Commissioners authorize move to Gravy (Aetna network) for 2026 employee health plan

The Dickinson County Commission voted Oct. 30 to authorize staff to pursue a 2026 employee health plan with Gravy, a carrier that uses the Aetna provider network, after a work-study session where the county's benefits broker laid out plan designs and cost comparisons.

Courtney, a representative from the county's benefits broker, told department heads and elected officials that the broader market has seen "30 to 60%" premium increases and that Gravy's offerings include four plan options, three that mirror the county's current design and a so-called comfort-care plan that eliminates most deductibles for routine and preventive services. "So we just wanna go over the options for the 2026 benefits," Courtney said during the presentation.

The comfort-care plan described by the broker pays 100% for many preventive services, primary-care and specialist visits, urgent care, physical therapy, virtual services and many routine diagnostics; it replaces a deductible with co-pay structures and higher out-of-pocket maximums. The broker also noted Gravy uses the Aetna provider network and CVS Health as its pharmacy manager, while local pharmacies such as Auburn Pharmacy would still be able to fill prescriptions.

Why it matters: commissioners and staff said remaining with Blue Cross Blue Shield at the renewal numbers would require substantial additional county funds and much larger increases in employee payroll contributions. The broker and staff said a move to Gravy would produce an estimated employer-side increase of roughly 23% and could be absorbed in the county's current budget; Blue Cross proposals were described as substantially higher and, in some communications shown to the commission, as large as the 30'to-60% range the broker cited.

Commissioner Marcus said department-level feedback was mixed: some employees and elected officials prefer the familiarity of Blue Cross Blue Shield, while others favored Gravy because it reduced projected paycheck impacts. "We got the information out when we could," Marcus said, noting staff had also surveyed employees; he and others said many workers wanted more time and local outreach to confirm provider participation.

Budget and employee impact: during discussion commissioners and staff discussed specific budget estimates presented in the meeting. One staff estimate used in the work-study said staying with the Blue Cross product would require roughly $326,000 more in total premium costs versus the Gravy option, about $153,000 of which would fall to the county budget and the remainder to employees (figures presented in the session). The broker told the commission the Gravy alternative would keep employer costs within the adopted budget while still offering broad no-cost preventive coverage for plan members.

Service and network concerns: staff and the broker acknowledged community questions about provider coverage, mental-health provider access and specialty pharmacy logistics. The broker said Gravy relies on the Aetna network and that some local providers had already been added in nearby jurisdictions that switched earlier. The broker also described a payment plan service (referred to in the presentation as "Gravy Pay") that allows members to pay large out-of-pocket bills over time with no interest or credit checks.

Process and next steps: commissioners authorized county staff to move forward with Gravy/Aetna for 2026 and to begin open enrollment. During the meeting the board asked staff to form a benefits/insurance committee with departmental representation and to step up communication with employees and local providers so members can confirm in-network providers and learn how to use the new plan's member-advocacy services. Court records of the motion show the action carried unanimously of those present.

Quotations used in this article come from county staff and the broker during the Oct. 30 work-study session and the subsequent commission meeting. The commission also approved routine consent items and a procedural notice for a cereal malt beverage renewal at the same meeting; those procedural votes did not change the insurance decision.

What remains unresolved: commissioners said they will continue to ask Blue Cross Blue Shield to revisit its renewal numbers, and that the county could reconsider carriers in future years; the new enrollment materials and a final benefits booklet were to be distributed to employees before open enrollment begins.

Ending note: staff set open enrollment to start in the coming weeks and said the county will provide in-person and virtual education sessions and targeted outreach to employees who have concerns about provider access or premium changes.