Joey Stoffer, CEBS

This is something that cou;d mean some significant effect in the market all over the country, however the reinsurance progream in the state of Minnespta also puts another wrinkle in this! Stay tuned! #thinkingdifferently #cfoinsights #ceoinsights #hr #hrbenefits #employee experience #ESOPCG

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Attention Travel Insurance Carriers: Have you ever connected the dots between your high claim ratios in the U.S. and Medicare Advantage? 🧐 Probably not—but here’s the kicker: Your cost containment vendors (no names here, but you know who they are 🤢 ) likely has contracts with nearly every hospital in the U.S. 🤬 These contracts often include a $ 💵 earning commitment for the hospital. Sounds fair, right? 😇 Now, here’s where it gets tricky: If your cost containment vendor is also administering Medicare Advantage claims (and trust me, they are 🙈 🙉 🙊 ), they’re incentivized to pay as little as possible on those claims because they’re generously compensated by the federal government 💵 💹 . But remember that $ 💵 commitment to the hospitals? That delta—the difference between what they underpay for Medicare Advantage and what’s owed to the hospitals—is being shifted to your claims. 🤬 🤬 🤬 That’s right—you’re unknowingly footing the bill to keep those contracts balanced. 😂 🤣 Ever noticed this nuance before hearing about FairFare? Didn’t think so. Lucky for you, we’ve done the homework, digging into these complexities and zealously following healthcare experts like Eric Bricker, MD. so you don’t have to (Eric Bricker, MD thx you for this eye-opening video!!). 🧐 Ready to stop overpaying for claims in the U.S.? Let’s talk. I’d be happy to share how we can help you cut through the noise and save money. DM me or hit me up for more insights!

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UnitedHealth Group, Cigna Healthcare, and CVS Health are suing the Federal Trade Commission, claiming its case against their pharmacy benefit managers (PBMs) over alleged insulin price inflation is unconstitutional. The crux of their argument? 𝗧𝗵𝗲 𝗙𝗧𝗖 𝗳𝗶𝗹𝗲𝗱 𝘁𝗵𝗲 𝗹𝗮𝘄𝘀𝘂𝗶𝘁 𝗶𝗻 𝗶𝘁𝘀 𝗮𝗱𝗺𝗶𝗻𝗶𝘀𝘁𝗿𝗮𝘁𝗶𝘃𝗲 𝗰𝗼𝘂𝗿𝘁 𝗿𝗮𝘁𝗵𝗲𝗿 𝘁𝗵𝗮𝗻 𝗳𝗲𝗱𝗲𝗿𝗮𝗹 𝗰𝗼𝘂𝗿𝘁, which the companies argue undermines due process by making the FTC both prosecutor and judge. The FTC isn’t holding back, calling this move a distraction from claims that PBM practices harm patients by driving up costs for life-saving medicines like insulin. For context, the FTC alleges that PBMs—who control 80% of U.S. prescriptions—engage in practices like rebating, which critics say incentivize higher drug prices. This legal fight highlights mounting scrutiny on PBMs and their role in the ever-rising cost of healthcare. Whether this is a valid constitutional challenge or just a delay tactic, it’s clear the gloves are off in the battle over drug pricing. #HealthcareCosts #InsulinPrices #PBMs #FTC #healthinsurance #pharmacy

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I always appreciate Sam’s posts as they are thoughtful and concise. What really upsets me about the letter from these Senators to CMS is how callously the word “brokers” is used in the paragraph below: —- “with more than $6 billion in MA plan spending on commissions and marketing, brokers are under pressure to churn through appointments as quickly as possible. The demand for volume means brokers are under pressure to focus on only a few plans and may not examine the full range of options” —- Let me be clear, the large majority of brokers are NOT under pressure to churn. We do NOT only examine a few plans. The actions being described are that of a call center. And therein lies the problem. The fact that our government officials clearly do not understand the difference between a call center and a broker is a tremendous problem. If we cannot educate our government officials regarding the difference, we are all going to be out of a career. Plain and simple. Pinnacle Financial Services, Inc. Tyler Insurance Group Angela Palo Kevin Shields Nick Palo NABIP Laura Tyler Andrew Horn, MHA Caroline Horn Eric Price, MBA Christopher Raon

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Have you read our Provider Partnerships newsletter? Now you can sign up to have it delivered right to your inbox each month: https://loom.ly/ZxZJZhc Specifically tailored for our providers, Provider Partnerships covers: • Claims and billing • Ohio Department of Medicaid updates • Resources • Mobile Wellness and Opportunity Center • Training opportunities #AmeriHealthCaritasOH #healthcare #medicaid #newsletter

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💊 We're supposed to think Medicare negotiating with Big Pharma is a big win, right? 🐭Something about the cheese seems off...🧀 Washington has been so far behind the Big Health Business Models, that this "win" seems only to be good for politicians. Is it reasonable to expect that costs will be shifted? Thinking it'll be worth reviewing earnings reports 🏧 for these companies a few quarters after the new pricing is implemented. What do you think? #MedicareSavings #DrugPriceNegotiation #HealthcareCosts #PharmaReform #SeniorSavings #HealthcarePolicy #PrescriptionDrugs #Medicare2026 #PatientAdvocacy #HealthcareEconomics https://lnkd.in/esy9fwhp

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As we approach 2025, significant changes are on the horizon for several states. It's crucial to stay informed about upcoming healthcare changes for your clients.

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The report by the Wall Street Journal this morning on Medicare Advantage payments for untreated issues is very serious and indicates to me that any change in administration in November will be unlikely to alleviate the intense pressure that the scaled MA plans are currently facing. No one should be particularly surprised by the report, if you set laws that establish payment under a certain structure, its reasonable to expect the carriers to find ways to collect those dollars. There may be some situations where there is actual fraud, but to my reading, its mostly upcoding within the legal allowances of what technically qualifies as a diagnosis. Of course the quick fix to require that it not just be a diagnosis but also something being actively treated will have its own unintended consequences as well. Between the DOJ investigations that have been disclosed by carriers or the DOJ, the Senate Finance Committee pressure, the general financial underperformance of the sector, the pressure in DC against consolidation and private equity and the bipartisan shots at Medicare carriers, it seems like the Presidency and control of the House and Senate are unlikely to have a major impact on the regulatory feel in DC come November. It will certainly impact what specific issues are focused on, but either way there will be an intense microscope on the industry. https://lnkd.in/ed3YqvHu

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Four in 10 adults in the United States have medical debt, highlighting the pressing issue of healthcare affordability. Last Wednesday, the Ohio Senate took a step towards transparency by passing a bill mandating hospitals to publish the cost of their services for public access. If it takes a bill to be passed to require posting your prices, it suggests you don't want anyone to see them. Every hospital, urgent care, surgical center, etc., should be required to post their pricing on their website in a downloadable PDF. Why wouldn’t you? Do you order a steak without knowing the price? Do you buy a car without knowing the price? Do you buy a home without knowing the price? Every single item we own came with a transparent price tag. So, why is medical pricing so secretive? Because they want to charge you as much as they can get away with! Don't let them raise your premiums. Stop the unbundling, upcoding, and phantom charges, and put that money back into your employees' pockets! us-beacon.com Read more about this initiative here: https://lnkd.in/gw8QbxpQ

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Did you know URL Insurance Group has not one, but two, NABIP certified ICHRA specialists? We also have a team of enrollment specialists who are experts in all individual insurance benefits. No matter if you're a group, individual, consultant, or Medicare-eligible, we have the products and services to protect you, your clients, and your loved ones. A group plan doesn't make sense for every business just like an ICHRA doesn't. Are you partnering with a consultant that is an expert in all things health insurance or are they just focused on one particular product? Don't get pigeon-holed by your broker only offering group insurance (level funded, self funded, fully insured, unbundled.... I. don't. care.) There's other solutions out there. We do this all IN-HOUSE. We don't claim to be specialists and then "refer" it out to friends, business colleagues, etc. It's not too late to discuss ICHRAs for your 2025 benefit strategy. Fun Fact: An employer can offer an ICHRA alongside a group health plan (just not to same employees). It doesn't have to be all or nothing!

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This story is from Illinois. They are trying to remove Step Therapy which is a common complaint of consumers. In simple terms Illinois new law means the insurance company can't force you to try less expensive options before covering treatment your Dr. thinks you should do. I can argue both sides. On the one hand if your trusted Dr. is saying you need to do treatment A then that seems reasonable. On the other hand when the insurance company says treatments B, C, and D show equal effectiveness at a lower total cost... that helps keep premiums down for everyone. Bottom-line is I imagine a lot of states are going to watch and see what happens in Illinois over the next few years. If this law does not cause the cost of medical care and the cost of medical insurance to rise dramatically other states may follow. I don't just sell Employee Benefits, I teach Employee Benefits. I tell my students the great part about our industry is legislation causes it to constantly change. New agents that stay current can compete with tenured agents that don't service "smaller accounts". I specialize in Florida employers 20 to 250 employees. #notyouraverageagency #examfx #naifatampaBAY #naifaproud

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📢 Medicare Update: 2025 Part B Premium Increase Alert Attention Medicare beneficiaries! CMS has announced an increase in the standard Medicare Part B premium for 2025, now set at $185 per month, up from $174.80 in 2024—a 5.9% rise. Additionally, the annual Part B deductible will increase to $257 from last year’s $240. Higher-income beneficiaries will continue to pay more based on income brackets. This premium adjustment reflects rising healthcare costs and new policies to address drug pricing. Be sure to review these updates as part of your Medicare coverage planning for the upcoming year. Remember, the annual enrollment period closes December 7— contact us to review your options to ensure the best coverage for your needs. #Medicare2025 #MedicarePremium #MRInsuraceSolutions

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