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Clinical Laboratories and Pathology Groups

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Costco Begins Selling an At-Home Self-Collection COVID-19 Test Kit; One of 12 Kits That Have Received FDA Emergency Use Authorization

It’s the latest example of how the ongoing SARS-CoV-2 pandemic is making it possible for new competitors to enter the clinical laboratory marketplace

In response to increasing demand for COVID-19 testing, warehouse retailer Costco (NASDAQ:COST) is seizing the opportunity to sell at-home saliva self-collection test kits to its customers. It makes Costco the latest company to enter the market for SARS-CoV-2 testing and compete against clinical laboratories.

And these non-invasive tests—which are as simple as spitting saliva into a container and mailing it to a medical laboratory—may be more effective at detecting the SARS-CoV-2 coronavirus than uncomfortable nasal swabs. 

Costco is selling its COVID-19 Saliva PCR Test Kit for $129.99 ($139.99 with video observation). Included in the price is a self-collection device, a biohazard bag, a sticker for personal data, and a box for shipping the saliva to a medical laboratory.

The test is actually P23 Labs’ TaqPath SARS-CoV-2 assay and will be administered by Azova, a digital health services provider. P23 says their test has a 98% sensitivity and 99% specificity, according to Business Insider.

The Costco P23 test kit  from Thermo Fisher Scientific
The Costco P23 test kit above, “uses parts from Thermo Fisher Scientific and works with collection kits made by testing companies Everlywell and OraSure Technologies, according to the FDA and a P23 spokesperson,” Business Insider reported. “Samples are tested in [P23’s] lab in Little Rock, Arkansas.” (Photo copyright: Costco.)

Saliva-Collection Kits Gain Popularity and FDA Emergency Use Authorizations

P23 Labs’ assay is one of 12 COVID-19 home tests that have received US Food and Drug Administration (FDA) Emergency Use Authorization (EUA). Three of which use saliva specimens.

The FDA’s EUA authorization summary for the P23 assay states it is “for use with saliva specimens that are self-collected at home or in a healthcare setting with or without the supervision and/or assistance of [a healthcare provider (HCP)], by individuals using the P23 At-Home COVID-19 Test Collection Kit, when determined to be appropriate by an HCP based on the results of a COVID-19 medical questionnaire. This test is also for use with nasal swab specimens that are self-collected at home or in a healthcare setting with or without the supervision and/or assistance of an HCP by individuals.”

In a news release announcing the first diagnostic test using saliva specimens, oncologist and FDA Commissioner Stephen Hahn, MD, said that “Authorizing additional diagnostic tests with the option of at-home sample collection will continue to increase patient access to testing for COVID-19. This (saliva sample collection) provides an additional option for the easy, safe, and convenient collection of samples required for testing without traveling to a doctor’s office, hospital, or testing site.” That test was manufactured by Clinical Genomics laboratory of Rutgers New Jersey Medical School.

Below is a list from Business Insider for at-home self-collection SARS-CoV-2 coronavirus tests that have received an FDA EUA. Most can be ordered online, and prices range from $109 to $149, which may be covered by insurance depending on the health plan.

Saliva coronavirus home tests:

Nasal swab coronavirus home tests:

Yale Study Indicates Saliva Tests Have Greater Detection Sensitivity over Swab

Should consumers choose COVID-19 saliva tests over nasal cavity swab tests? Maybe.

A study led by the Yale School of Public Health found and “conducted at Yale New Haven Hospital with 44 inpatients and 98 health care workers—found that saliva samples taken from just inside the mouth provided greater detection sensitivity and consistency throughout the course of an infection than the broadly recommended nasopharyngeal (NP) approach. The study also concluded that there was less variability in results with the self-sample collection of saliva,” states a Yale University news release.

In, “Saliva Is More Sensitive for SARS-CoV-2 Detection in COVID-19 Patients than Nasopharyngeal Swabs,” published on the preprint server medRxiv, Yale researchers also noted a saliva test—as compared to a test using a nasal swab—is less invasive and more likely to be reliably self-administered. However, they remain cautious about jumping to saliva as a specimen versus nasal swabs.

Anne Wyllie, PhD
Anne Wyllie, PhD, Associate Research Scientist at Yale School of Public Health, told Time magazine, “Saliva itself is a newer diagnostic method, and a lot of people don’t know how to work with it, are scared to work with it, or not sure how to work with it. Just because a protocol is working with swabs doesn’t mean the same protocol will work with saliva.” Nevertheless, public demand for less invasive COVID-19 testing means clinical laboratories may soon be receiving more requests for processing saliva over nasal swabs. (Photo copyright: Yale University.)

Yale received FDA EUA for SalivaDirect, a real-time quantitative polymerase chain reaction (RT-qPCR) for detection of SARS-CoV-2. However, SalivaDirect is not an “at-home” test. It requires saliva samples to be self-collected into a sterile container in the presence of a healthcare professional, and is being provided by Yale to clinical laboratories as an “open source” protocol, the FDA said in a news release.

“We are trying to work with smaller local labs that want to get up and running to support schools, community groups, universities, and colleges,” Wyllie told Time.

In “Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2,” published in the New England Journal of Medicine (NEJM), Wyllie and others suggest saliva can be just as effective in detecting the coronavirus that causes COVID-19. In their study, COVID-19 patients who were tested by healthcare workers using nasopharyngeal swabs were then asked to collect their own saliva samples.

The researchers found that “Collection of saliva samples by patients themselves negates the need for direct interaction between healthcare workers and patients. This interaction is a source of major testing bottlenecks and presents a risk of nosocomial infection. Collection of saliva samples by patients themselves also alleviates demands for supplies of swabs and personal protective equipment. Given the growing need for testing, our findings provide support for the potential of saliva specimens in the diagnosis of SARS-CoV-2 infection.”

The Yale scientists used primer sequences identified by the Centers for Disease Control and Prevention to detect the coronavirus. They found more SARS-CoV-2 RNA in saliva specimens than in the nasopharyngeal swab specimens. Also, 81% of saliva samples were positive one to five days after diagnosis, as compared to 71% of the nasopharyngeal swab specimens. 

“The findings suggest saliva specimens and nasopharyngeal swab specimens have at least similar sensitivity in the detection of SARS-CoV-2 during the course of hospitalization,” the researchers wrote in their NEJM paper.

The increasing popularity of at-home COVID-19 testing—along with studies showing that results improve when specimens are self-collected—suggest that medical laboratory managers should closely monitor the rise of COVID-19 home tests, as well as progress being made in saliva for diagnosing the SARS-CoV-2 coronavirus.

Further, it might be a smart strategy for clinical laboratories with the capability to perform this testing to approach retailers in their region and establish relationships where retailers sell the collection kits, and the lab performs the test and reports the results.

Since patients pay cash for the SARS-CoV-2 tests at the time they purchase the kits, clinical labs are guaranteed payment for the tests without the need to submit claims to consumers’ insurance companies. That’s another benefit to these types of arrangements.

—Donna Marie Pocius

Related Information:

Costco Sells At-Home COVID-19 Tests Using Saliva Samples

EUA for the P23 Labs TaqPath SARS-CoV—2 Assay

FDA Authorizes First Diagnostics Test Using Home Collection Saliva

There are 12 Coronavirus Tests You Can from Home: How They Work and How to Get One

Saliva Samples Preferable to Deep Nasal Swabs Testing for COVID-19

Saliva is More Sensitive for SARS-CoV-2 Detection in COVID-19 Patients Than Nasopharyngeal Swabs

FDA Issues Emergency Use Authorization Yale School of Public Health

COVID-19 Saliva Spit Test

Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2

Travel Restrictions Spur Four US Airlines to Get Into COVID-19 Testing, But Will Clinical Laboratories Get this Testing Business?

United Airlines creates pilot program for on-site rapid PCR tests, as other airlines facilitate at-home specimen collection for rapid coronavirus testing

Four US airlines attempting to recover lost business due to the COVID-19 pandemic are partnering with developers of rapid RT-PCR (reverse transcription polymerase chain reaction) tests to facilitate testing of passengers either at airports before they board their flights, at drive-through testing sites, or at-home in advance of scheduled travel.

This would be a great opportunity for clinical laboratories to gain business, but few details are known about how these airlines are selecting providers for the COVID-19 tests that will be part of their programs.

The deals come amid calls from the International Air Transport Association (IATA) “for the development and deployment of rapid, accurate, affordable, easy-to-operate, scalable and systematic COVID-19 testing for all passengers before departure as an alternative to quarantine measures” in many countries, states an IATA press release.

“The key to restoring the freedom of mobility across borders is systematic COVID-19 testing of all travelers before departure,” said Alexandre de Juniac, IATA Director General and CEO, in the IATA press release. “This will give governments the confidence to open their borders without complicated risk models that see constant changes in the rules imposed on travel.”

From a clinical laboratory testing perspective, the requirement for passengers to be tested prior to travel may contribute to two changes in the lab testing marketplace:

  • Consumers may become accustomed to buying home collection kits for COVID-19 and sending specimens to clinical laboratories. This could have the added benefit of helping consumers become comfortable doing this for other diagnostic tests as well.
  • Pursuit of profit from manufacturing COVID-19 tests that utilize consumer-collected specimens may increase competition in this market and would likely increase the number of at-home specimen collection products that are easier and more convenient to use.

US carriers offering the COVID-19 tests include United Airlines, American Airlines, Hawaiian Airlines, and JetBlue.

United Airlines

United is providing on-site testing through pilot programs at San Francisco International Airport (SFO) and Newark Liberty International Airport (EWR). At SFO, passengers are tested before taking flights to Hawaii. At EWR, they are tested prior to boarding a thrice-weekly flight to London Heathrow.

“We believe the ability to provide fast, same-day COVID-19 testing will play a vital role in safely reopening travel around the world and navigating quarantines and travel restrictions, particularly to key international destinations like London,” said Toby Enqvist, United’s Chief Customer Officer, in a press release.

United began offering testing at SFO on Oct. 15. According to “COVID-19 Testing for United Travelers,” the San Francisco to Hawaii passengers have two options:

  • A $105 drive-through test administered two or three days prior to flights by Color, a San Francisco Bay area health technology company.

The airline says a negative test ensures that travelers can bypass Hawaii’s mandatory quarantine requirements in Lihue, Maui, and Honolulu. For the Newark-to-London flights, United plans to run a pilot rapid testing program from Nov. 16 to Dec. 11. for passengers boarding Flight 14, departing at 7:15 p.m. Mondays, Wednesdays, and Fridays. Premise Health will administer the testing, which will be free to passengers. Those who choose not to be tested will be placed on other flights.

American Airlines testing passengers for COVID-19
A United Airlines flight attendant (above) receives an RT-PCR test for COVID-19 prior to boarding. If the flying public embraces preflight coronavirus testing, including at-home specimen collection kits, clinical laboratories may see a spike in requests for test processing. (Photo copyright: The Washington Post.)

American Airlines

American is offering COVID-19 testing for passengers scheduled on flights to Hawaii, Latin America, and the Caribbean, according to a press release. For the most part, these are at-home specimen collection RT-PCR tests provided by healthcare testing services company PrivaPath Diagnostics, Inc. (d.b.a., LetsGetChecked). Customers receive their results within 24 to 72 hours after the lab receives the samples.

On flights from Dallas Fort Worth International Airport to Hawaii and Costa Rica, passengers have the option of on-site rapid testing at the airport or in-person testing at CareNow urgent care facilities in North Texas.

As with the United flights to Hawaii, the testing program allows passengers to bypass quarantine requirements at their destinations. Customers pay $119 for the LetsGetChecked at-home specimen-collection kit and subsequent RT-PCR testing.

“Our initial preflight testing has performed remarkably well, including terrific customer feedback about the ease and availability of testing options,” American Airlines President Robert Isom said in the press release.

Hawaiian Airlines and JetBlue

In separate press releases, Hawaiian Airlines and JetBlue announced partnerships with Vault Health to offer at-home saliva tests to passengers. After receiving the at-home specimen collection kit, customers can connect through Zoom video conferencing with a Vault Health supervisor who ensures the sample is collected properly.

Hawaiian Airlines also offers drive-through testing at SFO and Los Angeles International Airport through a partnership with Worksite Labs. Passengers pay $90 to receive test results within 36 hours or $150 for express service on the day of travel. Worksite uses a Droplet Digital PCR shallow nasal swab test. The airline says it plans to expand this to other airports.

The Vault Health and Worksite Labs tests meet the state’s guidelines for exemption from the 14-day quarantine requirement, the airlines say.

Impact on Medical Laboratories

Airlines offering COVID-19 testing to their passengers may trigger both an opportunity and a change in the clinical laboratory testing marketplace. First, there is a business opportunity for labs to provide rapid molecular SARS-COV-2 tests to airlines.

Second, if consumers begin using at-home specimen collection kits in greater numbers as part of their air travel requirements, might this make them more comfortable doing self-collection for other types of clinical laboratory tests? A shift in consumer willingness to collect their own medical laboratory specimens—accompanied by ongoing innovations in diagnostic technologies, may eventually reduce the need for medical labs to operate extensive networks of patient service centers.

Of course, such a scenario is years away. But airline COVID-19 testing programs are just one of the progressive steps that can help make that possibility into a reality.

—Stephen Beale

Related Information:

These U.S. Airlines Are Offering Pre-Flight Covid-19 Testing—for a Price

United Airlines Launches World’s First Free Transatlantic COVID-19 Testing Pilot

American Airlines Takes First Steps to Open International Markets to Travel with Preflight COVID-19 Testing

American Airlines Adds Costa Rica to Preflight COVID-19 Testing Program

McKinsey and Company Says the COVID-19 Pandemic is Accelerating Six Critical Trends in Healthcare, at Least One Which Would Benefit Anatomic Pathologists

Clinical laboratory and pathology groups that support ambulatory and virtual care, and urgent care and retail clinics may experience growth

Global management consulting company McKinsey and Company’s report, “The Great Acceleration In Healthcare: Six Trends to Heed,” identifies six trends in healthcare that are accelerating due to the global COVID-19 pandemic.

Clinical laboratory managers and pathology practice administrators should consider how these trends may affect their business and patients when planning for the future.

The McKinsey graphic six trends that are likely to shape post-COVID-19 healthcare
The McKinsey graphic above illustrates the “six trends that are likely to shape post-COVID-19 healthcare.” Clinical laboratories that support health networks struggling with any of these challenges should take steps to prepare for anticipated changes to healthcare delivery. (Graphic copyright: McKinsey and Company.)

1: Healthcare Reform

McKinsey identified three areas where the coronavirus pandemic may impact healthcare reform:

  • “COVID-19-era waivers that could become permanent.
  • “Actions that may be taken to strengthen the healthcare system to deal with pandemics.
  • “Reforms to address the COVID-19-induced crisis.”

McKinsey reports that “the Centers for Medicare and Medicaid Services has introduced more than 190 waivers since the beginning of March 2020.” These waivers can affect all aspects of healthcare, from clinical practice to reimbursement. Some of them, according to McKinsey, are “only relevant during the crisis (for example, the waiver of intensive care unit death reporting). A retrospective assessment of others (for example, expansion of telehealth access) could reveal beneficial innovation worth preserving.”

Several areas that McKinsey says are clearly ripe for reform include improving the resiliency of the healthcare system and the way the system is funded.

Public sector budgets are generally kept strictly separate, each with its own rules and policies that dictate operations. But in his article, “After COVID-19—Thinking Differently About Running the Health Care System,” published in JAMA Health Network, Stuart M. Butler, PhD, Senior Fellow in Economic Studies at the Brookings Institution, wrote, “The intensity of the COVID-19 pandemic … is forcing jurisdictions all across the country to find ways to be nimble so that multiple agencies can work together.”

Thus, McKinsey recommends, “Given the substantial shifts in relative market positioning among industry players that prior reforms have created, leaders would do well to plan ahead now.”

2: Better Access to Healthcare Services

Some people who develop COVID-19 are at far greater risk of hospitalization and death than others, including those who have:

  • Chronic health conditions, including obesity.
  • Mental and behavioral health challenges, such as substance abuse.
  • Unmet social needs, such as food or housing insecurity.
  • Poor access to healthcare.

McKinsey wrote that these “intersecting health and social conditions,” combined with certain races that have higher risk for severe complications, including Black, Indian, and Hispanic/Latino Americans, “correlated with poorer health outcomes.”

Value-based healthcare, telehealth, and greater attention to the social determinants of health may help address some of these issues, McKinsey notes, but the pandemic has shined a spotlight on how lack of care increases risk for certain populations during a public health crisis.

3: Era of Exponential Improvement Unleashed

Some of the trends that appear to be accelerating as a result of the pandemic are good news. McKinsey cites several benefits, including:

  • Improved understanding of patients.
  • Delivery of more convenient and individualized care.
  • $350-$410 billion in annual revenue by 2025.

Through telehealth and other types of virtual care enabled by digital technology, “intuitive healthcare ecosystems” may arise and offer a more integrated experience for patients and their caregivers, McKinsey notes.

“While the pace of change in healthcare has lagged other industries in the past, potential for rapid improvement may accelerate due to COVID-19. An example is the exponential uptake of digitally enabled, virtual care,” McKinsey wrote. “Our analysis … showed that health systems, primary care, and behavioral health practices are reporting increases of more than 50–175 times in telehealth visits, and the potential market size for virtual care could reach around $250 billion.”

McKinsey and Co. report digital enabled virtual care graph
The graphic above is taken from the McKinsey and Co. report, which noted, “Proliferation of digitally enabled, virtual care could further contribute to the rise of personalized and intuitive healthcare ecosystems [that] have the potential to deliver an integrated experience to consumers, enhance productivity of providers, engage both formal and informal caregivers, and improve outcomes while lowering cost.” (Graphic copyright: McKinsey and Company.)

4: The Big Squeeze

The pandemic has caused an enormous outflow of cash from the healthcare system, and some experts don’t expect an injection of funding until 2022. “This outflow is expected to be primarily driven by coverage shifts out of employer-sponsored insurance and possible coverage reductions by employers as well as Medicaid rate pressures from states,” McKinsey states.

“We estimate that COVID-19 could depress healthcare industry earnings by between $35 billion and $75 billion compared with baseline expectations,” McKinsey predicted, adding, “Select high-growth segments will remain attractive (for example, virtual care, home health, software and platforms, specialty pharmacy) and will disproportionally drive growth. These high-growth areas are expected to increase more than 10% over the next five years, while other segments may stagnate or decline altogether.”

5: Fragmented, Integrated, Consolidated Care Delivery

McKinsey says, “The shift of care out of hospitals is not new but has been accelerated by COVID-19.” Rather than the hospital being the center of care delivery, patients are increasingly choosing to receive care at a range of sites across many healthcare ecosystems that are connected digitally and through analytics.

Early in the course of the pandemic, visits to ambulatory care facilities dropped nearly 60% by early April. But by mid-May, those visits were beginning to rebound.

In, “The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound Emerges,” the Commonwealth Fund reported that “the relative decline in visits remains largest among surgical and procedural specialties and pediatrics” but is “smaller in other specialties, such as adult primary care and behavioral health.”

virtual care and outpatient options show more potential revenue growth through 2022 graph
The McKinsey graphic above shows how “virtual care and outpatient options show more potential revenue growth through 2022.” Clinical laboratories that support those healthcare settings, especially ambulatory surgery, behavioral health, and retail clinics, should experience similar growth. (Graphic copyright: McKinsey and Company.)

6: Adoption of Next-Generation Managed Care Is Accelerating

How will COVID-19 affect the managed care industry? McKinsey says the “next generation” of managed care might use Medicare Advantage as a model.

“Payers pursuing the next generation of managed care model (through deep integration with care delivery) demonstrate better financial performance, capturing an additional 50 basis points of earnings before interest, taxes, depreciation, and amortization above expectation,” McKinsey noted, adding, “Employers and payers could consider fundamentally rethinking how employer-sponsored health coverage is structured. Learning from Medicare Advantage could provide inspiration for such a reimagination.”

What Should Clinical Laboratory Managers Do?

The McKinsey article concludes by stating, “While the challenges are numerous, leaders who seize the mindset that “disruptive change provides an opportunity to separate yourself from the pack” will build organizations meaningfully stronger than the ones they ran going into the crisis.”

The McKinsey article authors recommend that healthcare organizations take several proactive steps, including:

  • Launch a plan-ahead team.
  • Question your role and your future business model.
  • Prepare to transform your business.
  • Reimagine your organization to make faster decisions.
  • Take action to drive health equity.

Though the McKinsey and Company article covered healthcare in general, many of the authors’ observations and recommendations can apply to clinical laboratories and pathology groups as well and may be valuable in future planning.

—Dava Stewart

Related Information:

The Great Acceleration in Healthcare: 6 Trends to Heed:

After COVID-19—Thinking Differently About Running the Health Care System:

The Next Wave of Healthcare Innovation: The Evolution of Ecosystems

The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound Emerges

As Primary Care Providers and Health Insurers Embrace Telehealth, How Will Clinical Laboratories Provide Medical Lab Testing Services?

Fidelity Study Predicts Baby Boomer Medical Laboratory Personnel and Pathologists May Defer Their Retirements Due to Increased Healthcare Costs

Rising out-of-pocket healthcare costs could force older clinical laboratory workers to put off retirement plans altogether, even when on Medicare

For the past decade, anatomic pathology laboratory executives have been bracing for an expected avalanche of retiring baby boomer medical technicians, histotechnologists, cytotechnologists, clinical chemists, and pathologists who are reaching retirement age. However, rising out-of-pocket Medicare and other healthcare costs may cause these older medical laboratory professionals to defer full retirement as long as possible, a recent study concludes.

The latest Retiree Healthcare Cost Estimate from Fidelity predicts that the average 65-year-old couple will need to set aside a record $260,000 in today’s dollars for Medicare and all other out-of-pocket medical costs during their retirement years. That’s a 6% jump from 2015 and up 18% from 2014. The average 65-year-old woman can expect to need $135,000 of that total because she is expected to live two years longer than the same age man.

Fidelity blames the $15,000 increase from 2015 costs on seniors’ higher use of medical services, and rapidly rising prescription and specialty drug prices. The cost estimate does not include long-term care coverage, which Fidelity estimates would require an additional $130,000 in savings for an $8,000 maximum monthly benefit spread over three years and including a 3% inflation adjustment per year.

Out-of-Pocket Expenses Create Sticker Shock

Adam Stavisky, Senior Vice President of Fidelity’s Benefits Consulting Services, acknowledges healthcare costs may cause older workers to reconsider their workforce exit strategy.

“The sticker shock of this estimate hopefully reinforces for many people that they need to act now, regardless of their age,” Stavisky states in a Fidelity Viewpoints article. “Rising healthcare expenses are forcing people to make educated decisions now more than ever, ranging from the services they utilize to the age they choose to retire.”

Not covered by Medicare Part A or Part B

While Medicare is designed to cover most medical expenses in retirement, it does not cover long-term care or other services such as routine dental or vision care. Fidelity estimates a 65-year-old couple would need an additional $130,000 to insure against long-term care expenses. The increased cost of healthcare after retirement is considered by some to be one reason why many clinical laboratory scientists and pathologists of the Baby Boomer Generation may be putting off retirement. (Photo copyright: Medicare.)

While Medicare is designed to cover many healthcare related expenses in retirement, Medicare’s monthly premiums and out-of-pocket costs can be substantial, quickly adding up to $300 or more per month. According to a Commonwealth Fund Issue Brief, a retiree’s monthly premium in 2017 for Medicare Parts A and B is $134, with Medicare Part D (prescription drug coverage) adding $42 to that total. The Commonwealth Fund is a private foundation that advocates for higher quality healthcare and accessibility for low-income and elderly Americans.

In addition, higher income beneficiaries pay an “income-related monthly adjustment” to their premiums for Medicare Part B and Medicare prescription drug coverage. Adding to the monthly costs are deductibles and co-pays:

  • Medicare Part A, which covers hospitalization, has a $1,316 deductible and potential co-insurance;
  • Part B, covering outpatient services, doctors care, preventive services and medical equipment, has a $183 deductible, with 20% co-insurance for most doctors’ visits, inpatient services or durable medical equipment; and
  • Medicare Part D’s deductible, which varies by policy, is capped at $400 per year.

The Commonwealth Fund found that “more than one-fourth of all Medicare beneficiaries—15 million people—spend 20% or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services … Overall, beneficiaries spent an average of $3,024 per year on out-of-pocket costs,” the study concluded.

Retirement Cost Gap Affects Pre-retirees

Fidelity’s Retiree Healthcare Cost Estimate underscores how important it is for retirees to understand what Medicare does and doesn’t cover.

“Healthcare is creating a ‘retirement cost gap’ for many pre-retirees,” stated Lee Belniak, Vice President in Fidelity Workplace Investing, in a Fidelity Viewpoints post. “Although many assume their savings will cover all their expenses in retirement, healthcare costs are often higher than anticipated. Many people assume Medicare will cover everything, but it doesn’t. The average 65+ retiree today should expect to pay around $5,000 a year on healthcare premiums and out-of-pocket expenses, and should carefully weigh all options.”

A Medicare supplement (Medigap) plan, from a private insurer is one way to guard against runaway Medicare costs. A Medicare Supplement reduces out-of-pocket expenses when using Medicare Part A or B and may include vision and dental benefits. However, The Commonwealth Fund note in their Issue Brief that Medicare supplement plans are expensive, with premiums averaging $2,000 per year in most areas, but as much as $200 per month in New York City.

Fidelity recommends pre-retirees consider Medicare Advantage, a health insurance program within Medicare Part C, if available in their area. The most common types of Medicare Advantage Plans are:

Medicare Advantage Plans often charge a premium in addition to the Medicare Part B premium, but the plans may pay a higher percentage of claims than Medicare Parts A and B, and provide additional benefits such as routine vision and dental care. While Medicare Advantage plans charge co-payments or co-insurance for covered services, they include an annual out-of-pocket limit. Fidelity notes that, over an extended retirement period, a Medicare Advantage plan could reduce a retiree’s overall healthcare costs.

Most Boomers Not Prepared for Retirement

According to an Insured Retirement Institute (IRI) study on boomer retirement savings and expectations, only 23% of boomers believe their savings will last throughout retirement, and only six in 10 included healthcare costs in their retirement savings projections.

“Baby boomers are not taking full advantage of the resources available to help them achieve a secure and dignified retirement,” IRI President and Chief Executive Officer Cathy Weatherford noted in a press release. “Retirement planning which focuses on holistic strategies, and considers retirement risks such as longevity, healthcare, long-term care, and lifestyle expectations, is the key to ensuring boomers’ financial resources will provide income and security for their lifetimes.”

Clinical laboratory managers and pathology groups should be asking, “How many of our retirement age workers have no intention of retiring any time soon?” If the Fidelity and Commonwealth studies are accurate, the answer to that question could greatly impact how medical laboratories maintain their workforces.

—Andrea Downing Peck

Related Information:

How to Plan for Rising Healthcare Costs

Retire Health Costs Rise

Medicare Beneficiaries’ High Out-of-Pocket Costs: Cost Burdens by Income and Health Status

Baby Boomers’ Challenging Retirement Math

Boomer Expectations for Retirement 2017

Retirees Need $130,000 Just to Cover Healthcare, Study Finds

Gap Insurance Trend Protects Employees from Crippling Out-of-Pocket Costs and Offers Clinical Laboratories New Method to Receive Payments

Medical laboratory and pathology groups could benefit from trend by receiving payments for testing services from secondary payer rather than directly from patient

As high-deductible health plans (HDHPs) become the norm for more Americans, gap insurance is being touted as an innovative way to protect consumers from crippling healthcare costs. This added insurance protection is proving attractive to a growing number of patients with HDHPs.

Use of gap plans by more patients also could benefit clinical laboratories and pathology groups. That’s because patients with HDHPs who would normally be required to pay 100% of their lab testing charges until their annual deductible is met, would be covered for these costs because of their gap insurance. In these situations, labs would have a secondary insurer to bill until the annual deductible was met. (more…)

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