Latest news with #MillimanMedicalIndex
Business Wire
23-06-2025
- Health
- Business Wire
New Study from Marathon Health Reveals Advanced Primary Care Yields Immediate ROI and Curbs Acute Care Use
INDIANAPOLIS--(BUSINESS WIRE)-- Marathon Health, a leading provider of advanced primary care (APC) for employers and unions across the United States, has released a new large-scale claims study showing that APC — starting in year 1 of an employer's investment — significantly reduces health care costs, as employees engage in more preventive care and less acute/specialty care. The findings arrive at a critical moment: The 2025 Milliman Medical Index reports health care costs for a family of four have reached $35,119 in the typical employer-sponsored health plan, up 188% over the 20 years of the study. This far outpaces wage growth and inflation, putting increasing pressure on employee and plan sponsor budgets. 'Advanced primary care is a 21st-century approach rooted in decades of evidence,' says Dr. Nirav Vakharia, chief health officer at Marathon Health and a practicing primary care physician. 'For more than 50 years, research has shown that strong primary care leads to better clinical outcomes, less unnecessary utilization, and lower costs. What sets advanced primary care apart is that it doesn't reinvent the fundamentals — it delivers them with greater consistency through timely access, continuity between patients and providers, and whole-person care. That's how we create a health care system that truly works for working Americans.' Part of Marathon Health's ongoing and rigorous assessment of return on investment (ROI), the study examined over 3 million medical claim records across two cohorts — 89,000 members among 29 sponsors over five years; 224,000 members among 60 sponsors — via a methodology independently assessed by Milliman. Key findings under the most conservative of assumptions, including around engagement rates, show: Marathon Health's APC model pays for itself in the first year and delivers 3.7x ROI by year 5 Engaged members utilize more preventive care and less downstream acute care, and have: 21% lower claims costs 82% higher primary care utilization 15% fewer emergency room visits 41% fewer inpatient admissions The results reinforce APC's power to reduce unnecessary or avoidable high-cost care by encouraging prevention and early intervention — and employers have taken note. Advanced primary care adoption is rapidly accelerating: 76% of purchasers are currently offering APC or are considering adoption within the next 1-3 years, according to the National Alliance of Healthcare Purchaser Coalitions. Marathon Health will be hosting a public webinar on the study and its implications on June 26, 2025. Register here: To access the full study, visit About Marathon Health Marathon Health is a leading advanced primary care provider, partnering with employer and union plan sponsors to improve health for millions of Americans. With nationwide onsite, nearsite, and network health centers, and virtual primary care, Marathon delivers a value-based model that enhances the health care experience for members and providers, while driving meaningful cost savings for plan sponsors. Learn more at
USA Today
16-06-2025
- Health
- USA Today
How much does insurance cost for a family in 2025? Charts show rising expenses
How much does insurance cost for a family in 2025? Charts show rising expenses The average cost of insuring a family of four through the workplace has nearly tripled since 2005, according to a report from Milliman Medical Index in May. A typical employer-sponsored health plan now costs more than $35,000 for the average family. The burden of these increasing costs is falling on employers and employees alike. 'Every month, your paycheck is smaller than it would be, because your premium costs are higher," Caroline Pearson, executive director of the nonprofit Peterson Center on Healthcare, told USA TODAY. 'Every year, your wages go up by less because your employer is paying more for health care." From 2005 to 2025, costs of health care increased an average of 6% each year, outpacing median wages and the average annual inflation rate of 2.5%. Employees now contribute a larger percentage of their paycheck to health care premiums through payroll deductions. From 2005 to 2025, employee contributions toward their total health care costs increased from 21% to 27%. Pearson told USA TODAY that only a fraction of health care premiums comes out of an employee's pay. 'The vast majority is getting picked up by the employer,' Pearson said, 'as a benefit in lieu of wages.' Why is health insurance so expensive? The total cost of providing health care to the typical family of four accounts for inpatient and outpatient care, professional services, pharmacy/drug costs and other services such as home health care, ambulance services, durable medical equipment and prosthetics. For individuals, outpatient facility care and higher prescription drug costs are the top two drivers of increased spending on health care over the past two decades, according to Milliman. Pricing structures, disease prevalence, and new medicines and technologies also factor into rising care costs, according to USA TODAY reporting. How much are Americans spending out-of-pocket on care? The average American spent $1,211 out of pocket on health care in 2025, according to Milliman Medical Index. Out-of-pocket expenses are costs not covered by insurance. Americans spend more out-of-pocket on health care than people in most comparable countries, the health policy nonprofit KFF found. In the United Kingdom, for example, out-of-pocket health care costs totaled $764 per person in 2022. 'We don't consume a lot more health care than other countries,' Dr. Atul Grover, executive director of the nonprofit AAMC Research and Action Institute, told USA TODAY. 'We just pay a lot more for each thing.' Health care costs are rising across the board: The average cost of care for an individual with private health insurance is close to $7,800, an increase of about 7% from the year before, Milliman reported. Total health care spending is projected to climb to $21,927 per person in 2032, according to a report from the nonprofit Peter G. Peterson Foundation. At that pace, health care spending is on track to consume one-fifth of the U.S. economy by 2032. Cost of insurance: Why Americans pay so much more for health care in 2024 How many Americans are uninsured? As of last year, 26.2 million Americans did not have health insurance, or 7.9% of the population, according to the National Center for Health Statistics. Another 10.9 million Americans could lose their health insurance coverage through 2034 under President Trump's proposed tax cut bill, according to an analysis from the Congressional Budget Office. Americans without health insurance are more likely to skip getting medical treatment because of the expense, the Federal Reserve reported. Of those uninsured, 46% skipped medical treatment because they could not afford it, compared with 25% of the insured. In 2023, 23% of adults had major, unexpected medical expenses; the median cost was between $1,000 and $1,999, according to the Federal Reserve. CONTRIBUTING Daniel de Visé and Janet Loehrke
Axios
04-06-2025
- Business
- Axios
Annual cost of insuring a family tops $35,000
The cost of covering a family of four through workplace insurance now exceeds $35,000 — nearly triple what it cost 20 years ago as annual growth in health costs have far outpaced wages. The big picture: Growing pharmacy and outpatient facility costs drove most of the increase, which includes employee and employer shares, according to the 2025 Milliman Medical Index. Employers have been wary of passing health cost increases to workers in a tight labor market, but the rising demand for costly care may force a reckoning. State of play: The $35,119 annual cost to cover a hypothetical family of four this year factors in drug costs, inpatient and outpatient care, and professional services, along with an "other" category that includes home health, ambulance transport, medical equipment and prosthetics. A year of health care cost a family of four $12,214 in 2005 — the year Milliman launched the index. The 20-year cumulative gain of 188% outpaced the 84% growth in wages over the same time. Health costs have increased about 6% per year on average over the past two decades, according to Milliman's report. That's compared with an average inflation rate of 2.5% over that time. Health care for the average person with private coverage this year costs $7,871, including pharmacy rebates — an almost 7% increase from 2024. Zoom in: Annual family outpatient care costs have increased 286% over the past 20 years, landing at about $7,170 this year. Milliman attributed some of the increase to the expanded availability of radioactive drugs used for imaging tests and targeted therapies. New technology has made care more complex and costly. Reimbursement systems that tie payments to a percentage of billed charges have also helped drive the increase, per the report. Between the lines: Employers in 2025 still shoulder 58% of employees' health care costs, but their share has shrunk since 2005, when it was more than 60%. Employee premiums have increased from 21% to 27% of the total cost of care, while out-of-pocket costs have decreased from 18% to 15%. Reality check: Health care costs vary significantly by age, geography and pharmacy rebate arrangements. Milliman calculates family cost based on a family with a 47-year-old male, 37-year-old female, and children ages 4 and under 1. This was a "mathematically average" family in 2005, and Milliman continues to use that formula to keep data comparable year-to-year. The firm has an online tool that allows readers to input other family configurations to see their estimated 2025 health care costs. The analysis is based on Milliman's proprietary research tools and analyzes commercialclaims data. The family cost figure reflects nationwide average negotiated provider fees and average PPO benefit levels. What we're watching: How increasing use of newer pharmaceuticals like GLP-1s and innovative cancer therapies affect costs in the long run.
