Why do medical insurance premiums increase every year? Find out the reasons for
A friend asked, why does the premium for medical insurance increase year after year? In fact, there are two types of medical insurance systems in our country: the basic medical insurance for employees and the medical insurance for urban and rural residents. The annual premiums for these two types of insurance increase, but for different reasons.
1. The increase in the premium amount for basic medical insurance for employees.
According to national regulations, the premium amount for employee medical insurance is equal to the contribution base multiplied by the contribution rate.
For example, if the contribution base for employees in 2024 is determined according to the lower limit of the contribution base in Shandong Province, which is 4,242 yuan, and the combined contribution rate for employees and employers is 10%, then a monthly premium of 424.2 yuan is required.
Advertisement
However, the national social insurance contribution base has an upper and lower limit. Each year, the upper and lower limits of the medical insurance contribution base in Shandong Province are determined based on 60% to 300% of the total wages of the previous year. As the average social wage increases each year, the upper and lower limits of the contribution base will also rise.
For example, if Shandong Province announces a 5% increase in the total social average wage for the previous year in 2023, then the lower limit of the contribution base for this year will also increase by 5%, and the premium amount will increase by approximately 21.2 yuan.
For flexible employment personnel, the vast majority choose to pay at the lower limit of the contribution base. Some people ask, is it not possible to choose not to pay medical insurance at the lower limit of the contribution base? For many people, since the medical insurance reimbursement ratio is basically the same regardless of the contribution base, those who aim for medical insurance reimbursement are definitely not willing to choose a high base for payment.
In some places, there is a unified contribution base. For example, Chengdu City in Sichuan Province clearly stipulates that the contribution base for medical insurance for flexible employment personnel is 6,015 yuan or 7,518 yuan (only for pooling). In most places in the country, the medical insurance premium for flexible employment personnel is more than three to four hundred yuan per month.② The amount of payment for urban and rural residents' medical insurance has increased.
In recent years, the payment for urban and rural residents' medical insurance has also been continuously rising. The annual standards for resident medical insurance payments and financing are determined by the National Medical Insurance Administration, the Ministry of Finance, the State Taxation Administration, and other departments, which issue notices to ensure the work of urban and rural residents' medical security.
China's resident medical insurance was merged from the New Rural Cooperative Medical Scheme and the urban resident medical insurance. Initially, the individual payment standard was less than 100 yuan, and the government subsidy standard was also not high. Due to the low financing standard, the corresponding reimbursement standard was also not high. To improve this situation, the payment standard began to increase by 30-40 yuan annually.
By 2023, the individual payment standard for resident medical insurance was 380 yuan, and the financial subsidy standard was 640 yuan. This year, the state has clearly raised the financial subsidy standard by another 30 yuan. In previous years, the individual payment standard would also be increased synchronously, so it is estimated that this year's individual payment for resident medical insurance will be around 410 yuan.
The principles considered by the state when setting the payment standards are: economic and social development, progress in medical technology, the increase in medical expenses, and the medical security needs of resident medical insurance.
Last year, the total medical expenses for insured residents in the resident medical insurance were 1.96 trillion yuan. The hospitalization reimbursement ratio (payment ratio within the catalog) for insured residents was 68.1%, and even the payment ratio for primary and lower-level medical institutions reached 80.8%, which can effectively solve the situation of people becoming impoverished due to illness.
To be honest, with the increase in the amount of medical insurance financing, the three-tier protection of basic medical insurance, serious illness medical insurance, and medical assistance is becoming more and more perfect, and the protection for low-income groups is getting better and better.
Relatively speaking, medical insurance is a relatively fair insurance in terms of treatment, and the reimbursement ratio for everyone is basically the same, so the payment amount may be more balanced. #Top Headline Creation Challenge#
A friend asked, why does the premium for medical insurance increase year after year? In fact, there are two types of medical insurance systems in our country: the basic medical insurance for employees and the medical insurance for urban and rural residents. The annual premiums for these two types of insurance increase, but for different reasons.
1. The increase in the premium amount for basic medical insurance for employees.
According to national regulations, the premium amount for employee medical insurance is equal to the contribution base multiplied by the contribution rate.
For example, if the contribution base for employees in 2024 is determined according to the lower limit of the contribution base in Shandong Province, which is 4,242 yuan, and the combined contribution rate for employees and employers is 10%, then a monthly premium of 424.2 yuan is required.
Advertisement
However, the national social insurance contribution base has an upper and lower limit. Each year, the upper and lower limits of the medical insurance contribution base in Shandong Province are determined based on 60% to 300% of the total wages of the previous year. As the average social wage increases each year, the upper and lower limits of the contribution base will also rise.
For example, if Shandong Province announces a 5% increase in the total social average wage for the previous year in 2023, then the lower limit of the contribution base for this year will also increase by 5%, and the premium amount will increase by approximately 21.2 yuan.
For flexible employment personnel, the vast majority choose to pay at the lower limit of the contribution base. Some people ask, is it not possible to choose not to pay medical insurance at the lower limit of the contribution base? For many people, since the medical insurance reimbursement ratio is basically the same regardless of the contribution base, those who aim for medical insurance reimbursement are definitely not willing to choose a high base for payment.
In some places, there is a unified contribution base. For example, Chengdu City in Sichuan Province clearly stipulates that the contribution base for medical insurance for flexible employment personnel is 6,015 yuan or 7,518 yuan (only for pooling). In most places in the country, the medical insurance premium for flexible employment personnel is more than three to four hundred yuan per month.② The amount of payment for urban and rural residents' medical insurance has increased.
In recent years, the payment for urban and rural residents' medical insurance has also been continuously rising. The annual standards for resident medical insurance payments and financing are determined by the National Medical Insurance Administration, the Ministry of Finance, the State Taxation Administration, and other departments, which issue notices to ensure the work of urban and rural residents' medical security.
China's resident medical insurance was merged from the New Rural Cooperative Medical Scheme and the urban resident medical insurance. Initially, the individual payment standard was less than 100 yuan, and the government subsidy standard was also not high. Due to the low financing standard, the corresponding reimbursement standard was also not high. To improve this situation, the payment standard began to increase by 30-40 yuan annually.
By 2023, the individual payment standard for resident medical insurance was 380 yuan, and the financial subsidy standard was 640 yuan. This year, the state has clearly raised the financial subsidy standard by another 30 yuan. In previous years, the individual payment standard would also be increased synchronously, so it is estimated that this year's individual payment for resident medical insurance will be around 410 yuan.
The principles considered by the state when setting the payment standards are: economic and social development, progress in medical technology, the increase in medical expenses, and the medical security needs of resident medical insurance.
Last year, the total medical expenses for insured residents in the resident medical insurance were 1.96 trillion yuan. The hospitalization reimbursement ratio (payment ratio within the catalog) for insured residents was 68.1%, and even the payment ratio for primary and lower-level medical institutions reached 80.8%, which can effectively solve the situation of people becoming impoverished due to illness.
To be honest, with the increase in the amount of medical insurance financing, the three-tier protection of basic medical insurance, serious illness medical insurance, and medical assistance is becoming more and more perfect, and the protection for low-income groups is getting better and better.
Relatively speaking, medical insurance is a relatively fair insurance in terms of treatment, and the reimbursement ratio for everyone is basically the same, so the payment amount may be more balanced. #Top Headline Creation Challenge#