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The biggest questions surround the cost of care. That’s why we’re dedicated to making sure the cost for your coverage is transparent. Knowing where your health care dollar goes may shape how you buy health insurance next year. It might even inspire you to tuck away extra savings to cover unexpected health care expenses.
Rising prices for health care affects all of us. Sometimes the dollars available for care fall short of covering the bills.
Most of the cost for your care is covered by your health insurance premiums or employer. Today, in the U.S., the majority of every dollar paid in premiums actually goes to pay directly for health care. The largest percentage, 42 cents, goes to hospitals simply because that’s where the most expensive care happens. Prescription drugs capture the second largest chunk at 21.5 cents. Doctors get 12.1 cents of every dollar. Other health care services and related expenses account for nearly all the rest. Only 3 cents of every dollar is profit.
Most of us feel the pinch of rising health care costs. Still, many of us don’t know what’s behind the increases. One reason is prescription drug costs. The price of prescription medications has increased at a much faster rate than inflation over the past seven years.
Emergency care is another reason. Many people still go the emergency room for non-emergencies – even though that’s the most expensive way to get care.
Ongoing costs related to people who have chronic health conditions that require a lot of care is another big driver. Even if you’re healthy, your premium is combined with those of other members. Pooling premiums ensures we can cover health care costs for all members. For example, if one member needs a heart transplant, it takes premiums from 350 members to cover the cost of one heart transplant.
When health care costs go up, insurers have to find ways to make ends meet so all of our health care bills get paid. Today, insurers are working hard with health care providers to reduce costs. Despite their efforts, insurers also have to look at adjusting premiums for the coming years. Making the health care system work involves hospitals, doctors, drug companies, insurers and consumers working together. We all play a role. We all have a stake in making it work.
Want to know more? Read “Where Do My Health Care Payments Go?”
Originally published 6/1/2016; Revised 2022
Please explain why my Doctor is being told that my BS/BS plan does not cover implants. I quote the following from both the coverage statement AND your SPD:
Why are you lying to my doctor?
From our Coverage Statement:
Dental
Implants In Network
80% covered after deductible. Call your plan for prior authorization for specific medical conditions
Out of Network
60% covered after deductible. Call your plan for prior authorization for specific medical conditions
From our SPD:
Dental Implant Coverage under this Medical Plan
The medical plan covers dental implant body placement, associated bone grafting, barrier membrane placement & removal, sinus augmentation surgery, and soft tissue grafting when each service is shown to be medically necessary for:
Reconstruction of a dental ridge, distorted as a result of removal of a benign or malignant tumor. Bone
grafting following treatment of tooth-related cysts confined to the dental alveolus is a dental service and is not covered under the medical plan.
Replacement of previously sound natural teeth (stable, functional, free of decay, free of periodontal disease)
• lost or damaged solely by external, accidental injury, including falls
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• when conventional crowns, bridges, and/or removable dental prosthesis alone cannot restore adequate function.
• Note: a tooth or teeth lost or damaged in the course of biting or chewing are not covered under the
medical plan.
Securing or stabilizing a facial prosthesis which is placed to camouflage or cover an area of tissue missing due to trauma, disease or birth defect, e.g. an implant supported ear, nose, or cheek prosthesis.
Securing or stabilizing an upper jaw obturator following ablative tumor surgery or trauma.
Replacement of an anterior maxillary tooth or teeth, directly within a congenital alveolar bone cleft, when the tooth failed to form or is non-functional due to malformation or impaction.
Replacement of a single missing tooth when:
• the other remaining teeth are sound natural teeth (stable, functional, free of decay, free of periodontal disease) and
• a conventional bridge, crown, and/or denture cannot restore adequate function and
• a dental implant is medically necessary to restore adequate function.
Medical necessity for the restoration of alveolar ridge atrophy by bone grafting and the placement of multiple dental implants will be assessed on a case-by-case basis. If conventional dentures, partial dentures, crowns, bridges, and dental restorations can be expected to adequately restore function, dental implants will not be covered by the medical plan.
Note: smoking, exposure to intravenous and oral bisphosphonates, exposure to other anti-resorptive medications, use of steroids, external beam radiation therapy, implanted radiation sources, implantation into previously infected bone, and other circumstances may increase the risk of implant failure and may be among the reasons for denial
of certain implant procedures.