According to findings by AHIP, a national association whose members provide health care coverage and services, here's how every dollar spent on health care is allocated:

• Hospitals: 40.7 cents, including inpatient, outpatient and emergency room costs: 
  • Emergency Room Costs: 3.2 cents go to ER visits, including payments to physicians, facility costs and ambulance transport.
  • Inpatient Hospital Costs: 17.6 cents is for services, including for the administration of prescription drugs and payments to physicians and facilities.
  • Outpatient Hospital Costs: 19.9 cents for physician and facility non-drug related payments for treatment.

Whether you refer to it as Reference-Based Pricing (RBP), Medicare Reference, Cost Plus or something else, the important thing is to understand what it is and why it’s being used to lower health plan costs.

​Level-funded health plans with reference-based pricing provide high quality coverage at a lower cost by using Medicare fee schedules as a base. Then they negotiate with hospitals and physicians to determine an acceptable percentage margin over and above Medicare. Margins often fall within a range of 25% to 65%. 

​Anyone who has health benefit coverage has been, or will soon be, asked to review their current health benefit coverage for 2025. Here is what you need to know whether you have employer-sponsored coverage, coverage from the federal government’s health care Marketplace or private individual insurance.

​The start of the school year is upon us, and for many college students, especially those living away from home for the first time or participating in sports, securing adequate health insurance can be a significant concern. But short-term medical insurance can be a flexible solution for addressing temporary health needs during the academic calendar. Here's why:

​Beginning Sept. 1, 2024, new short-term health plans will be limited to three months and a one-month extension providing a duration maximum of four months per insurance carrier over a 12-month period (additional state rules may apply). 
 
Short-term health insurance plans (STM) are designed to provide individuals with economical, temporary coverage for illnesses and accidents. Benefits can include wellness visits, doctor office copays, and coverage for hospital emergencies, surgery and more. A range of deductible options usually are available to keep monthly premiums lower.

Under federal law, employers that offer a group health plan to employees have up to 90 days to implement a new team member on a company health insurance plan. Some offer coverage right away, and some stretch out their risk up to the allowable 90 days for financial or administrative reasons. But even if a new employee doesn’t have health insurance through the company, you want them to remain healthy and financially viable while orienting to their new job. And we know COBRA is not feasible for a majority of the working population. Is there an economical option to keep employees from going uninsured?

Artificial intelligence (AI) is infiltrating many areas of our daily lives. For instance, every time you say “Siri” or “Alexa, can you…” you are using AI technology. The goals for AI were to enhance learning, boost speed, precision and effectiveness of tasks that were otherwise done manually.

One of the expressed goals of the Affordable Care Act, when it was passed by Congress in 2010, was to make affordable health insurance available to more people. Unfortunately, that didn’t materialize for everyone – even for those covered by their employers’ health benefits.

For instance, the Kaiser Family Foundation and Los Angeles Times’ 2019 survey found that two in five adults covered by employer-sponsored insurance reported difficulty affording medical care, prescription drugs or premiums.

In an attempt to lower premiums, many employers have turned to level-funded plans that offer health benefits. Level-funded plans can save employers money by paying the claims of their employees with their own money instead of insurance premiums. Plus, 12 level monthly payments each year cover all the costs for an employer’s group plan.

One of the most affordable level-funded options are Minimum Essential Coverage Plans (MEC).

More and more individuals have increasingly turned to self-employment, freelance jobs and contract employment opportunities in the wake of the COVID-19 pandemic. This has contributed to a gig economy that experts say is now growing at a faster pace than the traditional employment market.