Out of Pocket Costs: 3 Pain Points to Address

Guest blog content provided to Q4iNetwork consultants by freshbenies freshbenies-Logo-CMYK 2018

It’s a sad healthcare reality that more and more Americans are being forced to decide whether they can afford to use their medical plans.

And while great brokers and employers are implementing strategic ideas to contain skyrocketing out of pocket costs, it seems to become even more challenging every year.

Employers are paying more to provide coverage, but employees and their families are also paying more than ever before as out of pocket costs continue to rise.

Here are three key problems associated with rising out of pocket costs that must be addressed by businesses and employee benefits advisors alike.

1. Shrinking coverage and higher costs go hand in hand 

Employers are paying higher prices for plans with shrinking networks and narrowed formularies. These plans are forcing families to shoulder over 40% of medical cost, which averages about $11,500 annually— with $4500 of that being out of pocket spend. This has resulted in an increase of more than $1,000 every year for working families for the last four years running.

How do smaller networks and the rising cost of care play out? Consider this statistic: one-third of patients are referred to specialists each year, and 50% of those referrals are out-of-network.

With those kinds of numbers, it’s easy to see how the pain points of rising premiums, smaller networks and high out of pocket costs quickly collide for employees. 

2. Foregoing care is costly for everyone

High Deductible Health Plans have been associated with a 55% reduction in office visits.

On the front end, HSAs have consistently remained a strong option for lower premiums and tax incentives, driven by the idea that it would empower employees to be better consumers. On the back end, however, we’re seeing that without providing practical transparency tools, education, and direction on how to navigate the cavernous healthcare space, people are tending to just avoid it altogether. Which means they are skipping both inappropriate and appropriate care. 

The great irony is that while the US spends the most on healthcare, we are not among the healthiest populations. Too often, Americans are being forced to decide whether they can afford to use their medical plans.

From missing an early diagnosis for a major medical issue to foregoing care for a respiratory issue that later lands an employee in the ER, these decisions are costly for families— and for employer-provided medical plans as well.

And if that wasn’t enough, people are also skimping on medications due to the rising cost of prescription drugs, which brings us to our third issue.

3. Rx is a BIG contributing factor 

Three in ten Americans (about 32 million people) have been hit with price hikes on drugs they routinely take. Most consumers feel they have little to no options when facing this situation.

This pharmacy out of pocket cost driver cannot be ignored. A few things to consider:

  • Increasing use of specialty drugs will prove to be the fastest growing cost component in any medical plan.
  • Removing medications from medical plans doesn’t remove the need for that prescription.
  • Empowering employees with tools and education can uncover more cost-effective options.

Higher overall medical costs, coupled with soaring out of pocket spend, make it harder to care for your employees and their families. The time to accept this as the norm is over. It’s time to do better by and for everyone.

If you’re working with a forward-thinking employee benefits broker to find creative new ways to address and solve these problems, you’re on your way to being part of the solution.


Photo credit vimvertigo