The High-Cost Reality: What 2024 Trends Mean For Self-Funded Employers

Here are five insights every employer should know.

1. Just a few members drive one-third of all costs
   
   High-cost claimants — defined as those with more than $100,000 in annual paid claims — made up a very small share of members in 2024. Yet they accounted for over 30% of total spend. These members often face serious, ongoing conditions that require sustained and expensive treatment. For employers, a single high-cost claimant can transform the financial outlook of a health plan year.
   
   
2. Million-dollar claims are rising fast
   
   The number of claims over $1 million jumped nearly 74% between 2021 and 2024. In 2024 alone, nearly 600 members generated claims of at least $1 million. Many of these claims were tied to circulatory conditions, newborn care, cancer, and severe injuries. These are conditions that can be difficult to anticipate and nearly impossible to absorb without protection.
   
   
3. Specialty drugs and gene therapies reshape the risk curve
   
   Specialty drug spending continues to grow at double-digit rates. Cancer therapies account for more than half of all specialty drug costs among high-cost claimants. Even more disruptive are gene therapies, which can cost up to $4 million for a single treatment. With more FDA approvals expected, the number of eligible patients will only grow. These are low-frequency but extremely high-severity claims — exactly the type that can destabilize a self-funded health plan.
   
   
4. Cancer, heart disease, and musculoskeletal conditions dominate costs
   
   Three categories — cancer, circulatory disease, and musculoskeletal conditions — represented nearly 54% of all high-cost claimant spending in 2024. Cancer treatments alone accounted for $11.9 billion of spend across high-cost members. These conditions are not only expensive, but also persistent. They often require ongoing treatment that elevates cost risks year after year.
   
   
5. Some high-cost members stay high-cost across years
   
   About 13% of high-cost claimants in 2023 were also high-cost in both 2022 and 2024, often with the same condition. This means that employers’ financial exposure is not limited to one-time catastrophic events. It can be a recurring burden. For employers, planning for these ongoing risks is as important as preparing for unexpected ones.

The Anthem difference

At Anthem, we combine deep claims data, specialized solutions, and robust stop loss coverage to help self-funded employers prepare for these realities. Our stop loss options, most often with deductibles between $100,000 and $250,000, are designed to protect your business against catastrophic volatility. With our Gene Therapy Solution, employers get added protection for high-dollar therapies that are reshaping the cost landscape.

When it comes to protecting your health plan, it is not just about managing today’s claims — it is about planning for tomorrow’s risks.

Download the full white paper to explore the 2024 data in detail.