Hot Topic: Pricing Transparency in Healthcare

Issues of healthcare costs and affordability are a major concern for both employers and their employees. Health spending in the United States is projected to grow by 5% in 2024, to a total of $4.9 trillion. Because of new Federal price transparency requirements, both employers and employees will start to have more control over their costs.

These requirements, including the recently introduced House Bill H.R. 5378, the Lower Costs, More Transparency Act, and Senate Bill S. 3548, the Health Care PRICE Transparency Act 2.0, codify existing price transparency regulations and extend the requirements to diagnostic labs, imaging services, and surgical centers. Regulations like this will allow consumers to compare prices across hospitals and providers. Health plans and employers may also use some of the price transparency data to negotiate lower rates. There is continued bipartisan interest in price transparency, making this a hot topic to watch in the coming years.

Unfortunately, only a few consumers use price transparency tools to shop for care, and those who do try to price-shop may find that timely or convenient alternatives are not available. For price transparency to make a meaningful difference in costs for consumers, targeted approaches with a more limited set of services that consumers truly shop for may be most effective.

In the context of healthcare, the U.S. has already implemented federal price transparency rules that require public disclosure of all commercial payer-provided negotiated rates. These rules aim to improve price transparency and have led to progress in negotiated rates. The Centers for Medicare & Medicaid Services (CMS) has also imposed fines for noncompliance and shortened the time hospitals must respond to notices of noncompliance.

Moreover, the CMS has initiated the Health Plan Price Transparency rule, which helps consumers know the cost of a covered item or service before receiving care. As of July 1, 2022, most group health plans and issuers of group or individual health insurance are posting pricing information for covered items and services, but there is certainly more work to be done.

These transparency rules, along with advances in technology and analytics, could empower patients to shop for care more than ever, helping offset growth in healthcare costs. However, it’s important to note that the effectiveness of these measures can be influenced by various factors, including the complexity of insurance benefits designs and the extent to which patients share in the financial benefits when they make high-value, low-cost choices.

While pricing transparency regulations make their way through the legal process, Fedlogic can help employers reduce healthcare costs through unlimited, confidential, and free consultations with employees about their true healthcare options. Contact Kate Kellner, Director of Client Services, at [email protected] with questions about how FEDlogic can help with much more than Medicare.

Client Spotlight:

Hoffman Transportation

Hoffman Transportation is a logistics and transportation company known for its comprehensive freight services. Headquartered in Channahon, Illinois, Hoffman Transportation operates across the nation, specializing in delivering customized logistics solutions to meet the unique needs of its clients, ensuring efficient and reliable transportation of goods.

Recently, Hoffman Transportation was awarded its third Heil Trophy for safety in North America from the National Tank Truck Carriers Organization. This award is well deserved, in addition to the others they’ve received for their commitment to excellence in logistics, customer service, and safety within the industry. Hoffman Transportation attributes its success to its strong and dedicated employees, who exemplify its core values.

Congratulations, Hoffman Transportation, and thank you for placing your trust in FEDlogic.

Check out the FEDlogic LinkedIn page for this and all client features.

Frequently Asked Questions: Medicare

18.7% of the US population - approximately 65 million people- were enrolled in Medicare in 2022, according to the US Census Bureau. Despite this large enrolled population and many more soon-to-be eligible, Medicare is a benefit that is often misunderstood by the American public. FEDlogic has compiled a list of frequently asked questions below to help make Medicare a little bit easier to understand.

1. Am I Required to Take Medicare at 65?

Enrollment in Medicare Part A (Hospital Insurance) is automatic if you're receiving Social Security benefits at age 65. However, you can choose to delay Medicare Part B (Supplementary Medical Insurance) without penalty if you have other qualified coverage, most often an employer group health plan based on your current employment or that of your spouse. Medicare has eight Special Enrollment Periods (SEPs) with different requirements to avoid a penalty for late enrollment after age 65.

2. What Does Medicare Cover?

Medicare covers various services, including hospital stays, doctor visits, preventive care, and prescription drugs. It is divided into several parts:

A - Hospital Insurance
B - Supplementary Medical Insurance
C - Supplemental or Advantage Plans
D - Prescription Drug Coverage

“Original Medicare,” or Parts A and B, covers Medicare-approved costs for inpatient and outpatient care but does not include coverage for vision, dental, prescriptions, and some other medical costs. For these reasons, most people also elect a Supplemental policy and/or a Prescription Drug plan (Parts C and D).

3. Who Can Get Medicare?

Medicare is federal health insurance available to people who:

• are age 65 or older

• have received 24 months of Social Security Disability benefit payments

• have End-Stage Renal Disease (ESRD) and need regular courses of dialysis treatments

• have been exposed to certain environmental health hazards

• have Lou Gehrig’s Disease (ALS)

4. Can Medicare Cover My Spouse as a Dependent?

Medicare eligibility is based on individual factors only, which include having sufficient work history and meeting one of the criteria listed in Question 3. A spouse who doesn’t meet those individual eligibility factors can not receive coverage from Medicare as a dependent. However, if a spouse doesn’t have sufficient work history to be eligible for Medicare, they may qualify for Medicare based on the work history of their spouse, as long as they meet the other eligibility requirements.

5. Is There a Difference Between a Medicare Advantage Plan and a Medicare Replacement Plan?

A Medicare Advantage Plan, also known as Medicare Part C, is a type of health plan offered by a private insurance company that contracts with Medicare. These plans work with Part A, Part B, and usually, Part D. A Medicare Advantage Plan may offer some extra benefits that Original Medicare (Parts A & B) do not.

When you join a Medicare Advantage Plan, Medicare pays a fixed amount for your coverage each month to the company offering the Medicare Advantage Plan. You will likely be responsible for different out-of-pocket costs, and follow set rules for how you receive services, such as seeing “in-network” doctors or getting a formal referral before seeing a specialist.

Some companies use different terms when referring to a Medicare Part C plan. For example, you might hear a Medicare Advantage Plan referred to as a “replacement plan.” It is important to note that a Medicare Advantage Plan does NOT replace Original Medicare (Parts A & B), though that is a common misconception. You must be enrolled in Original Medicare and possess a Medicare Beneficiary ID Number (MBI) in order to enroll in a Medicare Advantage Plan.

6. What Is a Medigap Coverage?

A Medigap policy is health insurance sold by private companies to fill the “gaps” in Original Medicare Plan coverage. It can help pay some of the health care costs not covered by Original Medicare.

You must have Medicare Part A and B to enroll in a Medigap policy, and you will need to pay premiums for both. Insurance companies can only sell you a “standardized” Medigap policy, which must follow Federal and state laws. It's important to compare Medigap policies because costs can vary from company to company, even though the coverage is the same.

7. Will I Have My Choice of Doctors and Hospitals?

According to the CMS website, 98% of providers nationwide accept Medicare Parts A and B, or “Original Medicare.” When you begin looking at adding additional coverage through supplemental and prescription drug policies, those may have specific networks of providers they work with, much like Employer Group Plans do. Supplemental and prescription drug policies are offered by private insurance companies and must be approved by Medicare, but their coverages, provider networks, and premiums vary.

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_{DISCLAIMER: The information, education, and advice provided by FEDlogic, LLC (“FEDlogic”) shall be intended for educational purposes only. Each individual’s circumstances are inherently different from those of another, and therefore, the advice given to an individual may result in unintended consequences to another. The information provided by FEDlogic shall not constitute legal, financial, or accounting advice and further shall not be interpreted as advice from the Federal government. While FEDlogic makes every effort to ensure that the information provided by its consultants is up-to-date, useful, and accurate, FEDlogic makes no guarantees and may not be held liable nor responsible for any inaccuracy or detrimental consequence resulting from the information provided. Notwithstanding the foregoing, any errors or omissions discovered by FEDlogic, its agents, or its customers will be addressed and resolved as soon as possible.}