“When we did this plan originally, every year I’d come, and the sky was falling. And it never fell …‘til this year.”
So began a presentation by Lew Wolters, a health/employee benefits agent from C&M Insurance working with Leelanau County, to the county board of commissioners in mid-December.
Wolters said the cost of the county employee’s self-insurance program is projected to go up by over 37% next year, in response to more employees reaching their pharmaceutical drug deductibles and the county having to pay the costs.
“Our medical loss ratio is over 100%. That means we took out way more than we put into this thing,” Wolters said.
Rather than pay a projected $2.6 million to maintain the current system this year — up from an actual cost of $1.8 million in 2024 — it may be time to make a change. Interim Administrator Richard Lewis said the new Board of Commissioners will consider adopting a new, five-tiered prescription drug plan.
If approved by the Board of Commissioners at their next regular meeting, this could mean that county employees could start paying $200 to $600 premiums for prescription drugs every month. Currently, their drug costs are covered by the self-insurance pool after they reach a $20,000 deductible.
The county’s robust health insurance plan was sometimes mentioned as an argument against raising wages for employees and officials last year, since it was thought to be another incentive to work for Leelanau County. If the prescription drug coverage becomes less favorable, they may need to find other ways to attract and retain employees.
According to Wolters, most of the county’s large claim payments for 2024 were from prescription costs. He said they represented $1.4 million of $1.9 million in payments. Wolters said employees had been using pharmaceuticals “appropriately” until last year, where prescription costs rose from about $669,000 in 2023 to just over $970,000 in 2024.
Wolters further said that health insurance industry regulatory changes mean that the county’s provider, Blue Cross Blue Shield, will no longer cover certain drugs. These include drugs for weight loss — with Wolters mentioning Ozempic in particular — smoking, and erectile dysfunction.
The new county board will discuss new health insurance options at their Dec. 14 executive session, for possible approval at their Dec. 21 regular session a week later.
“I see an opportunity here. We can re-educate your employees, who really are fairly educated. They understand the language, they understand the process. Somehow, we just got off track,” Wolters said.
