It’s no secret that, for years, health care costs have been on the rise, reflecting a massive burden for employers and employees alike.
According to the Kaiser Family Foundation, the average premium for employer-sponsored family coverage has increased approximately 54 percent since 2009. In 2019, the average annual premium for employer-sponsored health insurance was $7,188 for single coverage — a 4 percent increase over the prior year. For family coverage, the average premium rose 5 percent in 2019 to $20,576.
Now, in the wake of COVID-19, that cost could be exacerbated, as health plans look for ways to recoup the cost of mass testing and widespread treatment. For example, in New York, insurers originally sought a near-12 percent rate hike to health plans. The state government stepped in to quash that plan, instead opting for only a marginal hike, but that’s just for 2021. In 2022 and beyond, health care costs have the potential to soar.
Rathi Murthy is the Chief Technology Officer at Varo Bank, the first nationally chartered all-digital consumer bank in the United States. In this role, she leads the company's end-to-end technology strategy, overseeing the design and development of secure, scalable, and AI-powered digital banking platforms. Her leadership is instrumental in advancing Varo's mission to build inclusive, accessible, and real-time financial solutions for millions of consumers.
A seasoned technology executive, Rathi brings over 25 years of experience leading innovation and digital transformation at some of the world's most recognized technology and financial services companies. Prior to joining Varo, she served as Chief Technology Officer and President of Expedia Product & Technology at Expedia Group, where she modernized the company's global travel infrastructure, integrating AI-driven personalization, modular architecture, and advanced cloud capabilities across its family of brands.
Earlier, she held executive leadership roles at Verizon Media and Gap Inc., where she led enterprise cloud migrations, e-commerce platform evolution, and large-scale product delivery initiatives across global markets.
Rathi also served as Senior Vice President and Chief Information Officer of Enterprise Growth at American Express, where she was responsible for the technology strategy and operations of the Serve platform and a suite of prepaid products including Bluebird.
Rathi's early career includes engineering leadership roles at eBay, Yahoo!, Sun Microsystems, and WebMD, where she consistently delivered improvements in platform stability, operational agility, and customer experience.
In addition to her executive work, Murthy is a board member at PagerDuty, Inc., a leader in digital operations management, and serves as an External Expert Advisor to the University of San Francisco's Board of Trustees Committee on Information Technology Strategy. She is also a regular speaker at industry events and leadership forums, offering thought leadership on topics such as fintech innovation, integrating AI, platform transformation, and executive technology leadership.
Guy Baker, CFP, Ph.D., is the founder of Wealth Teams Alliance in Irvine, California.
He is a member of the Forbes 250 Top Financial Security Professionals list and is author of "Maximize the RedZone," a guide for business owners, as well as "The Great Wealth Erosion," "Manage Markets, Not Stocks" and "Investment Alchemy." He received the 2019 John Newton Russell Memorial Award for lifetime achievement in insurance.
So, if an even bigger health care premium crunch is coming, is there any way for taxpayers to find some relief? Potentially.
Last year, President Donald Trump issued Executive Order 13877, which directed the Internal Revenue Service on how to treat certain types of health plan arrangements. This year, the IRS responded by issuing proposed regulations. These new regulations included guidance for two alternate health care strategies — direct primary care, or DPC, arrangements and health care sharing ministries, or HCSMs. Under the proposed regulations, amounts paid for DPC arrangements and HCSMs are treated as deductible medical expenses. And that just may be the key to unlocking the respite many taxpayers desperately need.
What are DPC arrangements and HCSMs?
Before ditching traditional health insurance plans, taxpayers first need to understand how DPC arrangements and HCSMs work. Because these arrangements can take on a variety of forms, they will need to inquire about specific eligibility requirements and any limitations on the types of health services covered.
Under DPC arrangements, a patient contracts with their doctor for the provision of typical primary care services (e.g., preventative care, annual checkups, laboratory tests, etc.). Fees are usually fixed and paid on an annual or monthly basis (a typical monthly fee for a DPC arrangement is around $100), and in some cases doctors may charge an additional visit fee when services are performed. Obviously, this would be far more affordable than traditional health plans; however, many patients that pursue DPC arrangements also enroll in a high-deductible health plan to cover visits to specialists, urgent care or hospitals.
HCSMs are organizations whose members share medical expenses in accordance with a common set of ethical or religious beliefs, thus creating a cost-burden sharing system. According to the Alliance of Health Care Sharing Ministries, 1.5 million Americans are active members of an HCSM, and to date, the Department of Health and Human Services has certified 108 HCSMs.
That doesn’t mean it’s a slam dunk option for everyone, though. Proposed regulations lay out some detailed criteria that a group has to meet to gain HCSM status. For example, the organization has to have been in existence at all times since Dec. 31, 1999, and medical expenses of its members must have been shared continuously and without interruption since at least that date. It also must conduct an annual audit that’s performed by an independent CPA firm in accordance with GAAP, and have that audit made available to the public upon request. But if an organization can check all those boxes, it raises some intriguing options for some taxpayers that may be looking to save money during these uncertain times.
The grey area
While some of these options may seem enticing, they won’t be ideal for every taxpayer. For example, it appears that the IRS suspects its definition of a DPC arrangement may be limiting. Therefore, the agency is requesting comments on whether to expand the definition to include contracts with nurse practitioners, clinical nurse specialists or physician assistants who provide primary care services. Also, the IRS is requesting comments on whether other medical arrangements that don’t meet the definition of direct primary care (e.g., dental care or certain specialty services) should be included.
Meanwhile, the biggest disadvantage of HCSMs is inconsistent health coverage. HCSMs aren’t required to cover pre-existing conditions, cap out-of-pocket expenses or cover essential health benefits. They also can impose annual and lifetime benefit caps. In addition, because they’re based on common ethical or religious beliefs, HCSMs may require their members to abstain from certain activities. For some, this may seem too restrictive.
What’s more, if a taxpayer wants to take advantage of a health savings account, taking part in a DPC arrangement would limit, or in an HCSM’s case, outright preclude an employee from contributing to that HSA, which can offer substantial tax benefits.
The jury’s out
As health care costs continue to soar, some taxpayers will undoubtedly want to consider health care alternatives, but tax pros will have to weigh all the pros and cons before suggesting an alternative. Depending on the taxpayer’s circumstances, a DPC arrangement or an HCSM could either be a great fit or a square peg in a round hole. Preparers can help determine which category — if any — is right for their clients.
