Employers: More cost sharing, surcharges and telemedicine

03/05/2016

This week DirectPath and CEB released their 2016 Medical Plan Trends and Observations Report, which analyzed more than 750 employee benefit health plans. The eleven page report highlights their top ten trends in employers' 2016 health care strategies and notes year-over-year shifts.

Here's some major takeaways that they note:

"Employers are continuing to shift a larger share of the cost to employees, often through implementing high deductible health plans (HDHPs). Deductibles for individual and family coverage continue to rise, regardless of plan type; 28 percent of organizations now offer HDHPs for both individual and family care, an increase from last year. Average in-network individual deductibles increased by 40 percent and family deductibles by 17 percent compared to 2015." Also they cite that the average in-network emergency room copay increased by 22 percent compared to last year, while copays for urgent care remained the same.

"Virtual care has broader acceptance - The usage of telemedicine is growing, with almost two thirds of organizations offering or planning to offer such a service by 2018. In line with this finding, the American Telemedicine Association estimated that 1.25 million online patient consultations will happen in 2016."

"Surcharges are becoming more common - As another cost-cutting measure, nearly three-in-ten employers are adding surcharges, such as fees for spousal coverage and tobacco usage. Forty-one percent of employers are introducing or planning to introduce spousal surcharges, and 21 percent of employers imposed tobacco surcharges, which ranged from $10.50 per month to a high of $217 per month, and is a more common practice than spousal surcharges."

Here's their top ten trends that they expand upon in the report:

1. Deductibles for Individual and Family Coverage Continue to Rise, Regardless of Plan Type (Avg Individual deductible up 40%, from $777 in 2015 to $1,087)
2. Organizations Are Moving Toward Plans That Shift Cost and Ownership
More to Employees (discussed above)
3. Prevalence of High Out-of-Pocket Maximums (OOPMs) Leveling Out (72% had high individual high OOPMs and 79% for family)
4. Surcharges Are More Common (as discussed above)
5. Outpatient Surgery to Become Cheaper (Avg In Network Copy down 25% from 2015 to $41)
6. Emergency Room Copays Increase Further (Avg In Network Copay up from $116 in 2015 to $142)
7. Specialty Medication to Become More Expensive (Avg In Network retail copay for specialty up 45%, from $51 in 2015 to $74)
8. Pregnancy to Cost More (Avg In network copay up 35%, from $192 in 2015 to $259)
9. Virtual Care Becoming More Popular (37% offer telemedicine, 27% plan to offer)
10. Wellness Incentives Continue to Increase

For More Information:
 
2016 Medical Plan Trends and Observations Report
Direct Path | CEB, March 2016