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County officials say plan changes and negotiations cut risk, set $80,000 specific deductible
Summary
Benefits staff told commissioners Montgomery County’s HealthRx plan kept a specific deductible at $80,000 and that market negotiations reduced a potential aggregate liability by about $400,000, leaving an estimated all‑in max cost of about $3.1 million for the 2026–27 plan year.
County benefits staff reviewed HealthRx claims and renewal outcomes for the board, reporting a mostly stable membership (about 165) and highlighting a negotiation that reduced potential aggregate liability. The presenter said the county's specific deductible remains $80,000 per member and that, after market outreach and discussion with Aetna, the county’s projected all‑in maximum cost for the 2026–27 plan year is approximately $3,100,000, a reduction from an earlier figure near $3.5 million.
Staff also presented claim stratification and identified a handful of high‑dollar claimants who had used substantial portions of the deductible levels in the prior year. "We guarantee at least 400 completed surveys..." (note: that quote appears in a separate survey presentation). On plan details, the presenter described anticipated monthly reporting on claims running and noted pharmacy‑benefit manager (PBM) changes intended to control specialty drug pricing; staff said they would continue to monitor utilization and report monthly claim trends to the commissioners.
