In this episode of Next Generation Healthcare, we dive into the complexities and opportunities surrounding open enrollment season for small and medium-sized businesses. With medical insurance prices skyrocketing and new transparency laws reshaping the landscape, now is the time for SMBs to rethink their approach to employee healthcare. We’ll discuss the impact of the cash-pay industry, the advantages of Health Reimbursement Arrangements (HRAs), and why becoming a savvy healthcare shopper could benefit both employers and employees. Tune in for a critical look at how alternative options might be the key to more affordable, transparent, and flexible healthcare solutions.
In this episode of Next Generation Healthcare, we dive into the complexities and opportunities surrounding open enrollment season for small and medium-sized businesses. With medical insurance prices skyrocketing and new transparency laws reshaping the landscape, now is the time for SMBs to rethink their approach to employee healthcare. We’ll discuss the impact of the cash-pay industry, the advantages of Health Reimbursement Arrangements (HRAs), and why becoming a savvy healthcare shopper could benefit both employers and employees. Tune in for a critical look at how alternative options might be the key to more affordable, transparent, and flexible healthcare solutions.
1:25 – Open Enrollment Season: Comparing Traditional Insurance and Alternative Healthcare Options for SMBs
2:46 – Rising Costs: Medical Insurance Rates Expected to Increase by 25%
4:14 – Transparency Law: How New Legislation Aims to Clarify Healthcare Costs
6:11 – Cash-Pay Industry: Tips on Becoming a Smart Shopper in the Changing System
11:03 – Rethinking Open Enrollment: Exploring Health Reimbursement Arrangements (HRAs) and Eliminating Traditional Enrollment Processes
14:02 – Conclusion: Has the Insurance Industry Done More Harm than Good to Our Healthcare System?
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Welcome to Next Generation Healthcare, proudly presented by Optimal Telehealth.
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Are soaring health insurance costs for your family or business causing you stress? Tired of the long waits and high fees for a simple doctor's consultation? Then you've found your podcast. Next Generation Healthcare is here to empower you to take back control over your healthcare decisions, freeing you from the constraints set by insurance companies. In our episodes, you'll uncover the secrets to circumventing traditional insurance,
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at savings of 40 to 50%. This podcast is the creation of Larry Stout, the visionary founder and CEO of Optimal Telehealth. Now, let's hear from Larry.
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Okay, a big thanks to all our followers. I hope you found our content informative in the past. In our last episode, we interviewed Crystal Paulson, who's a patient advocate. And Crystal has an amazing story. You should go back. If you didn't see that episode, you should go back and look at it. But you'll learn a lot about patient advocacy and how it works. It can be a tremendous resource for you if you're dealing with the healthcare industry and the
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problems associated with it can relieve a lot of headaches and save you some money too. Today's episode is short, but it's poignant. It's going to be very important. It may be one of the most important episodes we've done. This is open enrollment season, so all of you employers out there are looking at renewing your healthcare insurance, negotiating rates, and you're not going to be able to negotiate much.
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But you're going to be negotiating what the content of the policies are going to be and what that's going to cost your employees and yourself. And then you're going to have to go through that ugly open enrollment process. So we're going to talk about that. And depending on the size of your company, this can be a significant undertaking. But regardless of the size of your company, employers loathe it. I mean, you just don't like it.
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We know that. So for so many years, you've had no options other than traditional medical insurance. That's the only medical benefits you can offer. And what we're gonna talk about today is an alternative to traditional medical insurance that is really superior, a much superior alternative that you should familiarize yourself with before you go through this open enrollment.
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Renewal of employee benefits seldom comes with good news. The Kaiser Family Foundation statistics indicate that since 2019, the price of medical insurance premiums has gone up 24%. Obviously, we've gone through an inflationary period, but let me repeat that. Since 2019, the price of medical insurance has gone up 24%. But the...
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payroll deductions for employees has only increased 5%, which is a clear indication the employers are absorbing most of that price increase. This is probably not a surprise to those who have lived through this period, but what might be a surprise is that the medical insurance industry inflates the cost of medical services by 80 to 100%.
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price transparency rule in January of 2021. Subsequent to that, our 117th and 118th legislature codified that as law. So now all medical service providers, hospitals, et cetera, and all insurance companies must publish both their insurance rates for medical services and their cash pay rates for medical services.
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That really goes to the heart of what we're talking about today, the heart of this episode. Why is there a need for a transparency law? You would think, I mean, up until the 1990s, insurance companies allocated 95% of their total revenue to pay claims. But since the 1990s, they've started getting engaged in more profit taking.
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And they've done that. That's evolved over the years into what we now call high deductible insurance plans. Deductible for insurance used to be, when I was young, it was $500. Of course, the dollar was worth a lot more then. But it was the premiums and the deductibles were very low. Today, the average silver plan, which is a middle of the road plan, has a $5,000 or $6,000 deductible.
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how many of your employees can handle $5,000 or $6,000, not even considering the co-pays, the co-insurance. I mean, you not only have a co-pay when you go to see your primary care physician, if you spend a night in the hospital room, you're going to pay $300 to $500 out of pocket as a co-pay for that hospital. So that's one of the main reasons with traditional insurance.
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You never know what the bill is going to be when you go through a major medical event until that bill hits your mailbox. There are just too many variables.
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If you evaluate next generation, as you evaluate next generation healthcare benefits, you'll see that's not the case. With medical cost sharing, there's an initial small conservative out-of-pocket amount that varies depending on the type of membership you choose. And after you pay that amount, it might be $1,000, it might be $1,500 for a major medical event. You are reimbursed for all of the expenses.
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This cash pay industry has evolved and developed to where, well, I like to say cash pay health care without spending your own cash because you don't have to spend your own cash to be a cash pay patient. You don't have to have, nobody's got that much cash, but the industry has wrapped themselves around this whole concept. And let's face it, it's just logical if the insurance industry is going to...
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industry is going to inflate costs by 80 to 100 percent, let's bypass the insurance industry and provide consumers with the resources necessary to go straight to the providers without the insurance company being involved. And you know what? The providers like that too because they don't like dealing with the insurance industry either. And this is exactly what's been happening over the last few years.
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An entire new industry has emerged to support consumers' access to cashpay medicine, so they no longer have to pay cash to get cashpay rates. Resources are readily available to educate and assist consumers, smart and make you smart shoppers. And that's what it does. It empowers you to become a consumer of health care services, make you a smart shopper. We shop for everything else, why would we not shop for medical services?
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Resources are also available to ensure medical bills are paid on time without draining the patient's bank account. Many major medical procedures can be performed absolutely free, with no out-of-pocket expense at all. The medical cost sharing communities represented by Optimal Telehealth
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save so much money by paying cash and negotiating cash pay rates. And this does not lower the quality of service. You're going to the same medical providers. There's no networks. You can choose your own medical providers. But they're saving so much money by the way they handle this process that many outpatient, major outpatient medical procedures, surgeries, etc. can be performed.
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without any out of pocket expense at all, absolutely free to the patient.
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Give your employees a cash pay option. If you want to do the right thing for your employees, I know you do, give them a cash pay option. Cash pay, next generation healthcare is not going to replace insurance. There will always be a place for it, but it coexists very well with an insurance plan. There's going to be some employees you have who are better served
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with insurance, but frankly the majority of your employees can be well served, superior in our opinion to insurance, and I think you'll agree once you look into it, will be well served with next generation healthcare. Let me be as frank as I can. If you go through open enrollment without educating yourself about cash pay medicine and learning how to make it available to your employees, you are doing both yourself and
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and your employees a disservice. This is a common sense solution to a huge national problem, and to move into next year with an insurance-only benefit plan is costing your employees and your companies significant, unnecessary expense. Today's high deductible insurance plans, with their co-insurance co-pays, place financial loads on employees that most are not able to support.
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This Next Generation Healthcare podcast was created to inspire and educate employers and consumers showing them that quality affordable healthcare is within reach, liberated from the constraints of traditional insurance. Our sponsor, Optimal Telehealth, represents some of the most significant companies in the cash-paid medical industry. But I'm not here to sell their services. There are many companies out there selling similar services.
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and it's unimportant which one you go to or where you seek your information. Become a shopper, but educate yourself. Talk to multiple companies. My objective is to motivate you to learn more about this very important topic. And it's with the inflationary period we've gone through, it's going to be more and more important to your employees and your company to take advantage of these cost savings.
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and at the same time provide better medical care. That's the important part, quality medical care. Now we opened this by talking about eliminating the open enrollment process. Sure, that's a real headache for you. You shouldn't go through this conversion process to cash pay without at the same time evaluating what are called health reimbursement arrangements or HRAs. They have the ability to get your company
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completely out of the insurance business. An HRA, if you haven't heard of them, HRAs give employers flexibility in how they provide benefits to employees. The two HRAs applicable to our discussion is the first one was Qualified Small Employer HRA or QSARA. It was released in 2016 for employers with fewer than 50 full-time or full-time equivalent employees.
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The IRS considers a full-time employee 30 hours a week. So a full-time equivalent would be two part-time employees working 15 hours a week each. So you've got the equivalent of a full-time employee. So if you've got 50 or less, you fall under Q-SERA. And if you fall under Q-SERA, if you've got 50 or less, you are also not under the mandates of the Affordable Care Act to provide insurance. But most companies, obviously in that size range,
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do provide insurance to their employees. Now, the other one is the individual coverage HRA, ICHRA, we call it ICRA. It was released in 2020 and was an offshoot of QSERA, and that's for employers of any size, but it's primarily used by employers with over 50 full-time or full-time equipment employees. ICRA does a lot of stuff, it really does, but for our purposes...
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It does the same thing QSERA does, it gives the employer the ability to provide, to contribute financially to the cost of individual insurance policies your employees purchase off the open market. And it keeps you compliant with tax, by the way, with pre-tax dollars. And it keeps you compliant with the Affordable Care Act.
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I'm going to take a deep dive into HREs in future episodes because it could be very complex. I'm bringing this to your attention because of its ability to eliminate the entire renewal and open enrollment process for your company. We all know it's a headache. Some companies, I've talked with some companies where it takes literally two or three months to go through all the open enrollment because of multiple locations and their personnel, their management personnel have it.
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travel around to the different locations to introduce the next year's plan, etc. It can be a big distraction. So totally taking that off your plate and giving it to somebody else is a tremendous benefit. As I bring this episode to a close, here's what I hope you learned. Health insurance industry has taken control of our healthcare system and held consumers hostage until they pay exorbitant prices for services, all for the sake of their own profits.
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Next-generation healthcare is not only viable, but a valuable alternative to traditional insurance. And the migration to cash-pay medicine is a logical common-sense solution to the high cost of medical services. I can't stress this enough. Again, you are doing a tremendous disservice to your people and your company without, if you fail to go out and educate yourself on this subject.
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It's well worth your time. You'll be glad you did, I assure you. I urge each viewer to go to the resource page at Opti share your questions or concerns about adding next-generation health care to your employee benefits plan, so I can respond to them in future episodes. As you know, I'm always receptive to any questions you may have, and if they're pertinent to other people, I'll even...
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put them on a future episode and we'll get those questions answered. If I've misstated anything I always say I'm not an expert on anything, I just know a little bit about a lot of things. If you're interested in learning more, check out our resource center at OptumTel Health dot com. You can locate the link in our show notes. You'll find an unlimited number of podcast blogs, download guides and more.
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to ensure your healthcare solutions and savings are empowered by you. We are trying to put you in control of your own healthcare. We hope you found this episode informative. Until next time, remember, next generation healthcare fosters a brighter and more empowered future for all. Thanks so much. Thank you for tuning in to Next Generation Healthcare, brought to you by Optimal Telehealth.
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Your engagement means the world to us. If you find our content informative, follow our podcasts on Apple, Spotify, or YouTube. We welcome your participation and will review listener input in future episodes. To leave your questions or comments, access additional episodes, or browse our blog post library, please visit the resources page at Opti You may also connect with us on LinkedIn, Facebook, or Instagram.
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for the latest insights and updates. We look forward to welcoming you back soon. Your journey towards empowered healthcare continues with us.