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ACA Employer Mandate Penalties on the Rise

by Inoventive Solutions
June 28, 2023

The penalties for not offering health insurance to your employees if you have 50 or more full-time or full-time equivalent employees in violation of the Affordable Care Act are set to rise again next year.

The IRS has increased the fines for employers that fail to provide health insurance for their workers under the ACA’s employer mandate, as well as for failing to provide coverage that is affordable or coverage that provides “minimum value.” The penalties will apply to plans that start on or after Jan. 1, 2024.

The way most employers find out that they may have violated the employer mandate is if they get a 226-J letter from the IRS, which would be prompted by one of your employees receiving premium subsidies after purchasing coverage on a government-run exchange.

Under the mandate, employers with 50 or more full-time or full-time equivalent workers are required to offer 95% of them affordable health coverage. There are two different penalties for violations:

The A penalty

This is levied on an applicable large employer (ALE) for failing to offer minimum essential coverage to 95% of full-time employees and their dependents and if just one of those employees receives a subsidy when they buy insurance on a government-run ACA marketplace.

New penalty amount:$2,970 per employee, up $90 from 2023.

This penalty can be especially damaging. While it is not assessed for the first 30 employees if triggered, it applies to all of the employer’s full-time employees, meaning costs can quickly add up.

The B penalty

This fine is levied if an applicable large employer fails to offer coverage that is affordable and/or fails to provide minimum value, and just one full-time employee receives subsidized coverage through the marketplace.

Coverage is deemed unaffordable if an employer fails to offer at least one self-only health plan where any employee’s share of the premium does not exceed 9.12 % (the 2023 threshold) of their household income. The affordability threshold has not yet been announced for 2024.

In order to provide minimum value, an employer-sponsored plan must cover at least 60% of average costs and provide substantial coverage for inpatient and physician services.

New penalty amount: The annual penalty for a type B infraction rises to $4,460 per employee in 2024, up $140 from this year. Typically, this penalty is broken down into monthly increments depending on how long an employee receives subsidized coverage on an exchange.

The takeaway

While you no doubt already offer coverage to your employees if you’re an ALE, it’s important to pay attention to next year’s affordability threshold.

Any downward change means you have to recheck to ensure that at least one of your plans offers coverage deemed affordable to your lowest-paid employee.

Also, be especially mindful during the new-employee onboarding process to ensure they are properly identified and offered coverage.

If the IRS suspects you are out of compliance, it will send you a 226-J letter. You’ll be glad you have all your paperwork in order if you receive one of these letters.

The 226-J letters are also sent to employers if they make mistakes on their Form 1095-C.

If you receive one of these letters, contact us for assistance.

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Insulin Makers Cap Prices for Insured Individuals

by Inoventive Solutions
June 20, 2023

Three drugmakers, which account for roughly 90% of the insulin in the U.S. market, in March 2023 announced that they will cap the cost of insulin for people with private insurance plans.

That includes those on employer-sponsored group health plans and plans purchased on a government-run exchange. The changes mean some or many of your employees will see significant reductions in their pharmaceutical outlays, particularly if they have high copays or deductibles.

The moves come after the Inflation Reduction Act, signed into law in 2022, capped out-of-pocket insulin costs for seniors on Medicare at $35 per month. However, the law does not apply to people younger than 65 who also need insulin.

According to the Centers for Disease Control and Prevention, an estimated 28.7 million people — or 28.5% of the population — were living with diagnosed diabetes in 2022, and chances are high that most employers have workers with the condition. Out of that population, 8.4 million use insulin, according to the American Diabetes Association.

Eli Lilly was the first company to announce, on March 1, that it would cap the cost of all its insulin products at $35 per month, with immediate effect.

On March 14, Denmark-based Novo Nordisk announced that it would lower the U.S. list price of some of its insulin products by up to 75%, putting the fast-acting insulins NovoLog and NovoLog Mix 70/30 at $72.34 for a single vial and $139.71 for a pen. The new pricing will take effect Jan. 1, 2024.

Finally, Sanofi two days later announced that it would cap the out-of-pocket cost of its most popular insulin, Lantus, at $35 per month for people with private insurance. This change also takes effect Jan. 1, 2024.

These changes will bring relief to millions of Americans, particularly after years of insulin makers jacking up their prices. A report on National Public Radio in 2022 noted that the cost of insulin had increased 600% in the past 20 years.

Another report found that some people with high-deductible health plans were paying $350 to $600 a month, for a medicine that costs $6 to make.

Next steps

There are moves afoot to force the industry to cap the price at $35 a month. Legislation has been introduced in Congress that would force drugmakers to cap their insulin price at that level.

You may want to circulate this news with your employees, so they are aware of the new pricing. A 2022 analysis by the Kaiser Family Foundation found that most people on private health insurance would benefit:

  • In the individual market, the median cost health plan enrollees pay for insulin is $62 per month. One-quarter of them pay $105 a month.
  • In the small group market, the median cost health plan enrollees pay is $54 per month, while one-quarter pay $83.
  • In the large group market, the median cost health plan enrollees pay is $54 per month, and one-quarter pay $77.
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New Anti-Obesity Drugs Put Employers in a Quandary

by Inoventive Solutions
June 14, 2023

A surge in demand for pricey, new and highly effective anti-obesity medications could put a financial strain on employers who sponsor their employees’ health plans.

Employers have long offered coverage for certain weight loss tools, such as bariatric surgery if employees qualify for the drastic procedure that requires an operation. Other medications that have been on the market for some time have limited effect, don’t work for everyone and can have serious complications.

But a new class of drugs that has hit the market in the last few years has proven extremely effective in helping people lose weight. As a result, pharmaceuticals like Novo Nordisk’s weight-loss-specific Wegovy and Saxenda, and Ozempic — a diabetes medication from the same company — are now in high demand.

There’s one big catch: These drugs are very costly, putting employers in a quandary. They want to attract and retain high-quality talent, but they don’t want to break the bank on their employee benefits offerings.

A recent survey by the Obesity Action Coalition found that 44% of people with obesity would switch jobs if it meant gaining access to obesity treatment coverage. Likewise, 51% would stay in a job they didn’t like to have access to the coverage.

These findings are significant considering how much these drugs cost and the fact that once someone starts taking them, if they stop, they will usually start gaining weight immediately.

What are these drugs?

This class of pharmaceuticals, known as glucagon-like peptide agonists (GLP-1s), have shown to be highly effective in helping people lose excess weight.

Since news spread of how effective they are, demand for these medications has skyrocketed.

Just three years ago, few people had heard of these drugs and they were not often prescribed, but that’s all changed.

For example semaglutide, which is known under the brand names of Ozempic, Wegovy and Rybelsus, was the fourth-most prescribed drug in terms of total costs in 2021 at $10.7 billion, an increase of 90% from the year prior, according to a report in the American Journal of Health-System Pharmacy.

While many of these drugs are injectable, some like Rybelsus come in pill form.

Shocking costs

Experts warn that if more workers seek out these drugs, payer outlays will spike, resulting in higher group health plan premiums for employers.

The list price of Wegovy is $1,350 per package, which breaks down to about $270 per week — or $16,190 per year.

That said, obesity has its own significant costs and proponents of these medications point at the potential for reduced costs on the back end if people lose weight and keep it off.

Medical costs of obesity in the U.S. were $173 billion in 2019, according to the Centers for Disease Control.

An unsustainable trend

It’s estimated that about 60% of large employers’ health plans cover one of these drugs, although with restrictions, including minimum body mass index (BMI) requirements and prior authorization.

Health plans may require enrollees who qualify for obesity care to first use other lower-priced anti-obesity drugs before they move to a GLP.

The American Gastroenterology Association recommends weight loss drugs for anyone who has a BMI over 30, or 27 if they have other medical complications, such as heart disease or diabetes. According to the CDC, 42% of Americans have a BMI over 30, which is considered clinically obese.

As the uptake of these drugs increases, employers and their health plans will need to make painful choices of to what extent the medications should be covered. Insurers are already considering ways to ensure that people who will most benefit from these drugs have access to them.

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2024 HSA Contribution Limits, HDHP Minimums, Maximums Set

by Inoventive Solutions
June 8, 2023

The IRS has raised the maximum amount employees can funnel into their health savings accounts by 7.8% for 2024, the largest increase ever, brought to you by inflation.

The IRS updates this amount annually, along with minimum deductibles as well as the out-of-pocket maximums for high-deductible health plans. Under its rules, HSAs, which help employees save for medical expenses, are only available to those enrolled in qualified HDHPs.

Understanding these amounts now can help you get an early start on human resources planning for next year.

Here are the changes coming in 2024:

HSA annual contribution limit

  • Self-only plan: $4,150, up 7.8% from $3,850 in 2023
  • Family plan: $8,300, up 7% from $7,750 in 2023
  • Catch-up contribution (for those aged 55 and older): $1,000 (unchanged)

HDHP minimum annual deductible

  • Individual plan: $1,600, up from $1,500 in 2023
  • Family plan: $3,200, up from $3,000 in 2023

HDHP annual out-of-pocket maximum

  • Individual plan: $8,050, up from $7,500 in 2023
  • Family plan: $16,100, up from $15,000 in 2023

Excepted benefit health reimbursement arrangement

  • Maximum annual employer contribution: $2,100, up from $1,950

The many benefits of HSAs

An HSA is a special bank account for your employees’ eligible health care costs. They can put money into their HSA through pre-tax payroll deductions, deposits or transfers. As the amount grows over time, they can continue to save it or spend it on eligible medical and medical-related 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. If they go to a new employer that offers qualified HDHPs, they can continue to fund the account in their new job.

Funds roll over from year to year and can earn interest. Many plans also have investment options for the funds to help savers further grow the account.

There are a number of benefits for employees who have an HSA:

  • The money an employee contributes to an HSA is not subject to income taxes, which reduces their overall taxable income.
  • They are not taxed on withdrawals.
  • If employees contribute to their HSA with after-tax money, they can deduct their contributions during tax time on Form 1040.
  • Employees can tap the funds for any approved out-of-pocket medical expenses.
  • They can also grow the account tax-free by investing the funds in the account, sort of like a nest egg for medical expenses in retirement. (That said, 62% of account holders spend the money on year-to-year or near-term expenses, according to a report by the Employee Benefit Research Institute.)

HSA-eligible expenses:

  • Payments for services or medicine that go towards health plan deductibles, copayments or coinsurance.
  • Dental or vision care (including orthodontics, eye exams, corrective lenses),
  • Medical devices.
  • Certain over-the-counter medicines, like pain relievers, allergy medication, cold and flu medicine, and menstrual products.
  • Vitamins and health supplements, if recommended by a medical or health professional for the treatment or prevention of a specific disease or condition.
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16 Surprising FSA and HSA Eligible Expenses Your Employees Should Know About

by Inoventive Solutions
May 30, 2023

Employers offer flexible savings accounts and health savings accounts to their employees so they can build up funds with pre-tax dollars to pay for health care and related expenses.

For the most part, people use their funds in FSAs and HSAs to reimburse themselves for out-of-pocket costs like copays, health insurance deductibles and the cost of prescription medications.

Unfortunately, many people don’t take full advantage of their FSAs and HSAs — and they could be getting reimbursed for a number of items they already are purchasing.

But while funds in an HSA roll over each year, the funds in an FSA must usually be spent by the end of the year, unless the employer allows its staff to carry over a certain amount to the following year.

Employers can offer one of two options to give their employees more time to spend their funds:

Grace period — You can provide an extra 2.5 months each year to spend the money in their flex accounts, which in most cases means until March 15 of the following year. In essence, they get 14.5 months to spend the funds. Whatever they don’t spend goes back to you, the employer.

Carry over — This allows your employees to keep some of the unspent money in an FSA from one year to the next.

In 2023, the maximum an employee can carry over is $610. This means that if they have money left in their FSA at the end of the plan year in 2023, they can keep up to $610 of it. If they have more than that at the end of the year, the rest goes back to you.

As a result, while employees with HSAs are not pressured to spend funds in their accounts every year, those with FSAs are. According to the Employee Benefit Research Institute, 48% of workers forfeited an average of $408 of their FSA funds in 2020.

Both FSAs and HSAs have the same rules for what they will cover.

However, employees often are unaware of the myriad of goods and services they can spend their funds on. To help your staff, you can educate them about these goods and services, and often the companies that host these accounts will provide a list of them. Typically, an expense is eligible if it mitigates, treats or prevents a specific disease or ailment from affecting the body.

These expenses are eligible too

You may also want to let them know about these 16 surprising eligible expenses:

  • Over-the-counter medicines — Anything from cough syrup and pain relievers to allergy medications and eyedrops.
  • Menstrual hygiene products
  • A fitness program if the person is suffering from a health issue like diabetes, hypertension or obesity.
  • Thermometers
  • Heating pads
  • Travel expenses to receive care
  • Massages if they are for relieving pain
  • Sunscreen with an SPF of 30 or higher
  • Insect repellent
  • Tobacco cessation programs
  • Genetic health tests (like 23andme).
  • Vitamins and supplements
  • Sleep deprivation treatment and medication
  • Breast pumps
  • Birth control devices (condoms, pills, etc.)
  • Baby monitors.
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PBMs Feeling the Heat on All Fronts

by Inoventive Solutions
May 23, 2023

While drugmakers have been assailed for years for increasing their prices and driving the cost of medications higher and higher, there is another player in the health care space that is receiving increased scrutiny: pharmacy benefit managers.

PBMs are intermediaries, acting as go-betweens for insurance companies, self-insured employers, drug manufacturers and pharmacies.

They can handle prescription claims administration for insurers and employers, facilitate mail-order drug delivery, market drugs to pharmacies, and manage formularies (lists of drugs for which health plans will reimburse patients.) 

Express Scripts, which provides network-pharmacy claims processing, drug utilization review, and formulary management, among other services, is the best-known PBM. CVS Caremark and UnitedHealth Group’s OptumRx are other major players. 

PBMs typically contract with both insurers (or self-insured employers) and pharmacies. They charge health plans fees for administering their prescription drug claims and create formularies that spell out the prices pharmacies receive for each drug on the list.

Commonly, the price the plan pays for a drug is more than the pharmacy receives for it. The PBM collects the difference between the two prices. 

It can do this because the health plan does not know what the PBM’s arrangement is with the pharmacy, and vice versa. Also, the plan doesn’t know the details of the PBM’s arrangements with its competitors. 

A PBM could charge one plan $200 for a month’s supply of an antidepressant, charge another plan $190 for the same drug, and sell it to a pharmacy for $170. None of the three parties knows what the other parties are paying or receiving.

Additionally, PBMs have been accused of pocketing the rebates that drug manufacturers offer, instead of passing them on to the end users: the patients who are prescribed the medications. Those rebates can be significant.

In the crosshairs

In theory, the PBMs should pass these rebates back to the individuals who are prescribed the medication so that they can reduce their out-of-pocket costs. However, if most of those costs are born by the insurer, those rebates would conceivably be transferred to the insurer that is paying for the drugs and the insurer could pass some of those savings on to enrollees.

But, because these arrangements are also confidential, the extent to which these savings are passed back to health plans is unknown.

As pressure on PBMs has grown, federal and state lawmakers, attorneys general in various states and state regulators have been taking action.

In 2022, 12 states enacted 19 measures that included a variety of restrictions and requirements for PBMs, according to the National Academy for State Health Policy.

A number of state attorneys general have filed lawsuits against some of the country’s largest PBMs. Ohio Attorney General David Yost has managed to wring more than $100 million in settlements with PBMs in the last three years, after filing lawsuits accusing them of violating state antitrust laws and overcharging state agencies like the Ohio Bureau of Workers’ Compensation and the Ohio Department of Medicaid.

And in Washington D.C., a bipartisan bill introduced in the U.S. Senate would require PBMs to file an annual report with the Federal Trade Commission about fees charged to pharmacies and reimbursements sought from drug companies.

The bill also authorizes state attorneys general “to conduct investigations, to administer oaths or affirmations, or to compel the attendance of witnesses or the production of documentary or other evidence.”

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HDHP Enrollees Less Satisifed with Their Health Plans

by Inoventive Solutions
May 16, 2023

A new study has found that people enrolled in traditional PPOs and HMOs are more satisfied with their plans than those who are enrolled in high-deductible health plans. But satisfaction greatly increases when HDHP enrollees stick with their plan for more than three years, according to the Employee Benefit Research Institute (EBRI)/Greenwald Research “Consumer Engagement in Health Care Survey.”

HDHP enrollees enjoy lower up-front premium costs in exchange for higher potential out-of-pocket costs for copays, coinsurance and deductibles, and high health care users may experience significant outlays not covered by insurance. The sticker shock that comes with paying for those deductibles is likely partly responsible for those feelings.

But the report authors noted that there may be other reasons too:

“Lack of experience with their health coverage may account — at least in part — for this difference. Higher out-of-pocket costs may also contribute to the difference in satisfaction, but other disconnects exist,” they wrote.

HDHP enrollees also were less satisfied about other aspects of their coverage, with the study finding that:

  • 47% of HDHP participants were satisfied with the cost of prescription drugs, compared to 63% of traditional plan enrollees.
  • 47% of HDHP participants were happy with the prices they pay for other health care services, compared to 57% of traditional plan members.

That said, the poll did not find any differences in terms of the perceived quality of care that HDHP and traditional plan enrollees receive.

The study authors also surmised that it is often people who are new to health insurance who may be most attracted to HDHPs due to the lower premiums. Similarly, those on a restricted budget may also gravitate towards these plans due to the lower premiums up front.

Interestingly, the survey found that the longer people stay enrolled in an HDHP plan, the more satisfied they become with it:

  • If enrolled in an HDHP for less than one year, just 32% of participants were satisfied with their plan.
  • If enrolled for one to two years, 44% were satisfied.
  • If enrolled three or more years, 55% were satisfied.

Key to HDHP satisfaction

The key to successfully navigating an HDHP comes down to educating yourself in how these plans work, the trade-off between higher out-of-pocket costs and lower premiums, and the importance of taking some of those premium savings and socking them away in a health savings account.

If you have an individual or family HDHP, you can usually qualify to put money into an HSA to fund future health care expenditures.

You can sock away $3,850 (individual account) in 2023 with untaxed income, which you can later use to pay for medical expenses you incur. For a family account, you can save up to $7,750.

HDHPs can look extremely enticing due to their low premiums, but many people jump into them without understanding the potential costs they’ll be paying for out of pocket.

While these plans are required to cover 10 essential services and preventative care, as required by the Affordable Care Act, most other services and medicines are paid for in full at the insurer-contracted rates with providers and pharmacies.

For people who have chronic conditions, and need regular medical care, an HDHP may not be the best plan. But if you are healthier and younger and don’t regularly see the doctor, you can save on your premiums by enrolling in an HDHP.

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More Employers Expand Mental Health Benefits

by Inoventive Solutions
May 9, 2023

American workers are more stressed than ever coming out of the pandemic, and an increasing number of people are also struggling with mental health issues. 

Sadly, the number of people dying from drugs, alcohol and suicide hit record levels in 2022.

When someone is battling addiction or has mental health issues, it affects all aspects of their life, including work. Stress can have a significant adverse impact on business. It costs employers an average of $300 billion a year in stress-related health care and missed work, according to a Harris Poll conducted for Purchasing Power.

That’s why more employers are stepping up to provide their workers with benefits to support behavioral health and emotional well-being.

Employee assistance programs

One of the most common ways that businesses have offered support is through employer-paid employee assistance programs (EAPs), which offer a set amount of free mental health services sessions, typically topping out at five to eight per year. But for many people who are experiencing mental health issues, this may not be enough.

Some larger employers have started offering mental health benefits that cover a higher number of therapy sessions and wider range of treatment options, including therapy and mental health coaching.

Additionally, studies have found that offering a mix of online services such as digital lessons and in-person or virtual therapy can lead to lower therapy dropout rates, plus higher rates of abstinence for clients with substance abuse issues.

As a result, some employers are offering programs that cover a spectrum of behavioral health care options, such as:

  • Self-care apps for employees experiencing occasional stress
  • In-person therapy sessions
  • Virtual therapy sessions
  • Prescription medication to treat common, diagnosable conditions such as anxiety or depression.

Companies usually offer EAPs at no cost to their employees. Most employers operate their EAP through a third party administrator, which can be crucial to the success of your EAP.

Employees have to feel comfortable discussing professional and personal problems with the EAP administrator, and if your business administers your EAP, it could prevent employees from coming forward and asking for the help they require.

That said, it’s up to you to make sure your staff understands that they can talk about mental health without fear of it affecting their jobs. You should train management and supervisors on the importance of confidentiality and job protection if one of your staff asks for assistance or raises mental health concerns.

Don’t forget your health insurance

There is an extensive list of mental health services your health plan should provide your staff. These services include outpatient and inpatient treatment, telemedicine, medication and counseling. Each of these attributes can be vital for treating mental illnesses.

Of course, there will likely be some out-of-pocket costs for your employees that use these services under their group health plans.

One service that is growing and improving success rates is the continuing evolution of telemedicine. According to the benefits news site BenefitsPro, telemedicine can make getting care anonymous and convenient, so patients can receive it where they’re most comfortable. This is especially valuable when dealing with the sensitive matter of mental health.

Other options

American workers are more stressed than ever, and some may not need counseling services from an EAP to reduce their life stress. Besides offering an EAP, there are other benefits that you can extend to your workers that can help them better deal with the ordeals of life and work, including:

Parental leave — Becoming a new parent is extremely stressful. If you don’t offer parental leave, and instead require parents to take unpaid time off, such as under the Family and Medical Leave Act, this stress is compounded. Paternal leave is paid time off for new parents, either mom or dad, after the birth or adoption of a child. It gives parents the opportunity to take care of their new child without the stress of work getting in the way. 

The benefit to the employer is that when the worker returns from their leave, they are more productive, sooner. Consider offering this to both male and female employees.

Paid time off — PTO combines sick leave and vacation time. It gives employees a set bank of time off at the beginning of each year. Employees can then choose whenever and however they want to use this time off. 

Flexible work — Flexible work is a great way to help employees with mental health issues. This benefit can include flexible hours (selecting hours they will work), flexible schedule (selecting when they work) and flexible location (like telecommuting).

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Insurers Promise to Keep Covering Preventative Services

by Inoventive Solutions
May 2, 2023

Most health insurers plan to continue offering free preventative care services despite a federal judge having imposed a nationwide injunction on an Affordable Care Act requirement that these services are covered with no out-of-pocket costs on the part of patients, according to a letter by industry trade groups.

With concern growing that this important part of the ACA would suddenly be revoked, some of the nation’s largest insurers and industry trade associations penned a letter to lawmakers, stating that: “The overwhelming majority do not anticipate making changes to no-cost-share preventive services and do not expect disruptions in coverage of preventive care while the case proceeds through the courts.

“Our associations have long supported preventive care and continue to do so. By responding together, we wish to make clear our strong support for continued access to preventive health care for millions of Americans who rely on it. “

Signatories to the letter include the Blue Cross Blue Shield Association, the American Benefits Council and America’s Health Insurance Plans.

The letter was written in response to Democrats on health committees in the U.S. Senate and House or Representatives asking for information from 12 of the nation’s largest health insurers on how they plan to respond to the decision by the U.S. District Court for the Northern District of Texas in Braidwood Management Inc. vs. Becerra.

That decision struck down the ACA requirement that most health plans and issuers cover without cost-sharing the more than 100 preventative services recommended by the U.S. Preventive Services Task Force (USPSTF).

The judge in the case reasoned that the ACA requirement to cover with no cost-sharing medications for HIV prevention violates the rights of the plaintiffs who have religious objections to these medicines. The order immediately blocked the requirement nationwide to cover not only the HIV-prevention medicines, but all preventative services recommended by the USPSTF.

The U.S. Department of Health and Human Services has appealed the decision to the U.S. Fifth District Circuit Court and the Justice Department has asked that the decision be paused as the appeal process plays out.

The lawmakers also asked if the insurance carriers would honor the ACA’s rules until all appeals are exhausted, including all the way to the U.S. Supreme Court.

Fallout from the ruling

The federal court’s decision has caused panic and concern among patients’ rights advocates that insurers would immediately stop covering these services, which have become an essential part of health care in the last decade.

If the ruling stands and survives appeals, insurers could impose deductibles and copays for potentially lifesaving screening tests.

The lawmakers on April 13 wrote in their letter to the insurance industry: “We are very concerned that the decision will unnecessarily cause confusion, force consumers to pay out-of-pocket, and result in patients foregoing preventive services screenings and treatment altogether. There is evidence that even modest cost-sharing deters patients from accessing care and exposure to cost-sharing reduces the use of preventive care.”

The trade associations that responded to the lawmakers’ request to continue honoring the ACA rules said that preventative care is popular and effective, and that the decision from the federal judge likely is just the start of a lengthy legal process.

If the decision were to stand, there are still some preventative screenings that are not covered by the ACA, and it would not affect all states. There are 15 states with laws requiring insurers to cover with no patient cost-sharing the same preventative services that the federal law requires.

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Smallest Firms See Largest Health Insurance Hikes

by Inoventive Solutions
April 25, 2023

A new report has found that small businesses that purchase their group health insurance online or through payroll vendors saw the largest premium hikes in 2022, significantly higher than those that went through brokers.

Overall rates for employers with 10 or fewer employees saw their family plan health insurance premiums jump 12% from 2021, compared to just 5.4% for all small to mid-sized businesses with up to 250 employees, according to the report by HR and benefits software company Ease.

The cost for individual group health plans increased 6.7% for the smallest SMBs, compared to just 4.3% overall between 2021 and 2022. As stated, the numbers for smaller companies were the most pronounced for those who buy their coverage online or via payroll vendors.

Meanwhile, employees’ share of premiums increased at a slower rate overall of 4.15% between 2021 and 2022, meaning that employers were not passing on the full increases in group health plan premiums to their staff.

Since 2018, individual premiums have increased by 21% while family premiums have increased by 18%. To put it into dollar signs, that’s an extra $104 for individuals and $231 for families each month for medical insurance.

The Ease report notes that those higher premiums are likely hurting those small employers more than larger SMBs with between 51 and 250 workers. The latter have seen an increase in health plan enrollment among their employees between 2018 and 2022, while those with one to 50 employees saw overall decreases. Overall, more than half of SMB employees opt out of their employer-sponsored coverage.

The HDHP effect

The report found that health maintenance organizations and preferred provider organizations continue to dominate the landscape in group health benefits for SMBs. While high-deductible health plan (HDHP) enrollment grew at an astounding 68% between 2021 and 2022, they only accounted for 6% of group health plan enrollment.

Some employers have gravitated towards HDHPs to reduce their and their employees’ overall premium spend, but these plans come at a cost: more out-of-pocket costs for workers.

In those cases, Ease CEO and co-founder David Reid recommends pairing an HDHP plan with other voluntary benefit plans that can “insure” gaps in coverage, such as short-term disability plans and group supplemental health insurance plans called Gap plans. They are similar to the Medigap supplemental insurance plans millions of seniors purchase each year to fill in holes in Medicare parts A&B.

Gap plans can help by providing coverage when employees have not met their health care deductible. These plans may cover most inpatient and outpatient services that are covered by the underlying primary health care plan and applied to the deductible or coinsurance provision.

Plans differ and employers may choose a variety of coverage options, including varied inpatient and outpatient benefits. Deductibles can be added to the plan to manage premium costs.

Coverage can often be configured to be compatible with HDHPs using health savings accounts.

Importance of your broker

Reid said that the report’s findings illustrate the importance of employers working with brokers and consultants to purchase their employee benefits.

“[SMBs] getting good advice are using more innovative solutions that allow them to make their dollars go as far as a large corporation’s dollar-spend on benefits,” he told the trade publication BenefitsPro. “Those who are bypassing a consultant and purchasing benefits through, say, their payroll vendor are generally seeing fully insured, off-the-shelf plans that increase in cost more quickly.”

As your broker, we have access to plans from different carriers and can work with you to put together offerings that will best accommodate your employees.

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