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Smart Benefits: The Latest Healthcare Reform Cost

Thursday, December 20, 2012


Insurers of fully insured plans and sponsors of self-insured plans will have to pay new fees to cover research by the Patient-Centered Outcomes Research Institute starting in 2013, according to the final regulation recently released by the Department of Health and Human Services. This new fee will affect all the major insurance carriers plus administrators of health reimbursement arrangements (HRAs).

What are the fees for?

As part of healthcare reform, the federal government created a non-profit to research comparative treatments for certain diseases to determine best outcomes for patient care and reduce unnecessary spending. The fees support this research.

What will it cost?

Insurers and plan sponsors will pay one dollar per covered employee on the plan if they are required to pay in 2013. The fee doubles to $2 for groups renewing and paying in 2014.

When are the fees payable?

Groups that renew medical coverage in October, November or December of 2012 and calendar year plans will need to pay the fees by July 31, 2013. Groups renewing in February through September 2013 will need to pay by July 31, 2014.

Who really pays?

While these fees are assessed to and paid for by the insurers, they will likely be passed on through the insurance premiums - costs shared by employer and employees.

The patient-centered medical outcomes fee is just one of a few that will kick in in 2013. Others include the Medicare tax increase for high income earners and the much talked about exchange fees, which are likely to be surcharges and usage fees to keep the exchanges operational.

Consumers need to pay attention to these fees and realize that, for every benefit, there is a potentially hidden cost – adding to the burden for the working consumer who will need to pay even more for coverage.

Amy Gallagher has over 19 years of healthcare industry experience. As Vice President at Cornerstone Group, she advises large employers on long-term cost-containment strategies, consumer-driven solutions and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, is a member of local organizations like the Rhode Island Business Group on Health, HRM-RI, SHRM, WELCOA, and the Rhode Island Business Healthcare Advisory Council, and participates in the Lieutenant Governor’s Health Benefits Exchange work group of the Health Care Reform Commission.


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