News Alerts

Who is Really Paying for Health Care: Four Myths

Is anyone really sure who is paying for healthcare? Who paid before the Affordable Care Act? Who is paying for it now? Let’s see if we can clarify this for everyone….

  • Premiums are fully paid though my paycheck for my employer sponsored plan.
    Unlikely. Probably not even close. Last year, the average cost of family coverage was $16,351, of which the average employee paid 29% through premiums. For individual only coverage, roughly 18%. It’s not only employees find that their health care costs have  increased dramatically; employers have seen a more than 70% increase over the last 10 years. All parties are paying more, and since employers bear a greater part of the burden their actual expenses are rising even more drastically than individual expenses.
  • Before the Affordable Care Act, the United States had an open market health care system.
    Not exactly. The government has assumed some of the cost of health care for some time. In addition to Medicare and Medicaid, federally financed research has been a mainstay of the drug industry and its consumers. States have also had a say in health care: health insurance is state regulated. Also, employers who file an income tax return are most often. entitled to tax deductions for private medical coverage costs.
  • Insurance companies don’t reimburse many procedures and costs.
    Again, that depends on the plan design. Many employer plans (more than 500 employees) are self insured which means that it is the employer who decides what is covered. An employer will also decide on networks and deductibles. Insurance companies in self insured plans are plan administrators.
  • Employees pay fully for Medicare through Medicare payroll taxes.
    Medicare, like social security, is a deduction from an employee’s paycheck. That doesn’t, however, cover the cost of payments for the typical Medicare recipient over time. Medicare adds to the budget deficit every year. The aging population, increasing life expectancies will only add to Medicare’s contribution to the deficit, unless there is an adjustment to the Medicare payroll tax.
  • Obamacare has certainly not made it any easier to figure out who is paying what.

    For additional information, contact EAB HealthWorks.