Medicare Compliance & Reimbursement
Plans Struggle To Justify Premium Costs To Even The Deepest Pockets
Plans have long relied on employers to help bridge the cost gap between employees and their health care premiums. Those days could soon be over.
As employers are able to contribute less and less toward workers' premiums, more and more workers are foregoing coverage. The number of uninsured Americans has risen for four straight years; 45.8 million people had no health insurance during 2004, according to the U.S. Census Bureau. And it's no wonder, considering that for six years in a row, health care premiums have grown more than twice as fast as prices overall or workers' earnings, notes a recent Alliance for Health Reform study, "The Uninsured and Rising Health Costs." The increase isn't exclusive to the elderly--the percentage of uninsured people under age 65 grew from 17.6 percent to 17.8 percent during 2003 to 2004, the study reveals.
A Career Path For Coverage
There is some good news--the number of Americans with health insurance grew to 245.3 million in 2004, up 2 million from 2003. Nevertheless, employer-based coverage has steadily declined from 2000 to 2004, while government-subsidized coverage has continued to rise.
Slower premium growth rates are probably just a flash in the pan. Two additional studies project that premiums will grow at a steeper rate during 2006. Hewitt Associates projects a 9.9 percent increase in premiums for 2006, up from 9.2 percent in 2005. Mercer Human Resources Consulting predicts a 6.7 percent rise, up from 6.1 percent.
In light of swelling health care costs, employers are experimenting with a variety of different cost-savings measures that allow them to provide coverage while minimizing expenses. For instance, 80 percent of workers' plans use case management to control costs, and 56 percent use disease management measures, the Alliance study reports. In these types of plans, enrollees must get their plan's approval before they obtain high-cost procedures and care. In addition, 20 percent of employers who offer health insurance include a high-deductible consumer-driven plan--often coupled with a health savings account--as an option.
But despite employers' best efforts to provide competitive coverage, today's workforce faces an uphill battle as retirement age draws near. In 2005, one in eight firms with 1,000 or more employees stopped subsidizing retiree health benefits for new-hires and future retirees, the study reports.
Full-Time Or Part-Time, Costs Don't Discriminate
Employers can only do so much to help employees keep up with skyrocketing premiums. In 2000, 69 percent of all employers offered health care coverage to employees. Today, that number is down to 60 percent, the Alliance reports. Both full-time and part-time workers are feeling the pinch--premium contributions have increased a whopping 82 percent during the last five years for single coverage, and 67 percent for family coverage, according to the study.
Even though most employers are picking up the bill for the same proportion of employee premiums that they were five years ago, the net effect on employees is still enough to force many workers to sacrifice health care coverage altogether--especially those who also find themselves facing higher deductibles year after year. In 2005, the average annual deductible for single coverage was $323--up 58 percent from 2001, the study reports.
Full-time workers without insurance increased from 17.5 percent to 17.8 percent during 2003 to 2004, the study reveals. Part-time workers without health insurance rose much more dramatically--25 percent of part-time workers had no insurance in 2004, up from 23.8 percent in 2003. Fewer than 10 percent of workers said they declined insurance because they either didn't need or want coverage.
Small Employers Offer Small Coverage
Fast-rising premiums, coupled with more modest wage growth, make offering competitive coverage to employees particularly difficult for small employers. The average preferred provider organization's annual premium for family coverage rose from $10,217 in 2004 to $11,090 in 2005, according to the study. On average, employers paid $8,449 of these expenses. Nevertheless, employees working for small companies remain three times as likely to go without insurance as large-firm employees, the study reveals.
In 2004, insurance premiums' growth rate began to decelerate somewhat, slowing from 11.2 percent during 2004 to 9.2 percent during 2005. In spite of this small progress, the number of small employers offering medical coverage decreased from 63 percent in 2004 to 59 percent in 2005, the study shows. Overall employer-based coverage took a smaller hit, but a hit nonetheless, dropping from 60.4 percent in 2003 to 59.8 percent in 2004.
Medicare Compliance & Reimbursement
- REIMBURSEMENT:
Top 10 Payment Changes In The New Deficit Reduction Act
Medicare providers get to start the 2006 claims year all over again.
The intense Congressional volley [...] - HHAs:
Home Health PPS Reins In Medicare Spending--To A Potential Fault
Financial incentives could lead providers to compromise quality of care.
Steady hospital readmission rates and emergency [...] - PHYSICIANS:
CMS Postpones Payments For PMDs
Congress withholds funding to delay interim final rule's implementation.
Power wheelchairs and scooters will be moving [...] - HIPAA:
Medicare Cracks Down On Secondary Payer Billing And Reimbursement
How to get reimbursement for a paper claim that a contractor has denied.
Physicians, suppliers and [...] - APPEALS:
Here's Who To Call To Get Appeals Settled Faster
Some carriers require redeterminations even for minor errors.
The new and improved appeals process is causing [...] - ONCOLOGY:
Agencies Combine Forces To Combat Cancer
A new HHS alliance puts biomarkers to the test.
A first-time collaboration between different Department of [...] - COVERAGE:
Plans Struggle To Justify Premium Costs To Even The Deepest Pockets
Employers' best efforts aren't enough to make health care affordable for non-retiree workers.
Plans have long [...]
