Group to Individual Trend - How Health Plans Can Optimize Retention

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1 Get Smart. Get Covered. Get Going. Group to Individual Trend - How Health Plans Can Optimize Retention Wellthie s Retail Ready White Paper Series What is the group to individual trend? Small group employers those currently defined as having less than 50 employees are dropping group health coverage due to rising health insurance premiums and growing administrative burden. Following the passage of the Affordable Care Act (ACA), the availability of subsidies on the individual marketplace has encouraged small group employers to transition employees from employer-sponsored group coverage to the individual marketplace as a cost-savings measure. Historically, employers have borne the majority of the cost of an employee s health insurance. Prior to the passage of the ACA, the cost of individual insurance was prohibitive, and there were no government subsidies available for consumers purchasing insurance on the individual market. MARKET FUTURES Only 22.5% of employers with 50 or fewer employees said they definitely will still be offering health benefits in 5 years. i Due to the rising cost of health insurance, employers are looking for ways to save. The establishment of government subsidies after the ACA increased the accessibility of health insurance by making it more affordable, allowing nearly 17 million individuals and families to gain coverage. ii As a result, employers today have a choice: to offer affordable coverage sponsored by the firm or to encourage employees to buy individual policies instead, and avail of individual tax credits. SMALL GROUP MARKET More than 1.9 million small businesses with 5 to 49 employees employing 34 million people in the US comprise the primary target market for small group health insurance. If we expand the definition of the small group market to include businesses with 50 to 99 employees, the total market size increases to 2.1 million firms. iii The robustness of the individual market, both in plan options and costs, has created an incentive for employers to capture savings by shifting both the cost and administrative burden of health coverage out 1

2 of their hands. For small group businesses, letting employees buy their own insurance can make the most financial sense. Since subsidies for lower income employees can be as generous as the amount employers were contributing towards benefits employers are incented to exit group plans. The Evidence The group to individual trend has become a significant concern for health plans across the country, as it has led to a significant loss of membership, and as a result, decreased profits. The evidence is staggering: health plans across the United States are experiencing a decline in their small group lines of business. As an example, one large Blue Cross Blue Shield plan lost 100,000 small group members in 2014, representing 30% of their total small group membership. In total, Blue Cross Blue Shield plans have lost 1 million members in 2014 for this trend. iv The challenge for health plans is determining how to translate these membership losses into a corresponding gain in their individual or other product lines. Much of the evidence lies in the premium increases small firms have seen in the last decade. Since 2004, premiums for small firms those with employees, have increased on average by 63% over 10 years from $9,737 in 2004 to $15,849 in v As these costs increase, small groups will continue to face the cost pressure that drives them to look for alternatives. Figure 1: Average Annual Premiums for Covered Workers with Family Coverage by Firm Size,

3 What are the legislative catalysts of the trend? Individual Mandate A core provision of the Affordable Care Act is that it requires all individuals to have health insurance, or else pay a tax penalty. To ensure that Americans who are purchasing insurance as a result of the individual mandate can do so affordably, the ACA provides Advanced Premium Tax Credits (APTCs) to individuals whose household incomes are 400% below the federal poverty line (FPL). The continued availability of financial assistance after King v. Burwell, in addition to guaranteed access to individual insurance, minimizes the friction of moving to individual coverage. Employer Mandate Does Not Apply to Smaller Firms Certain employers with more than 50 employees who don t provide affordable coverage to employees may be subject to a financial penalty. However, employers with less than 50 employees (considered small group employers) are not subject to the employer mandate. The lack of employer penalties on the smaller end provides the freedom for employers to choose what is best for their business. Expansion of the Definition of Small Group Business Currently all states define their small group insurance markets as those in which firms have up to 50 employees. Beginning in 2016, however, the definition of the small group market will be expanded to include employers with up to 99 employees, representing an additional 159,000 private-sector firms that offer fully insured coverage in vi Since health plans underwrite small group plans differently, premiums will likely increase for many of the companies with employees, driving more employees to the individual market. Considerations for the Employee Tax preferences differ between individual and group coverage; group coverage is still considered a tax deduction, and there are no tax preferences in the individual market. Anyone enrolled or eligible to enroll in an employer-sponsored plan that meets minimum value coverage is ineligible to receive tax credits in the individual marketplace. Plan designs and networks may differ between group and individual coverage, with individual plan provider networks typically being narrower than group plan networks. Considerations for the Employer An employer cannot use pre- or post-tax dollars to directly subsidize an employee s purchase of individual health insurance. However, an employer may increase an employee s compensation (subject to income taxes) so employees can purchase health insurance of their own accord. Employers can offer a sub-set of employees the option to enroll in a group health plan and others a compensation increase, so long as the employer does not discriminate on employee health status or consider the employee s eligibility for Medicare or Medicaid. vii 3

4 What are the implications of this trend? For Health Plans The goal for health plans is to retain small group membership and capture the maximum number of employees transitioning to the individual market. This means it is equally important for health plans to emphasize the value of their coverage options with brokers and employers. Doing so enables the health plan to most effectively impact the employer and employee s decision-making process. For Employers Employers are looking for ways to navigate the complex decision-making process required as part of the group-to-individual transition. Small group employers, in particular, seek to understand the impact of their coverage decision on their total business costs and separately understand the impact of their coverage decision on each employee. For many small businesses, employees are family members or close friends. Despite the cost constraints of keeping employees on a group plan, small business are uncomfortable with sending employees to buy individual coverage without the right decision-support and communication tools in place to feel confident about their coverage decision. How can health plans maximize retention? The question for health plans is how to maximize membership and margins despite the burgeoning group to individual trend. Most importantly, health plans must prevent transitioning employees opting into the individual marketplace from switching carriers or from forgoing health insurance altogether. Health plans can also acquire new members from other carriers or sell to individual insurance to businesses not offering small group coverage today. Target Employer Segments Specifically, health plans should target a few subsets of the small group market: Renewing small groups; particularly, cost-sensitive micro small groups with 10 or less employees Small groups in industries where incomes are on average less than $47,000 thus employees are more likely to be eligible for tax credits and with a significant proportion of part-time workers Small groups with employees who will face the large rate increases and in industries where employees salaries are on average less than $47,000 Small groups not currently offering group coverage today Engage Across Stakeholders To be most effective, health plans should engage a variety of stakeholders, including general agents, brokers, internal sales / retention teams, and small group business owners. By strengthening the relationship with brokers who often serve as the primary distribution channel for a plan s product offerings health plans can convert and acquire the greatest number of members. 4

5 What can Wellthie do for you? Our goal at Wellthie is to ensure that health plans can retain small group membership and capture groups transitioning to the individual market in one seamless, simple user experience. Wellthie s solution The Affordable Care Advisor for Business prevents membership losses by maximizing the number of consumers enrolled in either the health plan s group or individual product line. The platform offers the opportunity for Small Groups to understand their estimated costs, learn whether they are eligible for tax credits, and compare group and individual plan options, leading to increased enrollment by bringing employers to your health plan s website. By optimizing the employer s benefits plan and identifying small group members eligible for individual tax credits or other government programs, the Wellthie platform drives growth across all of a health plan s offerings including Individual, Group, Medicare, and Medicaid. It helps the health plan retain current members by giving general agents, brokers, and employers an innovative decision support, scenario planning, shopping, and communication tools in one integrated platform. About Wellthie Wellthie offers the only software platform that helps people understand their health insurance options, confidently choose the right plan from their insurer, and make the most of their benefits. Installed on an insurer s site and matched to their brand, Wellthie s easy-to-use software offers a welcoming front door that s designed to educate, enroll, and retain customers looking for health insurance. For more information, visit i Wall Street Journal, Small Firms Start to Drop Health Plans. firms- drop- health- plans (October 29, 2014). ii Bloomberg Business, Under Obamacare, 17 Million People Have Gained Health Insurance, RAND Finds. 06/health- how- 17- million- people- got- insurance- under- obamacare (May 6, 2015). iii Mark Farrah Associates, The Small Group Insurance Market. business- strategy/the- Small- Group- Health- Insurance- Market.aspx (July 30, 2014). iv Atlantic Information Services, Inc (AIS), The AIS Report on Blue Cross and Blue Shield Plans. (April 2015). v Kaiser Family Foundation, 2014 Employer Health Benefits Survey. costs/report/2014- employer- health- benefits- survey/ (September 10, 2014). vi American Academy of Actuaries, Potential Implications of the Small Group Definition Expanding to Employers with Employees. (March 2015). vii This is a nuanced policy that varies based on the particular employer group. 5

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