We know… it sounds too good to be true.
Consumers across the country are frustrated by the ever-increasing costs of health care, and employers are spending millions of dollars on health care plans that seem to only add to that frustration. Employees want better options; employers want to provide them; but no one is getting what they want.
This is where MyHealthMath comes into play. We know that health plans aren’t the problem. The problem is choosing the right one.
Lack of transparency, confusion over costs, and too few resources keep employees from making informed decisions about their health care plan. The end result? Frustrated employees stuck in the wrong plan, and companies wasting the money they invested in providing those plans in the first place.
Understanding employee pain points is the first step to solving them. That’s why every day, our analysts talk to employees about what makes choosing a plan so tough. Below, we share employee’s top five complaints and offer solutions that save everyone money. Whether or not you’re ready to tap into our technology, understanding these complaints will help you better identify and eliminate what fuels your employees’ frustration.
1. The costs included in a typical health plan (the plan structure).
Too often when choosing a health plan, consumers only look at their monthly premium (what comes out of their paycheck every month) and their deductible (the number they need to hit before their coverage kicks in). But these pieces only show part of the payment story. Because while insurance starts contributing when consumers meet their deductible, it doesn’t cover all the costs. Instead, they’ll pay a percentage of their medical costs, the co-insurance, until they reach their plan’s out-of-pocket maximum. If employees don’t understand the plan structure, they won’t calculate all their out of pocket expenses. And without calculating those expenses, they can’t predict what they’ll ultimately end up paying. Confusion leads to misinformation; misinformation equals frustration.
2. Comparing plans/understanding affordability
While companies often provide employees with multiple plan-types, employees struggle to compare plans and choose the one that best fits their needs. This confusion largely stems from limited information. Typically, human resources will hold an employee benefits meeting where they introduce the plans and provide a Summary of Benefits and Coverage (SEB). In theory, these seemingly straightforward plan summaries help employees easily compare key costs; in reality, they often preclude employees from making informed decisions about their health plans. SEBs leave out critical information, such as prescription costs and specialty services, and are written in insurance company jargon, which can seem like a foreign language to someone unfamiliar with the terms. They also don’t compare the different plans side-by-side, so employees must search for each piece in each plan and then struggle to put it all together to compare costs. And without an easy outlet for questions, confusion and resultant poor decision-making becomes common place.
We ensure employees don’t have to predict total costs themselves. Instead, we build a custom report for each employee that compares each plan, showing total costs based on premiums and predicted out of pocket expenses. Our detailed reports are visually-friendly, detailed, and straightforward. And our analysts are ready to hop on a consultative call at any time, so employees feel informed, supported, and empowered.
3. Knowing when to choose a high deductible health plan:
The big benefit of a high deductible health plan (HDHP) is that it qualifies for a health savings account (HSA). All HSA contributions are pretax, withdrawals are not subject to federal (and generally state) taxes, earning are tax-free, and savings roll over every year. Moreover, employers often match some portion of employee contributions. So even though consumers pay more up front for a prescription or procedure with an HDHP, they end up saving money in the long run by paying with funds from an HSA.
In most cases, these high deductible plans have the lowest monthly costs, making them a tempting option for employees. However, choosing HDHPs can backfire quickly if families have a costly procedure early in the plan year and haven’t had time to contribute to their HSA. In these instances, families are left paying the full cost out-of-pocket rather than benefitting from the savings of paying with their HSA.
“It’s a great plan if you understand it, can put money into your HSA and have initial low-medical usage,” explains MyHealthMath Analyst Heather Jamieson. “But if you can’t afford to contribute to your HSA, it can be a big problem because the money will need to come straight from your pocket. That’s why it’s critical that families learn about these plans up-front, consider their expected usage and contributions, and choose the plan that makes the most sense for them.”
Before building the report, our analysts schedule interviews with each employee and review a series of basic questions about their expected medical usage. This data informs their customized report and helps our analysts discuss the benefits and potential risks of a high deductible health plan.
4. Lack of cost transparency
When choosing an insurance plan, it’s important to consider all potential costs, including the costs for prescriptions, seeing specialists, and unplanned medical procedures. However, there is no simple way for a consumer to find the costs of potential services because costs vary by facility and by plan. This lack of transparency makes it nearly impossible for consumers to predict costs even at the time of a procedure or visit, never mind while choosing a health plan. And as a result, employees are again left making uninformed decisions about how they’ll afford quality health care.
Consider a mother of three planning for a potential hip surgery. When trying to predict costs, she calls her insurance company, but they tell her she needs to reach out to the hospital’s billing department. When she calls the hospital, they tell her she needs to contact her insurance company to find the procedure’s CPT code, which helps determine what the insurer and the consumer are responsible for paying. After shuffling back and forth between the two for a few more calls, she finally gets a price estimate, but the estimate still has inaccuracies because it doesn’t account for unknown surgical costs, such as anesthesia and imaging. It’s a system that sets the consumer up to fail, and employees are frustrated with trying to navigate it.
When we interview employees about their expected medical usage, our analysts will ask about any expected surgeries or upcoming major medical procedures. Our predicted costs for each insurance plan include any expenses associated with that surgery – e.g., physical therapy, imagery, and specialists costs. We also provide a report that excludes the potential procedure, so employees can make an informed decision about what they can afford and when.
5. Utilization based on coverage and plan terms rather than personal health:
A young woman has suffered from chronic headaches for years, with no relief. Her primary care refers her for acupuncture, but her insurance requires prior authorization after every ten visits. Overwhelmed by the thought of balancing another doctor’s visit and worried about having to cover costs, she stops attending the treatment.
A high school soccer coach tares his ACL in training and begins physical therapy. After three visits, he learns that his insurance doesn’t cover any of the costs. Facing an expensive medical bill he cannot afford, the coach stops attending therapy.
A mother suffering from maternal depression needs mental health counseling. She can’t find out if her insurance covers the recommended weekly visits, so she never gets help.
These are real stories that happen every day – stories employers can help prevent by empowering employees in health care planning. Without transparency, consumers choose health plans that don’t fit their needs and then struggle to understand potential costs or find the money to afford what they didn’t expect. And often, out of frustration, confusion, cost barriers or a combination of the three, they end up putting off services and treatment options they need. Employees who have sacrificed their personal health because of inadequate health plans are more than frustrated; their health is in jeopardy.
Our analysts are available to discuss the details of each plan’s coverage, so employees aren’t blindside by unexpected costs or requirements later in the year. Our customized report also provides predicted costs for a “worst-case scenario,” so employees can consider the impact of any potential medical needs.