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All News > Health Plan Costs

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San Francisco Releases Health Care Expenditure Rates for 2023
Mercer Link to more items from this source
[Guidance Overview]
Aug. 9, 2022

"San Francisco has posted the 2023 Health Care Expenditure (HCE) rates under the Health Care Security Ordinance (HCSO) rules. The HCSO applies to all employers that must obtain a San Francisco business registration certificate and have at least 20 employees in any location if at least one works in the city and county of San Francisco....  HCSO expenditure requirements do not currently apply to employees telecommuting outside of San Francisco."

Tags: Health Plan Administration  •  Health Plan Costs  •  Local Regulation

2023 IRS Play or Pay Affordability Percentage Released
Burnham Benefits Link to more items from this source
Aug. 8, 2022

"This is the most substantial decrease in this percentage since these rules were implemented. It is the lowest that this percentage has ever been set -- at 0.38% below the statutory affordability percentage of 9.5%.... [M]any employers may have to lower their employee contributions to meet the adjusted percentage."

Tags: Health Plan Costs

Affordability Percentage for Employer-Sponsored Health Coverage Will Shrink in 2023
Mercer Link to more items from this source
[Guidance Overview]
Aug. 5, 2022

"For the many 2023 calendar-year plans using the [federal poverty level (FPL)] affordability safe harbor, the required employee contribution cannot exceed 9.12% of the FPL for a particular area -- $13,590 for mainland US -- or $103.28 per month (slightly up from $103.15 in 2022)[.]"

Tags: Health Plan Costs

Editor's Pick IRS Releases ACA Shared Responsibility Affordability Percentage for 2023
Buck Link to more items from this source
[Guidance Overview]
Aug. 5, 2022

"Employers should consider the adjustments to the affordability contribution percentage in developing a contribution strategy for 2023 -- they may be able to increase the required employee contribution for their lowest cost self-only coverage and still satisfy one of the safe harbors." [Charts show prior year maximum contribution amounts and ACA indexed dollar limits.]

Tags: Health Plan Costs

IRS Announces Indexing Adjustments for 2023 ACA Affordability and Premium Tax Credit Determinations
Thomson Reuters / EBIA Link to more items from this source
[Guidance Overview]
Aug. 4, 2022

"Unless [the ARPA] expansion is extended, the upper income limit (400% of the federal poverty line (FPL)) will return for 2023 and the percentage that must be paid for Exchange coverage will increase across household income bands as reflected in this revenue procedure."

Tags: Health Plan Costs

Transparency Laws and Inflation May Strain Relationship Between Providers and Insurers
Hall Benefits Law Link to more items from this source
Aug. 4, 2022

"Insurers and plan providers may find that the valuable data they have been expecting from hospitals is already obsolete. Inaccurate data may lead to providers being unable to set appropriate reimbursement rates or offer accurate hospital rate information for their members. This phenomenon could lead to a strain on the historically close relationship between hospitals and insurers."

Tags: Health Plan Costs

Commercial Health Plans' Policies Compromise Patient Safety and Raise Costs (PDF)
American Hospital Association Link to more items from this source
[Opinion]
Aug. 4, 2022

15 pages. "Many health plans apply prior authorization requirements in ways that create dangerous delays in care, contribute to clinician burnout and significantly drive up administrative costs for the health care system. Insurers often force patients to suffer through periods of ineffective treatment before permitting access to the most appropriate therapy.... Many commercial insurers leverage their market power and position to steer providers to purchase their auxiliary products that drive up administrative costs and line insurers' pockets."

Tags: Health Plan Administration  •  Health Plan Costs

California Health Giant Faces Strike from Mental Healthcare Workers Demanding Funding, Staffing Investments
Courthouse News Service Link to more items from this source
Aug. 4, 2022

"About 2,000 Kaiser Permanente Northern California mental health workers announced on Wednesday plans to start an open-ended strike on Aug. 15. The workers' union representatives cited high clinician workloads, with patients waiting weeks or even months for mental health care."

Tags: Health Plan Costs

Amazon's Foray Into Primary Care Won't Be Easy
Harvard Business Review Link to more items from this source
[Opinion]
Aug. 3, 2022

"America's health care system seems, paradoxically, both endlessly innovative and profoundly dysfunctional.... Could Amazon's $3.9 billion acquisition be the breakthrough that will change all this?  ... We should never underestimate Amazon. But we also shouldn't underestimate the challenges it faces in working its usual magic in America's huge, troubled, tangled health care sector."

Tags: Health Plan Costs  •  Health Plan Design

Editor's Pick How the 2023 ACA Affordability Decrease to 9.12% Affects Employers
Newfront Link to more items from this source
[Guidance Overview]
Aug. 3, 2022

"Where possible within budgetary constraints, employers should prepare to offer at least one medical plan option to full-time employees in all regions with an employee-share of the premium not exceeding $103.28/month for employee-only coverage to simplify affordability compliance under the federal poverty line safe harbor."

Tags: Health Plan Costs

How Much Does Health Spending Eat Away at Retirement Income?
Center for Retirement Research at Boston College Link to more items from this source
Aug. 2, 2022

"Even with Medicare coverage and ignoring long term care, retirees face sizable out-of-pocket costs for premiums, copays, and uncovered services.... After subtracting these costs, the typical retiree has only 75 percent of Social Security and 88 percent of total income left."

Tags: Health Plan Costs  •  Medicare  •  Social Security

ACA Shocker: 2023 Affordability Percentage Will Be the Lowest Ever
Accord Link to more items from this source
[Guidance Overview]
Aug. 2, 2022

"The 2023 open enrollment season is quickly approaching and more so than any year to date employers are going to need to use extreme caution to ensure its health plan is affordable.... In 2023 the affordability threshold will be 9.12 percent which is the lowest the number has ever been since the ACA's inception. The number is down significantly from the 2022 amount of 9.61 percent."

Tags: Health Plan Costs  •  Health Plan Design

District Court Vacates Rebuttable Presumption Under No Surprises Act Rules for Air Ambulance Service Providers
Thomson Reuters Practical Law Link to more items from this source
Aug. 2, 2022

"The qualifying payment amount (QPA) presumption at issue in this case is similar to the one regarding emergency services (and certain other services) that the district court vacated last February in litigation brought by general health providers. The same judge who issued the February 2022 ruling also decided the current case involving air ambulance services." [LifeNet v. HHS, No. 22-162 (E.D. Tex. Jul. 26, 2022)]

Tags: Health Plan Costs  •  Health Plan Design

Text of IRS Rev. Proc. 2022-34: 2023 Required Contribution Percentage for Determining Affordable Employer-Provided Coverage (PDF)
Internal Revenue Service [IRS] Link to more items from this source
[Official Guidance]
Aug. 1, 2022

"[This] revenue procedure also updates the required contribution percentage in Section 36B(c)(2)(C)(i)(II) for plan years beginning after calendar year 2022 ... This percentage is used to determine whether an individual is eligible for affordable employer-sponsored minimum essential coverage under Section 36B.... For plan years beginning in calendar year 2023, the Section 36B Required Contribution Percentage ... is 9.12%."

Tags: Health Plan Costs

Deadline in Five Months: Prescription Data Reporting Requirement for Health Plans
EPIC Link to more items from this source
[Guidance Overview]
Aug. 1, 2022

"Starting in 2022, employer-sponsored health plans must submit prescription drug and healthcare spending information to the Departments annually. Reporting for 2020 and 2021 is due December 27, 2022. Plan sponsors may rely on a third-party reporting entity to submit information on their behalf. Plan sponsors should take steps to ensure that reporting entities are fulfilling their obligations to report."

Tags: Health Plan Administration  •  Health Plan Costs

A Billion, a Trillion? Price Transparency Brings Enormous Data Sets
aequum Link to more items from this source
[Opinion]
July 29, 2022

"There are thousands of procedure codes with prices attached, multiplied by thousands of doctors, labs and hospitals, layered over thousands of health-plan contracts. [One consultant] said he was dealing with 700,000 unique files for insurers' in-network prices. 'It's hundreds of terabytes, reaching petabyte scale,' [he said].... The analysis of this data is overwhelming and certainly costly...  Is it too skeptical to suggest that healthcare price transparency requirements will raise overall healthcare costs?"

Tags: Health Plan Administration  •  Health Plan Costs

District Court Strikes Additional Portions of Regs Implementing No Surprises Act Addressing Air Ambulance Services
Polsinelli PC Link to more items from this source
July 29, 2022

"The court concluded that the portions of the Rule applicable to air ambulance providers 'rewrite[] clear statutory terms' by 'requiring [IDR entities] to presume the correctness of the QPA and then imposing a heightened burden on the remaining statutory factors to overcome that presumption.' " [LifeNet v. HHS, No. 22-162 (E.D. Tex. Jul. 26, 2022)]

Tags: Health Plan Administration  •  Health Plan Costs

Recent Trends in Patient Out-of-Pocket Cost Sharing
Employee Benefit Research Institute [EBRI] Link to more items from this source
July 29, 2022

"[T]he share of out-of-pocket costs paid by patients with employer-sponsored health plans increased from 17.4 percent in 2013 to 19 percent in 2019, before a pandemic-related decline to 16.4 percent in 2020.... The increase in the share of expenses paid out of pocket observed between 2013 and 2019 appears to be driven by an increase in the number of workers enrolling in plans with higher deductibles."

Tags: Health Plan Costs

Anyone Can Now See Insurers' Prices. But Can 'Mere Mortals' Understand Them?
The Advisory Board Company Link to more items from this source
July 28, 2022

"health insurers have posted their pricing data on public websites, but the sheer size of these databases has made it difficult for consumers to access, much less understand.... So far, it's difficult for patients to see the prices under their specific plan or even different plans offered by one insurer. Employers also cannot easily use the information to compare their insurers' negotiated rates with others'."

Tags: Health Plan Costs

Court Finds No Implied Private Right of Action for Inadequate Reimbursement of COVID-19 Testing
Thomson Reuters / EBIA Link to more items from this source
July 28, 2022

"With the COVID-19 pandemic now entering its third year, plans should have well-established processes to ensure compliance with the diagnostic testing coverage requirements. It is noteworthy that this provider set its cash price for COVID-19 diagnostic tests at more than $900. It would be helpful if the agencies would issue guidance to combat apparent profiteering by certain providers." [Saloojas, Inc. v. Aetna Health of Calif., Inc., No. 22-1703 (N.D. Cal. June 23, 2022)]

Tags: Health Plan Administration  •  Health Plan Costs

CBO Report: Effects of Proposal to Extend Premium Tax Credits and Proposed Regs on Affordability of Coverage for Family Members (PDF)
Congressional Budget Office [CBO] Link to more items from this source
July 22, 2022

"Under the May 2022 baseline, CBO and JCT estimate that if the [premium tax credit] enhancements became permanent, federal deficits would increase by $247.9 billion over the 2023-2032 period -- a result of increases in direct spending of $181.4 billion and decreases in revenues of $66.5 billion over the period.... Under the May 2022 baseline, CBO and JCT estimate that, if the proposed regulation [as to affordability of family coverage] is made final, the number of people enrolled in nongroup coverage would increase, on average, by 900,000 in each year over the 2023-2032 period."

Tags: Health Plan Costs  •  Health Plan Policy

Commercial Health Insurance: Detailed 2020 Financial Results, and Trends That Emerged in 2021
Milliman Link to more items from this source
July 20, 2022

24 pages. "This report provides a detailed review of the commercial health insurance industry's financial results in 2020 and evaluates changes in the market's expense structure and enrollment relative to prior years. In addition, based on calendar year 2021 statutory financial statements and first quarter calendar year 2022, the report discusses emerging financial trends for the commercial health insurance markets."

Tags: Health Plan Costs

During Pandemic, Overall Healthcare Costs Decreased But Unit Prices Rose
Willis Towers Watson Link to more items from this source
July 20, 2022

"The Health Care Cost Institute (HCCI) reported that total medical costs for those in employer-sponsored health insurance went down by 8.9% in 2020, and out-of-pocket costs declined by 11%.... Unit prices continue to rise and pose the largest threat to health care affordability. Efforts to steer members to lower cost providers can help lower unit cost. Consolidation of providers has decreased leverage to gain discounts."

Tags: Health Plan Costs

An Early Look at What's Driving Health Plan Costs in 2023 ACA Markets
The Peterson-Kaiser Health System Tracker Link to more items from this source
July 18, 2022

"The median proposed premium increase is 10% across these 72 insurers. The main contributor to premium growth is health cost trend, which reflects rising prices paid to providers and pharmaceutical companies as well as a rebound in utilization. While [this] analysis focuses on the ACA markets, the main premium drivers [the authors] identified (prices and utilization) are systemic and not specific to the ACA markets."

Tags: Health Plan Costs

Connecticut Health Insurers Seek 'Jaw-Dropping' Rate Hike for 2023
InsuranceNewsNet.com Link to more items from this source
July 18, 2022

"Insurance companies that sell policies on and off Connecticut's [ACA] exchange are seeking an average increase of 20.4% on individual health plans next year ... On small group plans, the carriers are asking for an average increase of 14.8%.... Carriers in 2021 asked for an average hike of 8.6% on individual plans and 12.9% on small group plans."

Tags: Health Plan Costs  •  Local Regulation

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