Preventive Care Wellness Plan
Companies across the country continue to face rising healthcare costs, which directly impact the cost of providing employee health insurance. Higher medical claims lead to increased premiums, making it more difficult for employers to manage healthcare expenses while maintaining valuable benefits for their employees. One of the most effective ways to help control these costs […]
How is AI underwriting applied to group health insurance?
AI underwriting helps an insurance carrier estimate what an employer group may cost to insure. It reviews information such as the group’s employee census (ages, locations, number of dependents, and enrollment tiers), plan design, industry, and medical and prescription claims. AI looks for patterns that may predict future costs, such as higher use of specialists, […]
2026 Health Trends Report
The following is an excerpt from UnitedHealthcare’s 2026 Health Trends Report. The report provides valuable insight into health care costs. The good news is I have a few proven techniques to mitigate the increasing rise in health care costs. Thus, if you know a company wondering what course of action is open to them introduce […]
IRS Guidelines – Indexed for 2026
FICA Social Security Tax is 6.2% on income up to $183,600 Medicare Tax unlimited 1.45% to Unlimited ACA Affordability — The ACA benchmark for determining the affordability of employer-sponsored health coverage will drop significantly to 9.96% of an employee’s household income for the 2025 plan year. High Deductible Health Plans Minimum Annual Deductible (Individual/Family) $1,700 / $3,400 […]
How does Medicare paying physicians less than commercial insurance affect the commercial health insurance market?
According to a report from Omniscient Health, a healthcare data science, research and consulting firm, physicians are paid 33.6% less for treating Medicare patients than a decade ago thanks to reimbursement cuts coupled by rising practice expenses When Medicare pays healthcare providers less than commercial insurance does for the same services, it creates several ripple […]
Industry Trends
Large U.S. employers expect median health care costs to rise 10% in 2026. Small employers can typically expect larger increases. The projected increase is attributed to a variety of factors, with specialty drugs and catastrophic claims the biggest contributors. The top four factors Specialty drugs Catastrophic claims Utilization due to chronic conditions Medical provider costs […]
“One Big Beautiful Bill”
The President has signed the “One Big Beautiful Bill”. The health-related provisions are as follows: The bill: Did not take away the employer tax exclusion, a big win in maintaining the ability of employers to offer employee benefits. Did not renew the enhanced premium tax credits, which means they will revert to the original Affordable […]
IRS Guidelines – Indexed for 2025
FICA Social Security Tax is 6.2% on income up to $176,100 Medicare Tax unlimited 1.45% to Unlimited ACA Affordability — The ACA benchmark for determining the affordability of employer-sponsored health coverage will drop significantly to 9.02% of an employee’s household income for the 2025 plan year. High Deductible Health Plans Minimum Annual Deductible (Individual/Family) $1,650 / $3,300 […]
Pharmacy Benefit Management – Part 3 – Case Study
How can your company reduce pharmacy costs while providing the best care and service to employees? Our PBM model consistently delivers high value and significant savings to clients. While each element of our program produces savings for clients, the savings are maximized when all programs are implemented. As each pathway targets different savings opportunities. In […]
Pharmacy Benefit Management – Part 2
Do you know how specialty medications are impacting your company’s health insurance costs? While specialty medications offer promising treatment options for complex conditions, their high cost can pose challenges for affordability and access, impacting both patients and healthcare systems. Specialties not only cause significant increases to the overall plan, but can impose financial hardships on […]