Group items tagged

Companies are increasingly offering employees health plans that allow them more freedom to choose doctors and hospitals and that generally do not require referrals from primary care doctors for specialty care.

insurers generally still pay a fee for every visit and procedure, a payment system that has been blamed for driving up spending.

this movement back toward’’ fee-for-service medicine “is really going to hurt us.’’

The best way to reduce health-care and insurance costs is if the price of treatment declines.

A study by Avalere Health found that up to 90 percent of ObamaCare plans will force cancer patients to cover half the cost of new drugs until they hit the out-of-pocket maximum. By comparison, only 29 percent of non-ObamaCare employer-based plans do so.

On average, ObamaCare plans cover only 10 targeted therapies, and insurers don’t have to add new breakthroughs until 2016.

The low profit margins have forced insurers to downsize the number of doctors and hospitals in their networks — and to slash what they cover for out-of-network treatment.

Health insurance costs ate 7.7 percent of total payroll expenses for private-sector employers in 2012, according to the NIHM study.

n 2013, individuals paid, on average, $5,900 in total annual premiums for employer-sponsored coverage. On average, family plans cost more than $16,300. “With employees’ costs for medical coverage growing much more quickly than general inflation, hourly earnings and family income, some workers are inevitably (being) priced out of coverage,” the study said.

2018, 40 million American employees will be enrolled in private exchanges

A national survey by Aon Hewitt consultants suggests that the Affordable Care Act's taxes and fees add 1% to 2% in direct costs to employers.

The Aon Hewitt survey found that 44% of companies are considering offering workers just one health-insurance plan — a high-deductible plan — rather than offer a high-deductible plan plus a more traditional plan that covers 70% to 80% of medical costs.

But those people will not get government subsidies if their company offers affordable health insurance, defined as costing less than 9.5% of income.And such employees would lose their employer's contribution to their plan unless the company agreed to provide such a payment in lieu of coverage.

Several hospital chains are driving the boom – including HCA Inc., which will open its seventh ER later this year in Florida, and Wake Med Health and Hospitals, which will add its fourth next month in the Raleigh, N.C., metro area. They regard the facilities as a way to expand into new markets, generate admissions to their hospital and reduce crowding at their hospital-based ERs.

reater Houston has 150 emergency rooms — twice the number as greater Miami -- even though its population is only slightly bigger, according to a KHN analysis.

While the ERs charge insurers double or triple the amount per patient as an urgent care center or doctor's office, patients use them for routine care that could be provided in less costly settings, Ho says. That is the case with standard ERs as well. Yet, insured patients have little incentive to drive past the more expensive, freestanding ERs because their co-payment is only $50 or $100, just modestly more than what it might cost for a visit to an urgent care center or doctor’s office. Their insurers pay the balance generally.

Starting in October, consumers shopping on the new exchange will be able to choose from bronze, silver, gold, platinum and catastrophic plans that offer a range of premiums, deductibles and co-pays depending on variables such as how many doctors you want included in your network.That's why Smithberger says it's important that consumers look at more than the bottom line when choosing plans. It may be the lowest priced plan, but it may have a very high deductible or only offer a limited number of doctors.

Premium prices are influenced by many factors, including what insurers guess their costs will be, a region’s labor costs and how much hospitals and other facilities charge. Competition between insurers is also a significant factor.

While some of the lowest cost plans are in the “bronze” tier of coverage, such plans generally have higher annual deductibles and co-payments than a silver plan.  Also, the silver plans reduce some costs for subsidy-eligible consumers, which could reduce their exposure to big bills if they fell seriously ill.

“Although premiums are generally the first and last thing discussed when comparing plans, out-of-pocket costs may be an equally or even more important consideration, particularly for those with significant health care needs.”

The current system, researchers say, financially encourages doctors to do more procedures and is one of the reasons health costs have escalated. The health law required Medicare to gradually factor in quality into payments for hospitals, nursing homes, physicians and most medical providers.

Medicare had already decided that large physician groups -- those with 100 or more doctors, nurses, social workers or other health professionals -- will gain or lose as much as 1 percent of their pay starting in 2015. Those incentives would double to 2 percent the following year under draft regulations Medicare released this month. The proposal also would phase mid-sized physicians groups—those with between 10 and 99 health professionals—into the program in 2016 instead of in 2017. While they would be eligible for bonuses up to 2 percent, they would be shielded from any penalties for that first year.