Changes

*Some experts say that looking to lower health-care costs significantly isn't realistic for many firms and that slowing increases is more realistic. [http://www.cnbc.com/2015/01/08/5-smart-ways-small-firms-can-slash-health-care-costs.html (CNBC)]

**"Reducing your cost over time from one year to the next is probably an unrealistic standard. A company that is keeping its benefits costs in line with its compensation costs is probably doing exactly right." -Alan Cohen, chief strategy officer and co-founder of Liazon

[http://www.cnbc.com/2015/01/08/5-smart-ways-small-firms-can-slash-health-care-costs.html (CNBC)]

*Some private insurance premiums are negotiable, especially in the 50-99 employee space.

*As of Nov. 15, small businesses with 50 or fewer "full-time equivalent employees" under the Affordable Care Act's formula can now turn to the Small Business Health Options (SHOP) exchange.

*SHOP is "essentially a federal or state-run supermarket—or marketplace—where businesses can shop for small-business plans" according to Sally Poblete.

*Coverage for an individual plan sold through the exchanges can be customized to the individual - they will not necessarily get inferior coverage by switching to SHOP.

*See this [http://www.gao.gov/products/GAO-15-58 (GAO report)] on the reasons for low SHOP enrollment.

*Businesses who offer money to buy individual plans vs covering group plans often fare better

*Alternatively, employers set up health reimbursement accounts (HRA). The advantage of an HRA over a health savings account (HSA) is that the plan can be structured so that if an employee does not use the money in an HRA, the money will still belong to the company.

*Direct primary care works by charging users a monthly fee for unrestricted access to their doctor, instead of billing patients' insurance

*Costs ~$80/month and ~$1000/year for individuals and some practices offer discounts to employers