2011 Health Care Trend Survey

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1 Consulting Health & Benefits 2011 Health Care Trend Survey Summer

2

3 2011 Health Care Trend Survey Summer Contents Overview Health Care Trend Rates Trend Rate History About This Survey Report Companies Providing Trend Data

4 Overview Aon Hewitt annually provides health care trend data based on information provided by leading health care vendors. The summer 2011 survey results are reported in this document. This survey will next be updated in the winter of We hope this information will assist you as you evaluate health insurance premium renewals and develop self-funded health plan claim projections. In almost all cases, forecasted increases based on vendor-provided data are lower than forecasted increases reported in our Summer 2010 survey. Trends for major categories are generally lower by 0.5% to 1.5%. We are likewise observing a reduction in trend based on other reported sources. For example, the 12 month moving average of the S&P Healthcare Economic Commercial Index a leading measure of national medical trends for commercial plans developed jointly by Aon Hewitt and Milliman declined by more than 1.5% from July of 2010 through May of Key factors contributing to this reduction in trend include lower increases in utilization, reduced capital spending due to the slow economy, and mitigation of prescription drug trend as generic forms of many blockbuster drugs become available. While trends are declining they are still well above general inflation and this is expected to continue due to increasing patient demand for services, an aging population, increasing medical technology costs, unhealthy lifestyle choices, and cost shifting from social insurance programs such as Medicaid and Medicare to commercial plans. 4 Aon Hewitt

5 Health Care Trend Rates We collected data from over 60 leading medical, dental, pharmacy, and vision vendors related to their forecasted health care trend rates for the 12-month rating periods beginning between July and December Below is a summary of average trend based on this data. Plan Type Rates With Rx Without Rx HMO 9.8% 10.1% POS 10.0% 10.3% Medical Actives & Retirees <65 PPO 9.9% 10.0% Indemnity 10.1% 10.5% CDH 9.7% 9.8% Medical Retirees Age 65+ Medicare Supplement Medicare Advantage 6.5% 6.4% 6.1% 6.0% DHMO 4.0% Dental PPO 5.4% Indemnity 6.0% Pharmacy General 6.9% Specialty 14.5% Vision 3.6% 2011 Health Care Trend Survey Summer 5

6 2011 Trend Forcast Some observations about our summer 2011 trend forecast: n Medical trend rates are lower than rates from our summer 2010 survey by roughly 0.5% to 1.5% for most plan types. n Insurance company forecasts for consumer driven health (CDH) plan trend rates decreased by 1.3% from 11.0% in our summer 2010 survey to 9.7% in the current survey. This is a larger decrease than HMOs, POS plans, and PPOs. n Overall, trend rates for CDH plans, HMOs, PPOs, and POS plans are similar. CDH studies by some of these same insurance companies indicate that CDH trends for best practice CDH plans are considerably lower than HMOs, POS plans, and PPOs. The figures in this survey may be conservative due to (1) the number of members in CDH plans is still relatively small and (2) CDH results vary considerably from employer to employer depending on plan design, CDH enrollment, and degree of consumerism education. n The medical trend rates for retirees age 65 and older show similar declines relative to the summer 2010 survey. For Medicare Advantage plans, we would expect a higher degree of variability in trends than for other design types due to changes in government funding. n The general pharmacy trend rate is down about 1.5% from our summer 2010 survey and about 2.5% from our spring 2009 survey. Overall, the general pharmacy trend has declined in each survey over the past 7 years. n While general pharmacy trends are declining, trends for specialty pharmacy continue to increase. Specialty pharmacy trends are 0.5% higher than amounts in the summer 2010 survey. Note: Specialty pharmacy includes biotechnology agents designed for complex and chronic conditions. n Dental trend rates are down slightly from our summer 2010 figures. n The vision trend rate is up slightly from our summer 2010 survey. 6 Aon Hewitt

7 Trend Rate History The following table and corresponding charts summarize our most recent summer 2011 survey and our past eight spring or summer trend surveys: Plan Type Summer 2010 Summer 2011 HMO 16.4% 14.1% 13.2% 12.2% 10.9% 10.6% 10.4% 10.5% 9.8% Medical Actives & Retirees <65 (with Rx) POS 16.1% 14.1% 13.0% 11.9% 10.8% 10.5% 10.4% 10.6% 10.0% PPO 15.7% 14.2% 13.0% 12.4% 11.2% 10.7% 10.7% 10.7% 9.9% Indemnity 17.2% 15.3% 14.6% 14.4% 12.7% 12.4% 11.9% 12.4% 10.1% CDH N/A 14.1% 12.7% 12.5% 10.7% 10.5% 10.5% 11.0% 9.7% HMO 14.7% 13.4% 12.9% 12.0% 11.0% 10.8% 10.5% 10.8% 10.1% Medical Actives & Retirees <65 (without Rx) POS 14.5% 13.5% 12.7% 11.8% 10.9% 10.5% 10.5% 10.9% 10.3% PPO 14.4% 13.5% 12.7% 12.3% 11.3% 10.9% 11.0% 10.9% 10.0% Indemnity 16.4% 14.7% 14.6% 14.4% 13.1% 12.6% 12.4% 12.8% 10.5% CDH N/A 13.3% 12.4% 12.3% 10.7% 10.3% 10.4% 11.1% 9.8% Medical Retirees Age 65+ (with Rx) Medical Retirees Age 65+ (without Rx) Medicare Supplement Medicare Advantage Medicare Supplement Medicare Advantage N/A N/A N/A 11.5% 11.2% 7.3% 6.6% 7.5% 6.5% N/A N/A N/A 10.2% 9.2% 7.7% 7.3% 6.7% 6.1% N/A N/A N/A 9.9% 9.0% 7.3% 6.6% 7.8% 6.4% N/A N/A N/A 8.0% 8.0% 7.0% 7.0% 6.3% 6.0% DHMO 4.8% 5.0% 4.7% 4.8% 4.5% 4.2% 4.1% 4.2% 4.0% Dental PPO 7.6% 7.3% 7.1% 6.7% 6.1% 6.3% 5.9% 6.0% 5.4% Indemnity 7.6% 7.7% 7.6% 7.1% 7.0% 7.0% 6.5% 6.8% 6.0% Pharmacy General 17.7% 14.4% 13.1% 12.2% 9.5% 9.4% 9.3% 8.4% 6.9% Specialty N/A N/A N/A 17.0% 15.1% 12.4% 13.2% 14.0% 14.5% Vision 3.8% 3.9% 3.9% 3.6% 3.1% 3.1% 2.9% 2.9% 3.6% 2011 Health Care Trend Survey Summer 7

8 Medical Plans with Rx Medical Plans without Rx Dental Plans 8 Aon Hewitt

9 Prescription Programs Medicare Supp & Medicare Advantage Post-65 Plans 2011 Health Care Trend Survey Summer 9

10 About This Survey Report The trend rates shown on the previous pages represent national averages and are the predicted increase in claims cost. Trend increases for a specific company may vary significantly from these trend rates due to regional cost variations, company plan design, company demographics, and other factors. In addition, insured rate increases may be higher or lower than these trend rates based on an insurance company s profitability, the plan s claims loss ratio, the plan design, insured demographics, and other factors. It is important to note that these trend rates might not be appropriate for other purposes. Consultants should consider their specific client circumstances in selecting the appropriate trend rate. For example, standards such as ASC and Actuarial Standard of Practice No. 5 and No. 6 might dictate the use of alternative trend rate assumptions. These trend rates include the following components: Price Inflation. Price inflation is the average increase in the cost of goods and services of health care providers for medical, prescription drug, dental, and vision. Fixed Dollar Leveraging. Fixed dollar leveraging is the cost added to a health plan due to the subtraction of unchanging deductibles, copays, or out-of-pocket maximums from a trended claim amount. For example, suppose a claim of $500 increases by 10% in the next year to $550. If the deductible is $200, the insurance cost increases by 17% from $300 to $350. The fixed dollar leveraging is the difference between the 17% and the 10%. Utilization. This is the increase in the number of medical procedures performed in response to an aging population, new medical techniques, and more aggressive treatments of conditions. Technological Advances. This is the change in cost due to new procedures replacing old procedures. Examples of technological advances include organ transplants, artificial organs, Diffusion Tensor Magnetic Resonance Imaging, therapeutic cloning and Positron-Emission Tomography (PET) scans. Cost Shifting. This is an individual provider s shifting of costs from fixed or discount payers to reasonable and customary payers such as insurance companies or self-funded employers. Discount payers include Medicare, Medicaid, and managed care plans. 10 Aon Hewitt

11 Companies Providing Trend Data The following companies contributed to the Aon Hewitt Summer 2011 Health Care Trend Survey: Plan Type Company Medical Aetna BCBS (28 plans) CIGNA Coventry Health Partners Humana UnitedHealthcare (UHC) Medicare/Post-65 Retiree Medical Aetna BCBS (25 plans) Coventry Health Partners Humana Dental Aetna BCBS (24 plans) CIGNA Dominion Health Partners Humana United Concordia UnitedHealthcare (UHC) Pharmacy Aetna BCBS (26 plans) Caremark Prescription Services CIGNA Coventry Express Scripts Health Partners Humana Medco Health Solutions UnitedHealthcare (UHC) WalMart Vision Aetna BCBS (12 plans) CIGNA Davis Vision Humana UnitedHealthcare (UHC) WalMart 2011 Health Care Trend Survey Summer 11

12 About Aon Hewitt Aon Hewitt is the global leader in human resource consulting and outsourcing solutions. The company partners with organizations to solve their most complex benefits, talen and related financial challenges, and improve business performance. Aon Hewitt designs, implements, communicates and administers a wide range of human capital, retirement, investment management, health care, compensation and talent management strategies. With more than 29,000 professionals in 90 countries, Aon Hewitt makes the world a better place to work for clients and their employees. For more information, please visit wwww.aonhewitt.com. Copyright Aon 2011

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