Health Care, for further reading

At last night’s City Council Meeting, Councilor Haller mentioned a Boston Foundation/Massachusetts Taxpayers Foundation report called Municipal Health Plans: Gilded Benefits from a Bygone Era, which was released yesterday.  You can find a pdf of the report on this website.

One of the more interesting aspects of the report is Appendix A (see p. 16-17 of the pdf), which compares existing municipal plan costs to the state GIC plan.  Unfortunately, there’s no one-to-one comparison; that is, the state doesn’t offer Blue Cross/Blue Shield, and the appendix doesn’t list what the state premiums are for Fallon Direct or Fallon Select.  (updated: the GIC Fairy pointed me to the GIC rate sheet for FY2012; I’ve extrapolated out the Fallon rates below.)

Employer Plan Carrier Annual Individual Premium Employer Share Annual Family Premium Employer Share
Worcester BCBS-MA/Blue Choice POS $8,587 $6,440 (75%) $22,514 $16,886 (75%)
Fallon Direct/HMO $5,758 $4,319 (75%) $14,778 $11,083 (75%)
Fallon Select/HMO $7,065 $5,299 (75%) $18,308 $13,731 (75%)
State HPHC/PPO $7,236 $5,789 (80%) $17,674 $14,140 (80%)
GIC Tufts/PPO $6,959 $5,567 (80%) $16,896 $13,517 (80%)
GIC FY2012 Fallon Direct/HMO $5,422 $4,337 (80%)/$4,066 (75%) $12,908 $10,326 (80%)/$7,744 (75%)
GIC FY2012 Fallon Select/HMO $6,691 $5,353 (80%)/$5,018 (75%) $15,951 $12,761 (80%)/$11,963 (75%)

The report evaluated 14 municipal plans, and that the City of Worcester’s Fallon plans’ premiums tended to be on the lower end of the premiums for the evaluated municipalities; the BCBS plan premium was on the higher end.

The report notes that the current Worcester plan doesn’t include an annual deductible, that office visit and prescription drug co-pays are pretty low, that there’s no co-pay for high-tech imaging.  Worcester is one of the few municipalities they saw that charged more for a specialist visit and charged anything for outpatient surgery or inpatient hospitalization. 

Of additional interest:

Even though the majority of municipal plans in this study are HMOs and should have the least expensive premiums, municipal benefits are so extraordinarily generous that the HMO premiums are frequently more expensive than the PPO premiums for plans offered by other employers. Even municipal employees paying only 10 percent of the premium costs stand to save hundreds of dollars with modest plan adjustments. [p. 7]

The report’s a pretty quick read, and I recommend looking at it for a better understanding of how Worcester currently stands compared to other municipalities, the state, the feds, and private employers.