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.
Cathy Lanning serves as Senior Vice President for the Property & Casualty Marketing organization. In this role, she is responsible for the development and execution of integrated marketing plans for personal and commercial insurance products. Together with her team, she builds the brand and the Nationwide business leveraging data-driven direct marketing, partnerships, digital media, social media, cooperative agency marketing and lead generation strategies.
Most recently, Cathy led Strategic Partnerships where she established a large partnership portfolio with a data driven relationship-based selling approach. Together with partners such as alumni associations, cause organizations and sports organizations, Nationwide was able to understand the exact needs of a household and bring the right solutions at the right time to meet their protection needs. Under her leadership, the business unit grew by over 100% in five years.
Cathy joined Nationwide in 2007 as part of the leadership team that launched Nationwide Bank. Throughout her tenure at the company, she has held roles that require innovation, vision and team building. This includes establishing new digital marketing tools for agents, launching new products in the market, and establishing the Marketing Analytics organization. The Marketing Analytics organization delivered the first-generation marketing mix models, comprehensive digital analytics, and forecasting models, all of which helped Nationwide understand marketing effectiveness across channels and identified investment optimization pathways. The insights served the business lines across the company and opened new horizons for efficient growth and retention.
She has broad experience in brand management, analytics, partnership development, direct marketing, distribution marketing, innovation, product development and strategic planning. Prior to joining Nationwide, Cathy was the Brand Manager at The Scotts Company and Product Manager at WorldCom focused on Virtual Private Networks.
Cathy is a proud Ohio State University alumnus, holding a Bachelor of Science in Psychology, a Bachelor of Science in Business Administration (Marketing) and Masters in Business Administration. She is also a graduate from the Northwestern Kellogg Senior Women in Leadership program.
Outside of work, Cathy is a passionate advocate for education and community learning programs. To live this mission, Cathy serves on the board of The Ohio State University Alumni Association, The Girl Scouts of Ohio’s Heartland and The Wellington School.
Shelley Brazeau Temple serves as President of Nationwide P&C Personal Lines. In this role, Shelley is responsible for all aspects of the Personal Lines Profit and Loss (P&L) segment including product, underwriting, sales and distribution, claims and service.
She most recently served as Nationwide P&C Senior Vice President and Chief Claims and Operations Officer. Prior to that, she served as Senior Vice President of Member Solutions, leading the company’s insurance servicing and billing operations and direct phone sales organization.
Other leadership positions she has held are:
- Regional Vice President of Nationwide’s South Central Operations, responsible for sales, pricing, underwriting and product in a six-state geography, and managing a more than $660 million in sales revenue through exclusive agents and direct sales.
- VP of Strategy and Operational Effectiveness for Customer Service and Direct Sales of Nationwide, developing and executing an innovative contact center strategy.
- VP of Personal Lines Service Operations, responsible for personal lines service and processing center operations.
Shelley began her career at Nationwide as a Claims associate 27 years ago. Her increased responsibilities in leadership positions throughout the years also led her to work with internal audits, product and agency sales.
Shelley holds a bachelor’s degree from Bowling Green State University and the Chartered Property and Casualty Underwriting (CPCU) designation. She has served on several non-profit boards, including Ronald McDonald Children's Charities and the American Lung Association of the Midland States with participation in development, audit/finance and executive committees.
As an accounting professional, these are tough days. But that doesn’t mean your practice can’t grow during this season.
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.
