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Many Employees Choosing the Wrong Health Plans

by Inoventive Solutions
June 17, 2022

A new study  has found that many people in employer-sponsored health plans are enrolling in plans that are costing them more than they ought to be paying.

Many employees choose pricey plans with low deductibles, which force them to spend more up front on premiums to save just a few hundred dollars on their deductible.

As result, many employees are spending hundreds, if not thousands of dollars more on their health care/health coverage than they need to.

Study 1: The deductible angle

A study by Benjamin Handel, a U.C. Berkeley economics professor, found that the majority of employees at one company he studied were in the highest-premium, lowest-deductible plan ($250 a year) their employer offered.

This resulted in them spending about $4,500 a year on health care, compared to only $2,032 had they gone with the cheaper plan (which had a $500 annual deductible) and received exactly the same care.

Study 2: Too many choices?

Additionally, the research paper “Choose to Lose: Health Plan Choices from a Menu with Dominated Options,” published in the Quarterly Journal of Economics, found that more choices also didn’t yield more savings for individuals in employer-sponsored plans.

The study examined the health plan choices that 23,894 employees at one large U.S. employer made. They were able to choose from 48 different combinations of deductibles, pharmaceutical copayments, co-insurance and maximum out-of-pocket expenses. All of the plans offered the same network of doctors and hospitals.

As a result, workers paid an extra $528 in premiums for the year to keep their deductible at $750 instead of $1,000. In other words, they paid $528 to save $250.

For nearly every plan with a deductible of $1,000 (the highest deductible available for those seeking single coverage), the additional premiums required to reduce the deductible, with all other plan attributes fixed, exceeded the maximum possible out-of-pocket savings provided by the lower deductible.

The study also found that the lowest-paid workers were significantly more likely to choose dominated plans (the most expensive).

Both of the studies above looked at plan options with relatively low deductibles when compared with high-deductible health plans, which have become more popular with time.

In 2018, the minimum deductible for an HDHP is $1,350 for an individual and $2,700 for a family. But, under current regulations, total out-of-pocket expenses are limited to $6,650 for an individual and $13,300 for a family with a HDHP.

While these plans have gotten a bad rap lately, a study published by the National Bureau of Economic Research found they are often cheaper for employees, as well.

The authors, both from the University of Wisconsin-Madison, found in a study of 331 companies, that at firms offering both a HDHP and a low-deductible plan, selecting the HDHP typically saves more than $500 a year.

Strategies

To help offset the cost of a HDHP, you can offer your staff health savings accounts (HSAs), which offer a tax-advantaged way to save for health care costs. While there are annual contribution limits, HSAs allow your employees to roll over their balance from year to year. The funds they contribute to their HSA are pre-tax, so the savings are significant.

The Wisconsin-Madison authors surmised that many people choose the costlier health plan for two reasons:

  • Inertia – It’s easier for consumers to stick with their old plan rather than crunch the numbers to see if a new plan may be more appropriate.
  • Deductible aversion – When employees see a low-deductible plan they may associate it with better quality care, even though the network and coverage may be the same.

The best strategy to guide your staff to the plan that best suits them is to educate them. You should have workshops for your staff prior to open enrollment, to help them understand why the higher-deductible plan may often be the best choice for them if they want to save money on their overall premium and out-of-pocket expenses.

Ideally, you could encourage them to set aside the same amount of money in their HSA that would be enough to cover their deductible. This way, your employees would not feel burdened by health expenses they may have to pay for during the year.

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More Employers Add Narrow Networks to Offerings

by Inoventive Solutions
June 9, 2022

More employers are including narrow provider network insurance plans among their plan offerings to their employees to give them a lower-cost premium option.

Narrow provider networks limit the number of covered providers included in health insurance plans. While these plans have been mainstays on Affordable Care Act marketplaces, employers have been slow to adopt them.

But according to the Willis Towers Watson “Health Care Delivery Survey,” 18% of large employers offer a narrow network — also known as a high-performance network — in their employee health plans. Those numbers are expected to have grown to an estimated 25% in 2022, experts say.

Premiums for such plans cost 16% less on average than plans with broad networks, according to a study in the journal Health Affairs of plans sold on the individual health insurance market. 

If an employer wants a more economical premium cost, choosing a plan with a limited (or narrow) network may help. Those who want greater choice may pay more for access to a network with more providers. Narrow networks include all specialties, but a smaller network may offer only two podiatrists, for example, while a larger network may offer 10 or more.

What they are

An insurer that offers the narrow network plan will contract with a local, community-based medical provider, large enough to ensure they have all the specialties needed for the insurance plan.

Typically, these plans feature fewer doctor and specialist choices, but they are, by law, required to have all medical specialties represented in their network. Many people think the plans are restrictive, but that’s not the case. The main driver of these plans is their focus on coordinating care and the central role of the patient’s personal physician.

On top of that, insurers say that providers in these narrow networks have track records of delivering care more efficiently and cost-effectively by focusing on improving patient health rather than billing for more services.

Cost savings: In exchange for a narrower network, up-front premiums are often lower than other plans that have more choices of providers.

Additionally, narrow networks control longer-term costs by encouraging enrollees to go to their primary care providers first with any new health concerns or issues, instead of going straight to a specialist. Increased use of primary care physicians and less use of specialists can also help control your employees’ out-of-pocket expenses.

The drawbacks

These plans are not for everyone. For someone who may not use their health insurance much, a narrow network could be ideal. But for many people the narrow network may not include their personal doctor and hospital that they are accustomed to going to.

And in some cases a specialist could be miles away, requiring a long drive. This is something for parents of young children to consider when choosing a plan.

Also, even if you have staff that focus on staying in-network, sometimes going out of network is unavoidable. And many narrow network plans do not cover any services outside of their network, while others may cover a small portion.

Under the Affordable Care Act, health plan enrollees are protected from massive medical bills because health plans are required to limit the amount of out-of-pocket costs to $8,700 for an individual and $17,400 for a family. But that applies only to services from an in-network provider. There is no limit if your employee goes out of network.

The takeaway

Employers know they need to offer health benefits to attract and retain top employees.

Narrow network plans provide a way to contain costs without sacrificing care, but because they’re comprised of local, community-based medical providers they’re best for a workforce that works at a single location and therefore lives within proximity to the job site/office.

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Workers Cite Health Benefits as a Top Factor When Accepting a Job

by Inoventive Solutions
June 3, 2022

Despite the job market upheaval and intense competition for talent, there is a mismatch between the value that human resources executives and job prospects put on employee benefits, according to a new survey.

One in five workers surveyed said that health care and health insurance are a major factor when deciding to accept a job, compared with only 13% of human resources executives, according to the “2022 Health at Work” survey by Quest Diagnostics.

And when asked to cite the top two factors for attracting and retaining workers, 50% of employees cited comprehensive health insurance, making it the highest-rated factor. That’s compared with only 37% of HR executives.

While making more money was still the top reason for looking for new work, the results illustrate the importance of health benefits and that employers are not as tuned into their employees’ needs as they think they are.

But the one issue hanging over all employee benefits, particularly health insurance, is the costs. Employees are now expecting employers to do more to control these costs, particularly as premiums are expected to increase as more people are dealing with chronic conditions and delayed treatment due to the COVID-19 pandemic. That should be a wake-up call for employers.

Here are some of the approaches that employers are taking:

Pay a fixed amount to an employee’s total premium — In this scenario you agree to pay a set amount towards the premium regardless of which plan your worker chooses. If they choose one with more generous benefits and lower out-of-pocket costs, they’ll pay more out of pocket than if they choose a plan with a lower premium. You can choose either a flat rate or a specific percentage of total premium.

Offer narrow network health plans — Employees who sign up for these plans can only receive care and services from providers in the plan’s network. If they go out of network, it will likely not be covered and the employee has to pay for the costs out of pocket.

And because the network is narrow, meaning the insurer doesn’t contract with a number of different providers, premiums are usually lower, but still offer quality care.

Offer wellness programs — If implemented properly, these programs can help your workers improve their overall health through lifestyle change. There are a number of wellness programs with a focus on a variety of areas, such as smoking cessation, weight loss, exercise programs and activities, and health screenings.

These are all programs aimed at preventing disease and poor health, reducing the need for expensive medical care later.

Offer a telemedicine option — Virtual care services have exploded during the last two years and more plans are covering these services.

Offering telemedicine as part of your benefits package can lead to substantial cost savings as it allows your employees to access health care professionals when they need them, 24/7. This can reduce the chances of trips to urgent care facilities and emergency rooms, which are both costly.

Offer HDHPs — High-deductible health plans tend to be less expensive than other plans because they shift more of the cost to the employee, who pays out of pocket in exchange for lower premiums.

Typically, employers will arrange for workers to contribute a portion of their pay, pre-tax, into a health savings account, which they can later use to pay for health services and medicine. The idea is that your employees will use the money they save on premiums and deposit it into the HSAs, which have a number of benefits:

  • Funds going into the accounts are not taxed,
  • Withdrawals are not taxed,
  • HSAs have an investment feature that lets account holders invest their funds, much like a 401(k) plan, and
  • Employees can keep the accounts, and even move them between employers.
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Dental and Vision Benefits Are Inexpensive, and a Big Hit with Workers 

by Inoventive Solutions
May 26, 2022

Employers nationwide are looking for ways to attract and retain talent and differentiate themselves from competing employers, and many are looking to the two most popular voluntary benefits: employee dental and vision plans.

That’s important in today’s tight job market. After all, a recent survey from CareerBuilder found that 55% of workers believed an employer’s menu of benefits was more important than salary when considering a job position or offer.

Here’s why dental and vision benefits are so popular and why, if you don’t already do so, you should consider offering them as well.

Background

For many years, dental and vision plans were employer-paid. They were just part of a standard package available to full-time workers at little or no cost to themselves.

However, as businesses have tightened their belts, many of them moved dental and vision plans to the voluntary benefits side of the ledger, with employees picking up some or all of the premium costs via payroll deduction.

Even when workers are covering the costs, dental and vision plans are overwhelmingly popular with them, because of the relatively low out-of-pocket premiums and the terrific value they provide.

Appeal to workers

Employees like vision and dental benefits because they provide real savings that they and their families are able to see every year — because they actually use the plans. 

That’s compared to other voluntary benefits like major medical, life insurance and disability insurance, which employees may need many years down the road, if ever.

According to the “2021 MetLife Employee Benefit Trends Survey,” 68% of employees consider dental insurance and 49% consider vision benefits to be among their “must have” benefits.

Their employers like them because they can provide these benefits, cementing the bond of loyalty between the employer and employee, for a small fraction of the overall compensation budget. Indeed, dental premiums have been falling in recent years.

Appeal to employers

Employers are also embracing dental and vision care as research is increasingly pointing to good dental and vision health as correlated to overall health — hopefully improving worker productivity and reducing eventual health care costs. 

For example, diabetes and high blood pressure are increasingly being discovered during routine eye exams. Optometrists across the country are commonly finding early warning signs of hypertension from observing ocular pressure — a nearly invisible symptom outside of eye exams.

Their patients armed with this knowledge are able to seek intervention before their condition worsens and results in bigger claims against the employer health plan. A study by HCMS Group found that:

  • 34% of all diabetes cases are first identified via eye exams, at a saving of $3,120 per employee, according to HCMS Group.
  • 39% of all hypertension cases are first identified via eye exams, at an average saving of $2,233 per employee.
  • 62% of high-cholesterol cases are first identified through eye exams — saving $1,360 in eventual health care costs thanks to early detection.

Finally, simply offering something like a vision plan — especially to workers who are at high risk of eye strain from staring at a computer for hours every day — sends an important message to workers that you care about their wellness. 

Who pays premiums?

According to the National Association of Dental Plans:

  • Only 6% of employers are currently paying the entire cost of employee dental benefits.
  • At 24% of employers, the worker pays 100% of the cost via a payroll deduction program.
  • 70% of employers share the premium cost with staff who sign up.

Plan structures

Furthermore, about 80% of group dental plans are preferred provider organizations, or PPOs, which aim to control costs by contracting with a limited network of providers willing to cut their rates to plan members in exchange for the promise of a steady stream of plan referrals.

The percentage of plans embracing the PPO model has been increasing, while dental HMOs and old-fashioned indemnity plans have been losing market share. 

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Employers Focus on Cost Containment, Mental Health and Telemedicine

by Inoventive Solutions
May 18, 2022

A new survey has found that managing health care costs and expanding mental health benefits will be a top priority for U.S. employers as they ramp up benefits to compete for talent in the tight job market spawned by the COVID-19 pandemic.

Additionally, virtual care is expected to become an essential and long-lasting feature of employers’ health insurance and employee benefits strategies over the next few years, according to the “2022 Emerging Trends in Healthcare Survey” by Wills Towers Watson.

The focus on health care and insurance costs, mental health and expanded telehealth comes as employers continue pulling out all the stops to compete in a tight job market but face health care inflation headwinds.

Here’s the direction many employers are going, according to the survey.

Dealing with rising costs

In light of continuing rising health insurance costs, 94% of employers surveyed said they are redoubling their efforts to make benefits more affordable for their workers.

Nearly two-thirds of employers (64%) said they will take steps to address employee health care affordability over the next two years. Steps they are considering include:

  • Improving quality and outcomes to lower overall cost.
  • Adding or enhancing low- or no-cost coverage for certain benefits.
  • Making changes to their employees’ out-of-pocket costs.
  • Increasing the amount they contribute towards their employees’ health insurance premium.

Employers also felt that many of their employees were not getting the most out of their benefits and needed further education on all of their offerings. More than half (54%) said that lack of employee awareness about where to find programs to support their needs was a significant challenge.

Mental health

Eighty-seven percent of employers said that enhancing mental health benefits will be a priority for them.

That’s in response to numerous studies and reports indicating that the COVID-19 pandemic has spurred a mental health crisis.

Another poll — the “Workforce Attitudes Toward Mental Health” report — by Headspace Health illustrates the depths of the problem:

  • 83% of CEOs and 70% of employees report missing at least one day of work because of stress, burnout and mental health challenges.
  • Only 28% of employees report feeling “very engaged” in their work.
  • Top global stressors for employees are COVID-19; burnout because of increased workload or lack of staff; poor work-life balance; and poor management and leadership.
  • 40% of women and 33% of men surveyed said they feel burned out at work.
  • Remote workers are feeling increasingly isolated.

In response to this, 66% of employers surveyed by Willis Towers Watson said that ensuring that their health and well-being programs support remote workers will be a key priority of their strategy over the next two years. More than six in 10 employers plan to enhance programs and well-being activities to focus on health issues of their employees’ family members.

Virtual care

Use of virtual care — or telemedicine — has exploded during the pandemic, particularly in 2020 and 2021, when many people were afraid to go to the doctor in person for fear of contracting COVID-19.

Additionally, many health care providers pushed virtual care to avoid having too many people come to medical facilities that were burdened by an avalanche of patients.

Congress passed laws allowing health insurers to cover telemedicine as they would other visits to a doctor. And now telemedicine is poised to be a permanent fixture of employers’ health care strategies.

Willis Towers Watson found that by the end of 2023:

  • 95% of employers expect to offer virtual care for medical and behavioral health issues,
  • 61% of employers expect to offer lower cost-sharing for virtual care,
  • 53% of employers expect the expansion of telemedicine to help decrease costs in the long run, and
  • 50% believe virtual care will improve health outcomes for their employees.

Fortunately for employers, a number of companies have cropped up during the last few years that focus on delivering state-of-the art telemedicine platforms.

The takeaway

The pandemic has spurred many employers to prioritize their employees’ well-being, as well as look for ways to manage costs.

With competition for employees fierce, many employers are focused on reducing their staff’s share of costs, while also expanding mental health services in response to growing demand.

Meanwhile, telemedicine services are still evolving, a trend that’s likely to continue for the foreseeable future as health care providers, insurers and employers see it as a way to rein in some costs.

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IRS Sets Health Savings Account Maximums for 2023

by Inoventive Solutions
May 13, 2022

The IRS has announced significantly higher health savings account contribution limits for 2023, with the amount increasing more than 5% for individual HSA plans.

The new limits were announced in conjunction with other changes, such as increases in the minimum deductibles and maximum out-of-pocket expenses for high-deductible health plans (HDHPs).

The IRS also announced rises in the maximum contribution amounts to excepted-benefit health reimbursement arrangements (HRAs).

The increases are much larger than usual due to inflation, which has been trending higher than it has in more than four decades.

Here are the new figures for 2023:

HSA annual contribution limit

  • Individual plan: $3,850, up from $3,650 in 2022
  • Family plan: $7,750, up from $7,300 in 2022

HDHP minimum annual deductible

  • Individual plan: $1,500, up from $1,400 in 2022
  • Family plan: $2,800, the same as in 2022

HDHP annual out-of-pocket maximum

  • Individual plan: $7,500, up from $7,050 in 2022
  • Family plan: $15,000, up from $14,100 in 2022

Maximum out of pocket for ACA-compliant plans (non-grandfathered plans)

  • Individual plan: $9,100, up from $8,750 in 2022
  • Family plan: $18,200, up from $17,400 in 2022

Excepted-benefit HRAs

Maximum annual employer contribution: $1,950, up from $1,800 in 2022. Excepted-benefit HRAs are limited to paying for vision and dental coverage or similar benefits exempt from the ACA, and are not covered by the employer’s primary group plan.

For those 55 or older: People who are 55 or older are allowed to contribute an additional $1,000 a year to their HSA, under federal law.

Also, if both spouses with family coverage are 55 or older, they must have two HSA accounts in separate names if they each want to contribute an additional $1,000 catch-up contribution.

If only one spouse is 55 or older but the younger spouse contributes the full family contribution limit to the HSA in his or her name, the older individual must open a separate account to make the additional $1,000 catch-up contribution.

HSAs explained

Under federal law, an HSA must be tied to an HDHP. An HSA is a special bank account that can be used to pay for or reimburse for your employees’ eligible health care costs. They can put money into their HSA through pre-tax payroll deduction, deposits or transfers.

As the amount grows over time, they can continue to save it or spend it on eligible expenses.

Employers can also contribute to the accounts, but the annual contribution maximum applies to all contributions in total (from the employee and the employer).

The money in the HSA belongs to the employee and is theirs to keep, even if they switch jobs. The funds roll over from year to year and can earn interest. Some plans also have investment options for the funds.

Here’s how they work:

  • Employees can make withdrawals with a debit card or check specific to the HSA.
  • Employees can use the money in their HSA to pay for care until they reach their deductible, out-of-pocket expenses like copays and coinsurance.
  • They can use the funds to pay for other eligible expenses not covered by their HDHP, like dental or vision care (eye exams and corrective lenses).

Planning ahead

Knowing what these limits are in advance can help employers plan their messaging for the 2023 open enrollment season.

If you want to get ahead of the ball, you can start updating your payroll and plan administration systems to reflect the 2023 amounts.

You should also include the new limits in relevant communications you send to your staff, particularly in regards to open enrollment, plan documents and summary plan descriptions for next year.

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Year-Long Benefits Education Yields Happier Employees

by Inoventive Solutions
May 3, 2022

While most organizations ramp up their benefits communications about a month before open enrollment starts, the efforts often drop off at the start of the year.

That’s a shame because many employees are woefully unaware of how their benefits function and are often not taking full advantage of what their employer and they are paying for. Employees that don’t understand their benefits fully may end up paying out of pocket for services that are covered.

With surveys showing that three in five employees have only a basic understanding of the benefits they receive from their employer, it’s important that you continue to educate your staff about their benefits, coverage changes brought on by recent regulations and how to get the most out of their current benefits.

If you enlighten them about what they have and how to use those benefits, they will be more likely to stay with you.

Keep it going

The month or two prior to open enrollment is when most companies kick their benefits communications into high gear. They start sending their employees e-mails, mail and memos making them aware of open enrollment and that they can start researching plans.

Most companies will hold at least one meeting with the troops to answer questions and explain any changes that are being made. But after open enrollment ends, communications often go into hibernation until the prelude to the next open enrollment.

You can fill that void by regularly “dripping” information to them over the course of the year. Each drip can be a short benefits meeting or educational information that is sent out to your employees.

For example, under a Biden administration executive order, as of Jan. 15, all health insurers are required to reimburse covered individuals for up to eight at-home COVID-19 tests per month. By keeping your staff informed of developments like these, they can save money and take advantage of this benefit more fully. Here’s how:

Be proactive

It’s important that you communicate benefit developments to your staff, and that requires that your human resources or benefits team stays on top of changes.

It’s the team’s responsibility to proactively alert employees about changes and updates about their benefits, as well as reminders about how certain benefits work. By sending out these reminders, or holding meetings, you can educate your workers in making the right benefit and coverage decisions.

Leverage technology

One key part of educating your employees requires tapping technology by offering an online hub that houses all of the information about each of the benefits you offer. This way, they can go to this source first if they have questions. It’s also more convenient for them as they can access it in the privacy of their homes.

Many health plans now also have apps for enrollees that give them a plethora of information about their coverage, including how much they have paid in deductibles over the year and other information about their health insurance.

Plan communications for the year

Design a content calendar that focuses on putting out timely information and reminders. For example, remind employees about how their health savings account works and what they can spend the funds on.  

During flu season, send out reminders on preventative measures they can take, including how their health insurance can help them get a flu shot.

Another topic could be instructions on adding spouses to their plans or notifications about Medicare for employees who are nearing 65 years old.

The key is to stay in front of your staff and always encourage them to come to your benefits team with any questions they have. One e-mail to your team could result in reminding one of them to come to you for clarification about their coverage.

The takeaway

By regularly communicating about your benefits to your staff, you can provide them with the confidence that they have the information they need about their benefits, and that if they don’t, they know how to get it. That in turn helps them make the best decisions for themselves and their families.

And your organization will also benefit as regular engagement gives you the opportunity to better evaluate your benefits offerings and identify areas where you can improve or expand.

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How Your Employees Can Get Free COVID Test Kits

by Inoventive Solutions
April 28, 2022

While COVID-19 cases start rising again, more people are once again likely to contract the coronavirus — and that usually involves getting tested. But for employees in your group health plan, they have many options for obtaining a test with no out-of-pocket costs.

Under an executive order issued by President Biden, employees in a group health plan are eligible to receive COVID-19 at-home test kits with no cost-sharing, copay, coinsurance or deductible. Additionally, most health plans are also covering tests performed at hospitals, clinics and pharmacies.

While we told you about these new rules a few months ago, it’s likely that a good many of your employees don’t know about it. With that in mind, you may want to disseminate information to them about how they can be reimbursed by their insurer for COVID-19 tests they purchase.

Here’s what your employees need to know:

Steps for reimbursement

Procedures will vary from insurer to insurer, but the order requires that health insurance carriers reimburse members for up to eight tests a month and no doctor’s order, prior authorization or prescription is required. This applies to any tests they purchased on or after Jan. 15, 2022.

Most health plans have preferred pharmacies that they urge their enrollees to go to for their take-home COVID-19 tests. In these instances, the plans will typically cover the cost at the point of sale so that the health plan member doesn’t have to pay out of pocket.

Covering costs upfront eliminates the need for members to submit reimbursement forms.

However, if they go to a non-network pharmacy or drugstore or purchase a kit online, the health insurer is still required to reimburse them for a test up to $12 (or the cost of the test if it’s less than that).

In these cases, the employee will have to pay for the test upfront and then seek reimbursement from their health insurer.

You can contact your health insurer for information and resources for how your staff can receive reimbursement. Most insurers have published materials to make it easier for your workers to access COVID-19 tests with no cost to them.

Typically, to be reimbursed for at-home test kits, members must submit the reimbursement form and a receipt that shows proof of purchase, which should include the name of the retailer, including the street address, or, if bought online, the website address; date of purchase; UPC code for the at-home test kit; and the cost of the kit.

The order that health plans cover these tests with no out-of-pocket costs for their enrollees will sunset when the federal public health emergency is declared over.

On-site tests

Health plans are also covering the cost of tests that are administered at pharmacies or in hospital settings after either a doctor ordered a test or if the person was exposed to someone who had COVID-19.

Like at-home tests, insurers will cover the costs of these tests regardless of if they are received in-network or from an out-of-network provider or pharmacy.

The types of COVID-19 tests health insurers currently cover are:

  • Individual testing with or without symptoms,
  • Testing ordered by a health care provider,
  • Testing for contact tracing, known or suspected exposure, and
  • Testing before or after travel (COVID-19 screening tests for domestic travel are usually covered by most plans, but enrollees should not expect their plan to cover any testing they do abroad).

After the public health emergency ends, however, it’s likely most insurers will stop covering tests obtained out of network.

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Gen Z, Millennials Grow Disillusioned with Their Health Insurance

by Inoventive Solutions
April 21, 2022

Surprise bills and billing errors are driving growing dissatisfaction among Millennials and Gen Zers with their health insurance, a new study has found.

HealthCare.com‘s “2022 Medical Debt Survey” found that about one in four Gen Zers and Millennials with medical debt skipped rent or mortgage payments because of their debt. That’s compared with 21% for Gen Xers and 12% for baby boomers.

The study reflects the increasing burden that health insurers’ policies for out-of-network care and higher deductibles are having on Americans, particularly those who are the most recent entrants to the job market. Since they typically earn less than those who have more experience, Millennials and Gen Zers are more susceptible to hardships if they receive unexpected bills.

To help these generations of workers, consider offering them educational sessions on how to choose health plans, coupled with training on how to avoid unexpected health care bills by going to in-network providers, and how to shop around in advance for scheduled procedures.

Already facing outsized medical cost hits, an increase in billing mistakes and surprise bills is contributing to a dim view of health insurance among Millennials and Gen Zers. In fact, 68% of Gen Zers who have health insurance but still incurred medical debt said their health insurance plan didn’t cover the service they received (or they received services out-of-network).

Additionally, the study found that:

  • 39% of Millennials are unsatisfied with their health insurance options.
  • About three in 10 Gen Zers (31%) and Millennials (27%) with medical debt believe that their debt is the result of a billing error.
  • 48% of Millennials have received a surprise medical bill.
  • 35% of Millennials have received a mistaken bill or had a claim denied.
  • 26% of Millennials have medical debt.

Affordability of health insurance is also a big consideration. Some 54% of Millennials say their health insurance is somewhat or very affordable.

Millennials are also using their health insurance benefits differently than prior generations:

  • 48% say they have used an urgent care center in the past. These visits can often cost more than a typical visit, but not as much as going to the emergency room.
  • 35% have used telehealth services for physical ailments.
  • 26% have sought mental health services through telehealth platforms.
  • 27% have used discount pharmacy apps.

The takeaway

The key to improving your younger generation workers’ understanding of their health benefits and how best to use them is through education. It starts with perhaps having a special session during each open enrollment focusing on what type of health plans are best suited for their generation.

If you offer high-deductible health plans, educate your staff on the importance of putting money aside in health savings accounts so they have money to pay for those unexpected expenses.

They should also be educated in how to use their health insurance to avoid larger costs, and the ramifications of using providers not in their health plan’s network. The education should also cover the costs of going to an emergency room compared to scheduling an appointment with their doctor or going to an evening clinic at their office.

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Employers See Staff Drop Coverage, Sign Up on Exchanges

by Inoventive Solutions
April 12, 2022

A surge in federal government subsidies has led many people to drop their employer-sponsored health insurance and instead seek out coverage on government-run Affordable Care Act exchanges, according to a report by the Kaiser Family Foundation.

Subsidies, which were increased substantially by COVID-19 stimulus legislation, are so large for some who purchase coverage on exchanges that many of them can access ACA plans that cost just a few dollars a month, depending on their income, according to the report.

But the defectors are likely to return to their employer-sponsored health plans as the subsidies are set to expire at the end of 2022, which will likely make their employer-sponsored coverage more affordable. Only individuals who work for organizations that have fewer than 50 full-time workers have been able to make this switch and enjoy low premiums.

Individuals who work for employers that are large enough to qualify as “applicable large employers” are barred from jumping into the individual market as they do not qualify. They instead are required to sign up for their employer’s group health plan or forgo coverage altogether. 

What’s happening

The American Rescue Plan, which took effect in 2021, expanded and increased tax credits available for purchasing coverage on federal- and- state-run exchanges through the end of 2022. Before that, the law limited eligibility for premium tax credits through the federal and state exchanges to households whose income is from 100% to 400% of the poverty level.

The stimulus bill removed that cap for 2021 and 2022, as well as limit the amount anyone pays in premiums to 8.5% of their income as calculated by the exchange. That means someone who made 450% of the poverty level would receive a premium tax credit that would reduce the premium they pay to 8.5% of their income. In those cases, the total tax credit runs into the thousands of dollars for the year.

The premium tax credit is based on factors that include income, age and the benchmark “silver” plan in a person’s geographic area. The amount they qualify for is basically advanced to them over the course of the year via reduced premiums. If they choose a bronze plan, they can greatly reduce their share of the premium.

These effects have been most pronounced for lower- to middle-income and single-income households. 

However, the premium tax credit comes to an end on Dec. 31, 2022, and the premium tax credit regime reverts to the prior one.

How to handle next open enrollment

It’s advisable that you assess your health insurance enrollment and see if any of your staff dropped their group health coverage and signed up for individual coverage on the exchange. If you are an applicable large employer, that should not have happened for the reasons mentioned above.

If you are a smaller employer not subject to the ACA, you should reach out to any employees who signed up on an exchange and inform them about the impending premium tax credit changes. Advise them that reverting to the old premium tax credit rules is likely to result in their share of the premium increasing substantially.

Remind them that your annual open enrollment is their only chance to secure group health coverage and that they should review their marketplace coverage as early as possible. If they wait too long and miss your open enrollment deadline, they could be stuck with the more expensive marketplace coverage.

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