Blue Shield's virtual-first health plan comes with $0 out-of-pocket costs
Employee Benefit News
FEBRUARY 13, 2023
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Out of Pocket Cost Related Topics 
What are reimbursable out-of-pocket costs?
PeopleKeep
FEBRUARY 14, 2022
With the cost of health insurance coverage on the rise and consumers seeing their once low deductibles grow sky high, many Americans have been forced to pay more for their healthcare without the help of insurance. These costs that aren’t covered by insurance companies are called “out-of-pocket” costs.
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Innovation is a driving force behind mental health parity
Employee Benefit News
SEPTEMBER 20, 2023
Hybrid plan designs that reduce out-of-pocket costs will make benefits more accessible and ultimately help level the playing field.
IRS Loosens Preventive Care Coverage Rules
InterWest Insurance Services
DECEMBER 5, 2024
New guidance issued by the IRS expands the types of preventive care benefits that high-deductible health plans are required to cover with no out-of-pocket costs on the part of plan enrollees. The changes are aimed at reducing out-of-pocket costs for diabetes-related expenses, certain cancer screenings and contraceptives.
Who is Eligible for the Individual Coverage HRA (ICHRA)?
PeopleKeep
OCTOBER 4, 2024
With this type of HRA, employers can reimburse employees tax-free for their individual health insurance premiums and other qualified out-of-pocket costs. One type of HRAs is the individual coverage HRA (ICHRA). But before you offer an ICHRA at your organization, you must understand its eligibility requirements.
What (Most) Decision-Support Tools Get Wrong
Flimp Communications
SEPTEMBER 19, 2024
Calculator tools estimate costs by multiplying units of services by applicable copay or average costs. Consequently, they tend to underestimate employee out-of-pocket costs and expenses for ancillary services such as diagnostics, anesthesia, therapy, and supplies.
3 in 4 Workers Would Accept Lower-Pay for Better Benefits: Survey
InterWest Insurance Services
OCTOBER 17, 2024
A new study has found three out of four U.S. The main driver in workers prioritizing benefits is the rapidly rising cost of group health insurance premiums and out-of-pocket costs, according to the study by Voya Financial.
Health Savings Accounts (HSAs) and Medicare: Eligibility, contributions and more
Higginbotham
MARCH 24, 2025
However, you can still use the funds that are already in your HSA to pay for qualified medical expenses, including Medicare premiums, deductibles, copayments and certain out-of-pocket costs. What happens to your HSA once you enroll in Medicare?
Financial Burnout in 2025: How to Address Employee Concerns
Best Money Moves
OCTOBER 22, 2024
Younger generations are particularly vulnerable, with 72% unable to afford $1,000 in out-of-pocket healthcare costs. Employers can help by offering more comprehensive health plans that minimize out-of-pocket costs from the start.
HDHP Enrollees Less Satisfied with Their Health Plans
InterWest Insurance Services
MAY 18, 2023
” HDHP enrollees enjoy lower up-front premium costs in exchange for higher potential out-of-pocket costs for copays, coinsurance and deductibles, and high health care users may experience significant outlays not covered by insurance. If enrolled three or more years, 55% were satisfied.
New Rules Expand Services Covered with No Cost-Sharing
InterWest Insurance Services
MARCH 22, 2022
The Department of Health and Human Services has issued some new “frequently asked questions” for its Affordable Care Act pages, and new guidelines that require health plans to expand what they are required to cover with no cost-sharing.
Managing Employee Healthcare Costs in 2021
Best Money Moves
NOVEMBER 4, 2020
Managing Out-of-Pocket Costs in 2021. Employers should make working with health insurance brokers to help employees better understand the difference between healthcare plans and estimated out-of-pocket costs for various services a higher priority.
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It’s Time for a Mid-Year Financial Check-Up
Money Talk
JUNE 29, 2022
Among the culprits: climate change, higher costs for labor and supplies to repair houses and cars, and higher out-of-pocket costs for employer-provided health insurance. Now is a good time to explore money-saving strategies to reduce insurance costs. have generally trended up.
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Can you have two health insurance plans?
PeopleKeep
DECEMBER 29, 2021
Whether or not you’ll have any out-of-pocket costs. We’ll cover: Why someone might have two health insurance plans. How to coordinate primary and secondary health insurance plans. How to determine which insurance is primary and which is secondary.
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Cutting Through the Alphabet Soup of Dental Insurance Plans
InterWest Insurance Services
MAY 2, 2024
However, there still may be a network, and your out-of-pocket costs may be lower if you see dentists from within these networks. Meanwhile, DMOs generally offer the lowest monthly premiums and have low out-of-pocket costs for routine services like cleanings.
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Health Plans Covering Fewer Drugs, Imposing More Restrictions
InterWest Insurance Services
AUGUST 15, 2024
It’s also important that they understand how much of a certain drug their health plan will cover and what their estimated out-of-pocket costs will be, so that they can budget accordingly. These formularies also dictate copays and coinsurance — the patient’s out-of-pocket costs for each drug.
What to do if your zero-deductible health plan goes away
PeopleKeep
FEBRUARY 16, 2022
One of the biggest factors is how high your out-of-pocket costs will be. There are many factors to consider when it comes to selecting health insurance. One option that appeals to many employers is the zero-deductible health plan because it means the insurance company will start accepting claims from the very beginning.
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Why your integrated HRA shouldn't be tied to one carrier
PeopleKeep
JANUARY 18, 2022
For many employers offering a group health insurance plan, adding a supplemental benefit in addition to the group plan can help offset your employees’ out-of-pocket costs. This is especially true with high deductible health plans (HDHPs) that require employees to pay a higher amount on their own before their insurance kicks in.
As Health Care Costs Bite, Here’s How You Can Help Your Workers
InterWest Insurance Services
JANUARY 27, 2023
Even if you are providing them with a robust plan, there are often out-of-pocket cost-sharing and deductibles to contend with. For employees in high-deductible health plans, the costs can be steep. Many preventative services are covered with no out-of-pocket cost-sharing, but checkups usually are not.
Get Communications Right for Open Enrollment
InterWest Insurance Services
OCTOBER 6, 2022
They may look at a low premium without considering the cost on the back end in terms of a higher deductible and/or other out-of-pocket expenses. Break expenses down with different health care scenarios and the associated out-of-pocket costs based on the plan they have.
Four High Deductible Health Plan Mistakes to Avoid
InterWest Insurance Services
FEBRUARY 20, 2024
For example, if a majority of the employees are older and/or have certain health conditions, pushing an HDHP on them may not be a good move as their out-of-pocket costs may rise significantly and outweigh any savings from lower premiums.
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5 ways you can help employees get the most from their benefits
Insperity
OCTOBER 31, 2017
Be sure to provide each new hire with: A detailed, printed overview of available benefits and out-of-pocket costs, if any. Help employees truly understand their out-of-pocket costs. Leverage new-employee orientation and the hiring process to educate new team members about benefits.
Budgeting and Prepping for Open Enrollment
InterWest Insurance Services
AUGUST 1, 2023
Going out of network is discouraged with high out-of-pocket costs. Preferred provider organizations – PPOs contract with hospital and provider networks to help control costs. While they will cover services outside of the network, the cost is higher than going in-network.
Budgeting and Prepping for Open Enrollment
InterWest Insurance Services
AUGUST 22, 2023
Going out of network is discouraged with high out-of-pocket costs. Preferred provider organizations – PPOs contract with hospital and provider networks to help control costs. While they will cover services outside of the network, the cost is higher than going in-network.
Aetna Lawsuit Highlights The Need For Modern Family Planning Benefits
Wellable
SEPTEMBER 22, 2021
While coverage kicks in immediately for heterosexual couples, resulting in zero out-of-pocket cost for treatment, the policy's discriminatory rules require LGBTQ patients to pay thousands of dollars out of pocket before their coverage kicks in.
Little-Known Things to Consider When Shopping for Group Health Insurance
Insperity
MAY 13, 2015
HDHPs are health insurance plans with lower premiums and higher deductibles and out-of-pocket maximums than traditional health plans. Yet, many first-time group health insurance buyers shy away from these plans and opt to offer a low deductible plan because it minimizes out-of-pocket costs for their employees.
Employee Mental Health Leave Requests Skyrocketing
InterWest Insurance Services
APRIL 18, 2024
Studies show that one in four adults skips needed care or medications due to cost. Consider adding a direct primary care benefit, which allows workers and covered family members unlimited appointments with their primary care physician with no out-of-pocket costs. Offer mental health or sick day leave.
The Importance of Tracking Health Plan Metrics
InterWest Insurance Services
AUGUST 29, 2024
If your staff are using their plans less frequently than their peers at other companies, it could point to issues, such as the plan being too costly, either via the employees’ share of premiums or out-of-pocket costs. By digging deeper into claims, you can see where your workers are mostly going for health care services.
HRA Gym Cost Reimbursement? Not So Fast Says IRS
InterWest Insurance Services
JUNE 27, 2024
These accounts are only to be used for qualified, legitimate medical expenses, like out-of-pocket costs for medical services, prescription medications and medical hardware.
Four Ways to Ensure Your Group HDHP Will Fail
InterWest Insurance Services
JANUARY 18, 2024
For example, if a majority of the employees are older and/or have certain health conditions, pushing an HDHP on them may not be a good move as their out-of-pocket costs may rise significantly and outweigh any savings from lower premiums.
16 Surprising FSA and HSA Eligible Expenses Your Employees Should Know About
InterWest Insurance Services
JUNE 2, 2023
For the most part, people use their funds in FSAs and HSAs to reimburse themselves for out-of-pocket costs like copays, health insurance deductibles and the cost of prescription medications.
Waiving HDHP Deductibles Has Little Effect on Premiums, Study Says
InterWest Insurance Services
AUGUST 10, 2022
Among HDHP plans that expanded pre-deductible coverage to 116 drug classes used to manage expensive long-term, chronic medical conditions, the cost of these drugs was almost entirely offset by reduced health care utilization. no deductible and no coinsurance), the net impact on premiums was an increase of 4.7%.
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Insulin Makers Cap Prices for Insured Individuals
InterWest Insurance Services
JUNE 22, 2023
Finally, Sanofi two days later announced that it would cap the out-of-pocket cost of its most popular insulin, Lantus, at $35 per month for people with private insurance. On March 14, Denmark-based Novo Nordisk announced that it would lower the U.S. for a single vial and $139.71 The new pricing will take effect Jan.
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5 Must-Have Benefits for Millennial Employees
Best Money Moves
MAY 22, 2019
Research by the West Health Institute/NORC at the University of Chicago found more than 40 percent of Americans didn’t see a physician when they were sick or injured because of high healthcare costs. Comprehensive healthcare plans that reduce out of pocket costs for employees will be highly attractive to millennial employees.
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Hospitals Are Hiding Prices from Patients, Advocacy Report Says
InterWest Insurance Services
OCTOBER 20, 2022
The Centers for Medicare and Medicaid Services’ transparency rules were implemented to shine the light on what hospitals charge for their various medical services, the negotiated rates insurers have with health plans and the out-of-pocket costs enrollees can expect to pay for these services.
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PBMs Feeling the Heat on All Fronts
InterWest Insurance Services
MAY 26, 2023
In the crosshairs In theory, the PBMs should pass these rebates back to the individuals who are prescribed the medication so that they can reduce their out-of-pocket costs. Those rebates can be significant.
Hospital Indemnity Insurance a Key Voluntary Benefit
InterWest Insurance Services
DECEMBER 28, 2021
But if you have an 80-20 plan, your worker is still responsible for her deductible (averaging over $1,600), plus 20% of that cost, or over $6,000. That leaves your worker exposed to a total out-of-pocket cost of over $7,600. Few people can cover that.
PBMs Feeling the Heat on All Fronts
InterWest Insurance Services
AUGUST 10, 2023
In the crosshairs In theory, the PBMs should pass these rebates back to the individuals who are prescribed the medication so that they can reduce their out-of-pocket costs. Those rebates can be significant.
5 Benefits to Help Employees Cope with Inflation
Best Money Moves
JUNE 1, 2022
Health care costs can often drag behind increases in consumer prices, so employees may face an increase in costs that will last throughout this year and next. According to the Kaiser Family Foundation, 46% of employees reported that they have less than $1,000 in out-of-pocket costs for any unexpected hospital/doctor visit.
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Employers Prioritizing Enhanced Benefits in New Year, Not Cost-Cutting
InterWest Insurance Services
JANUARY 5, 2023
With Americans increasingly struggling to pay their health care bills, more employers are shying away from only offering their workers high-deductible health plans (HDHPs) that reduce premiums up front for higher out-of-pocket costs for workers.
More Employers Add Narrow Networks to Offerings
InterWest Insurance Services
JUNE 16, 2022
Under the Affordable Care Act, health plan enrollees are protected from massive medical bills because health plans are required to limit the amount of out-of-pocket costs to $8,700 for an individual and $17,400 for a family. There is no limit if your employee goes out of network.
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Smallest Firms See Largest Health Insurance Hikes
InterWest Insurance Services
APRIL 27, 2023
Some employers have gravitated towards HDHPs to reduce their and their employees’ overall premium spend, but these plans come at a cost: more out-of-pocket costs for workers.
Family Coverage Costs Hit Small-Business Workers Hardest: Study
InterWest Insurance Services
DECEMBER 29, 2023
What small firms can do While small employers really can’t do anything about rising group health plan costs, they can take steps to ease their employees’ premium obligations and out-of-pocket costs: Assume more of the premium — If it’s within their budget, they can increase the amount of family coverage premium they will cover.
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How to Retain Hourly Employees
Best Money Moves
MAY 28, 2019
High out-of-pocket costs for healthcare have led to financial toxicity , which happens when Americans skip medications that could improve their quality of life because they can’t afford them. Exploring scheduling options that give hourly employees more control is a strategy that could potentially reduce turnover.
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