November is National Alzheimer’s Awareness Month in the U.S., and its goal is to bring public awareness to the warning signs of dementia and to challenge the stigmas and misinformation surrounding the disease.
It’s also an opportunity to talk to clients about how chronic conditions like dementia and Alzheimer’s can impact the workplace and potentially influence employee benefits offerings.
Employee populations are likely more effected by Alzheimer’s than anyone realizes. Today, an individual develops Alzheimer’s every 66 seconds—an estimated 6.2 million Americans are living with the disease—and by 2050, the rate is expected to increase to one person every 33 seconds.
Alzheimer’s, however, doesn’t just affect the person afflicted. In 2020, more than 11 million Americans provided an estimated 15.3 billion hours of care for people with Alzheimer’s or dementia, and of those 11 million caregivers, approximately 60% provided care while also maintaining full-time employment.
More than 33% of those caregivers report their own health has suffered due to care responsibilities, and it has affected their work performance.
As part of the national awareness effort, we are publishing a two-part series this month to talk about Alzheimer’s disease in the workplace and offer proactive ways you can collaborate with clients on employee-benefits solutions that offer support to employees while keeping healthcare costs in check and minimizing compliance risk.
In part one, we will address options for employees who are afflicted with Alzheimer’s or dementia, and part two will focus on benefits that support caregivers.
Alzheimer’s in Employee Populations
Alzheimer's is a type of progressive dementia that affects memory, thinking and cognitive behavior. The disease is most common in those over age 65, affecting one in nine people. Alzheimer’s has no cure, and symptoms eventually grow to interfere with daily living.
In the U.S., 65 years old has traditionally been considered retirement age; however, many Americans are now choosing to remain in the workforce longer. In fact, 25% of the current workforce is Baby Boomers, the age group most likely to develop Alzheimer’s.
Employers who have a significant employee population age 40 and older need to not only be prepared for the increased healthcare costs associated with chronic conditions, but also consider options carefully to remain compliant with anti-discrimination laws.
Compliance Concerns & Benefit Options
The landscape for regulatory compliance is constantly evolving, and many of your mid-size and smaller clients might find it challenging to stay up to date on specific regulations and employer responsibilities.
This is an area where you can offer not only insurance market insights, but also guidance that helps clients steer clear of compliance missteps as they design their benefits plan.
Americans with Disabilities Act (ADA): The law prohibits employment discrimination against qualified individuals with a disability. (Individuals, however, must be able to perform the essential functions of the job with or without accommodation.)
Alzheimer’s is a progressive disease, and the progression rate differs by diagnosis. If symptoms are recognized early, some medical treatments (emerging technologies and prescription drugs) can slow the disease progression, which might allow an employee with the disease to continue to perform his or her job duties for years.
This means employers should be prepared for ongoing healthcare costs associated with early Alzheimer’s. Prescription drug prices are one of the largest contributors to costs, with monthly prices ranging from $240 to $460 for just one medication.
While fully insured clients don’t have the option to choose their own pharmacy benefits manager (PBM), they could look at carriers with more comprehensive prescription benefits plans.
Many insurance carriers offer care-management services for health-plan participants with chronic conditions, including the guidance of a nurse familiar with the individual’s case as well as Medication Therapy Management (MTM), an ongoing review of prescriptions to avoid medication-adverse events.
For example, an MTM provider reviews the entire medication profile (including nutritional and over-the-counter products) to determine if any product (or product interaction) could be contributing to or causing cognitive impairment. The MTM provider can then consult with the participant’s physicians and suggest changes to prescriptions that would eliminate or reduce negative side effects.
Employers need to be careful about age-based premiums and employee contributions for such benefits plans, however, or they could run afoul of another employment law.
Age Discrimination in Employment Act (ADEA): Employers cannot discriminate against employees aged 40 and over based on age. This means they cannot deny employee benefits based on age, nor can they require employees to pay a larger proportion of their premiums than younger employees pay.
Notable Impact on Premiums
In age-banded plans where carriers charge premiums based on age, employers cannot contribute a flat rate (e.g., $200) to all employee premiums because this is not considered a proportionate contribution if the premium for one employee is $600 and $800 for another.
Employers can, however, contribute the same percentage (e.g., 50%) for all employees. While the employee contribution to the premium will differ, the employer’s contribution rate is equal. Thus, it isn’t deemed discriminatory.
Notable Impact on Offering Early Retirement
Private employers are not required to offer health benefits to retirees unless they have an employment contract that states otherwise (union contracts often include provisions for retiree-benefit programs), which might make it tempting to offer early retirement to avoid healthcare costs.
The ADEA, however, specifically forbids employers from terminating an employee aged 40 and over based on age. An early retirement agreement must include a legal contract in which the employee knowingly and voluntarily waives his or her right to age discrimination claims.
Another notable impact related to age and potential retirement involves Medicare.
Medicare: Employees are eligible for Medicare at age 65, but they are not required to enroll if they remain eligible for comparable benefits through their (or their spouses’) employers.
Whether to remain on an employer’s health plan or switch to Medicare can be a stressful choice for employees and their spouses. There are a variety of options for Medicare and Medicare Advantage plans that could be more beneficial to the employee than remaining on the employer’s plan, but comparison shopping can be confusing.
This is an opportunity for you to advise employers about offering phased retirement and transitional retirement health plans like Amwins Retiree Benefits Choice Program, which gives employees access to exclusive group health plans and Medicare Benefits Specialists.
These specialists provide education and help employees review health plans and understand options. Specialists also guide employees through a stress-free enrollment process.
This can be a win-win for employers—supporting employees while also transitioning their healthcare costs out of the employer-sponsored health plan.
Healthcare costs continue to increase year over year, and chronic conditions like Alzheimer’s, heart disease and diabetes can be huge contributors to plan costs. Employers are continually on the lookout for ways to manage the expense associated with employer-provided health plans, and more employers are trying to design benefits plans that appeal to a multi-generational workplace. Increasing awareness about the healthcare challenges commonly associated with certain populations can help employers make strategic decisions about benefits offerings that truly meet employees’ needs.
Your relationship with Amwins’ expert brokers not only gives you access to comprehensive benefits offerings, but also knowledge resources and tools that can set you apart in the marketplace. Together, we can provide the support your clients need.