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Costs For New Enrollees In ACA Plans Higher Than For Long-Term Enrollees

Author: Venus Dean-Bullinger    Posted: August 22, 2016

I recently read an article in the SHRM newsletter that discussed the Blue Cross and Blue Shield Association revealing that consumers who were “newly insured under the Affordable Care Act were sicker, used more medical care and had higher medical costs than those who already had coverage.”  We all had assumed that those who had not been sold individual plans due to “Pre-existing Conditions” would be high utilizers of their new plans.  Why, because they had already been diagnosed with chronic illnesses like: diabetes, depression, high blood pressure, asthma and heart disease that had gone untreated.  On average, the medical cost for those that purchased plans through one of the ACA exchanges were 22% higher than enrollees on an employer offered group plan in 2015.  Reports are also showing that medical spending was about $100 higher for an individual consumer versus a group consumer.  The individual groups were also found to visit the emergency room more than the employer group.


Looking at these statistics, we can assume that once the new enrollees receive treatment and become healthier, that the cost of coverage and treatment will drop.  Unfortunately knowing how our health care trajectory has looked the last decade….maybe we shouldn’t assume anything.


I believe that everyone can understand why the cost for all plans are on the rise.  We have more sick enrollees utilizing new benefits.  Due to the fact that so many are new to the system, they don’t quite understand how best to utilize these new plans (and it can be confusing for all of us).  This is where the education that Rapport Benefits offers to both our individual and group clients helps everyone save money.  From using an Urgent Care rather than an Emergency Room, or making sure that your doctor, or practitioner prescribes generic rather than a name brand drug.  These are some small things that can make a big difference in driving utilization and cost.


Let’s all try to make a few simple changes that might create some big changes in the future.

Oh, and feel free to reach out to one of us here at Rapport with any questions or concerns that you may have.

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