While the rate impact of the reg­u­la­to­ry envi­ron­ment plays out, one thing is clear from the 2017 UBA Health Plan Sur­vey: employ­ers con­tin­ue to shift a greater share of expens­es to employ­ees through out-of-pock­et cost increas­es. While this is just one of 7 mega trends uncov­ered in the sur­vey, it is par­tic­u­lar­ly inter­est­ing this year because sin­gles were hit more heav­i­ly than fam­i­lies as com­pared to years past.

While aver­age annu­al total costs per employ­ee increased from $9,727 to $9,934, employ­ees’ share of total costs rose 5%, from $3,378 to $3,550, while employ­ers’ share rose less than 1%, from $6,350 to $6,401. The good news for employ­ees is that, for a sec­ond year in a row, medi­an in-net­work deductibles for sin­gles and fam­i­lies held steady at $2,000 and $4,000, respec­tive­ly. Sim­i­lar­ly, some out-of-net­work deductibles remained unchanged, with fam­i­lies’ medi­an out-of-net­work deductible remain­ing at $8,000 in 2017. Con­verse­ly, sin­gles, who had been hold­ing steady in 2014 and 2015 at a $3,000 medi­an out-of-net­work deductible, saw a 13.3% increase to $3,400 in 2016, and anoth­er jump in 2017 to $4,000. Since deductible increas­es help employ­ers avoid pre­mi­um increas­es, we will like­ly see this trend con­tin­ue, espe­cial­ly as insur­ance car­ri­ers are required to meet the ACA met­al levels.

Both sin­gles and fam­i­lies also are see­ing con­tin­ued increas­es in medi­an in-net­work out-of-pock­et max­i­mums, up to $5,000 and $10,000, respec­tive­ly. Fam­i­lies bore the brunt of the increase in medi­an out-of-net­work out-of-pock­et max­i­mums between 2014 and 2016, going from $16,000 in 2014 to $18,000 in 2015, to $20,000 in 2016, but then hold­ing steady at $20,000 in 2017. The max­i­mum for sin­gles, which had remained steady at $9,000 in 2015 and 2016, increased in 2017 to $10,000.

Inter­est­ing­ly, out-of-net­work expens­es are not sub­ject to ACA lim­i­ta­tions, so it was the­o­rized that they’d like­ly con­tin­ue to sky­rock­et with more plans elim­i­nat­ing out-of-pock­et max­i­mums for non-net­work ser­vices. Per­haps to off­set that, more employ­ers adopt­ed plans with no deductible for out-of-net­work ser­vices, while employ­ees saw a mas­sive decrease in the num­ber of employ­ers offer­ing no deductible for in-net­work ser­vices. Look­ing at deductibles and out-of-pock­et costs just among the ever-dom­i­nant PPO plans, in-net­work and out-of-net­work deductibles for fam­i­lies and sin­gles are gen­er­al­ly below aver­age. How­ev­er, the medi­an in-net­work sin­gle deductible for PPO plans has held steady at $1,500 in 2016 and 2017, along with the fam­i­ly deductible at $3,000. The increas­es were seen in the out-of-pock­et max­i­mums, which rose in 2017 to $4,500 for sin­gle (up from $4,000 in 2016), and to $10,000 for fam­i­ly cov­er­age (up $1,000 from $9,000 in 2016).

For a com­pre­hen­sive chart with average/median, in-net­work/out-of-net­work deductibles, max­i­mums, and copays, down­load UBA’s free 2017 Health Plan Sur­vey Exec­u­tive Sum­ma­ry. To bench­mark your exact plan against oth­ers in your region, indus­try or size brack­et, con­tact a UBA Part­ner near you to run a cus­tom bench­mark­ing report.

By Bill Olson

Orig­i­nal­ly post­ed by www.UBABenefits.com