DirectPath and CEB released the 2016 Medical Plan Trends and Observation Report with data from more than 750 employee benefit health plans.
Here are the key trends from the report:
1. Employers are shifting larger costs to employees with high deductible health plans, among other strategies. The deductibles for individual and family coverage are rising for nearly all plan types, and 28 percent of organizations now offer high deductible health plans for individual and family care.
2. The average in-network individual deductibles increased 40 percent and family deductibles increased 17 percent compared to 2015.
3. Telemedicine is growing and around two-thirds of the organizations were offering or planning to offer telemedicine by 2018. The American Telemedicine Association estimates 1.25 million online patient consultations will happen in 2016.
4. Around half of employees have some type of wellness incentive ranging from $52 to $1,600 per year. Some companies offer premium reduction up to 10 percent.
5. Around 30 percent of employers are adding surcharges, including fees for spousal coverage and tobacco use as a cost-cutting measure. Forty-one percent of employers are introducing or planning to introduce spousal surcharges and 21 percent of employers impose tobacco surcharges.
6. The tobacco surcharges range from $10.50 per month to a high of $217 per month and is a more common practice than spousal surcharges.
7. Organizations are steering employees toward cheaper care settings, including outpatient surgery. The average in-network copay for outpatient surgery was reduced to $41 in 2016, down from $55 in 2015. At the same time, inpatient surgery increased to $67. Out-of-pocket expenses for in-hospital delivery increased 35 percent in 2016.
8. The average emergency room copay increased 22 percent compared to last year. Copays for urgent care remained the same.
“Even though the impending Cadillac Tax is still a ways off and it is an election year, organizations continue to look ahead and are making further moves to implement cost-savings measures,” said Bart Yancey, CEO, DirectPath. “The tide of change is strong. It’s up to consumers to become savvy about their healthcare options, and it’s up to their employers to provide the educational resources to help them make smart decisions, whether it’s knowing when to visit an urgent care center versus an emergency room, choosing a generic drug or considering telemedicine.”