Health Insurance Industry Issues and Legislation

Over the past two years, stop-loss premiums for employer-sponsored health plans have risen by 7% to 16%, driven primarily by high-dollar claims and the escalating costs of specialty drugs. In a recent survey, 25% of payors reported facing at least one claim exceeding $1 million, with 7% of those surpassing $2 million. The upward trend continues this year, fueled by more assertively billed hospital claims, the introduction of costly new treatments, and the ongoing increase in specialty drug expenses.

Successful negotiation of claims, including catastrophic ones, is crucial in managing healthcare spending and reducing stop-loss premiums for self-funded payors. H.H.C. Group expertly negotiates substantial discounts on both in-network and out-of-network claims daily. In just the past month, we successfully saved a client and its stop-loss carrier an incremental $1.3 million on top of an already discounted in-network claim.

Healthcare consultants are anticipating the most significant rise in health insurance costs in a decade. Projections indicate employer costs will surge anywhere from 5.4% to 8.5% for 2024. Interestingly, amidst the tight labor market, there seems to be some relief for workers. A recent survey reveals that over two-thirds of employers intend to either absorb all or a portion of the anticipated increase.

Weight loss drug manufacturers are heavily marketing their products putting self-funded payors in a challenging position. Initially designed for diabetes treatment, these drugs are now proving highly effective for obesity. However, their ongoing and expensive nature is leading employers to face tough coverage decisions. Some are choosing to bear the costs, while others are opting to discontinue coverage altogether.