Direct Primary Care (DPC) is capturing the attention of employers who want to offer better health care coverage to their employees. With DPC, a patient can form a one-on-one relationship with their doctor and have 24/7 access to medical care. DPC has been shown to help provide superior healthcare for individuals, lowering their overall healthcare costs and improving outcomes.

The challenge for employers who want to offer DPC – how to ensure employees are covered for both primary care health services and care the DPC doctor can’t provide.

Winter holidays are meant to be a joy-filled season with family and friends, but they also can bring a lot of stress. Here we are in 2021, with the continued risk of COVID-19 and its new variants still posing threats. In addition, now we have product and food supply shortages across the country – this sounds like a recipe for a higher-than-normal stress-filled holiday season. 

The Affordable Care Act (ACA), also known as Obamacare, is a health care reform law that was enacted in March 2010. Some of the key goals of the ACA were to:
 

• Extend health coverage to millions of uninsured Americans.
• Expand Medicaid eligibility
• Create a Health Insurance Marketplace for individual health insurance, prevent insurance companies from denying coverage due to pre-existing conditions, and requiring plans to cover a list of essential health benefits.
• Allow lower-income families to qualify for subsidies for coverage purchased through the Marketplace.

 
However, even though there are some “pros” to the Affordable Care Act, there are just as many “cons” for an ACA plan, many of which led to significantly higher health insurance premiums for individual and small employer health insurance.

Reference-based pricing (RBP) is touted as the economical alternative to Preferred Provider Organization (PPO) pricing and statistics bolster that claim.

RBP is a reimbursement methodology primarily used by self-funded employers. Instead of carriers negotiating a fee directly with a provider (usually through a PPO network), employers reimburse providers and facilities according to a reference point – such as a percentage above of Medicare rates. For instance, Allied National’s self-insured Funding Advantage Freedom Plans reimburse physicians at 125% of Medicare and facilities at 150%.

The question many people have is whether RBP really can save employers and employees a significant amount of money on group health plan premiums and member out-of-pocket costs.

The answer?

Article reposted with permission from BenefitsPro. Written by Kelly Smith, Senior Vice President at MVP Health Care.

​Brokers are experiencing an increase in demand for level-funded plans, which are an exciting offering providing predictability, funding diversity and innovation to their portfolio.

“Open Enrollment is coming!” – A phrase you’ve most likely heard at least a few times recently.
 
The federal Open Enrollment Period (OEP) happens once a year for individual health plans in the ACA marketplace. For most states, you have from Nov. 1, 2021, to Jan. 15, 2022, to choose a health plan for 2022 and get signed up. In order to get coverage starting Jan. 1, 2022, you would need to be enrolled by Dec. 15, 2021.

Although Preferred Provider Organizations (PPOs) have been a popular group health benefit plan feature since their introduction in the 1980s, their shine is starting to fade.
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PPOs are supposed to be a great way to lower health care costs. Providers agree to a discounted rate in exchange for insurers steering members to their services. The problem is that retail prices charged by hospitals and physicians continue to rise steeply. 

Ned Schaut, President at Agency Leverage, and host of Benefits Influencer - a podcast highlighting thought leaders in the Employee Benefits industry – recently interviewed Allied National Executive Vice President Gary Ashley. 

The pandemic has had an enormous impact on every aspect of our lives, including the way employees view employee benefits. Employers are having to rethink what kind of perks, benefits and incentives will keep workers engaged and offer a competitive advantage in a post-pandemic world. 

Despite the numerous changes to the Affordable Care Act (ACA), applicable large employers (ALE) must still provide group health benefits to their employees. These benefits must meet at least the minimum standard as set by the federal government or the employer will be required to pay a penalty.