Employers and employees will see some changes when it’s time for health insurance enrollment at the end of this year.
One expected trend: Spouses who previously purchased their health insurance from the marketplace established by the Affordable Care Act could be switching to their husband’s or wife’s employee-sponsored plan. That’s according to experts who include Hughes Waren, the Wilmington-based regional vice president of eBen, a firm that helps companies plan for employee health benefits and offers insurance plan brokerage services.
Waren said provisions in federal legislation (the One Big Beautiful Bill Act signed into law by President Donald Trump in July) and the potential expiration of a federal tax credit are likely to contribute to this trend.
“Employers may have to start subsidizing the dependent coverage more to help these people that are losing tax subsidies and then come on group plans,” Waren said.
The tax credit loss is expected to result in the average enrollee in the ACA marketplace seeing a 75% premium cost increase, according to news stories citing research by nonpartisan research organization KFF.
Health care spending account (HSA) contributions and usage could increase next year, Waren said. The spending plan approved in July changes HSA regulations to expand HSA-eligible services.
In Wilmington, two doctors have founded a family practice that offers memberships, and they hope to get employers on board. Doctors Brian Collins and Michael Cullura opened Port City Direct Primary Care nearly four months ago.
“It’s slowly gaining some more popularity,” Cullura said of the membership model in primary care.
His office’s membership fees start at about $80 for patients under the age of 40 or $100 over 40. “If you have multiple people, there’s discounts, and then $30 for children,” Cullura said. “That would be just a monthly membership fee that you’d pay to us, and that covers everything that we do in the office.”
He said he and Collins have been talking to a couple of local small businesses about the possibility of those employers paying for memberships for their employees.
“The cost of health care for all their employees is pretty considerable to their bottom line,” Cullura said.
A membership to his and Collins’ practice could “save the employer some money but also provide really better access to care for their patients.”
By better, he also means faster.
“Unfortunately, with the traditional health insurance model, a lot of times when patients try to call to get an appointment or get established with a doctor, it takes months to get in, or if you need a sick visit, it may take weeks before they’re able to get you in to see you,” Cullura said. “And that’s part of the idea of this membership model is we don’t have to take on the amount of volume that a lot of the other local doctors have to take on that use traditional insurance. By doing that, we are able to be more available and accessible to our patients.”
Cullura, who is in his 40s, said he knows from personal experience the challenges of getting health care in a timely manner.
He recounted the time recently when he had what he suspected was a virus.
“I don’t want to be my own doctor … I needed somebody else to take a look at me. And so I called my doctor’s office and told him I wanted to get in for a sick visit, told him the symptoms I was having. They told me it was going to be a three-week wait,” Cullura said.
Cullura, who also works in an emergency department and is board certified in emergency medicine, said such anticipated waits can result in patients heading to the emergency room.
“Then they end up getting these huge bills from an emergency department for something that can and probably should have been handled by their primary care doctor,” he said.
A patient who participates in a membership model for primary care would still need another kind of insurance or way to afford potential catastrophic health care expenses.
State and local officials have looked at different ways to address what is one of the highest costs for an employer.
The NC Chamber created Carolina HealthWorks, a multiple employer welfare arrangement (MEWA), to offer health insurance for employees through small businesses in the state, said Natalie English, president and CEO of the Greater Wilmington Chamber of Commerce. But as of early August, state officials were awaiting a response to their application for the arrangement to be approved by the N.C. Department of Insurance.
““The Trust board for Carolina HealthWorks is still waiting for final approval from the Department of Insurance,” said English, who is a member of the Trust board. “The team has worked closely with the staff of the department and are encouraged by those conversations.”
English said the Wilmington Chamber will be aiding Blue Cross Blue Shield of NC in hosting a briefing for brokers in the Cape Fear region next month. “That briefing will be to inform and educate brokers on the new products they will be able to offer their clients. Once DOI approval is provided, our chamber, the NC Chamber and BCBSNC will market the opportunity to small business owners across the state,” English said.
She said officials are “excited about helping small business owners identify significant cost savings which will provide them with employee retention tools as well as capital to reinvest in their business growth. As their business grows, so will the economy of our region.”
Waren said, ““If the NCDOI approves the (state) chamber plan,” he added, “it very well could be the best option for moderately healthy employer groups with two to 50 employees. It’s worked in Ohio.”
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