access to care. Concurrently, the government response to the pandemic included massive increases in public spending on medical services and products. As a result, health care revenue from employer-sponsored plans sharply declined following a drop in health services utilization as providers cancelled elective care and as patients practiced social distancing by avoiding health facilities."

Tags: Health Plan Costs

Who Has Past-Due Medical Bills and What Are the Impacts? (PDF)
Employee Benefit Research Institute [EBRI] Link to more items from this source
Nov. 11, 2022

"[T]he percentage of Americans who report past-due medical bills has remained in the low 20 percent range since 2015, down from 26 percent in 2012.... Among individuals with health insurance, one-quarter (24 percent) reported past-due medical bills, compared with 35 percent of uninsured individuals."

Tags: Health Plan Costs

Evaluating Your Health Plan’s Diabetes Coverage
International Foundation of Employee Benefit Plans [IFEBP] Link to more items from this source
Nov. 10, 2022

"One in four health care dollars spent is either directly or indirectly related to diabetes ... [1] Examine the current plan.... [2] Analyze data on diabetes direct plan costs ... [3] Examine indirect costs data ... [4] Simulate the impact of the following plan design options."

Tags: Health Plan Costs  •  Health Plan Design

Things You Might Have Wrong About the Self-Funded Health Insurance Market
Forbes; subscription may be required Link to more items from this source
Nov. 10, 2022

"In the current employee benefits environment, with a tight labor market and rising healthcare costs, self-funding can be a considerable option, particularly for those looking for more control over benefits and costs.... Misconception one: It is only for large employers or corporations.... Misconception two: It's too expensive or there's too much risk.... Misconception three: Coverage isn't the same.... Misconception four: It's too complex."

Tags: Health Plan Costs  •  Health Plan Design

The Inevitable Healthcare Inflation Lag and Strategies to Mitigate
Bolton Link to more items from this source
Nov. 10, 2022

"Although there may be some inflationary pressure on current healthcare costs, the employers' claims data revealed the increases are primarily due to a surge in plan members seeking health-related services they avoided during the pandemic ... and the continued rise of specialty pharmacy costs.... [T]his past year's healthcare costs have been 'fixed' based on prior contracting, thus healthcare inflation has not been factored into today's rates and will be significant as new contracts are negotiated over the next few years."

Tags: Health Plan Costs

Health Insurance Is Influencing Americans' Job Choices
MedCity News Link to more items from this source
Nov. 10, 2022

"More than 31% of people with employer-sponsored insurance stuck with a job they disliked for the company's health insurance ... Another 8% of respondents left a job they liked to seek better coverage."

Tags: Health Plan Costs  •  Health Plan Design

CRS Report: Health Insurance Premium Tax Credit and Cost-Sharing Reductions
Congressional Research Service [CRS] Link to more items from this source
[Guidance Overview]
Nov. 8, 2022

16 pages. "The budget reconciliation measure, enacted on August 16, 2022, extends the ARPA provision that expands eligibility for and the amount of the PTC for three years to sunset at the end of tax year 2025. The [IRS] promulgated a rule on October 13, 2022, to address family eligibility for the PTC, which would expand the number of individuals who would become eligible. This report describes current law and applicable regulations and guidance, specifically with regard to how the PTC and CSR requirements apply in 2022." [R44425 updated Nov. 7, 2022]

Tags: Health Plan Costs

Rising Healthcare Costs Driving Alternative Approaches to Retiree Healthcare Benefits
Willis Towers Watson Link to more items from this source
Nov. 8, 2022

Infographic. "Costs for Pre-Medicare retirees are projected to increase 4.8% next year.... Costs for Medicare-eligible retirees are projected to rise 2.7% next year ... 1 in 5 [employers] have ceased offering or are considering replacing a group plan to pre-Medicare eligible retirees. Among those employers that terminated a group plan, 75% are replacing it with access to and financial support for individual insurance through a private marketplace."

Tags: Health Plan Costs  •  Retiree Health Plans

The Effects of Inflation on OPEB Valuations
Bolton Link to more items from this source
Nov. 7, 2022

"How will the recent inflationary environment impact future medical care cost increases and OPEB liabilities? The answer varies depending on whether we are talking about long-term or short-term future medical care cost increases."

Tags: Health Plan Costs  •  Retiree Health Plans

Out-of-Pocket Health Care Spending: A Second Opinion About Rising Costs (PDF)
Employee Benefit Research Institute [EBRI] Link to more items from this source
Nov. 4, 2022

"[B]etween 2013 and 2019, the share of total medical expenditures paid out of pocket by patients increased, from 17.4 percent to 19 percent.... [P]atients are increasingly enrolling in plans with higher deductibles. This is driving up out-of-pocket expenses in the aggregate, even though out-of-pocket expenses in higher-deductible plans have remained flat or have decreased[.]"

Tags: Health Plan Costs  •  Health Plan Design

Employers Stem Rising Healthcare Costs and Boost Affordability
Willis Towers Watson Link to more items from this source
Nov. 3, 2022

"7 in 10 employers expect moderate to significant cost increases over the next 3 years ... 52% will implement programs or switch vendors to reduce total costs. Only 1 in 4 will shift costs to employees through higher premium contributions ... Concerns about healthcare costs extend to employee affordability ... Actions to take now."

Tags: Health Plan Costs  •  Health Plan Design

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