I’ve switched to the University of South Carolina’s employee health insurance plan effective September 1st. Before that I was on the Duke Grad Student plan. Both plans were self-funded by the employer which means the state or the university paid all the claims while the insurance company just did the administrative grunt work of running a plan. South Carolina’s standard plan is roughly a Gold plan while its low cost plan is roughly a Silver plan. The Duke plan was a platinum plan. Both networks are pretty damn broad. The Duke plan was “free” to me while the South Carolina saver’s plan has an employee deduction from my paycheck of less than a burrito per pay-check. These are both good plans!
But the impact of age on risk pools is amazing.
At Duke I was an elderly grad student. The median grad student was likely in their late 20s. The women were disproportionally unlikely to be pregnant relative to their age-cohort. We were CHEAP and in any given year, relatively low risk!
At South Carolina, I’m probably pretty damn close to the median aged enrollee. Looking up and down my hallway, there are some people about my age, some people substantially younger but still on the employee plan and some people who are notably older.
The average premium reported on my W2 Box 12DD for South Carolina will be substantially higher than my Duke insurance premium not because the benefit is richer (it is not), not because the network is intrinsically better/broader (they’re about the same) but because the risk pool is substantially older. An employer group risk pool typically is healthier than the general population as Medicare and Medicaid act as explicit payers of first resort for several expensive categories of care and a de facto high cost risk pool through the disability system, but even within employer groups, there are massive differences in group composition.
