Costs for the most popular types of health care coverage are projected to increase at double-digit rates into 2008, according to a national survey of insurers and administrators by Buck Consultants.
In its 18th National Health Care Trend Survey, Buck measured the projected average annual increase in employer-provided health care benefit costs. Insurers providing medical trends for the survey cover a total of approximately 91 million people.
Costs for the most popular plans continue to increase by more than 10 percent, similar to trends reported in Buck's 17th survey, conducted in early 2007.
Costs for Preferred Provider Organization (PPO) were projected to increase by 10.75 percent, up 0.15 percent from 2007. Point-of-service (POS) plans could see increases of 10.54 percent, down slightly (0.02 percent) from 2007. Health Maintenance Organizations (HMO) will see increases of 11.14 percent, up 0.03 percent from 2007. The most significant year-to-year difference was projected to be in High Deductible Consumer Driven plans, which although up 10.36 percent, is 0.75 percent lower than 2007s increase of 11.11 percent.
Health insurers reported an average prescription drug trend of 11.68 percent, up slightly from the 11.33 percent reported in the prior survey. This is considerably higher than the 4.52 percent reported by pharmacy benefit managers (who generally do not take any underwriting risk).
Health insurers reported lower trends for plans that supplement Medicare -- 7.32 percent for plans with drug coverage and 6.82 percent for plans without. This reflects the impact of federal controls on Medicare fees and the lower increases expected in Medicare deductibles and co-pays.
"Insurers are concerned about the cost shifting to private employers that may result due to health care reform at the state level," said Harvey Sobel, FSA. "Complying with federal and state mental health parity laws is also expected to raise costs."
Health insurers use trend factors to calculate premium rates, and large self-funded employers use these trend factors to budget their future health care costs. In general, trend factors provide for price increases that may result from such variables as inflation, utilization of services, technology, changes in the mix of services, and mandated benefits.
For additional information on this and other HR topics, consult CCH Human Resources Management or Personnel Practices/Communications.
Adjust font size Save for Later Email to Friends Print Mode Submit your own content on this or any topic. Get started. According to the newest National Health Care Trend Survey, the cost of health care will continue to rise for the remainder of 2007 and well into the New Year. This survey, which utilized responses from 79 different health insurance companies, HMOs, and third party administrators, was released on November 28, 2007.
The survey was performed by Buck Consultants which is considered a leader among the companies in the human resource and benefits consulting business sector. This the eighteenth year that Buck Consultants has measured the average increase in cost of employer-sponsored health care benefit costs. The companies that participated handle coverage for nearly 91 million people living in the United States.
The survey examined the trend of health care insurance plans. Overall, the cost of health care for the nation's most popular plans continued to increase. Costs for Preferred Providers Organizations (PPO) saw a .15% increase and Health Maintenance Organizations (HMO) saw a .03% increase. While these two areas saw increases, some plans actually decreased in cost. Point of Service (POS) plans decreased in cost by .02 and High Deductible Consumer driven plans decreased by .75%. The survey also examined other costs relevant to health care. One such area includes prescription drugs which had a trend of 11.68%. This is up from the last survey which reported the trend at 11.33 percent. Medicare supplement plans had a lower trend of 7.32 percent for plans that included drug coverage and 6.82 percent for those plans without drug coverage.
A survey of employers nationwide shows that workers in the Northeast are choosing preferred provider organizations over other types of health coverage, and are less likely than most to sign up for the newfangled consumer-directed health plans.
PPOs have been chosen by just over 47 percent of workers in the Northeast. It is the most popular type of insurance in the region, but not as popular as it is in other parts of the country. Slightly more than 51 percent of workers in the West to 71 percent of workers in the Southeast have PPO coverage.
The survey represents 11,723 employers nationwide. It is a product of United Benefit Advisors, a national organization of consultants including HR Benefit Advisors Ltd. in Buffalo and Rochester.
Consumer-driven plans are chosen by just under 5 percent of workers in the Northeast. Created in the 2003 Medicare legislation, the style of coverage couples high-deductible insurance policies with health savings accounts, or HSAs, where participants can stash money pre-tax to pay for health expenses until they reach the deductible. Though the insurance industry annually has predicted wild spread of the consumer-driven model, adoption is low. It ranges from 10 percent in the Central region to 2.4 percent in the West.
Fee-for-service plans are the least-popular option nationally, with enrollment ranging from 2.8 percent in the West to 0 percent in the Central region. Just .6 percent of workers in the Northeast are covered by such plans.
Employers nationwide are shifting more of the cost of health care to their
workers but with health insurance premiums expected to continue to outpace
inflation and worker wage increases, cost shifting is a short-term fix, said
Rocco Lueck, managing director of the HR Benefits Buffalo office. Many are
implementing wellness programs, such as stress management and smoking
cessation programs, to help offset future expenses, he said.
Annemarie Franczyk Business First
What is the benefit of using this PPO plan?
When you use the providers within the network, you will be receiving quality medical care with the highest level of benefits at the lowest rates. Your out-of-pocket expenses will be significantly lower when you utilize a healthcare provider within the network. You do not have the hassle of filling out forms to receive services. Another added benefit is that each family member that is covered is not required to use the same physician as you. Each covered member may choose the physician of their choice within the network of preferred providers. In the event of an emergency, as a PPO member you do not have to be concerned about coverage because the plan allows for worldwide coverage, 24 hours per day.
What types of plans are available?
When looking into these plans, you can choose between six different types of plans:
* Beneficial Plan offers a waived deductible up to three office visits during the plan year.
* Beneficial Rx Plan waives the deductible as the Beneficial Plan and includes substantial savings on Prescriptions.
* Plus Plan offers low out-of-pocket expenses when you need primary care services.
* Preferred Plan offers a reasonable monthly rate along with the freedom of selecting a provider for your medical needs.
* Traditional Plan allows you the flexibility to choose your providers so that you can receive the best medical care at a reasonable cost.
* Health Savings Account is a high deductible health plan that allows you to save qualified health expenses on a tax-free basis.
Along with the plans mentioned above many PPO, plans also offer dental coverage. As you are looking for the most cost effective family PPO plan that provides the maximum benefits remember to match the offers you receive with the medical needs and budget of your family. You do not want to spend extra money on coverage that you will not utilize. Once you have selected the plan that is right for your family, relax in the knowledge that your loved ones have medical insurance if they should require health insurance and student health insurance
In America the cost of health care is on the rise with no sign of becoming any cheaper in the near future. One way of combating this is with the use of health insurance. There are many types of health insurance available but one of the most popular types is managed care. This article will examine two managed care plans PPO and HMOs and will compare and contrast to see the differences and similarities between the two.
HMOs and PPOs are similar in the fact that the two of them members need to choose a primary care physician (PCP). The PCP is responsible for the majority of the medical care for the members of the medical plan. If any member needs to see a specialist, then the PCP has to be consulted and offer a reference before the specialist can be seen. It is with the PCP aspect that the HMO and PCP differ. As stated it is necessary for member of the HMO to have a PCP, this is not true for members of the PPO. The members of the PPO can choose a PCP if they please but they are not required to. This also means that the members of the PPO can refer themselves to a specialist of their choice.
When members sign up for the different managed health care plans, HMO & PPO there are usually different stipulations associated with both. One such stipulation is in regards to medical coverage. Both HMO and PPO members are covered once they seek or receive medical care within the private network. The plan will cover all expenses associated with their treatment. The two managed care plans differ when it comes time to receive treatment outside of the network. HMO members will not receive coverage or benefits if they decide to get medical care outside of the private network. If they do insist on doing so they will have to pay out of their own pocket. Members of the PPO can go outside of the network to receive care; however the coverage benefits would be substantially less. To entice members to stay and receive coverage in network, the PPO often times gives financial benefits which will encourage their members to stay within the network.
In closing the choice of the best managed care plan for you rests on the individual. Both the HMO and PPO have their advantages and disadvantages. Depending on what is the best choice that fits the individuals lifestyle, then they should proceed with managed care plan. HMO is a much more restrictive and you do not have the flexibility in your choices. You do what is laid out to you and if you go outside of their network you will not receive any benefits. The PPO allows you some amount of flexibility but the financial rewards are diminished. You are not tied to a network like the PPO and this increase the options that you have. As stated the difference between an HMO and PPO is all a personal choice and it will depend on what the person wants out of the plan.
For more information on topics related to Pittsburgh Insurance, especially PPO or HMO plans then visit Pittsburgh Health Insurance. James Dalton also writes on Indianapolis Insurance at his website.
Most of the people who are shopping for major medical insurance are concerned about their budget more than the coverage. The premium quoted becomes the deciding factor while choosing medical insurance. It determines the type and extent of the medical insurance they want to purchase. The rates offered for the medical insurance plan depend on the current health, habits, hobbies, and lifestyle of the person looking for insurance. Relatively healthy people are offered lower rates than someone who is suffering from any illness.
Indemnity and managed care medical insurance plans differ in their fundamental approach of providing coverage. Indemnity plans are preferred for the wide choice of doctors allowed which include specialists, such as cardiologists and surgeons. They also provide a comparatively larger range of approved hospitals and other health care providers. Managed care plans do not have as wide a choice as in case of indemnity plans. They usually have tie-ups with certain doctors, hospitals, and other health care providers. This allows managed health care plans to offer a range of services to its members at reduced cost.
Health maintenance organizations or HMOs offer managed care medical insurance plans for lower rates as compared to insurance plans that charge a fee for the service rendered. However, it is not the right choice for people who might want to opt for specialized insurance coverage. Preferred Provider Organizations or PPO insurance is aimed at combining the lower cost of managed care with the greater range of choice found with indemnity health insurance. A PPO health insurance plan has all the features of an HMO plan but it allows the policyholders to choose medical practitioners from a wider range.
The point of service or the POS plan is a lesser-known plan that attempts to combine the properties of PPO and HMO. A POS plan requires the policyholders to choose a primary care physician to monitor their health care, who has to be chosen from within the health care network. This chosen physician becomes the point of service for the policyholders.
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Health insurance is offered in various forms today. Traditionally, health insurance plans were indemnity plans; the insured paid a premium, the physician provided health care services, the health insurance plan was billed, and the health insurance plan paid for covered services. As health care costs became astronomical, health insurance companies developed different plans that were aimed at providing quality health care at affordable prices. Managed health care became the buzzword for the health insurance industry, and health insurance plans became more complicated.
Health maintenance organizations, or HMOs, and preferred provider networks, or PPOs, have largely replaced the traditional indemnity health plan. HMOs and PPOs utilize strategies to contain health care costs. These health plans are similar in certain ways. Both HMO and PPO plans contract with health care providers to provide health care services at reduced rates for the health insurance plan members. Typically both plans require the the member have a primary care provider, or PCP, who serves as a "gateway" to coordinate care for the member, and all specialty services are accessed by referral from the PCP. Both HMOs and PPOs require that certain services and products, usually the more costly ones, be reviewed by the health insurance reviewers for prior approval or prior authorization before the service is rendered. The health care provider must submit justification for these services as "medically necessary", and the reviewer determines whether the service is a covered service. The plans do make provision for emergency situations that cannot wait for prior approval/authorization, but still require an approval process.
HMOs and PPOs differ in significant ways, however. A PPO plan often covers services rendered by providers that are not in the plan network, though usually at a lower rate than given for network providers. HMOs usually offer no coverage for out-of-network health care providers.
Advantages of HMO/PPO plans typically include lower health insurance premiums than those of traditional health insurance plans. HMOs and PPOs often offer coverage for preventive and health maintenance care not covered by indemnity plans. The health plan member is usually not required to file claims for health care services; contract providers bill the health insurance plan directly.
Disadvantages of these managed health care plans include limiting coverage to providers in the health care plan. Plan members must change primary care providers if their provider is not in the health plan network. Many members do not want to change health care providers. Another disadvantage is that prior approval/authorization processes can be time-consuming and slow down the delivery of needed health care services. Specialty health care can only be accessed through referral from the PCP.
In summary, HMOs and PPOs offer lower premiums and increased coverage, but limit members to their network of providers. Indemnity plans allow the member to see the health care provider of their choice, and to access specialty care when they want, but usually pay higher premiums for health insurance coverage. Ultimately the health plan member must decide whether choice of physician and access to specialty care are worth the higher premiums. Whatever plan is chosen, it is vital for members to know their health insurance plan, including what services are covered and what providers are in network.
Kay Lowe holds a Master'd degree in health care ahd has 30+ years in the health care field. She is also webmaster for Health-Infosource.com, a website dedicated to disseminating health information.
Today in the United States, Managed Care Plans have become the most popular form of health care coverage. Managed Care Plans are very different from Indemnity Plans. Under an Indemnity Plan, a policy holder can seek medical attention whenever and wherever it is essential. With a Managed Care Plan, a policy holder has many limitations and restrictions.
Managed care plans have become so common because these plans are what most employers offer to their employees. Employers bear the cost of their employees' medical coverage. For employers, medical benefits to the employers happen to be their biggest expense. Thus, employers tend to opt for the most economical of health plans to provide their employees. Managed care plans are the most economical type of health insurance plan for employers.
It is a fact that medical expenses can be controlled if access to health treatments and services is controlled. Managed care plans uphold this truth, which is beneficial for companies offering medical benefits to employees. However, if viewed from a patient's perspective, if one is in need of a treatment that goes beyond the basic preventive care, availing of such a treatment can become difficult.
Managed care plans categories are as follows: a Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO); and a Point of Service (POS). HMOs and PPOs are the most popular. A brief about the features of each is given below:
A Health Maintenance Organization (HMO) plan is more economical than a PPO coverage and offers coverage for preventive care. If you are an HMO participant, you pay a monthly premium and very minor co-payment whenever you visit a doctor. The HMO network has many medical care providers. You have to choose from these medical care providers. The medical care providers have an agreement with the insurance company to offer medical services at already negotiated and reduced rates. You must select a Primary Care Physician (PCP), who will always be the first to examine you each time you have a medical condition. Your PCP will give a referral if you need to see a specialist for your condition.
As an HMO participant, you can only choose a PCP from your HMO's approved list of medical care providers. It's possible that your preferred doctor won't be on that list. The costs of a medical care provider who is not in your HMOs network won't be covered by the HMO. Also, in most cases the HMO network is small in size, so getting appointment with a PCP can be difficult.
A Preferred Provider Organization or PPO coverage is very much like an HMO. The only difference is that with a PPO plan, you don't need to be examined by a PCP first. Although not required, you are advised to select a medical care provider from the PPO's approved list. If you should ever need to go to a specialist, you don't need to have a referral. If you visit a medical care provider outside your PPO's network, the co-payment is higher and the PPO part of medical care will be less.
PPOs do offer more amount of freedom but the costs involved are higher. These costs can be exceptionally high when you seek the services of a medical care provider outside the network of PPO.
A POS managed care plan is mix of HMO and PPO. It offers more freedom to choose a medical care provider and has lower costs. You can choose a PCP, but it is difficult to get a referral to a specialist. If you stick to the network, the paperwork is negligible and your co-payment amounts will also be at aminimum. A POS plan has no deductibles. This might make a POS plan appear lucrative, but POS plans are not very popular.
You have do a thorough research and analysis regarding which managed care plan to choose. The plan should satisfy your needs. The coverage provisions and additional costs differ significantly from plan to plan, so do invest time and put effort and clarify your doubts as soon as possible.
Interested in saving money on your health insurance? Try visiting Best-Free-Insurance-Quotes.com located at http://www.best-free-insurance-quotes.com - A website that will save you money on all of your insurance needs
Whether your company doesn't offer health coverage, you're self-employed or you have retired early but aren't yet eligible for Medicare, you always can purchase your own health insurance policy. The big question is: How much coverage can you afford? Let members of the Financial Planning Association of Greater Indiana help you sort out the details. Visit the group's Web site at www.fpagrindiana.org.
Bruce Snyder Jr.
Hanson & Snyder If you find yourself without health insurance provided through your employer, there are many options available for you. It will, though, cause you to purchase this coverage on your own. Here are some tips: Determine what you can afford in monthly premium payments. It will do you no good to get insurance for a few months and have it lapse because you couldn't afford the premiums. Do some research. There are several types of plans available such as HMO (health maintenance organization), PPO (preferred provider organization) and POS (point of service), to name a few. Each has benefits you may or may not need. Determine what type of coverage you need. If you are getting ready to start a family, make sure the coverage you seek has both maternity and child coverage. If you take many prescription medications, determine what would be the most appropriate coverage for you. Sometimes pre-existing conditions might be excluded. Shop around. Get quotes from multiple sources and make sure you are comparing similar plans. If you have a doctor you like to work with, determine whether he or she will work with the plan you are thinking about going with. Having no health insurance coverage can be a stressful situation. By following some of these ideas, the stress of buying coverage can be reduced. To get started, sit down with your financial adviser in order to discuss the options available to you. Dennis J. Meyer
Meyer Financial Strategies Insurable or not, if you need individual or family major medical health insurance, it's available. The big question: What can you afford? Because there are a variety of benefits, deductibles and companies to choose from, the premiums can vary dramatically. Also, premiums for females are higher than males, and where you live (by ZIP code) can make a difference, too. Plus, if you don't have a "preferred" health history, the insurance company may charge you a higher premium than what was quoted and applied for, or worse yet, decline your application. But, if you're declined, you can still get benefits through the Indiana Comprehensive Health Insurance Association. If you think you have health history issues, visit www.ichia.org or call (317) 614-2133. This will prepare you for what the highest premium could be for traditional benefits. Then contact an insurance agent who can represent a variety of companies, benefits and deductibles. When you meet with the agent, have a good idea about your medical history for the past 10 years. If you're looking for family coverage, you'll need to know those people's medical histories, too. Disclosing this information to an insurance agent will assist in making sure that you're getting a fairly accurate quote up front, without formally applying for the benefit. If premium affordability becomes the issue, consult a financial adviser, as this benefit is a must-have! Elaine R. Bedel
Bedel Financial Consulting Yes. Anyone who does not have health insurance available through an employer can purchase his or her own policy. Anyone who retires before age 65 without retiree medical benefits or the ability to continue employer-paid coverage through COBRA also may want to buy a policy. In that case, health coverage is necessary until an early retiree becomes eligible for Medicare coverage. It is not prudent to go without health insurance coverage for any amount of time. Too often individuals assume that since they are healthy in their eyes, they can get by without purchasing medical insurance. Even healthy individuals need coverage. Accidents happen. Before you begin to shop around for your coverage, you need to determine the amount that you can afford to pay out-of-pocket for medical services before the policy begins to pay. This is the "deductible amount." Can you afford $250, $500, $1,000 or more? The higher the deductible amount, the lower the policy premium. If you can afford a deductible of $1,000 or more, consider the newer health savings accounts rather than traditional health insurance policies. An HSA plan couples a high-deductible policy with a savings account. You contribute pre-tax dollars and then use the funds to pay your out-of-pocket expenses until the deductible amount is met. Seek the help of a knowledgeable financial adviser or insurance professional.
Meyer is a certified financial planner.
A Preferred Provider Organization, or PPO, is a popular type of health insurance because it offers more freedom than an HMO, but is less expensive than traditional health insurance plans. If you're in the market for health insurance, you should definitely look into cheap PPO health insurance plans.
What is a PPO?
With a PPO, your health insurance company contracts with health care providers to provide health care at pre-set prices. All kinds of health care providers participate in PPOs, including doctors, hospitals, clinics, physical therapists, pharmacies, etc. As the insured you pay:
* A co-payment for services
* An annual deductible
* A percentage of medical fees
You can choose from any health care provider in the network, but if you go outside the network you have to pay a higher portion of the expenses.
What is the Difference Between a PPO and an HMO?
Health Maintenance Organizations, or HMOs, usually have no deductible and lower co-payments than PPOs. As with PPOs, you choose from health care providers within a network. However, HMO plans are more restrictive:
* If you go outside the network, you may receive no coverage at all
* You need a referral from your doctor before you can see a specialist
* You may need approval from the plan's management for some specialty care
How Do I Find a Cheap PPO Plan?
To find a cheap PPO health insurance plan, begin by visiting insurance comparison websites. On these websites you complete a simple form with information about yourself and your health insurance needs. Shortly thereafter, you'll begin to receive quotes from multiple A-rated health insurance companies. All you have to do is compare the coverages and premiums and choose the one that is right for you.
The best websites even let you talk with insurance professionals by phone, or through an online chat service, so you can get expert answers to all your health insurance questions (see link below).
Visit http://www.LowerRateQuotes.com/health-insurance.html or click on the following link to get PPO health insurance plan quotes from top-rated companies and see how much you can save. You can also get more insurance tips there.
The authors, Brian Stevens and Stacey Schifferdecker, have spent 30 years in the insurance and finance industries, and have written a number of articles on finding cheap PPO health insurance plans.
Sun-Times Columnist Last week's column mentioned the importance of the "open enrollment" period for corporate health plans, and generated a few questions. In fact, many employees spend only a few minutes reviewing their options, and this year-end task gets relegated to the bottom of the "to-do" list. That could be an expensive mistake.
So this week's column offers some resources for those who would like to make informed decisions about their employer's health plan alternatives, but simply don't know where to start.
It's worth spending the time to understand your options, because your company might have added new choices, including a Health Savings Account. Or your plan might have switched PPO (Preferred Provider) options, eliminating your favorite physician from the list. Or your own personal and family health needs might have changed, as you age or with the birth of a child, so that a different portion of the company's health care plan might be better suited to your needs.
Choices might include:
HMO: Health Maintenance Organization. On the plus side, the costs are low, with one fixed or a very low payment required for office visits. On the minus side, you will be limited in your choice of physicians and specialists. And the HMO must authorize diagnostic tests.
PPO: Preferred Provider Organization. You'll have your choice of a wide range of physicians in the plan -- and might be able to choose a provider outside of the plan, if you pay for a substantial portion of the cost. You might be required to pay larger out-of-pocket expenses for co-payments and diagnostic tests, or a higher monthly premium will be deducted from your paycheck.
HEALTH SAVINGS ACCOUNT. You set aside money on a pre-tax basis to pay for health care expenses throughout the year. If you don't spend the money, you may roll it forward on a tax-deferred basis, to help with future medical expenses. The plan probably gives you a wide choice of providers, counting on your willingness to choose the most cost-effective course of treatment.
After examining the company's choices, you have to set some priorities, and decide which plan is appropriate. Some of those priorities might include:
Choice of physicians, hospitals and other providers
Cost of premiums, co-payments and "out of pocket" expenses
Coverage for prescription drugs
Wellness program coverage
Tax advantages
If you're still confused about those choices and how they meet your priorities, there's plenty of help online. Many of the most informative sites are offered by health insurers. They have both the money and the vested interest in creating educated health care consumers, so they're worth checking out in spite of the abundance of logos!
Humana offers www.FamilyHealthBudget.com to help you calculate how much you're really spending on health care, when you include premiums and out-of-pocket expenses.
This site will help you take a realistic look at costs, no matter whether you are covered by your employer's plan, a spouse's plan or Medicare. And there's advice even if you don't have insurance coverage. Plus, you'll find in-depth explanations of the kinds of plans mentioned earlier in this column.
Aetna serves up www.PlanforYourHealth.com , which offers both a "health benefit priorities" tool and a "health expense calculator." The link to Navigating Health Benefits on the home page is especially useful in this open enrollment period to help you make choices based on premium costs, co-payments and plan limitations.
Unfortunately no one has developed the perfect tool to make the decision for you. That still requires your own logical thinking.
But you can't make a sensible decision if you don't take the time and make the effort to carefully examine your choices. And that's The Savage Truth. t
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