In a recent article we shared upcoming changes in health insurance premiums coming as a result of the merger of the Individual and Small Group health insurance markets in Maine.
This article provides Small Group employers with some additional tips for saving money on healthcare costs, while still providing a very important benefit for employees. As always, we recommend you review these recommendations with your health insurance broker to determine whether these savings tips are right for you and your employees.
Here are five options to consider as your small business looks to manage healthcare costs while offering the best possible benefits to employees:
Evaluate carriers’ provider networks
Make sure your carrier’s priorities match yours—providing the best possible network for care while lowering employees’ out-of-pocket costs. Among the most significant benefits of health insurance coverage are the lower rates for services carriers negotiate with providers and through provider networks. These rates are far less than costs absent health insurance or when paying providers directly. Health insurers, including Community Health Options (Health Options), take a step even further by establishing preferred provider networks. These networks are based on a providers’ price of care while factoring in the overall quality of care based on publicly available quality rankings. So, providers who offer better outcomes while keeping costs low often become preferred providers. Most carriers provide participants with financial incentives to use the preferred provider network. The carrier’s incentive is the same as yours—lowering the overall cost of care, which greatly influences overall premiums and employees’ out-of-pocket costs depending upon your plan design.
Explore premium offset plans
Consider working with a broker to establish premium offset plans, which give participants a tax break on their portion of health insurance premiums, all paid with pre-tax dollars. Premium offset plans require that the employee portion of the health insurance premium be deducted from payroll, a capability supported by most payroll services. It may seem insignificant, but premium offset plans add up to big savings for employees, especially for those paying additional premiums for family plans.
Offer Health Savings Account Compatible Plans
When selecting a health plan, consider options compatible with Health Savings Accounts (HSAs). HSA plans are a great way to allow plan participants with a high deductible health plan to save money in a tax-free account to pay for qualified medical expenses. HSAs, for instance, cover the costs of deductibles and co-insurance expenses for healthcare, dental and vision. In 2023, participants can save up to $3,850 in pre-tax dollars using a health savings account offered by a local bank or credit union. The savings account is designed to cover qualified medical expenses and is paired with a qualified medical plan. (Brokers can help employers establish a qualified health insurance plan.)
Provide Health Reimbursement Accounts
High deductible plans like the new Clear Choice Bronze plans are great options to provide health insurance for your employees and to keep premiums as low as possible. But once claims start rolling in, funding a large deductible can become overwhelming for plan participants. That’s where Health Reimbursement Accounts (HRAs) come into play.
HRAs are a type of funding vehicle whereby a Small Group employer agrees to pay a certain portion of the employees’ deductibles and/or co-insurance to minimize their claims costs. For example, an employer with a Bronze plan with a $5,900 deductible might pay $3,000 after the employee incurs $2,900 in out-of-pocket expenses. That way, the employee pays “first dollar” of the deductible and has an incentive to keep costs down, while the employer is obligated to pay the remainder of the deductible.
The good news about an HRA is that if the employee does not use the full $3,000, the employer keeps any unspent money and benefits financially by offering a lower priced premium plan. It’s rare that employers would be on the hook for the full commitment for all covered plan participants. Small group employers need an experienced broker and a third-party administrator to implement an HRA program as part of an overall health insurance program.
Tap into Direct Primary Care
Direct Primary Care (DPC) has recently emerged as a popular way to manage primary care healthcare expenses but be warned: There are just 40 such providers in the state of Maine. Still, it’s an option worth exploring with a broker. DPC providers do not accept health insurance as payment for care. Instead, they typically charge an annual fee for service, which covers all primary care visits during the year, including preventative care. Employers providing some level of self-funding for a small group plan in the form of an HRA, for example, may find the cost of subsidizing Direct Primary Care reduces the likelihood of employees incurring higher deductible costs.
Resources for Small Groups and their Brokers
Community Health Options, a Maine-based nonprofit health insurer, is committed to the Small Group health insurance market and to providing an easy purchasing experience for Small Groups and their brokers to navigate the changes in the merged market. To that end, the Health Options team has been reaching out to brokers and Small Group employers to educate them about the upcoming changes in the merged market and ways they can keep costs down. For information, call 207-402-3353.
Ever Heard of Interoperability?
Long word, long process; here’s the short story
Unless you work in the healthcare industry, you’re probably living your life without knowing what interoperability means. But soon, if you use health and wellness services at all, you’ll need to know at least a little bit about what it means.
Good to Know
Interoperability means that healthcare information and data can be connected among doctors, facilities, service providers, insurers, and others so that you have access to your health information wherever and whenever you need it. If you’ve ever changed providers or needed to see a specialist, you know that your medical records can take a while to catch up with you. That’s all going to change.
To get technical about it, this transfer of data will happen through application programming interfaces (APIs). Eventually, rather than waiting weeks for your medical records to move between providers’ offices, files will transfer almost instantaneously. That’s progress!
Need to Know
Opening these channels of information is actually a federal requirement for businesses in healthcare. So, as an insurance company, we’re required to create a secure information network that gives you access to your health information in real-time. This kind of accessibility helps you get more efficient and accurate care. It will enable your providers to identify problems more quickly and allow them to make quicker and more informed decisions.
Interoperability is a huge change in how the entire health industry works, and it won’t happen overnight, but the first steps are about to begin. In early July, 2021, Health Options will support electronic access to your claims through third-party applications in your mobile device or browser. For additional information, please click here.
But don’t worry. You’re still in control. Health data applications that you choose to connect will have access to your name, date of birth, plan information, providers used, medical, pharmacy and lab claims, and other data. See a list of the healthcare applications here. If you choose not to share your access – your information remains private. You turn data sharing on and off via your health and wellness application on your personal device. If you don’t download an app and turn on permission, nothing changes.
More to Know
You might never have given a single thought to healthcare data connections, or maybe you thought all your data dots were connecting behind the scenes already. Either way, knowledge is power. At its very basic level, this data sharing will help you and your providers make informed choices, eliminate wasted time and resources, and streamline healthcare services. This might mean fewer redundant blood tests and X-rays in the future, and we can all connect with that idea.