ACA Premium Hikes, Expiring Subsidies, and the ICHRA Ripple Effect: What to Watch in 2026

By Justin Leader

With the enhanced ACA subsidies set to expire and insurers filing for 15–20%+ premium increases in 2026, many are bracing for what could be a massive affordability shock for middle-class families, especially those who have relied on expanded subsidies since 2021.

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Another Pharma Mfg. Bypasses Middlemen – Costs Drop More Than 40%

We are beginning to see pharmaceutical manufacturers breaking away from supply chain middlemen (PBMs) saving consumers imbedded commissions (rebates) for savings of 40% and more. For example Novo Nordisk Direct and Lilly Direct offer certain GLP-1 drugs for $500 or less, a more than 50% price drop.

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Proactive Risk Management Is Key To Managing Rising Health Care Costs

This illustration is on a 465 life case that has been on a Reference Based Pricing plan for over a decade. They have never had a rate increase.

The illustration breaks down the various cost components.

In this instance the plan is a Cash Pay Centric Plan with a Reference Based Pricing wrap.

Plan contributions are a sum of all costs distributed across participation tiers.

Plan contributions shown include a margin over expected claims. A plan sponsor may decided to fund less than the suggested funding rates especially if there are adequate booked reserves from the prior year.

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What is Insurance Risk?

We talk about $10/month plus the cost of the risk, but what does that really mean?

By Monte K. Jennings – Jul 14, 2025

Introduction

Today we are going to talk about risk. First we will define risk, then we will walk through an example of how we calculate risk in layman’s terms, and finally we will discuss what the risk means to you, your family, your wallet, and most importantly your insurance premium. We will also discuss why these things are so difficult to calculate.

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What Do Hidden Fees Really Mean in Your Health Plan? A Wake-Up Call for Employers

“Hidden fees are eating away at your health plan—just as they once ate away at retirement savings plans. But with the right tools, oversight and processes, you can uncover mismanagement, improper practices or unethical conduct—and reclaim control of your plan spend.”

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Medical Industrial Complex Sucks More Money From New Jersey Taxpayers

“The largest recommended increase is in the Local Government (SHBP-LG) plan, where AON has called for a 36.5 percent increase in premiums. In the School Employees’ Health Benefits Program (SEHBP), AON has recommended a 29.7 percent increase. And in the State Health Benefits Program (SHBP-State), the recommended increase is 21.0 percent.”

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Medical Decisions Should Be Made By Doctors, Not Insurance Companies

By Dr. Elisabeth Potter, MD

I’m sharing an actual recent peer-to-peer call that shows what physicians and patients face when trying to get a surgery approved. This call felt as absurd as it sounds.

The peer-to-peer call was to advocate for surgery to prevent and treat lymphedema for a patient with breast cancer. Her risk is high and we can perform a surgery to lower it.

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The Rise of A New Class of HealthCare Navigator

By Sidney Haitoff on Linkedin

As access barriers are torn down by new payment models, modern admin infrastructure, and AI, we’ll see a new class of healthcare navigator emerge. These sherpas will help curate optimal pathways, manage alerts and alarms, translate new data models, and coordinate collaboration across service sites and delivery channels, and triage issues.

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“New Frontier” In Employee Benefits For County Employees

“For county employees, navigating healthcare can often feel like another job—long waits, rushed appointments, and unclear bills. But with this new Advanced Primary Care model, employees enjoy easy, on-site access to care, at times that work with their schedules, and a location that is convenient for them. No complicated scheduling systems or insurance red tape—just care when they need it.”

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ZorroRX

ZorroRX is a health benefits program designed to make healthcare more accessible and affordable for patients while reducing costs for employers. We partner with hospital pharmacies to offer $0 copays on medications, free telehealth visits with specialized pharmacists, and dedicated concierge support.

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More Reasons Why Employers Are Getting Out of The Health Insurance Business

“The Big Beautiful Bill, signed into law by President Trump on July 4, 2025, spans nearly 900 pages and touches numerous aspects of federal policy. Nestled within this lengthy legislation are employee benefits provisions that will require employers to navigate new rules, opportunities, and compliance requirements.”Amundsen Davis

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Me Too Brokers

By Bill Rusteberg

It’s easy to spot a Me-Too Broker. You know the type. The kind that goes along to get along. Remember Little Johnny in second grade? He was the teacher’s favorite. Remember that? Well………..Little Johnny changed his name to John and he’s now a group health insurance broker posing as a consultant.

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Centene Corporation – The Biggest Health Insurance Carrier You Never Heard Of

By Patrick Moore

5 years ago when I was building a slide deck about the biggest health insurance companies in the 🇺🇸 the named popped up. I spent my career on the group side so it was never really a company i paid attention to. They focus alot on the medicaid and the individual market under a brand called Ambetter Health.

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Will Employers Replace Defined Benefit Plans with Defined Contribution Plans?

“Employers should assess employee preferences for group plans versus CHOICE arrangements, documenting decisions to demonstrate fiduciary prudence…...Employers must ensure group coverage remains comprehensive and cost-effective compared to CHOICE arrangements…… Fiduciaries may need to evaluate whether continuing group plans……….”

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Commissioner’s Bulletin # B-0005-25

June 5, 2025

To:   Insurance companies writing personal automobile and residential property policies in Texas

Re:   2025 HelpInsure.com price comparisons data call

The Texas Department of Insurance (TDI) issues this data call to gather information for the HelpInsure.com website. HelpInsure is a resource for Texas consumers who are shopping for personal automobile or residential property insurance. Insurance Code Section 32.102 requires that TDI provide this information. Responses for this data call are due by July 11, 2025.

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There’s No Such Thing As A Million Dollar Claim

By Bill Rusteberg

A few years ago we were having a few late afternoon beers, as was customary on most business days, at the CEO’s private office in West Texas. Although I was not a “regular” since I lived many miles away, when I had occasion to visit I always looked forward with keen anticipation to the late afternoon “business meeting” that would invariably take place. It was always an enjoyable time, with much banter back and forth, with an occasional visitor or two dropping by to add to the atmosphere.

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The Jacked Up World of Cost Containment

Victor Lustig

The American health care delivery system is about as jacked up as jacked up can get. Employers scramble to mitigate rising health care costs by hiring outside cost containment firms employing any number of strategies. This additional plan expense can effectively double or triple fixed costs leaving fewer budgeable dollars to pay claims.

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Script Sourcing Third Party Vendors Save Plan Sponsors Millions In Prescription Drug Spend

PBM Sales Rep. Reacts To The News……………….

Plan sponsors seeking solutions to high cost prescription drugs must understand a single source solution is not their best bet. Lowering Rx costs is all about sourcing the right drug at the right price. It’s that simple.

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Carrier Ditches Traditional Group Insurance Plans To Promote ICHRA

Insurance company announces it will exit the fully-insured, self-funded and level funded market to concentrate on individual policies through Individual Coverage Health Reimbursement Arrangements (ICHRA).

“We are committed to helping employers find affordable health insurance options for their employees. We believe that one answer can be found in our individual plans and are excited to provide a solution for employers in CT through an Individual Coverage Health Reimbursement Arrangement (ICHRA).”

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Mark Cuban Floats Bold Healthcare Plan: ‘Zero Premiums To Insurance Companies’ With A Cash-Pay Revolution

“This is not a new idea but a good old idea. Cuban proposes the government provide the equivalent of a $50,000 stop loss policy for all Americans – an ACA Re upgrade. Let’s do it!” – Molly Mulebriar

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Federal Judge Rules Providers Can Sue To Enforce Unpaid IDR Awards

“Get your check book ready………………” – Don Pedro

Eliott Listman – Allia Group – Litigation CEO

A federal court in Connecticut ruled that providers can sue to enforce unpaid IDR awards under the No Surprises Act, rejecting insurer arguments that there’s no private right of action.

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Medicare and Social Security Go-Broke Dates Pushed Up Due To Rising Health Care Costs

Medicare is on track to be broke in eight years. If Medicare For All is implemented then it stands to reason the Medicare risk pool will benefit by the addition of younger and healthier people. Odds makers expect that to happen because it will. Medicare won’t be a risk pool of oldies anymore.

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