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One of the most important financial and personnel-related decisions you can make for your startup is deciding on which health insurance plans to offer your employees.

Throughout the Bay Area and Silicon Valley, COVID-19 has made many startups reevaluate their choice of health plans. Not to mention that investors may be looking for ways to tighten spending with an economic crisis still looming large. Even before the COVID-19 pandemic, selecting which health insurance plan for your business has been a tough balancing act between trying to cater to your employees, recruit top talent, and adhere to your funding situation.

Your first step in trying to navigate how to successfully choose your group health insurance is to understand which tiers you want to offer. After the Affordable Care Act (ACA), health care plans were categorized into different level tiers by insurance companies. ​

You can think of the different metal tier categories like the Olympics. Small group ACA Plans are split into Bronze, Silver, Gold, and Platinum levels.

The higher the tier, the more coverage is paid for by the insurance company in terms of lower deductibles, copays, and out-of-pocket expenses. But at the same time, the higher the metal tier, the more you would pay for in monthly pre-tax premiums.

The plans reflect what percentage of coverage insurance companies pay for out-of-pocket expenses versus what an insured employee enrolled in the health plan would pay. As a general approximation, the plans cover out-of-pocket expenses at the following rates:

  • Bronze: insurance company pays 60% / insured employee pays 40%
  • Silver: insurance company pays 70% / insured employee pays 30%
  • Gold: insurance company pays 80% / insured employee pays 20%
  • Platinum: insurance company pays 90% / insured employee pays 10%

But a lot more goes into understanding the metal tiers than their percentage of coverage. Let’s break down the plan levels further to see which one would be best for your startup.

Bronze Plans

Bronze plans are the lowest tier of health plans. If you are low on cash flow then a Bronze plan will be the least cost for your startup. These plans have the lowest monthly premium out of most major plan options yet they have the highest price point for when you access your care.

You could even have a deductible as high as $6,000, which may only be waived for the first three doctor’s visits of the year.

As an employee, Bronze plans are a good option if you’re looking for coverage in case of an emergency and if you want some form of health coverage without paying a lot each month.

Startups that offer Bronze plans usually do so to offer a Health Savings Account, also known as an HSA. You can create an HSA for High Deductible Health Plans (HDHPs), which are typically only Bronze level plans. But a major caveat is that most companies no longer fund HSAs due to HDHPs providing less and less savings over the years.

Based on my clients’ experiences, Bronze plans are often cheap to buy but expensive to use. In other words, you may be able to cut down on pre-tax monthly costs when it comes to your premiums but you and your employees will be paying for it after-tax when it comes to actually using medical services.

Silver Plans

Silver plans usually have a moderate monthly premium but the enrolled employee will have less out-of-pocket expenses to pay than a Bronze plan.

A typical deductible for a Silver plan is around $1,800 to $2,200 and may be waived for office and specialist visits with only a copay to pay. Some Silver plans even waive the deductible for certain lab tests, x-rays, and outpatient surgeries.

Silver plans are ideal if you are looking to control costs but you still would like to have an increased amount of coverage for care and services.

Silver plans are a smart compromise if your startup doesn’t have limitless resources but you still would like to offer your employees more robust coverage.

Gold Plans

Gold plans typically have high monthly premiums but low costs for when the insured employee receives care.

Startups that want to retain and even recruit talent gravitate towards Gold plans. With a Gold plan offering, employees can be more at ease knowing that the costs of their appointments and procedures will cost less when they use them. For what you receive, Gold plans can be a cost-effective option even with the higher premium.

Employees who utilize large amounts of care would select a Gold option when available since they are willing to pay more in pre-tax premiums so that they could have more coverage for expensive appointments and services.

Platinum Plans

Platinum level plans are the highest tier and offer the most coverage for the insured employee’s medical costs out of all the tiers.

On the other hand, Platinum plans tend to have the highest monthly premiums. If you rarely use health care services then Platinum plans may be a poor option. Typically, Platinum plans are favored by those who have chronic health conditions or diseases, disabilities, or want to pay more on the front end than the back end for using services.

However, there may be tax incentives to a Platinum plan. As an employee, I would want to pay more pretax for higher premiums taken out of my payroll than pay more for services after tax when I try to use them.

Some of the top tech companies offer Platinum benefits. For startups, you may need proper funding in order to provide lucrative Platinum plans. Even with the right funding, startups face difficulty in sustaining Platinum plans because of the high cost and burn rate.

Just remember selecting a Platinum option depends entirely on who you’re recruiting from, if you’re targeting talent who may be accustomed to Platinum level coverage, as well as if you’re sufficiently funded.

Offering More Than One Tier

The wisest solution for a startup would be to offer your employees different options of plan tiers. With the right contribution model of how much your startup pays and how much your employee pays for premiums, you can offer a variety of solutions for your employees that would fit their individual health needs.

Employees can truly reap the benefits of having a diversity of options. Say you’re an employee and become pregnant or are expecting to become pregnant. If your startup offers a variety of plan options, you can sign-up for a Platinum plan to take advantage of the lower out-of-pocket costs for the tests, appointments, and delivery. Even with higher monthly premiums you can save a lot more with having high level coverage for services.

You can then downgrade to a lower tier with less of a monthly premium after you have your baby since having a baby is a qualifying event that allows you to change your health plan. Since all carriers are different, please make sure to check with your carrier and get it in writing before you do this.

A variety of plans will also cater to the diversity of your employees. Someone who is young, healthy, and doesn’t want to pay a lot in premiums may opt for a Bronze or Silver plan. Meanwhile if you are an employee and are going to have a major surgery this year, you may want to think about upgrading to a higher plan so you pay less out-of-pocket.

In the end offering different solutions will be the best way to go.

How Am I Supposed to Decide Between All These Plan Tiers?

All in all, the numbers make the decision for you. If cashflow is not an issue for your startup, then offering high-level plans may make sense for offering a comprehensive benefits package.

Don’t be afraid to start with lower-tiered benefits and work your way up. Employees will always appreciate if you upgrade their tiers as your startup grows, although downgrading plans may hurt morale when funding slows or during economic crises. Remember to exercise caution when selecting a plan tier.

We understand that even if you know the differences between all the various health insurance tiers, it may be difficult to decide which level, let alone which exact plans, will offer you and your employees the best coverage, care, and value.

At AEIS, we are your trusted partner that will help you make the best decision for your startup when it comes to employee benefits. We believe a robust, well organized, and well communicated employee benefits package is essential for incentivizing and retaining top talent.

Setup a complimentary consultation today with myself, Ron Bland, at ron@aeisadvisors.com and 650-348-6234 x12 for a review of your current plans and how we can work together.

By Ron Bland

Disclaimer: Any compliance related information in this blog is intended to be informational and does not constitute legal advice regarding any specific situation. Should you require further compliance assistance or legal advice, please consult a licensed attorney.

June 2020

By Dillon Castro

The New Normal

During the time of consistent economic growth and low unemployment that we’ve experienced for most of the last decade, businesses have experienced unprecedented success. Unfortunately, rapid growth and prosperity in business can often cause inefficiencies to go unchecked. When times are good these issues may seem trivial or benign… until the economy unexpectedly tightens. That is what we are experiencing right now in the Bay Area and throughout the country.

The COVID-19 pandemic has decimated businesses, and while the government is doing what it can to prevent a complete downturn by creating economic stimulus and aid packages, it’s likely that the US, and perhaps the world, will feel the economic ripple effect for quite some time after we get through the worst of this. Businesses will need to take a hard look at how they allocate their financial resources.

Health Insurance As a Capital Expense

After payroll, benefits (particularly health insurance) are usually at or near the top of every employer’s list of biggest expenses, yet in the midst of a pandemic, continuing to offer health insurance will be necessary to recruit and retain employees.

To control costs many small businesses will believe that they have little choice but the “easy” route of reducing the benefits offered or increasing the employees’ share of costs, either of which may aggravate employees more than actually help the bottom line.

What are employers to do?

One business solution for employers to consider is a type of health insurance arrangement called “Level Funding”.

Level Funding

Since the passing of the Affordable Care Act (ACA), employers with less than 100 employees typically purchase small group health insurance plans that have non-negotiable, fixed costs. There is little to no financial incentive for employers to educate employees on best practices for healthcare consumption. Additionally, the premium costs continue to rise year after year regardless of an employer’s individual utilization.

A level-funded health plan allows employers to still pay a fixed premium, but the insurance company takes the health of the employees and their dependents into consideration when determining the premium. Rather than the premiums going on a one way trip to the insurer, employers can qualify to get a refund on the premiums if the utilization of the plan is lower than expected. If the utilization is higher than expected the carrier can increase the premium rates at the renewal, but the employer is often not required to stay with the plan.

We work with carriers who offer level-funded plans and for most small businesses it is one of the best tools out there to help employers to continue offering the level of benefits that their employees have come to expect while also saving on the bottom line.

The Way Forward

If you believe you are paying too much for health insurance, but don’t want to risk watering down your benefits offering, schedule a call with us today for business solutions to help eliminate inefficiencies to be ready for the post-COVID business environment.

Trying to decide which of the many employer-sponsored benefits out there to offer employees can leave an employer feeling lost in a confusing bowl of alphabet soup—HSA? FSA? DCAP? HRA? What does it mean if a benefit is “limited” or “post-deductible”? Which one is use-it-or-lose-it? Which one has a rollover? What are the limits on each benefit?—and so on.

While there are many details to cover for each of these benefit options, perhaps the first and most important question to answer is: which of these benefits is going to best suit the needs of both my business and my employees? In this article, we will cover the basic pros and cons of Flexible Spending Arrangements (FSA), Health Savings Accounts (HSA), and Health Reimbursement Arrangements (HRA) to help you better answer that question.

Flexible Spending Arrangements (FSA)

An FSA is an employer-sponsored and employer-owned benefit that allows employee participants to be reimbursed for certain expenses with amounts deducted from their salaries pre-tax. An FSA can include both the Health FSA that reimburses uncovered medical expenses and the Dependent Care FSA that reimburses for dependent expenses like day care and child care.


  • Benefits can be funded entirely from employee salary reductions (ER contributions are an option)
  • Participants have access to full annual elections on day 1 of the benefit (Health FSA only)
  • Participants save on taxes by reducing their taxable income; employers save also by paying less in payroll taxes like FICA and FUTA
  • An FSA allows participants to “give themselves a raise” by reducing the taxes on healthcare expenses they would have had anyway


  • Employers risk losing money should an employee quit or leave the program prior to fully funding their FSA election
  • Employees risk losing money should their healthcare expenses total less than their election (the infamous use-it-or-lose-it—though there are ways to mitigate this problem, such as the $500 rollover option)
  • FSA elections are irrevocable after open enrollment; only a qualifying change of status event permits a change of election mid-year
  • Only so much can be elected for an FSA. For 2018, Health FSAs are capped at $2,650, and Dependent Care Accounts are generally capped at $5,000
  • FSA plans are almost always offered under a cafeteria plan; as such, they are subject to several non-discrimination rules and tests

Health Savings Accounts (HSA)

An HSA is an employee-owned account that allows participants to set aside funds to pay for the same expenses that are eligible under a Health FSA. Also like an FSA, these accounts can be offered under a cafeteria plan so that participants may fund their accounts through pre-tax salary reductions.


  • HSAs are “triple-tax advantaged”—the contributions are tax free, the funds are not taxed if paid for eligible expenses, and any gains on the funds (interest, dividends) are also tax-free
  • HSAs are portable, employee-owned, interest-bearing bank accounts; the account remains with the employees even if they leave the company
  • Certain HSAs allow participants to invest a portion of the balance into mutual funds; any earnings on these investments are non-taxable
  • Upon reaching retirement, participants can use any remaining HSA funds to pay for any expense without a tax penalty (though normal taxes are required for non-qualified expenses); also, retirees can use the funds tax-free to pay premiums on any supplemental Medicare coverage. This feature allows HSAs to operate as a secondary retirement fund
  • There is no use-it-or-lose-it with HSAs; all funds employees contribute stay in their accounts and remain theirs in perpetuity. Also, participants may alter their deduction amounts at any time
  • Like FSAs, employers can either allow the HSA to be entirely employee-funded, or they may choose to also make contributions to their employees’ HSA accounts
  • Even though they are often offered under a cafeteria plan, HSAs do not carry the same non-discrimination requirements as an FSA. Moreover, there is less administrative burden for the employer as the employees carry the liability for their own accounts


  • To open and contribute to an HSA, an employee must be covered by a qualifying high deductible health plan; moreover, they cannot be covered by any other health coverage (a spouse’s health insurance, an FSA (unless limited), or otherwise)
  • Participants are limited to reimburse only what they have contributed—there is no “front-loading” like with an FSA
  • Participant contributions to an HSA also have an annual limit. For 2018, that limit is $3,450 for an employee with single coverage and $6,900 for an employee with family coverage (participants over 55 can add an additional $1,000; also, remember there is no total account limit)
  • Participation in an HSA precludes participation in any other benefit that provides health coverage. This means employees with an HSA cannot participate in either an FSA or an HRA. Employers can work around this by offering a special limited FSA or HRA that only reimburses dental and vision benefits, meets certain deductible requirements, or both
  • HSAs are treated as bank accounts for legal purposes, so they are subject to many of the same laws that govern bank accounts, like the Patriot Act. Participants are often required to verify their identity to open an HSA, an administrative burden that does not apply to either an FSA or an HRA

Health Reimbursement Arrangements (HRA)

An HRA is an employer-owned and employer-sponsored account that, unlike FSAs and HSAs, is completely funded with employer monies. Employers can think of these accounts as their own supplemental health plans that they create for their employees


  • HRAs are extremely flexible in terms of design and function; employers can essentially create the benefit to reimburse the specific expenses at the specific time and under the specific conditions that the employers want
  • HRAs can be an excellent way to “soften the blow” of an increase in major medical insurance costs—employers can use an HRA to mitigate an increase in premiums, deductibles, or other out-of-pocket expenses
  • HRAs can be simpler to administer than an FSA or even an HSA, provided that the plan design is simple and efficient: there are no payroll deductions to track, usually less reimbursements to process, and no individual participant elections to manage
  • Small employers may qualify for a special type of HRA, a Qualified Small Employer HRA (or QSEHRA), that even allows participants to be reimbursed for their insurance premiums (special regulations apply)
  • Funds can remain with the employer if someone terminates employment and have not submitted for reimbursement


  • HRAs are entirely employer funded. No employee funds or salary reductions may be used to help pay for the benefit. Some employers may not have the funding to operate such a benefit
  • HRAs are subject to the Affordable Care Act. As such, they must be “integrated” with major medical coverage if they provide any sort of health expense reimbursement and are also subject to several regulations
  • HRAs are also subject to many of the same non-discrimination requirements as the Health FSA
  • HRAs often go under-utilized; employers may pay an amount of administrative costs that is disproportionate to how much employees actually use the benefit
  • Employers can often get “stuck in the weeds” with an overly complicated HRA plan design. Such designs create frustration on the part of the participants, the benefits administrator, and the employer

For help in determining which flexible benefit is right for your business, contact us!

by Blake London
Originally posted on ubabenefits.com

We have entered Open Enrollment season and that means you and everyone in your office are probably reading through enrollment guides and trying to decipher it all. As you begin your research into which plan to choose or even how much to contribute to your Health Savings Account (HSA), consider evaluating how you used your health plan last year. Looking backward can actually help you plan forward and make the most of your health care dollars for the coming year.

Forbes magazine gives the advice, “Think of Open Enrollment as your time to revisit your benefits to make sure you are taking full advantage of them.” First, look at how often you used health care services this year. Did you go to the doctor a lot? Did you begin a new prescription drug regimen? What procedures did you have done and what are their likelihood of needing to be done again this year? As you evaluate how you used your dollars last year, you can predict how your dollars may be spent next year and choose a plan that accommodates your spending.

Second, don’t assume your insurance coverage will be the same year after year. Your company may change providers or even what services they will cover with the same provider. You may also have better coverage on services and procedures that were previously not eligible for you. If you have choices on which plan to enroll in, make sure you are comparing each plan’s costs for premiums, deductibles, copays, and coinsurance for next year. Don’t make the mistake of choosing a plan based on how it was written in years prior.

Third, make sure you are taking full advantage of your company’s services. For instance, their preventative health benefits. Do they offer discounted gym memberships? What about weight-loss counseling services or surgery? How frequently can you visit the dentist for cleanings or the optometrist? Make sure you know what is covered and that you are using the services provided for you. Check to see if your company gives discounts on health insurance premiums for completing health surveys or wellness programs—even for wearing fitness trackers! Don’t leave money on the table by not being educated on what is offered.

Finally, look at your company’s policy choices for life insurance. Taking out a personal life insurance policy can be very costly but ones offered through your office are much more reasonable. Why? You reap the cost benefit of being a part of a group life policy. Again, look at how your family is expected to change this year—are you getting married or having a baby, or even going through a divorce? Consider changing your life insurance coverage to account for these life changes. Forbes says that “people entering or exiting your life is typically a good indicator that you may want to revisit your existing benefits.”

As you make choices for yourself and/or your family this Open Enrollment season, be sure to look at ALL the options available to you. Do your research. Take the time to understand your options—your HR department may even have a tool available to help you estimate the best health care plan for you and your dependents. And remember, looking backward on your past habits and expenses can be an important tool to help you plan forward for next year.

Recently, the President signed a bill repealing the Affordable Care Act’s Individual Mandate (the tax penalty imposed on individuals who are not enrolled in health insurance). While some are praising this action, there are others who are concerned with its aftermath. So how does this affect you and why should you pay attention to this change?

First, as an individual, if you do not carry health insurance, you are currently paying a penalty of $695/adult not covered and $347.50/uninsured child with penalties going even as high as $2085/household. These penalties have been the deciding factor for most uninsured Americans—go broke buying insurance but they have insurance or go broke paying a fine and still be uninsured. With the repeal signed in December 2017, these penalties are zeroed out starting January 1, 2019.  While it seems that the repeal of the tax penalty should be good news all around, it does have some ramifications. Without reform in the healthcare arena for balanced pricing, when individuals make a mass exodus in 2019, we can expect higher premiums to account for the loss of insured customers.

As a business, you are still under the Employer Mandate of the ACA. There have been no changes to the coverage guidelines and reporting requirements of this Act. However, with healthy people opt-ing out of health insurance coverage, the employer premiums can expect to be raised to cover the increased expenses of the sick. Some do predict the possibility of the repeal of some parts of the Employer Mandate —specifically PCORI fees and employment reporting. The Individual and Employer Mandates were created to compliment each other and so changes to one tend to mean changes to the other.

So, why should you pay attention to this change? Because the balance the ACA Individual Mandate was designed to help make in the health insurance marketplace is now unbalanced.

Taking one item from the scale results in instability. Both employers and employees will be affected by this tax repeal in one way or another.


Since the ACA was enacted eight years ago, many employers are re-examining employee benefits in an effort to manage costs, navigate changing regulations, and expand their plan options. Self-funded plans are one way that’s happening.

In 2017, the UBA Health Plan survey revealed that self-funded plans have increased by 12.8% in the past year overall, and just less than two-thirds of all large employers’ plans are self-funded.

Here are six of the reasons why employers are opting for self-funded plans:

1. Lower operating costs frequently save employers money over time.

2. Employers paying their own claims are more likely to incentivize employee health maintenance, and these practices have clear, immediate benefits for everyone.

3. Increased control over plan dynamics often results in better individual fits, and more needs met effectively overall.

4. More flexibility means designing a plan that can ideally empower employees around their own health issues and priorities.

5. Customization allows employers to incorporate wellness programs in the workplace, which often means increased overall health.

6. Risks that might otherwise make self-funded plans less attractive can be managed through quality stop loss contracts.

If you want to know more about why self-funding can keep employers nimble, how risk can be minimized, and how to incorporate wellness programs, contact us for a copy of the full white paper, “Self-Funded Plans: A Solid Option for Small Businesses.”

by Bill Olson
Originally posted on ubabenefits.com

The Department of Labor’s new claim rules for disability benefits took effect April 2, 2018. The changes were announced over a year ago, but the effective date was delayed to give insurers, employers, and plan administrators adequate time for implementation. Although we’ve reported on the key issues in this blog previously, now seems like a good time for a refresher on how the new rules affect employer plans.

Affected Plans

The new claim rules apply to disability benefits provided under plans covered by the Employee Retirement Income Security Act (ERISA); that is, plans sponsored by private-sector employers. Then the new rules apply if the ERISA plan must make a determination of disability in order for the claimant to obtain the benefit. Group short- and long-term disability plans are the most common examples, but pension, 401(k), and deferred compensation plans also may be affected.

Many plans do not make their own determination of disability, but instead condition the plan’s benefit on another party’s determination. For instance, employer plans that base the benefit on a disability determination made by the Social Security Administration (SSA) are not affected by the new rules.

New Rules

For ERISA plans affected by the new rules, the following additional requirements apply to disability claims filed on or after April 2, 2018:

  • Disclosure Requirements: Benefit denial notices must explain why the plan denied a claim and the standards used in making the decision. For example, the notices must explain the basis for disagreeing with a disability determination made by the SSA if presented by the claimant in support of his or her claim.
  • Claim Files and Internal Protocols: Benefit denial notices must include a statement that the claimant is entitled to request and receive the entire claim file and other relevant documents. (Previously this statement was required only in notices denying benefits on appeal, not on initial claim denials.) The notice also must include the internal rules, guidelines, protocols, standards or other similar criteria of the plan that were used in denying a claim or a statement that none were used. (Previously it was optional to include a statement that such rules and protocols were used in denying the claim and that the claimant could request a copy.)
  • Right to Review and Respond to New Information Before Final Decision: Plans are prohibited from denying benefits on appeal based on new or additional evidence or rationales that were not included when the benefit was denied at the claims stage, unless the claimant is given notice and a fair opportunity to respond.
  • Conflicts of Interest: Claims and appeals must be adjudicated in a manner designed to ensure the independence and impartiality of the persons involved in making the decision. For example, a claims adjudicator or medical or vocational expert could not be hired, promoted, terminated or compensated based on the likelihood of the person denying benefit claims.
  • Deemed Exhaustion of Claims and Appeal Processes: If plans do not adhere to all claims processing rules, the claimant is deemed to have exhausted the administrative remedies available under the plan (unless exceptions for minor errors or other conditions apply). In that case, the claimant may immediately pursue his or her claim in court. Plans also must treat a claim as re-filed on appeal upon the plan’s receipt of a court’s decision rejecting the claimant’s request for review.
  • Coverage Rescissions: Rescissions of coverage, including retroactive terminations due to alleged misrepresentations or errors in applying for coverage, must be treated as adverse benefit determinations that trigger the plan’s appeals procedures.
  • Notices Written in a Culturally and Linguistically Appropriate Manner: Benefit denial notices must be provided in a culturally and linguistically appropriate manner in certain situations. Specifically, if the claimant’s address is in a county where 10 percent or more of the population is literate only in the same non-English language, the notices must include a prominent statement in the relevant non-English language about the availability of language services. The plan would also be required to provide a verbal customer assistance process in the non-English language and provide written notices in the non-English language upon request.

Action Steps for Employers

Employers are reminded to work with their carriers, third-party administrators, and advisors to make sure their plans comply with the new requirements. Consider these steps:

  • Identify all plans that are subject to ERISA. (Plans sponsored by governmental employers, such as cities and public school districts, and certain church plans, are exempt from ERISA.)
  • Does the ERISA plan provide any benefit based on disability? If so, is the benefit conditioned on a determination of disability made by the plan or by another party, such as Social Security?
  • For insured plans, such as group STD and LTD insurance plans, the carrier generally is responsible for compliance with ERISA’s claim rules. The employer, however, does have a duty to make reasonable efforts to ensure the carrier is complying.
  • For self-funded plans, the employer is responsible for compliance. Although the employer may engage the services of a third-party claims administrator, the employer remains responsible for the plan’s compliance with all rules.

Originally Published By ThinkHR.com

As the costs of health care soar, many consumers are looking for ways to control their medical spending. Also, with the rise of enrollment in high deductible health plans, consumers are paying for more health care out-of-pocket. From medical savings accounts to discount plans for prescriptions, patients are growing increasingly conscious of prices for their healthcare needs. Price shopping procedures and providers allows you to compare prices so that you are getting the best value for your care.

Why do you need to look beyond your nearby and familiar providers and locations for healthcare? Here’s a hypothetical example: Chris is a 45-year old male in good physical health. During his last check-up he mentions to his doctor that he’s had some recent shortness of breath and has been more tired as of late. His doctor orders an EKG to rule out any problems. If Chris went to his local hospital for this procedure, it would cost $1150. He instead looks online and shops around to find other providers in his area and finds he can get the same procedure for $450 at a nearby imaging center. His potential savings is $700 simply by researching locations.

So where do you start when shopping around for your health care?  A good place to begin is by researching your health plan online. Insurance companies will post cost estimates based on facility, physician, and type of procedure. Keep in mind that these are just estimates and may vary based on what coverage you are enrolled in. Another way to shop is by checking out websites that have compiled thousands of claims information for various procedures and locations to give an estimate of costs. However, deciphering whether a site is reporting estimates based on the “medical sticker price” of charges or rates for private insurance plans or Medicare is difficult.  There are huge differences in prices at different providers for the exact same procedure. This is because contracts between insurance agencies and providers vary based on negotiated amounts. This makes it hard to get consistent pricing information.

Check out these sites that do a great job comparing apples to apples for providers:

  • Healthcare Blue Book
    • What Kelly Blue Book is to cars, Healthcare Blue Book is to medical pricing
  • New Choice Health
    • Reports on pricing of medical procedures, providers, quality of facilities, and customer feedback for healthcare in all 50 states
  • The Leapfrog Group
    • Publishes data on hospitals so patients can compare facilities and costs for treatments and procedures

After compiling all the information on prices and procedures, you can still call and negotiate costs with the location of your care. Fair Health Consumer has tips on how to negotiate with providers and plan for your healthcare needs.

Knowledge is POWER and when you spend time researching and comparing healthcare costs, you are empowering yourself!  Exercising due diligence to plan for you and your family’s medical needs will save you money and give you confidence in your decisions for care.

Thank you for putting the Plan Document together for us!  It is a big accomplishment knowing that we are in compliance!   Once again we are grateful and thankful for your continuing support and enjoy the relationship that we share.

- Office Manager, Food Distribution Company