If a recent federal judicial ruling stands, employers could start imposing cost sharing for select preventive services and medications. Enrollees utilizing these services could face a substantial increase in their personal out-of-pocket spending. EBRI reviews the financial impact of these possible changes for employers and employees.
At a Glance | August 17, 2023 Limited Upside for Employers to Resume Cost Sharing on Preventive Services The U.S. Department of Health and Human Services estimates that 151.6 million people had access to free preventive care under the Patient Protection and Affordable Care Act (ACA) in 2020. If a recent federal judicial ruling stands, employers could start imposing cost sharing for select preventive services and medications. Enrollees utilizing these services could face a substantial increase in their personal out-of-pocket spending, while employer savings from reintroducing cost sharing would be negligible. PROPH Y L A XIS HIV PrEP PrEP is highly effective at preventing HIV. While the medication is costly, the $ % % 2,747 0.2 0.08 savings to employers would Enrollee Enrollees Employer be negligible relative to the Copay (20%) Using Service Savings cost to enrollees. INTERV ENTION Preventive Interventions for Perinatal Depression Perinatal depression affects as many as 1 in 7 women and is one of the most common $ % % 91 1.0 0.02 complications of pregnancy Enrollee Enrollees Employer Copay (20%) Using Service Savings and the postpartum period. COUNSELING Behavioral Counseling Interventions for Healthy Weight Behavioral counseling in Pregnancy interventions to limit excess gestational weight gain during $ % % 33 0.04 <0.01 pregnancy may improve Enrollee Enrollees Employer health outcomes for women Copay (20%) Using Service Savings and infants. This study was conducted through the EBRI Center for Research on Health Benefits Innovation (EBRI CRHBI), with the funding support of the following organizations: Aon, Blue Cross Blue Shield Association, ICUBA, JP Morgan Chase, Pfizer, PhRMA, and The Commonwealth Fund. SOURCE: Paul Fronstin, Ph.D., Employee Benefit Research Institute; M. Christopher Roebuck, Ph.D., RxEconomics, LLC; and A. Mark Fendrick. M.D., University of Michigan, ” Imposing Cost Sharing on Preventive Services Significantly Impacts Expenditures for Eligible Enrollees but Does Not Substantially Reduce Aggregate Employer Health Care Spending: Implications of Braidwood Management Inc. v. Becerra,” EBRI Fast Facts, no. 474 (June 22, 2023). © 2023 EBRI This report is copyrighted by the Employee Benefit Research Institute (EBRI). You may copy, print, or download this report solely for personal and noncommercial use, provided that all hard copies retain any and all copyright and other applicable notices contained therein, and you may cite or quote small portions of the report provided that you do so verbatim and with proper citation. Any use beyond the scope of the foregoing requires EBRI’s prior express permission. For permissions, please contact EBRI at permissions@ebri.org.