Ever have a trip to the emergency room and wonder why fees are so astronomical? In 1986 the EMTALA was signed into law. This increased access to to basic medical care for the uninsured, but also put tremendous cost pressure on hospitals. Since around 55% of emergency room care goes uncompensated, these costs are spread out to insured members of the population in the form of really high costs.
With presidential debates kicking off soon, lowering health care costs to consumers continues to be a lead concern for voters.
In 2018, 71% of IVF patients treated paid for most or all of their IVF treatment out-of-pocket with average amount paid over $22,000 per cycle. Due to the high cost and selective nature of the benefit, most employers are still reluctant to provide this as an employee benefit.
With record low unemployment, many companies are turning to emerging benefits to attract and retain employees:
Wellness program ROI can be difficult to measure, as shown in this recent study of employer BJ's Wholesale Club.
Crossing the border to buy expensive prescriptions is a tempting strategy, especially for San Diegans. There are substantial safety and legality concerns. Income-based Rx prescription assistance programs offered by pharma companies and non-profits should be evaluated and exhausted first. Google: "prescription assistance programs".
Amazon now accepts HSA/FSA cards for over-the-counter medical supplies:
The Affordable Care Act made great improvements to insurance market standardization, transparency, and access. Recent proposed initiatives from the Department of Health and Human Services will help increase transparency for Rx and hospital costs at the consumer level. These are great initiatives for reducing healthcare costs!
When buying common consumer items (sneakers or electronics for example), there's often a 150-200%+ price swing between the lowest clearance price and the highest price available. Same goes with healthcare prices.
Employers should be educating their employees how to utilize cutting edge online consumerism tools to find the best deal for Rx and elective procedures. If employees get caught with a life threatening emergency and billed an outlier out-of-network rate, they should leverage public pricing data to negotiate down their bill.
Wellness plans designed for employees with the highest risk factors will yield the highest results in reducing claims costs:
Against a backdrop of a historically tight labor market, rising wages, and insurance cost increases well below recent trend...some benefits are becoming less popular:
Two key employer-based healthcare trends to watch in 2019:
1. High-deductible/HSA plans popularity decreasing
2. Narrow-network HMO plans popularity increasing
Change is inevitable in life, and this is especially true when it comes to medical insurance. Here are 10 key areas for employee to focus on at open enrollment time:
Student loan repayment has become a hot new employee benefit. Unlike tuition assistance which is tax deductible up to $5,250 per year, student loan reimbursements to employees are still taxed as ordinary income. Still a great benefit to attract and retain great employees.
In a big step towards more consumer pricing transparency, the Centers for Medicare & Medicaid Services(CMS) issued updated guidelines on August 2nd which will require more user-friendly electronic disclosure of hospital charges. Will be interesting to see how the government and/or third party vendors aggregate this data and make it available to consumers for comparison shopping of hospital fees.
Scripps just passed the 2nd year of their integration and partnership with The University of Texas MD Anderson Cancer Center, which is routinely ranked as the #1 cancer treatment center in the US.
I attended a conference at Scripps Memorial Hospital La Jolla this morning and learned Scripps is in the process of expanding their clinic presence to all of San Diego county. Great news for South County and East County residents!
Why Cuban cab drivers earn more than doctors
Interesting video that shows potential inequity when a market-based economy coexists with a government controlled healthcare sector. (Think long lines at the DMV). Potentially an extreme case given the fact they've been under a Marxist system since 1959 and have only recently allowed private payment for some services. Worth a watch.
Amazon will spend $1 Billion to acquire Rx startup PillPack. The acquisition promises to disrupt the prescription drug market, hoping to substantially reduce costs for insurers and consumers.
The Trump Administration just extended availability of less comprehensive short term "skinny" health insurance plans from 3 months to 36 months.
The Trump Administration's action to halt risk adjustments payments may further deteriorate the individual medical insurance markets:
In January 2018, The Trump administration issued guidance allowing(but not requiring) states to impose a "work/community service requirement" for people receiving Medicaid benefits. Work requirements in New Hampshire, Indiana, Arkansas and Kentucky have already been approved, and there are six states with pending applications.
Domestic partner imputed income is a commonly misunderstood benefits tax compliance issue. This article does a good job explaining what actions employers need to take:
Medical Bills and EOBs
Ever been to see a doctor, then experienced a deluge of paperwork in the following weeks? Here's a great info graphic explaining every component of the insurance carrier EOB and provier medical bill.
Oscar Health is a startup medical carrier who focuses on narrow provider networks and technology to manage costs. They have around 240,000 active members in NY, CA, TX, TN, and OH. Current market valuation is $3.2 Billion. Already a substantial presence in LA and OC, Oscar Health has not commented on if/when they may expand into the San Diego market.