Wellmark presents county health-plan review; high-deductible option could cut premiums but shifts costs to employees

Wellmark presented an initial renewal and claims analysis to the Kossuth County Board of Supervisors, reporting that overall plan costs and stop-loss fees are rising and offering a high-deductible health plan as a potential option to reduce county premium costs.

Michelle, the Wellmark presenter, walked the board through claims trends, noting medical inflation near 9% and an individual stop-loss increase of about 13%. She said the plan's fixed fees rose in part because of stop-loss costs but that pharmacy rebate credits slightly offset those fees. "For your suggested rates with your claims, we're looking at a 12 and a half percent increase based on claims dollars and fixed fees," Michelle said.

She offered a modeled high-deductible plan using 2026 regulatory minimums (example: $3,400 single / $6,800 family) and said the initial pricing Walmart/Wellmark suggested would be roughly 18% cheaper in premium versus the current plan; the expected claims model showed a larger differential (about a 28% expected claims reduction in the model), reflecting that members would assume more of the first-dollar costs. Michelle noted high-cost claimants remain concentrated among a small share of members and the county's in-network pharmacy and telehealth metrics provide options to reduce costs.

Board members raised concerns about employee affordability and implementation timing. One supervisor flagged a family-level premium difference that could amount to several thousand dollars per year, noting this affects staff retention and the county's overall compensation burden. Several supervisors asked Wellmark to provide side-by-side quotes that would model the high-deductible plan with telehealth first-dollar coverage and to quantify the difference if the current plan's fourth-quarter carryover deductible were removed.

Wellmark also recommended steps to promote lower-cost care options, including telehealth, which the presenter highlighted as much less expensive for routine visits (example averages shown: plan paid ~$204 for an in-person PCP visit vs. ~$51 for telehealth). Michelle offered to run final rates in April after additional months of claim data and to provide more detailed comparisons and formal plan documents before any board decision.

No formal decision was taken at the meeting; the board asked staff to return with refined numbers, options to incentivize high-deductible enrollment (such as employer HSA contributions or premium differentials), and the implications for the county's self-insurance fund balance.