It’s no secret that, for years, health care costs have been on the rise, reflecting a massive burden for employers and employees alike.
According to the Kaiser Family Foundation, the average premium for employer-sponsored family coverage has increased approximately 54 percent since 2009. In 2019, the average annual premium for employer-sponsored health insurance was $7,188 for single coverage — a 4 percent increase over the prior year. For family coverage, the average premium rose 5 percent in 2019 to $20,576.
Now, in the wake of COVID-19, that cost could be exacerbated, as health plans look for ways to recoup the cost of mass testing and widespread treatment. For example, in New York, insurers originally sought a near-12 percent rate hike to health plans. The state government stepped in to quash that plan, instead opting for only a marginal hike, but that’s just for 2021. In 2022 and beyond, health care costs have the potential to soar.
John Bovenzi is a co-founder of The Bovenzi Group, a boutique financial consulting firm. He served as deputy to the chairman and chief operating officer of the Federal Deposit Insurance Corp. for 10 years.
Grayson Milbourne is the Security Intelligence Director at OpenText Cybersecurity, a division of OpenText. Grayson's nearly two decades of security intelligence expertise include malware analysis, data science, and security education. In his current role, Grayson is focused on efficacy development to ensure the company's security management products (which include the Webroot portfolio) are able to defend against the most cutting-edge threats.
Grayson is a longtime advocate for better 3rd party testing of security products and represents OpenText Cybersecurity at the Anti-Malware Testing and Standards organization, AMTSO. Through his efforts, AMTSO released testing standards that greatly improved testing quality when followed. Grayson is an avid participant in the security community and drives awareness of current threats by speaking at major events such as RSAC and Virus Bulletin. He is a frequent guest on local NBC affiliates and several cybersecurity podcasts. Beyond his passion for protecting people from cyberthreats, Grayson loves aviation and holds a private pilot license. His other passions include strategic boards games, skiing and playing golf. He lives in Louisville, Colorado with his wife, Danielle and their two cats, Theodore and Aiden.
Merrilee Matchett is the head of Global Customer Service & Operations and a member of the Strategic Advisory Group for MetLife. In this role, she directs a team of more than 10,000 associates responsible for managing the operations and servicing teams that support and enable the U.S. Group Benefits, Retirement & Income Solutions, MetLife Holdings, and Asia, EMEA and LATAM businesses across more than 40 global markets. She is also the Chairperson of MetLife Europe, and MetLife Europe Insurance.
Matchett joined MetLife in 2021 from Bank of America, where she was responsible for service and operations for global wealth management, private banking, and institutional and personal retirement businesses supporting more than $3 trillion in client balances. She was also the Chairperson of Financial Data Services, LLC, responsible for the end-to-end operational support of domestic and offshore mutual funds.
Matchett has been an advocate for diversity and women in financial services throughout her 30-year career and has been recognized with numerous market awards for outstanding service and operations performance. She is a member of the MetLife enterprise Diversity, Equity & Inclusion Council, and represents MetLife on the board of INROADS, helping to provide career pathways for talented diverse youth across the United States.
She holds a B.A. in management with a law major from the University of Canberra, Australia. Additionally, she is FINRA accredited and licensed to trade and run a broker dealer.
So, if an even bigger health care premium crunch is coming, is there any way for taxpayers to find some relief? Potentially.
Last year, President Donald Trump issued Executive Order 13877, which directed the Internal Revenue Service on how to treat certain types of health plan arrangements. This year, the IRS responded by issuing proposed regulations. These new regulations included guidance for two alternate health care strategies — direct primary care, or DPC, arrangements and health care sharing ministries, or HCSMs. Under the proposed regulations, amounts paid for DPC arrangements and HCSMs are treated as deductible medical expenses. And that just may be the key to unlocking the respite many taxpayers desperately need.
What are DPC arrangements and HCSMs?
Before ditching traditional health insurance plans, taxpayers first need to understand how DPC arrangements and HCSMs work. Because these arrangements can take on a variety of forms, they will need to inquire about specific eligibility requirements and any limitations on the types of health services covered.
Under DPC arrangements, a patient contracts with their doctor for the provision of typical primary care services (e.g., preventative care, annual checkups, laboratory tests, etc.). Fees are usually fixed and paid on an annual or monthly basis (a typical monthly fee for a DPC arrangement is around $100), and in some cases doctors may charge an additional visit fee when services are performed. Obviously, this would be far more affordable than traditional health plans; however, many patients that pursue DPC arrangements also enroll in a high-deductible health plan to cover visits to specialists, urgent care or hospitals.
HCSMs are organizations whose members share medical expenses in accordance with a common set of ethical or religious beliefs, thus creating a cost-burden sharing system. According to the Alliance of Health Care Sharing Ministries, 1.5 million Americans are active members of an HCSM, and to date, the Department of Health and Human Services has certified 108 HCSMs.
That doesn’t mean it’s a slam dunk option for everyone, though. Proposed regulations lay out some detailed criteria that a group has to meet to gain HCSM status. For example, the organization has to have been in existence at all times since Dec. 31, 1999, and medical expenses of its members must have been shared continuously and without interruption since at least that date. It also must conduct an annual audit that’s performed by an independent CPA firm in accordance with GAAP, and have that audit made available to the public upon request. But if an organization can check all those boxes, it raises some intriguing options for some taxpayers that may be looking to save money during these uncertain times.
The grey area
While some of these options may seem enticing, they won’t be ideal for every taxpayer. For example, it appears that the IRS suspects its definition of a DPC arrangement may be limiting. Therefore, the agency is requesting comments on whether to expand the definition to include contracts with nurse practitioners, clinical nurse specialists or physician assistants who provide primary care services. Also, the IRS is requesting comments on whether other medical arrangements that don’t meet the definition of direct primary care (e.g., dental care or certain specialty services) should be included.
Meanwhile, the biggest disadvantage of HCSMs is inconsistent health coverage. HCSMs aren’t required to cover pre-existing conditions, cap out-of-pocket expenses or cover essential health benefits. They also can impose annual and lifetime benefit caps. In addition, because they’re based on common ethical or religious beliefs, HCSMs may require their members to abstain from certain activities. For some, this may seem too restrictive.
What’s more, if a taxpayer wants to take advantage of a health savings account, taking part in a DPC arrangement would limit, or in an HCSM’s case, outright preclude an employee from contributing to that HSA, which can offer substantial tax benefits.
The jury’s out
As health care costs continue to soar, some taxpayers will undoubtedly want to consider health care alternatives, but tax pros will have to weigh all the pros and cons before suggesting an alternative. Depending on the taxpayer’s circumstances, a DPC arrangement or an HCSM could either be a great fit or a square peg in a round hole. Preparers can help determine which category — if any — is right for their clients.
