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%. 

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?