When Midsize Employers Offer HDHPs, 34% of Employees Elect Them

Thirty-four percent of employees who work for midsize employers would choose a high deductible health plan (HDHP) if given the choice, according to a report by Benefitfocus. Millennials over 26 are the most likely to opt in at 40%. Thirteen percent of employers offer at least one HDHP. Regardless of  whether the plan is a PPO or HDHP, employees face higher out-of-pocket costs. With rising copays and coinsurance, the average family could spend nearly 40% more on health care than on food in 2016. To close the gap, many employers are funding health savings accounts (HSAs) and flexible spending accounts (FSAs). Yet adoption is low at large and midsize companies. On average, eligible employees contribute less than half the maximum amount allowed. Shawn Jenkins, Benefitfocus CEO, said that employers will drive more choice and innovation in  benefits and in the plan selection process in order to attract and retain talent. He added that, as the market shifts toward consumer-driven health plans, employers must make make it a top priority to offer decision support, education, and financial wellness resources.

HHS to require proof of eligibility for late health plan enrollment

People who want to use HealthCare.gov to subscribe to a health insurance plan or change plans outside the open enrollment period must now prove that they are eligible, marketplace CEO Kevin Counihan said. The requirement is “a much-needed step in the right direction,” said AHIP spokeswoman Clare Krusing. The New York Times (free-article access for SmartBrief readers) (2/24)

What Consumers Look for In a Health Plan

When choosing a health plan, the cost of insurance premiums is the top concern for younger healthcare shoppers (under 45). In-network access to doctors ranks higher with older consumers (45 and over), according to a 2015 FAIR Health survey of more than 1,000 adults in the United States.

While older consumers place access to their doctors at the top of the list, all age groups are more concerned about whether certain doctors are in their plan’s network than they are about network size. This information comes at a time when more employers and health plans are introducing narrow and tiered networks to reduce healthcare costs. Consumers also have more access to health plan choices due to the growth of public and private healthcare exchanges.

“While consumers did not list the number of doctors in the network as a prime consideration when enrolling in a health insurance plan, if the primary care doctors consumers prefer are not in their network, it will factor into their decisions when selecting a plan,” said Robin Gelburd, president of FAIR Health.

Latinos, women, adults younger than 45, low-income households and people with children in their households are the most likely to say that cost usually or always influences their decisions when choosing a doctor:

  • 63% of Most Latinos (versus 48% of the general population) usually or always consider cost.
  • 56% of consumers with children in their household usually or always consider cost, versus 45% of respondents without children at home.
  • Sixty percent of those with annual household incomes under $35,000 always or usually consider cost, versus 48% of the general population.

Q: Which one of the following is your most important consideration when enrolling in a health insurance plan?

Age Monthly premiumcost Total out-of-pocket costs (Including co-pays and co-insurance) Primary care physician or family doctor accepts plan Deductible Number of doctors in the network
18-34 28% 25% 23% 12% 6%
35-44 28% 24% 16% 14% 9%
45-54 17% 22% 32% 9% 5%
55-64 20% 24% 32% 7% 4%
65+ 18% 18% 30% 4% 7%
Total Population 23% 23% 26% 10% 6%

Patients Want Access to More Health Plan Information

Thirty-six percent of exchange consumers with chronic conditions have a hard time finding information about covered providers and medications, according to a survey sponsored by the National Health Council (NHC) and conducted by Lake Research Partners. Thirty-eight percent have a hard time finding a list of prescription drugs on the exchange site. Only 37% of patients who are enrolled in silver plans say they have all the information they need when making a decision.

At the same time, only seven state exchanges analyzed by the NHC have additional website resources and tools beyond the federal minimum requirements, and only one state has passed contracting requirements to enhance plan information transparency. Consumers said the following would be helpful:

  • 88%  a standardized list of covered providers.
  • 85% a standardized list of covered drugs.
  • 83% a calculator to help them estimate out-of-pocket health costs.

While federal rules set minimum requirements for the exchanges, some states have taken extra steps to make their insurance markets more patient focused. With the assistance of Avalere Health, the NHC evaluated 32 states on 15 metrics identified as important to the patient community and spread across five principles – non-discrimination, transparency, state oversight, uniformity, and continuity of care. All states analyzed have taken steps to enhance the patient experience, but to widely varying degrees. Twenty out of the 32 states have addressed five or fewer of the metrics as of January 1, 2015.

What Doctors Want You to Consider Before Choosing a Health Plan

As open enrollment for 2015 exchange plans gets underway, the American Medical Association (AMA) urges patients to review the plans they are considering in order to prevent interruptions in care and higher out-of-pocket costs. Whether it’s a new plan or a renewal, patients should consider deductibles, co-pays, drug costs, which physicians and facilities are covered, and the cost of out-of-network treatment. Patients should ask whether their physicians are participating in plans they are considering. AMA President Robert Wah, MD said, “It is very important that patients look beyond the big print, color-coded plan designations and price of insurance plans and check the small print details before making their selection.” AMA asks patients to consider the following:

1) Are your family’s doctors in the plan? If not, what will you have to pay out-of-pocket for office visits or other services your doctor prescribes? Is the plan’s directory of participating physicians up-to-date and accurate? Are there physicians on the list who are still accepting new patients?

2) What does the plan cover? What percentage of your health care costs will you have to cover? If so, how much and can you afford it? How much will you have to pay out of pocket for the medicines your family needs? Will you be able to use hospitals, labs and other facilities that are convenient to where you live or work? Does the plan provide access to a sufficient number of specialists that you need?

3) Does your primary care physician have to get permission from the insurance company to refer you to a specialist? Does that rule include specialists you see regularly for a chronic condition? Does the insurer use penalties or incentives to induce physicians in the plan to limit referrals in any way?

For more information, visit www.ama-assn.org.

Many Americans Don’t Ask Basic Questions Before Choosing a Plan

Three out of four Americans say they understand health insurance. But 42% say they are somewhat likely or not at all likely to review plan details before signing up for coverage, according to a survey by the American Institutes for Research (AIR).  “Because many people believe they know more than they actually do about health insurance,…they may face the shock of high out-of-pocket expenses they didn’t expect,” said Kathryn A. Paez, Ph.D., R.N., an AIR principal researcher, and coauthor of the study. The survey reveals the following:

  • About half can identify general characteristics of an HMO, and 23% can identify the characteristics of a PPO.
  • While most can identify common insurance terms, such as “appeal” (80%) and “premium” (81%), far fewer can identify more complicated concepts, such as “step therapy” (37%) or “medically necessary” (60%).
  • Only 20% can calculate how much they would owe for a routine doctor’s visit.
  • Seventy-nine percent are at least moderately likely to check which hospitals and physicians are covered by various plans.
  • Those aged 22 to 34 answered 55% of the knowledge and skills items on the survey correctly, compared to 63% of 55- to 64-year olds.
  • People who have not seen a doctor in the past year answered 49% of the knowledge and skills questions correctly compared to 64% of those who see a doctor several times a year.

Health Plan Report Card

The California Office of the Patient Advocate (OPA) is offering a health plan report card. Available in English, Spanish, and Chinese, the Report Cards allow consumers to compare the quality of care from the state’s 10 largest HMOs, six largest PPOs and more than 200 medical groups.  For more information, visit www.insurance.ca.gov.

The Most Overlooked Benefits of Travel Insurance

One of the most overlooked travel insurance benefits is primary versus secondary coverage, explains Frank Trigo, general manager of InsureandGo. The vast majority of travel insurance policies offer secondary medical coverage, which is coverage in excess of all other valid and collectible insurance.

If you already have a private or group health plan, the travel insurance medical policy with secondary medical will only pay the expenses in excess or over the amount covered by the other primary health insurance policy that you have at home. “With primary coverage, you won’t have to jump through hoops to find out if your private or group health care plan will cover you when travelling internationally, you won’t have to incur out of pocket expenses and you won’t risk being denied medical care in a foreign country due to payment. Some cheaper policies may have higher medical coverage limits but if the coverage is secondary, that high limit might not be as valuable as a primary policy with a lower limit,” he adds.

Many policies cover your personal property regardless of where the loss occurs: be it in a cafe, on a tour, or from your hotel room. But many policies don’t cover electronics, such as tablets, phones, or computers so it’s important to check each policy carefully under the baggage and personal property section.

Since the cost of getting airlifted from a cruise ship or flown to a hospital in air ambulance for care is astronomical, travelers should look for policies that have a minimum of $100,000 in medical evacuation. “Also, the travel insurance company will make all the arrangements with the provider which is a tremendous benefit in itself,” says Trigo.

Transportation of beside support person in case you are hospitalized is another overlooked benefit. “Imagine you are hospitalized and alone in a foreign country. A good travel insurance policy will cover the costs to bring a person selected by you to your bedside if you are hospitalized for seven consecutive days,” he adds.

Trigo says that 24-hour emergency travel assistance is one of the most valuable, but under-marketed benefits of a travel insurance policy. The company can coordinate all aspects of your emergency, such as directing you to a proper medical facility, guarantying your admittance, coordinating care, monitoring your condition, and keeping loved ones back home apprised. For more information, visithttp://www.insureandgousa.com.

Small Business Report Plan Cost Hikes

Ninety-one percent of small businesses surveyed by the National Small Business Assn. (NSBA) were hit with cost increases during their most recent health insurance renewal. Twenty-five percent were hit with increases exceeding 20%. NSBA President Todd McCracken said, “These costs have real-world implications: one-third of small businesses held off on hiring a new employee and more than half say they held off on salary increases for employees.”

While the majority of employers say that offering health insurance is very important to recruiting good employees, just 51% of the smallest firms offer health benefits. Among the 70% of small firms that offer health insurance, the majority pay for more than half of the cost of their employees’ plans.

The average monthly per-employee cost of health insurance premiums for a small firm is $1,121 compared to just $590 in 2009. Small businesses spend an average of 13 hours and $1,274a month on the administrative side of understanding the Affordable Care Act. For more information, visitwww.nsba.biz

CDHPs May Become the Most Popular Plan Type

Consumer Driven Health Plans (CDHPs) could become the most common plan type offered in the next three to five years, according to a study by Aon Hewitt. CDHPs are now the second most prevalent plan offered by employers after PPOs.

Fifty-six percent of employers offer CDHPs, and another 30% are considering offering one in the next three to five years. While 10% of employers offer CDHPs as the only plan option, another 44% are considering doing so in the next three to five years. In 2012, employers reported a cost trend of 4% for CDHPs compared to 6% for PPOs, 7% for HMOs, and 6% for exclusive provider networks.

Employers are using a variety of tactics to encourage enrollment, including subsidizing premiums at a higher level than they do for other plan options (44%), making the high-deductible plan the default plan option (22%), and covering preventive medicines before the deductible applies (44%).

A growing number of employers are considering offering voluntary benefits to address consumers’ fears that they will not be able to afford a catastrophic illness with a CDHP. While just 9% of employers offer voluntary benefits with a CDHP, another 44% are considering adding this type of coverage in the next three to five years.

Seventy-eight percent of CDHP consumers are satisfied with their plan and 89% say they will re-enroll, according to recent Aon Hewitt’s research. Sixty percent of employees who were enrolled in CDHPs say they have made positive health changes. Twenty-eight have gotten routine preventative care more often, 23% have sought lower-cost health care options, and 19% have researched health costs more frequently. For more information, visit www.aonhewitt.com.

Last Updated 12/01/2021

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