coverage

Health Coverage By the Numbers (vol 2): The Cost of Coverage and Employer Contributions

Job-based health insurance is still far and away the largest single source of health care coverage in the U.S. As we continue to work on behalf of clients to drive new and better ways to stem the tide of health care costs, here are some key stats from 2017 to ponder:

1.)  Average annual premium nationally for single coverage — .$6,690 (or $557 per month)

2.)  Average annual premium nationally for family coverage — .$18,764 (or $1,564 per month)

3.)  Generally speaking, most employers cover at least 50% of the employee’s cost of premium. Nationally, employers cover on average 81% of the cost of single (employee only) premium.

4.)  Not all employers contribute to family coverage. Employers that do contribute to family coverage, cover on average 69% of the cost to cover dependents.

Source: Kaiser Family Foundation

Health Coverage By the Numbers

Job-based health insurance is the largest single source of health care coverage in the U.S.

1.) Employer-sponsored insurance covers more than 157  million workers and their dependents.

2.) The next largest source of coverage, Medicaid, insures less than half as many, 63 million.

3.) Medicare enrolls 45 million;

4.) Individual market (on/off Marketplace) provides coverage for about 21 million.

Source: Kaiser Family Foundation (KFF.org)

 

In Acquiring Aetna, CVS Health is Aspiring to Become “the Trusted Front Door to Health Care”. What’s the Impact on Current Aetna Customers?

In a letter to the broker community Aetna CEO Mark Bertolini provided a glimpse of where the combined CVS/Aetna entity hopes to head once everything is completed. If approved, the blockbuster transaction is expected to close late in 2018.

Here’s what Bertolini had to say:

“CVS Health and Aetna are joining to become the trusted front door to health care. Nearly 70 percent of the U.S. population lives within three miles of a CVS Health retail store and nearly five million Americans visit CVS Health every day. We will use CVS Health’s 9,700 retail locations to establish entirely new community health hubs dedicated to improving consumer wellbeing and answering questions about health, prescription drugs and health care benefits.

Our company will deliver care by utilizing CVS Health’s network of 1,100 in-store clinics, which are significantly less expensive than traditional health care delivery settings. Further integration of our pharmacy operations will help offset some of the projected increases in prescription drug prices, resulting in cost savings for employers and consumers.”

How Does This Week’s Announcement Impact Our Employer Clients Currently on Aetna Plans? And, Should You Be Concerned?

If you have an Aetna plan in place now or are considering switching to an Aetna plan in 2018 there’s no cause for any immediate concern.

According to Bertolini the pending transaction would have no immediate effect on the Aetna products already in place or any Aetna products offered in the market in 2018.

Or, as the title of a recent Wall Street Journal article analyzing the effects of the acquisition proclaimed CVS-Aetna Is More Tortoise Than Hare.

Pharmacy Coupons and Insurance Companies Making Adjustments

This is an example of one Ohio company adjusting how they administer coupons people use at the pharmacyThe program helps make sure members’ out-of-pocket cost for prescription drugs are properly applied to deductibles and maximum out-of-pocket amounts.

The benefit of the coupon is easy to grasp.  Someone on an expensive brand medication can obtain it at low or no cost.

The problem can be that the carrier processes it as a paid claim and the member never pays what the plan requires.  There are reasons both employers and carriers want real out of pocket to be met by the member.

The carriers now are adjusting and working on ensuring that the member is not given credit or given a reimbursement for something they never paid for personally.  Members can use the coupons, but the carrier will credit only what the member actually paid.

This seems like a reasonable solution.  It will likely become a normal way coupons are processed.

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