S&S Benefits.....Opinion, Hearsay & News Review

A survey of group health insurance costs by industry shows that the finance industry is highest cost at $11,842 PEPY in 2015, up 16% from 2014. Government plans still have the third highest cost at $11,817, yet employee contributions are 45.2%  ($2,105) less than the average employee contribution of $3,333 PEPY.

A UBA survey finds that 53.7% of employers offer one health plan to employees, while 28.7% offer two and the remaining 17.6% offer three or more options. Plan costs increased by  an average of 6.2% in 2015. The highest per employee cost of $12,822 PEPY was in Alaska and the lowest of $7,610 was in Hawaii. The other highest cost states were Wisconsin, North Dakota, New Hampshire and Minnesota. The other lowest cost states were Arizona, Florida, Maryland and Tennessee.

The BCBS Association, which represents 36 BCBS plans, has released a study that (SURPRISE!) shows that Obamacare members have 22% higher costs than the average group plan member and that costs had increased by 12% from 2014 for Obamacare members. Although premiums were up, HHS reports that the average monthly cost to those enrolled in 2016 were only going up by $4.00 after subsidies.

UnitedHealth Group has decided to call it quits for Obamacare in Georgia and Arkansas. Overall the company expects to lose $650 million on Obamacare exchange plans in 2016. Remember..? “if you like your plan you can keep it.”

More co-ops are in trouble. In Massachusetts, the co-op has $95 million in assets, but net losses were $43 million and it needed 40,000 members to break even, but had only 14,000 customers, In Ohio, the co-op had assets of $108 million, but net losses of $79 million. In Wisconsin, the co-op lost half of its $74 million in assets and in New Mexico the co-op lost $23 million. In Illinois, the co-op had $107 million in assets, but lost $91 million.

A KFF survey of employers shows that the average deductible paid by employees rose 256% from $99 to $353 from 2004 to 2014. Average coinsurance payments were up by 107% to $242 during the same time period. Co-pays fell by 26% to $152. Overall patient cost sharing  rose by 77%  from $422 to $747. During the same time period, payments by health plans rose 58% from $2,748 to $4,354. From 2004 to 2014, workers’ wages rose 32%.

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A report from S&P Dow Jones Indices found that for the first time, average individual policies cost more than average  group rates for individuals and they are now about 10% higher than group plans. This is due to the inability to underwrite these programs as part of Obamacare.

Valence Health surveyed more than 150 hospitals, health systems and other provider organizations. Over 75% of respondents were self-funded. Of those, 54% had an insurer pay their claims and 36% used an independent TPA. Those who used an independent TPA were, unsurprisingly, far more likely to be very satisfied with their services.

The National Center for Policy Analysis says that on average, hospitals charge 3.77 times more than what Medicare pays, which is why self-funded groups should consider a “cost plus” approach to charges, rather than network discounts.