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Individual and Family Products Medicare Plan Options (Medicare Advantage, Medicare Supplement, Part D)

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Health Care Costs

Like most people, you've come to count on doctors and hospitals to keep you well, from colds to cancer to diabetes. Over the last few years, you may have found your cost of care has gone up. When your insurer says your premiums cover the cost of care, what does that mean? Where does your money go?

Direct Health Care Costs (90¢) – For each dollar you spend on health insurance premiums, about 90% – or 90¢ – goes directly to pay for your care.

Hospitals (39¢) – Even if you never get sick enough to go to one, around 39¢ of your premium dollar goes to hospitals. This is because your premiums get pooled with other members' premiums. Insurers, like Blue Cross and Blue Shield of Texas, use this money to pay claims. If hospitals charge your insurer more, it takes more of your dollars to cover those charges.

This money is used by hospitals to:

Pay workers
Update, expand and build new hospitals
Buy new equipment to test and treat patients
Cover the cost of caring for the uninsured
Make profits (2% for a small hospital to 20% or more for a large hospital system).¹

Doctors (22¢) – The next biggest chunk of your premium goes to pay doctors and other health care providers. Keep in mind, a specialist costs more than a family doctor. And, doctors in a larger city may cost more than those in smaller and rural areas.

This money is used by doctors to:

Cover their cost for care for patients
Pay their staff
"Keep the lights on" at their office or clinic
Buy equipment to test and treat patients
Cover their medical malpractice insurance
Pay themselves

Drug Costs (21¢) – U.S. drug spending is rising by 7.3% yearly. Many new drugs are coming on the market. Some that treat serious illnesses have big price tags². And, more people are insured now. They can get care and drugs that they may have gone without when they were uninsured. So more people are spending more on drugs.

What goes into the cost of drugs?

Research and development
Making the drugs
Getting them out to people

Other Health Care Services (8¢) – From finger splints to wheel chairs, these costs come out of your premium, too.

This piece of the dollar also covers:

Dental
Therapy
Hospice
Skilled nursing
Other indirect provider services

Other Costs (10¢) – With 90¢ dedicated to the cost of care, that leaves just a dime out of every dollar for the insurers' cost of providing coverage.

This money is used to:

Process claims
Provide customer service
Offer programs to help people stay well

The remaining 2 or 3¢ is the insurers' profit margin.

Take Charge of Your Health

Many health care costs are related to personal behavior. Unhealthy habits can result in chronic health issues, which cost our economy an estimated $1 trillion each year. Here are just a few ways you can improve your health while helping to manage your health care costs. Many long-term illnesses can be prevented or managed when found early. Most health insurance plans cover a range of preventive services like screenings, immunizations, and other types of care. Be sure to take advantage of these benefits.

Help Prevent Health Care Fraud and Abuse

Health care fraud is a key driver of rising health care costs. About 3% of all health care spending — or $68 billion each year — is lost to health care fraud. Here are some things you can do to help prevent health care fraud and abuse.

Review your health care charges. Look over your Explanation of Benefits from your insurer and receipts from your doctor or pharmacist to make sure the right dates of service are recorded, and that you are billed for the right services or medications.
Protect your health information. Keep your insurance card and health care records in a safe place at all times.
Monitor your medications. Count your pills each time that you pick up a prescription.
Report suspected fraud and abuse as soon as possible. Blue Cross and Blue Shield of Texas members can call our Provider Fraud Hotline at 800-543-0867 to report suspected health care fraud.

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Sources

¹ Forbes. "Hospital Profits Soar as Obamacare Prescribes More Paying Patients." Mar. 1, 2015.
² Business Insider. "Here are the 6 Reasons Prescription Drugs are so Expensive." Sept. 25, 2015.
Percentages based on National Health Expenditure Data, Centers for Medicare and Medicaid Services, Agency for Healthcare Quality and Research, IMS Institute, 2013.