Back in 2017, we wrote about a topic that vexes insurers and self-insured employers: specialty drugs. More specifically, we wondered whether specialty drugs are worth their high cost. Five years later, there aren’t any more conclusive answers about whether these drugs are effective enough to warrant sky-high prices—and in the ensuing five years, those prices have only gotten higher. Continue Reading >
As self-funded health plans have steadily grown in popularity over the last decade, many business leaders have found themselves in unfamiliar territory. After switching from fully-funded insurance to self-funding, there’s a great deal of information to absorb. Stop loss insurance is one tool that self-insured employers may utilize but not fully understand. Continue Reading >
Employers have to walk a fine line around employee mental health. It’s not appropriate for employers to probe their employees with personal questions about their physical or emotional health. At the same time, employers have a vested financial interest in making sure that members of their workforce have access to necessary mental health resources. Continue Reading >
Out-of-pocket expenses can become overwhelming or even financially devastating for someone who’s dealing with a serious, ongoing health issue. The Affordable Care Act cost-sharing caps limit some out-of-pocket medical costs for consumers, requiring health plans to cover costs that exceed those limits. Annual ACA caps can have some impact on a self-insured employer’s healthcare spending. Continue Reading >
Employers are clear about the fact that they need to control healthcare costs. They often aren’t as clear about the strategies they can use to do that, in a way that benefits both the organization and its employees. Self-funding a health plan is an increasingly popular choice among businesses of all sizes, but business leaders might be wary about the financial risk of taking direct responsibility for paying employees’ claims. Continue Reading >
We’ve probably all experienced sticker shock at the pharmacy counter. How can employers with self-funded plans continue to provide high-quality health benefits when so many of their healthcare dollars are going to prescription drug costs? A piece of legislation that would allow Medicare to negotiate some drug prices could possibly provide some relief, for both Medicare members and self-insured employers alike. Continue Reading >
It’s not news to anyone that prices have gone up across the board over the last few years. Your business is probably paying more for everything from healthcare benefits to office supplies than you could have anticipated. If you’re concerned about inflation, you’re not alone—and your concerns are legitimate. Continue Reading >
As self-insured employers look for ways to control healthcare costs, they have to evaluate every strategy that might help them accomplish that goal. Reference based pricing is a pricing strategy that eliminates rate negotiation between employers and healthcare providers, and may result in employers spending less on their employees’ medical claims. Continue Reading >
While stop-loss coverage has become an increasingly popular tool for self-insured employers, it’s still a topic of confusion for many people. The purpose of stop-loss coverage is to provide a layer of financial protection for employers. Two primary types of stop-loss policies exist, aggregate and specific, and employers typically use both types to give themselves maximum financial protection. Continue Reading >
Does your self-funded plan offer dental and vision coverage? How about acupuncture, chiropractic care and fertility treatment? Many self-insured employers don’t cover them—but employees with health savings accounts (HSAs) may still be able to afford these and other medical costs not covered by their insurance. Continue Reading >
In 2011, the top 5 most expensive medical conditions treated in US hospitals were: Septicemia, Osteoarthritis, Complication of device, implant or graft, Liveborn, and Acute myocardial infarction
From 2010 to 2013, the number of claims that were individually $1 million or above rose by 1,000%
In 2017 approximately 18% of the American public will purchase insurance through exchanges, radically transforming the health insurance landscape.
In 2014, 98% of large firms (= 200 Workers) offer 1+ wellness programs to their employees.
The most costly 1% of patients account for 20% of national health expenditures – accruing average annual expenses of nearly $90,000 per person.
6% of firms offering fully-insured plans report they intend to self-insure because of Obamacare.
In 2014, PPO plans remained the most common plan type, enrolling 58% of covered workers.
In 2012, 93% of businesses with 5,000+ employees and 80% of companies with 1,000-4,999 employees were self-funded
Massachusetts has the third-highest prevalence of self-funded insurance in the small-group market (Fewer than 50 employees).
In 2013, the average deductible was $2,906 for individuals selecting plans from marketplaces. This compares with average deductibles of $1,135 for an individual with employer coverage.
In 2013, the average annual premiums for employer-sponsored health insurance are $5,884 for single coverage and $16,351 for family coverage, up 5% and 4% respectively from 2012.
From 2010 – 2013, cancer followed by chronic/end stage renal disease and leukemia accounted for the top 3 costliest illnesses.
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