Aetna aims to offer alternative to high-deductible plans in 2 new benefit designs

By  Paige Minemyer | Jul 23, 2020 1:32pm

As employers’ attitudes toward high-deductible health plans begin to shift, Aetna is launching two new plan benefit designs aimed to address their concerns. 

The new designs, called Upfront Advantage and Flexible Five, offer members coverage for some preventive services before they meet their deductibles. In Upfront Advantage, members will have access to services worth up to $500 for an individual and $1,000 for a family for free before their deductible is met. 

In Flexible Five, members will instead be offered five coupons per person for these services; a family of four, for example, would receive 20 coupons that can be applied to services such as primary care visits, behavioral health visits, urgent care, lab tests or x-rays conducted during those visits and generic drugs. 

Justin Steinman, vice president and health of product solutions and management at Aetna, told Fierce Healthcare that Aetna President Karen Lynch directed the team to begin developing some alternatives to traditional high-deductible plans about a year ago, and market research indicated that 86% of members fail to meet their deductible in a calendar year. 

The goal in the new designs is to push high-deductible health plan members to seek out routine and preventive care that they need and may be avoiding due to cost, while also avoiding a massive hike in costs for the plan sponsor, he said. 

“It really feels like a win-win for both the employer and the employee,” he said. 

The plan covers the cost of the services provided upfront by boosting the deductible, Steinman said, a decision that will have a limited impact on most members who are already failing to meet that benchmark with their care needs. 

It also eliminates an associated health savings account, which are often paired with HDHPs to encourage members to save to cover their health costs, though research suggests they rarely take advantage of them. 

Employers heartily embraced high-deductible health plans as a way to drive down health benefit costs, with enrollment in such plans rising from 25.3% in 2010 to 40% in 2016. However, they’ve had a change of heart about such coverage of late as continuing to shift health costs on to employees becomes untenable. 

Steinman said that Aetna developed its new plan designs with feedback from several of its national large employer clients, and that interest has been high from, for example, retail companies with distribution centers and store associates, or large manufacturers. 

Financial pressures related to COVID-19 are also driving demand for other approaches to plan design, he said. 

“We're hearing from employers loud and clear: ‘Give us some alternatives to high-deductible health plans,’” Steinman said. 

https://www.fiercehealthcare.com/payer/aetna-aims-to-offer-alternative-to-high-deductible-plans-2-new-benefit-designs