How Medical Debt Impacts Employee Well-being

Medical debt is a significant challenge for many workers in the United States. With rising healthcare costs and inadequate financial protections, a considerable percentage of employees struggle to pay their medical bills. The repercussions of this issue extend beyond individual financial distress, affecting workplace productivity as well. Fortunately, employers are uniquely positioned to support their employees’ financial well-being and alleviate medical debt.

The Burden of Medical Debt

Medical debt imposes a significant burden on numerous Americans, causing significant financial strain. A substantial portion, approximately 37% of U.S. employees, find themselves grappling with this type of debt, while about 32% struggle to meet their medical bill payments. Moreover, the escalating costs of healthcare have led to a surge in medical bills being sent to collections. Even with health insurance coverage, individuals still confront mounting debts due to high deductibles, out-of-network charges, and expenses surpassing out-of-pocket maximums. Consequently, medical emergencies, chronic illnesses, or extended hospital stays can spark a financial crisis for a considerable number of employees.

Why Are Workers Struggling With Medical Debt?

For most Americans with outstanding medical debt, the debt arises from a single illness or medical procedure rather than recurring care. Rising healthcare costs are a primary reason for the current prevalence of medical debt. Research from the Kaiser Family Foundation indicates that average deductibles have more than doubled in the last decade. Furthermore, as of 2020, over half of U.S. workers were enrolled in high-deductible health plans, a significant increase from 35% in 2015. Simultaneously, health premiums continue to rise for many Americans.

Inflation and the escalating cost of living further strain workers’ financial reserves. Less than half of Americans possess enough savings to cover an unexpected $1,000 expense, leaving many individuals vulnerable to medical debt. While many employees have employer-sponsored health insurance, these plans do not always provide adequate financial protections. In some cases, those with employer-sponsored health plans are considered underinsured, leaving them susceptible to substantial medical bills. Underinsured employees are less likely to seek timely medical care, leading to costlier treatments down the line, ultimately increasing employers’ healthcare expenses.

Medical Debt’s Impact on Employees

Rising healthcare costs prompt many insured workers to postpone necessary care to avoid medical debt. One-third of employees skip preventive checkups, follow-up care, and scheduled procedures. Consequently, workers’ physical and mental health suffer, resulting in increased emergency room visits and higher healthcare costs for employers and employees.

Moreover, medical debt has adverse effects on employees’ performance. Financial stress stemming from medical debt can lead to distractions at work, depression, or anxiety. Employees burdened with medical debt often allocate funds intended for essentials like food, housing, and education towards their debt repayment. Financially stressed workers typically exhibit reduced productivity, struggle to complete daily tasks and experience strained relationships with their colleagues. These declines in productivity can prove costly for employers.

Strategies for Employers to Address and Mitigate Medical Debt for Employees

Employers have a unique opportunity to address and mitigate medical debt among their employees. Employers can proactively support their workforce by implementing strategies such as promoting healthcare consumer education, helping manage healthcare costs, and tailoring benefits. These efforts not only alleviate the burden of medical debt but also enhance productivity, job satisfaction, and employee retention. For comprehensive healthcare resources and guidance, employers can reach out to their Account Manager or contact us here.

IRS Announces Updated HSA and HDHP Limits for 2024

On May 16, 2023, the Internal Revenue Service (IRS) released its annual procedure outlining the adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPS). Revenue Procedure 2023-23 introduces significant changes that will take effect on January 1, 2024, influencing healthcare expenses and benefits.

Maximum HSA Contributions Limit

The maximum HSA contribution limit will rise in 2024 to $4,150 for individuals with self-only HDHP coverage, compared to the current limit of $3,850. For those with family coverage under an HDHP, the maximum HSA contribution will increase to $8,300, up from $7,750. This adjustment allows individuals and families to allocate more funds into their HSAs, enabling them to better manage and cover their healthcare expenses.

Minimum Deductible Amount for HDHPs

In 2024, the minimum deductible amount for HDHPs will undergo adjustments, with an increase from $1,500 to $1,600 for individuals and from $3,000 to $3,200 for families. This change emphasizes the high-deductible nature of HDHPs, requiring individuals to meet these thresholds before their insurance company covers any claim.

Maximum Out-of-Pocket Expense Limit for HDHPS

Alongside the minimum deductible, the maximum out-of-pocket expense limit for HDHPs will also increase. For self-only HDHP coverage, the maximum amount that individuals are required to pay out-of-pocket will increase from $7,500 to $8,050, while for the family coverage, it will rise from $15,000 to $16,100. Once the total out-of-pocket expenses reach this limit, the insurance plan typically covers 100% of the remaining eligible medical costs for the rest of the year, effectively serving as a cap on the financial responsibility individuals or families may incur for healthcare services under their HDHP.

HSA Contribution Limits for Individuals Age 55+

There will be no changes to the HSA catch-up limit rules for individuals aged 55 and above. The annual catch-up contribution remains at $1,000, allowing individuals closer to retirement the ability to save additional funds in their HSAs. This provision provides them with the opportunity to bolster their savings and better prepare for healthcare expenses during their later years.

EBHRA Inflation Adjustments

Revenue Procedure 2023-23 also addresses excepted benefit health reimbursement arrangements (EBHRAs) by setting the maximum amount at $2,100 in 2024, an increase from $1,950. The adjustment allows participating employers to provide their employees with a higher level of reimbursement for eligible healthcare expenses.

Contribution & Out-of-Pocket Limits for HSAs and HDHPs
20242023Change
HSA Contribution Limit
(Employer + Employee)
Self-Only: $4,150
Family: $8,300
Self-Only: $3,850
Family: $7,750
Self-Only: +$300
Family: +$550
HSA Catch-Up Contributions
(Age 55+)
$1,000$1,000No Change
HDHP Minimum DeductiblesSelf-Only: $1,600
Family: $3,200
Self-Only: $1,500
Family: $3,000
Self-Only: +$100
Family: +$200
HDHP Maximum Out-of-Pocket Amounts
(Deductibles, Co-payments and other amounts, but not Premiums)
Self-Only: $8,050
Family: $16,100
Self-Only: $7,500
Family: $15,000
Self-Only: +$550
Family: +$1,100

Recommended Actions for Employers

Please contact your Pierce Group Benefits Account Manager for additional information about how this may affect your 2023 – 2024 HDHP/HSA offerings.

Inflation Reduction Act Passed, Signaling Changes to the Healthcare Industry

On August 12, 2022, the U.S. House of Representatives passed the Inflation Reduction Act (IRA). Following the passage, President Biden is expected to officially sign the IRA into law on Tuesday, August 16, 2022. The IRA was narrowly passed along partisan lines under “reconciliation” rules, which enabled the bill to be passed by an evenly divided Senate, with Vice President Harris casting the deciding vote. While the new law will have significant impacts on corporate taxation and climate change, it also contains several provisions impacting group health plans that are of importance.

ACA Subsidies

The IRA puts in place a three-year extension of the expanded Affordable Care Act (ACA) subsidies that were originally enacted as part of the American Rescue Plan Act of 2021 (ARPA). ARPA subsidies give help to nearly 90 percent of those who signed up for health coverage on the health insurance marketplaces during the 2022 open enrollment period, assisting individuals who make as much as $52,000 and families with an income of up to $106,000. Those subsidies were set to expire at the end of 2022 without the passage of an extension, and policymakers had been concerned about skyrocketing premiums for those reliant on the subsidy in 2023. More than 10 million Americans were projected to lose part or all of their premium tax credits, resulting in a potential loss coverage for 3 million insureds.

While the passage of this extension does not directly impact employer-provided group health insurance, it will certainly have indirect impacts. Under the shared responsibility provisions of the Affordable Care Act (ACA), applicable large employers (ALEs—those with at least 50 full-time or full-time-equivalent employees in the prior calendar year) must either offer minimum essential coverage that is “affordable” and that provides “minimum value” to their full-time employees (and their dependents), or potentially make an employer shared responsibility payment to the IRS. The employer shared responsibility provisions are sometimes referred to as “the employer mandate” or “the pay or play provisions.” Although it should be mentioned that the three affordability safe harbors used by employers are unaffected directly. Therefore, penalties are still based on the employee’s self-only cost to elect coverage on the employers least expensive plan and are not based on the family premium cost.

Whether an employer will owe a penalty to the IRS depends in part on whether at least one full-time employee receives a subsidy for purchasing coverage on a health insurance exchange. The expansion of the subsidies under ARPA made it more likely that employees would qualify for a subsidy. Now is a good time for employers to ensure that their coverage for 2023 provides minimum value and is considered affordable. There is more information regarding those determinations on the IRS website, and your AssuredPartners employee benefits consultant can also help you with making that determination. The affordability threshold for 2022 is 9.61% of household income, but in 2023, that percentage will decrease to 9.12%.

Medicare Drug Prices

The IRA will also have a significant impact on retiree drug spending, for the first time allow the government to negotiate prices on select Medicare medications. It will also cap seniors’ out-of-pocket spending on drugs at $2,000 a year and penalize drug makers that increase prices for Medicare Part B and D drugs by more than the inflation rate. Additionally, the IRA will cap the cost for insulin at $35 per month for Medicare enrollees starting in 2023.

Under the legislation that established the Part D drug program in 2003, the government was prohibited from negotiating directly with pharmaceutical manufacturers. Individual insurance companies participating in Part D can negotiate, but they have not had the bargaining power of the federal government. Allowing the government to negotiate directly is expected to save about $100 billion through 2031, according to Congressional Budget Office estimates.

There is no provision in the IRA that requires drug manufacturers to give the same prices to the private insurance market that it negotiates with the federal government. Democrats in Congress had attempted to include such a provision, but were unable to do so, since that provision failed to have a direct impact on federal spending and taxation, and therefore could not be included in a “reconciliation” bill. Without such a provision, it remains to be seen whether the federal government’s new bargaining power will decrease costs across the prescription drug market or if it will result in cost-shifting to employer-provided health plans.

This blog post was originally posted by AssuredPartners and written by Amy Donovan, Esq. Pierce Group Benefits is a part of the AssuredPartners family of companies.

ACA Affordability Rates Announced for 2023

With the issuance of Rev. Proc. 2022-34, the IRS announced the 2023 indexing adjustment percentage for determining affordability of employer-sponsored health coverage under the Affordable Care Act (ACA). The percentage is adjusted annually for inflation and will be set at 9.12% for plan years beginning with January 1, 2023. This represents a substantial decrease from 2022’s 9.61%, which may in turn cause many employers to have to reduce their employee contributions to accommodate the adjusted 2023 percentage.

Under the ACA’s provisions for plan years beginning January 1, 2023 and subsequent to that date, employer-sponsored minimum essential coverage will only be considered affordable if an employee’s required contribution for the lowest-cost, self-only coverage option does not exceed 9.12% of the employee’s household income for the tax year. Neglecting to offer affordable, minimum value coverage to full-time employees could result in penalties under §4980H(a) or (b) of the employer shared responsibility rules, commonly referred to as the “sledgehammer” and “tack hammer” penalties, respectively.

As expounded upon in IRS Notice 2015-87, employers may measure affordability of their coverage using three different safe harbor tactics (Form W-2 wages, the employee’s rate of pay, or the federal poverty line (FPL)). The affordability test applies to annual premiums for self-only coverage. If an employer offers multiple health plans, the affordability test is applicable to the lowest-cost option satisfying the requirement for minimum value. In situations where an employer offers distinct regional coverage options for employees in different states, the affordability analysis would be based on the lowest-cost option open to those specific employees. The affordability percentage is indexed in the same manner as the household income percentage.

As noted above, the adjusted percentage is applied on a plan year (not calendar year) basis, so non-calendar year plans with plan years prior to January 1, 2023 will continue to use the 9.61% standard until their new plan year begins.

This blog post was originally posted by AssuredPartners and written by Nathanael M. Alexander, Esq. Pierce Group Benefits is a part of the AssuredPartners family of companies.

Out-of-Pocket Maximums Announced for 2023

The Department of Health and Human Services (HHS) recently announced the proposed 2023 Benefit Parameters, outlining the maximum out-of-pocket (OOP) limits applicable to non-grandfathered plans for plan years beginning in 2023. Each year, these OOP maximums are adjusted for inflation. However, HHS has now promised to release the updated amounts “…by January of the year preceding the applicable benefit year…

Under the Affordable Care Act (ACA), non-grandfathered health plans are required to comply with an overall annual limit on out-of-pocket expenses for essential health benefits, regardless of whether the plan is self-funded or fully insured. The current limits applicable to 2022 plan years is $8,700 for self-only coverage and $17,400 for family coverage. The 2023 limits will be raised to $9,100 for self-only coverage and $18,200 for family coverage, respectively.

Here’s a summary of the amounts for traditional plans for the 2022 / 2023 plan years for reference:

 Traditional Plans HDHP/HSA Plans 
SingleFamilySingleFamily
2023$9,100$18,200$7,500$15,000
2022$8,700$17,400$7,050$14,100

High-deductible health plans (HDHPs) with Health Savings Accounts (HSAs) feature different limits than traditional plans, including OOP maxes, along with deductible and contribution limits. The 2023 HDHP/HSA limits have yet to be released by the IRS for 2023. Historically these are released in May and will be communicated when available.

Although, it should be noted in the interim that if your plans offer both traditional and HDHP/HSA plans (that are not grandfathered), your plans are subject to both sets of requirements and you must ensure compliance with the lowest applicable out-of-pocket maximum. Plus, the ACA requires that a per person (individualized/embedded) out-of-pocket maximum doesn’t exceed the ACA limit, even if you are in the larger (family) tier. This assists single family members in accessing benefits sooner without having to hit the full amount for the family tier.

This blog post was originally posted by AssuredPartners and written by Nathanael M. Alexander, Esq. Pierce Group Benefits is a part of the AssuredPartners family of companies.

Edited on May 31, 2022 to include released 2023 HDHP/HSA limits.

IRS Announces HSA and HDHP Limits for 2023

Each year around this time the IRS announces the inflation-adjusted limits for Health Savings Accounts (HSAs) and High Deductible Health Plans (HDHPs), as they are required to do so annually prior to June 1st. On April 29, 2022, the IRS released Revenue Procedure 2022-24.

Rev. Proc. 2022-24 addresses the following:

  • The maximum HSA contribution limit;
  • The minimum deductible amount for HDHPs; and
  • The maximum out-of-pocket expense limit for HDHPs.

The categorical limits noted above will of course differ depending on whether an individual has self-only or family coverage under an HDHP. The adjusted limits will go into effect as of January 1, 2023. Plan years beginning before that date use the 2022 HSA limits. Individuals are eligible to make contributions toward an HSA if they are enrolled in a qualifying HDHP and do not have other, disqualifying, first-dollar coverage (E.g., generally, please see IRS Publication 969).

For 2023, eligible individuals with self-only HDHP coverage may contribute up to $3,850 to their HSAs over the course of the year. This is an increase from 2022’s $3,650 maximum contribution amount. Those with family coverage under an HDHP will be permitted to contribute up to $7,750 to their HSAs in 2022, an increase from 2022’s $7,300 maximum contribution limit.

For 2023, the minimum deductible amount for HDHPs will increase to$1,500 for individual coverage and $3,000 for family coverage. Although, the HDHP maximum amount for annual out-of-pocket expenses (the amount that an individual is required to pay) will rise to $7,500 for self-only coverage and to $15,000 for family coverage, up from $7,050 and $14,100 from 2022, respectively.

There is no change to the age 55+ HSA catch-up limit rules for 2023. That value remains at $1,000 per year and will continue to allow individuals age 55 or older to put away an additional “catch-up” contribution up to that amount annually.

Contribution & Out-of-Pocket Limits for HSAs and HDHPs
20232022Change
HSA Contribution Limit
(Employer + Employee)
Self-Only: $3,850
Family: $7,750
Self-Only: $3,650
Family: $7,300
Self-Only: +$200
Family: +$450
HSA Catch-Up Contributions
(Age 55+)
$1,000$1,000No Change
HDHP Minimum DeductiblesSelf-Only: $1,500
Family: $3,000
Self-Only: $1,400
Family: $2,800
Self-Only: +$100
Family: +$200
HDHP Maximum Out-of-Pocket Amounts
(Deductibles, Co-payments and other amounts, but not Premiums)
Self-Only: $7,500
Family: $15,000
Self-Only: $7,050
Family: $14,100
Self-Only: +$450
Family: +$900

Related Resources

This blog post was originally posted by AssuredPartners and written by Nathanael M. Alexander, Esq. Pierce Group Benefits is a part of the AssuredPartners family of companies.