Wellmark spent 90.2 cents of each premium dollar for the cost of care (doctors, hospitals, pharmacies, and other providers of care).
As complex as health care can be, one rule is easy to understand:
The more paid out in claims, the more premium dollars are needed.
Health insurance basics aren’t taught in school.
So when it comes to understanding insurance, the entire topic can be overwhelming.
We’d like to help you understand the basics by teaching you how health insurance works, where your premium dollars go, and what you can do to become a smarter health care consumer.
Health insurance 101
Understanding insurance – The basic concept behind health insurance is a community approach to cost-sharing. In insurance lingo, this is called a “pool,” which includes others who have also purchased health insurance coverage.
The premiums people pay go into a pool. |
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A pool is a collection of premiums used to pay claims for all members in the pool. |
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When someone receives medical care, money is used from the pool to pay the bills.. |
As health care costs rise ... |
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... and health care use increases ... |
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... the amount of money in the pool |
Your premiums go up because the amount of money in the pool must increase to pay all the bills. |
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This ensures that there is enough money in the pool ... |
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... to cover the potential health care expenses and prevent a catastrophic event from bankrupting an individual or a family.. |
Teamwork
Your dollars support the pool
You’ll have the peace of mind that if you have a health problem, we’ve got you covered. Your premiums not only support the health care needs of you and your family, they also support others in your pool. It’s our job to make sure there is enough money in the pool to cover potential health care expenses for everyone.
Nearly one quarter (23 percent) of our members did not file any claims in a year’s time. In other words, they paid their premiums, but did not use any health care services.
The vast majority of dollars spent (81 percent) came from 11 percent of members who had major claims. Often these major claims are unexpected. For example, due to a heart attack, surgery, accident or sudden illness.
| Impact of claims | Haven’t filed any claims?
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| Claims incurred for all Individual Under 65 Market for period 4/1/2010-3/31/2011. Common claims: Claims less than $2,500 Major claims: Claims exceeding $2,500 |
| Some uses of premiums | Did you know ...
About 400 people paid their premiums and sought no services to have dollars available to take care of one prematurely born baby. |
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| Care provided | Average cost of care1 | Approximate # of member premiums2 | ||
| Having a baby |
$5,500 | 2 | ||
| Diabetes | $10,700 | 4 | ||
| Back surgery | $16,700 | 6 | ||
| Heart attack | $30,100 | 11 | ||
| Premature baby | $975,000 | 400 | ||
| 1Average cost of care based on midpoint of range in Des Moines, Iowa. Cost will vary by actual services received. 2Based on average per member annual premiums at rates effective 4/1/2011. |
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What else impacts premiums?
Three main reasons why health care costs change
At Wellmark Blue Cross and Blue Shield, changing premiums is not a process we take lightly. We genuinely care about you, as well as all of our members. In many cases, you are our friends and family. Catastrophic health situations aren’t the only type of claims that impact the cost of care.
1. Members are using more services. Overall, the number of times members of a pool go to the doctor, have tests run or prescriptions filled is increasing.
2. Cost per service is increasing. For example, the price of medical treatment and certain prescription drugs means increased spending.
3. The type of services received is more expensive. For example, a trip to the emergency room is far more expensive than an office visit. An MRI is far more expensive than an x-ray.
Homework
What can i do to help reduce health care costs?
Your role as a consumer of health care is critical. Using the tools and resources on myWellmark.com to make smart health care decisions goes a long way in controlling costs. Here are just a few things you can do:
| What you can do | How myWellmark.com can help |
| Use your benefits wisely | Learn the details of your health plan within the My Benefits section. |
| Use generic drugs when possible | Check prices for your medications at pharmacies near you, and explore lower-cost drugs. |
| Prevent health care problems before they start | Access the preventive care guidelines to help keep you and your family on the road to good health. |
| Use the emergency room only when necessary | Save the emergency room for true emergencies. Find the nearest hospitals and urgent care centers. |
| Be healthy | Find general health information and interactive tools to keep you and your family healthy. |
Use the tools and resources on myWellmark.com to make smart health care decisions. Register today.
Report card
We’re investing in you
Wellmark has met and exceeded the minimum Affordable Care Act (ACA) requirement for the Individual Under 65 Market in 2011.
| Benefits paid per premium dollar | |
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The Affordable Care Act (ACA) requires all insurers in the state of Iowa to spend at least 67 percent of each premium dollar on medical costs. Wellmark far exceeds this requirement. |
Lesson plan
What’s wellmark doing to help me?
Wellmark cares about the health of Iowans and the rising costs of health care. We are working hard to reduce the growing health care and related insurance costs. Here are some ways we are helping to manage your health care costs:
- Wellness programs. We provide support and guidance to help keep you healthy.
- Improving the health of Iowans. We invest in Iowa communities through our Blue Zones ProjectTM as part of the Healthiest State Initiative. This project is helping to change environments across the state to make the healthy choice the easy choice.
- Administrative costs. We carefully manage the dollars needed to run our business efficiently so that the majority of the dollars we receive in premiums goes toward health care costs.
- Accountable Care Organizations (ACOs). We help to achieve better health outcomes. An ACO is a group of doctors, hospitals, and other health care professionals who are held accountable for the quality and cost of care delivered to a defined population. This new payment model focuses on coordinating care to improve quality, provide greater value, and slow increases in health care costs.
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