“evil” Cadillac plan


From a 10000 foot level, ACA mandates unlimited benefit levels, and “limits” member cost via higher deductible levels & out-of-pocket cost to $6850. Assume two covered members contract advanced cancer each spending $600,000 in claims during a plan year. One was covered under an “evil” Cadillac plan with a $500 deductible then 80/20 until out-of-pocket limit of $6,850. The second was covered under a “silver” $5000 deductible plan and paid the same $6850 out of pocket maximum, until total claims equaled $600K. On the Cadillac plan, employer liability is the same as the silver plan, $593,150: however, the “silver” $5000 deductible encourages members to skip age appropriate cancer screenings, thus over time, cancer is discovered at more advanced stages? 70% of America’s commercial health expenditures are consumed by the sickest 10% of any group, either by employer, Taft Hartley or group of individually covered members. Today’s industry advertised total health plan cost equates to $12000 per employee! Another way to consider: today, 9 out of ten covered employees average $3600 annually with the sickest 10% taking the total’s average to $12000 per employee. https://www.linkedin.com/pulse/how-can-america-lower-healthcare-cost-improve-outcomes-dan-ross?trk=hb_ntf_MEGAPHONE_ARTICLE_POST

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