Obesity Treatment Drugs: A New Era of Coverage
The Biden administration has proposed expanding Medicare and Medicaid coverage for anti-obesity drugs. This reinterpretation of existing laws aims to address obesity as a disease and acknowledge the health benefits of weight loss. While this change could increase access for millions of people with obesity, it also raises concerns about potential cost increases for Medicare and Medicaid. Despite these concerns, the proposal could influence other payers to expand coverage and alleviate pressure on lawmakers seeking to authorize Medicare coverage through legislation.
Health Insurance Costs
The cost of employer-sponsored health insurance continues to rise. Family premiums increased by 7% in 2024, reaching an average of $25,572. While this increase is similar to the rise in inflation and wages over the past five years, it still places a significant burden on both employers and employees. Read the KFF News Release to learn more.
Biden Administration Proposes Changes to ACA Preventive Care
On November 4, 2024, the Biden administration proposed new rules that would modify how the ACA addresses preventive care. The draft regulation aims to require health plans to cover over-the-counter contraceptives, including condoms and emergency contraception, without cost-sharing. It also mandates insurers update transparency tools to clearly show OTC contraceptives are covered, and prohibits utilization management techniques like step therapy for ACA preventive services. Learn more about the proposed coverage expansion from CMS.
2025 Updates to New Jersey Disability and Family Leave Programs
For 2025, New Jersey’s Temporary Disability Insurance (TDI) program will provide eligible employees with up to 26 weeks of cash benefits. Employee contributions will be set at 0.23% of earnings. Employers will be assigned to a lower contribution table and notified of their required contribution through the state’s Employer Access portal.
Compliance Corner! COBRA and FMLA Participants Must Be Included in Open Enrollment
Plan sponsors must offer COBRA participants the same open enrollment opportunities as active employees. COBRA beneficiaries should receive all open enrollment materials and be able to change their benefits—such as switching plans or adding/removing dependents—just like other participants. This applies to medical, dental, and vision coverage. The same rules also apply to employees on FMLA leave, ensuring they can make benefit changes during open enrollment.