One fact exists. This is not your grandfather’s health plan. Health reform’s Affordable Care Act made sure of that.
Employer sponsors are still trying to come to terms with the heaping serving of legislative changes. Let’s dust off the crystal ball and see what may be in the future for 2016 health plans.
Health Plans Forecast
As someone who no longer has employer-sponsored benefits, I’ll sprinkle in a few predictions for those of us who purchase our own insurance.
Most 2016 predictions for large employers come from the National Business Group on Health. Its annual survey shares what large employers expect in 2016.
1. Higher Premiums
Why does this not surprise us? Depending on your coverage (and the source of predictions), premium rates could increase as much as 22 percent or more. Before you start shooting the screen, understand there are a lot of moving parts to those predictions.
The National Business Group on Health survey revealed large employers are expecting an increase of about 5 percent. According to the survey, companies do plan on passing some of that cost on to employees (many requiring dependents contribute more than employees).
Public Exchange Health Plans
Public health exchanges or insurance marketplaces (like those at Healthcare.gov) carry a very big “it depends” when it comes to premium increases.
The Kaiser Family Foundation conducted an analysis of premium changes in 12 states (so far) plus the District of Columbia. The analysts reviewed premiums for the lowest- and second-lowest cost silver marketplace plans. The results average a 3.1 percent increase.
Not too bad, right? Unless, of course, you live in Portland, Oregon where it shows an increase of 22.8 percent in 2016. However, there are some important caveats.
- Small sample – The small sample of states and the plans analyzed are just that – a small sample. Your results could be much different.
- Limited category – The silver plans (which average about 70% coverage) are one category of plans. Platinum plans average about 90% coverage with higher premiums. There are also Gold plans (average 80% coverage) and Bronze plans (average 60%).
- Missing tax credit – The above increase averages are also before any tax credit.
So, if you are eligible for a subsidy on your premium, you could find the amount out of your pocket will not change dramatically.
2. A Continuance of High-Deductible Health Plans
If you do purchase your own health insurance, you probably noticed that high-deductibles dominated the health insurance marketplace. The same is true for health plans offered through employers.
The one big exception is many companies (particularly large ones) contribute to some form of a health savings account, which helps with out-of-pocket costs. If you’re like me and purchase your own insurance, your own money funds any health savings account.
Telehealth (or telemedicine) is a virtual health care connection. It could be a video chat with your doctor, an email or online sharing of health information.
The National Business Group on Health survey shows employer sponsors are jumping on board. Nearly three-quarters of the respondents offer (or will offer) benefits for the telehealth option. The belief is it will help reduce costs and provide better access to healthcare professionals for people living in remote areas.
4. Focus on Specialty Drugs
Specialty drugs treat complex medical conditions, such as multiple sclerosis or hepatitis C.
The good news is a small percentage of the population has those conditions. The bad news is the cost of specialty medications is sky-high. For example, a 12-week course for a hepatitis C specialty drug is a whopping $84,000.
Expect a lot of scrutiny before any insurer puts a rubber stamp on the cost of specialty drugs.
5. More Technology
From health wearables to interactive enrollment systems, health plans are taking the digital ride.
- Bite-size packages – Employee benefits are packaged in small bites of online modules with the hope of improving employee engagement.
- Health & fitness technology – Corporate wellness programs expand to include benefits for health apps and wearable devices in the quest for a healthier workforce.
Privacy and security advocates fear the connection of personal health information to the workplace or to online hackers.
Fitbit, Inc. is the first (that I know of) in the health wearable field to claim compliance with privacy and security regulations of the Health Insurance Portability and Accountability Act (HIPAA).
The race is on to see what kind of technology will solve the problem of the unsophisticated healthcare consumer.
Whether you have health benefits through your employer or purchase your own, expect change. Like many other facets of our lives, the crystal ball reveals technology and costs will play a major role.
Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.