V-BID Update: Still time to Register for Tomorrow’s Free Virtual Summit! Plus, Chronic Conditions Costly

In this Issue:

• Last Chance! Register for Tomorrow’s Virtual V-BID Summit
• GLP-1 Coverage Expansion Moves Forward
• Chronic Illness Drives Healthcare Spending Among Millennials
• Chronic Conditions Drive Majority of Health Care Use
• HSA-HDHP and HRA Enrollment Declines to 15%
• Proposed ACA Rules Would Sharply Raise Out-of-Pocket Costs
• Retirement Health Care Savings Targets Rise Again

GLP-1 Coverage Expansion Moves Forward with BALANCE Model Applications Now Open

CMS has completed price negotiations with Eli Lilly and Novo Nordisk and is now accepting applications from state Medicaid agencies and Medicare Part D plan sponsors to participate in the BALANCE Model, which aims to lower cost-sharing and expand access to GLP-1 medications for weight management. The model is expected to launch in participating states as early as May 2026, representing a significant step toward value-based coverage of treatments that may prevent or delay obesity-related chronic conditions.

Chronic Illness Drives Healthcare Spending Among Millennials

A UnitedHealthcare and Health Action Council white paper finds that Millennials and Gen Z are developing chronic conditions like diabetes and obesity earlier in life, visiting emergency rooms more frequently, and engaging with primary care providers less often than any other generation, with their claims growth rate nearly double that of Baby Boomers between 2023 and 2025. The findings underscore the value of benefit designs that prioritize preventive care, early screenings, and evidence-based chronic disease management to reduce long-term cost exposure for both employees and employers.

Chronic Condition Patients Drive Majority of Health Care Use, with Fragmented Care Adding Cost

A Vizient Research Institute report found that patients with multiple chronic conditions accounted for more than half of inpatient admissions and generated roughly 10x more hospital and emergency department visits than those without chronic conditions in 2024. Medicare members with multiple chronic conditions who receive care across more than one health system incur about 30% higher annual expenditures than those treated within a single system.

HSA-HDHP and HRA Enrollment Declines to 15% of Insured Adults in 2025

A new EBRI/Greenwald survey finds that enrollment in high-deductible health plans paired with an HSA or HRA fell to 15% of insured adults in 2025, raising questions about consumer engagement with account-based benefit designs and their role in managing out-of-pocket costs.

Proposed ACA Rules Would Sharply Raise Out-of-Pocket Costs for Marketplace Enrollees

The Trump administration has proposed ACA marketplace rules that would allow deductibles to reach $15,000 for individuals and $31,000 for families–far exceeding current limits–while potentially lowering monthly premiums. The administration’s own estimates project the proposal could result in up to 2 million people losing coverage by 2027, raising significant concerns about access to high-value care.

Retirement Health Care Savings Targets Rise Again, Reaching Up to $469,000 for Some Couples

A new EBRI issue brief projects retirement health care savings needs under the Inflation Reduction Act’s 2025 Part D out-of-pocket drug cap, finding that costs remain significant–a couple with high prescription drug expenditures may still need up to $469,000–with targets varying widely by plan type, premiums, and drug use, highlighting the impact of benefit design on long-term cost exposure.

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