Reference-based pricing: What about balance bills?

Posted by Emily Kubis on Wed, May 09, 2018 @ 08:05

Solutions for employers

Reference-based pricing is a new way for self-insured employers to pay for employee’s medical costs. Instead of using a traditional insurance carrier’s network, employers simply pay hospitals a percentage in excess of Medicare’s reimbursement rate for the same service.

Why would employers adopt this plan?  Generally, the benefit that insurers provide to employers are their network discounts for services. But with healthcare prices skyrocketing, employers are questioning whether this strategy provides enough value.

(More: How a 40-employee group saved $100,000 with reference-based pricing.)

Here’s how hospital pricing usually works.

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Tags: health insurance small employers, Self-Insured, self-funded, reference based pricing, self-insurance, balance billing

What is the Medical Loss Ratio?

Posted by Emily Kubis on Fri, Apr 06, 2018 @ 08:04

Is the MLR driving up employer healthcare costs?

A piece of the Affordable Care Act that seeks to cap insurer profits may be driving employer healthcare costs in some cases.

The ACA’s Medical Loss Ratio intended to cap the profits of insurance companies by requiring them to pay out 80 percent of what they collect in premiums, leaving 20 percent for administrative costs, marketing and profit.

The reasoning behind this was to put eight out of every ten insurer dollars toward claims, as opposed to other parts of their business.

However, this also means the maximum profit insurers can collect is 20 percent of premiums. As a result, the avenue to profit growth is to increase premiums altogether, especially for those not surpassing the 80 percent threshold.

Employers are left to question whether insurers are best positioned to help employers lower medical claims, and what really drives annual premium increases of 10 percent, 15 percent, 20 percent or more.

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Tags: health insurance small employers, Self-Insured, healthcare costs, Medical Loss Ratio, employer digest, employee benefit adviser, self-funded, reference based pricing, self-insurance, network discount

What is an insurance network discount worth?

Posted by Emily Kubis on Wed, Apr 04, 2018 @ 09:04

Consider the value of insurance discounts

Some self-insured employers are adopting new strategies to pay for their group benefits plan. These plans, including direct contracting with hospitals or reference-based pricing, typically do not use a traditional insurance network.

Many employers are finding they can obtain better value for the services they pay for by either negotiating with the hospital directly, or by paying an excess of Medicare’s reimbursement rate.

Why would employers want to adopt these strategies? Generally, the benefit that insurers provide to employers are their network discounts for services. But with healthcare prices skyrocketing, are employers getting the most value through this set up? Let’s look at how it typically works. 

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Tags: health insurance small employers, Self-Insured, employer digest, employee benefit adviser, self-funded, reference based pricing, self-insurance, network discount

Self insurance on the rise

Posted by Emily Kubis on Wed, Mar 28, 2018 @ 06:03

Rising healthcare costs make self-insurance more attractive

A new study from Arthur J. Gallagher & Co. reports that self-insurance is on the rise across the employer spectrum, including lower midsize, upper midsize and large employers.

The rate of employers self-insuring has increased between 8 and 10 percent since 2016, the study found.

This trend is expected to continue as costs associated with traditional, fully-insured plans become prohibitively expensive, especially for small and midsize employers.

The big benefit of self-insurance is the savings potential. Because employers pay the claims, they reap the benefit of low-claim years. Additionally there are also blended options, where employers can take on less risk and still benefit in low-claim years while minimizing risk in high-claim years.

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Tags: health insurance small employers, Self-Insured, employer digest, employee benefit adviser, self-funded, self-insurance

How a 40-employee group saved $100,000 with reference-based pricing

Posted by Emily Kubis on Fri, Mar 23, 2018 @ 10:03

A more cost-effective way to pay for healthcare

Reference-based pricing is a new payment model for employer-sponsored healthcare. Through reference-based pricing, self-insured employers forgo the traditional insurance contract. Instead, employers pay employee claims directly to hospitals and providers, typically in excess of Medicare. In other words, employers pay the hospital 140 percent of what Medicare would reimburse for the same service.

This strategy can save employers thousands of dollars per year—below is a case study of one of our clients who saved $100,000 on premium and plan costs by transitioning to this strategy.

But why would an employer want to forgo the traditional insurance contract? A piece of the Affordable Care Act is the reason why.

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Tags: health insurance small employers, Self-Insured, employer digest, employee benefit adviser, self-funded, reference based pricing, self-insurance

Should my organization self-insure?

Posted by Emily Kubis on Fri, Feb 16, 2018 @ 09:02

Are these myths keeping you from self-insuring?

Just because your group plan has always been fully-insured doesn’t mean this is still the best strategy for your organization. While self-funding has traditionally been reserved for large groups, new solutions are available that make it possible for groups with even 20 employees to self-fund their benefits plan.

First, what is self-funding, or self-insuring?

The major difference between self-insured and fully-insured plans are in regards to who operates the plan, and who pays the claims. With self-funded insurance, the employer operates the plan and pays the claims. With fully-funded insurance, the insurance company operates the plan and pays the claims.

The big benefit of self-insurance is the savings potential. Because employers pay the claims, they reap the benefit of low-claim years. Additionally there are also blended options, where employers can take on less risk and still benefit in low-claim years while minimizing risk in high-claim years.

But many small employers remain wary. Are these self-insurance myths keeping you from considering alternate funding methods

These ideas commonly keep small employers from considering self-insured health plans, but they aren’t the roadblocks many employers think they are.

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Tags: health insurance small employers, Self-Insured, employer digest, employee benefit adviser, self-funded, self-insurance

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employer healthcare freedom
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