Risk Managers – Thought Leadership on Health Insurance

Does Commercial Insurance Always Pay More Than Medicare?

Commercial insurance is supposed to pay more than Medicare. That is the whole reason a practice takes commercial patients in the first place.

Employer Sponsored Family Coverage Can’t Compete With Market Place Coverage

Mary, who teaches smartness because she is, learns artificial economics is driving market demand…………….and she gets a self-imposed pay raise.

Independent PCP Considers Insurance Sales

By Bill Rusteberg

In response to a previous blog posting (SEE POSTING HERE) we received an email from a primary care physician we know asking if insurance sales was an opportunity for him and “if so, how?”

Martin Frankel: The Recluse Who Looted Insurance Companies

SOURCE: The Fraud Archive

He was a recluse who hid from the world, then learned how to buy other people’s caution, their trust, and their reserves. Martin Frankel turned insurance companies into a private vault—and tried to wrap the scheme in Vatican respectability.

Mulebriar Strikes Again

“Texas takes unlicensed TPA activity very seriously, especially when municipalities or public funds are involved……..”

American Healthcare Finance – Is History Repeating Itself?

“Distribute a benefit and you distribute dependency. Distribute dependency and you distribute political power to whoever controls the distribution.”

47% of the American population is receiving government funded healthcare……

Teneshia – Houston’s #1 Fiscal Conservative

Credit: KHOU 11

A Harris County official was just approved for a $305,000 salary. She says she won’t take it.

RiskManagers Website Defies Normalcy Because It Does

How many times have you visited a website and walked away wondering what exactly do they do? That’s by design. The strategy is to create as much curiosity as possible to motivate engagement.

Chasing Dollars 7 Minutes At A Time

By Kendrick Johnson DO

I spent years inside the insurance-based primary care system. Here’s the part nobody says out loud: The 7-minute visit isn’t a failure of the system. It’s the output of the system.

Disney Is Dropping Healthcare Coverage For Working Spouses

The Affordable Care Act requires large employers to offer coverage to employees and their dependent children but imposes no obligation to cover spouses…….200,000 Disney employees lose spousal coverage…………….

Medicare For All Is Only One Election Away

“It’s time we eliminate the world’s longest waiting period!“ says Johnny Walker. “Not only is it the longest waiting period known to mankind, it requires decades of prepayment to the tune of hundreds and thousands of dollars before coverage ever begins!”

Small-Town Pharmacist Reveals the Financial Reality of Owning a Drug Store, Says She’s ‘Barely Making Enough’ (Exclusive)

Fair Jones tells PEOPLE she is “working myself to the bone” to save the Mississippi pharmacy she dreamed of owning

“Some can cost the pharmacy $1,000 or more for one patient’s one-month supply, while Jones says she may make only $10 in profit on the prescription. Filling 10 of those prescriptions in a week could cost her $10,000 upfront while bringing in just $100 in profit.”

Negotiating 2027 Renewals with Blue Cross and other BUCAs

By Daniel Meylan – Independent Healthcare Risk Financing Consultant

Over the past week I’ve had multiple advisor conversations across the country from Kansas to Texas to Missouri to Pennsylvania and heard about many Blue Cross fully insured renewal increases that exceed 30%. The way things are shaping up, any 2027 renewal offer from BC under 20% may be considered acceptable, especially for groups of 50 or less.

Government Backed TPAs to Compete With Legacy TPAs?

“The time has come for Congress to give employers a more accountable and affordable option to administer their medical benefit plans. We call this system disruptor the Fair Pay, Fair Play TPA”.

This article says Congress should gift employers a more affordable option to administer their medical benefit plan by competing with greed driven, plan gouging, for profit legacy TPAs.

Humberto Zamora

Humberto Zamora was one of the first entrepreneurs in the Lost & Found Money business who saw an opportunity well before anyone else did. From humble beginnings he earned millions helping hospitals collect Found Money.

IDR Awards Turbocharge Toilet Paper Numbers

“Awards usually land at 3–10× the toilet-paper number. But sometimes it’s 100× or 150×”

Large Texas School District Seeks Insurance Consultant

The United Independent School District is soliciting proposals from qualified consultants to serve as a strategic partner providing expertise, guidance, and administrative support for the District’s employee benefit programs.

School District’s Travel Expenses Called ‘Jaw-Dropping’ Amid District Budget crisis

“Sen. Lindsey Tichenor pressed the superintendent on the district’s credit card statements, calling its travel expenses “jaw-dropping.”

2 Texas Financial Advisers Found Guilty in $80 Million Ponzi Scheme

By Christopher Hoffman – August 19, 2026

SAN ANTONIO – Two Lubbock financial advisers have been found guilty of running a massive Ponzi scheme that federal officials say took in about $80 million from investors, leaving roughly 500 victims with millions of dollars in losses.

Crystal City ISD’s New Health Plan Won’t Survive The Light of Day

At their August 19 board meeting trustees of the Crystal City Independent School District awarded the district health plan to Curative Insurance Company effective October 1.

Is Your Premium Only Cafeteria Plan Compliant?

ATTENTION PLAN SPONSORS: There’s not too many compliant POP Cafeteria Plans out there. The good news is we haven’t seen any badge heavy, gun toting Cafeteria Plan police raiding worksites either. But it’s always good to err on the side of caution so take this as an unsolicited Public Service Announcement intended to keep your butt out of trouble.

90 Degree Benefits GP90 Plan

Discover how pairing a high-deductible health plan with a GAP90 plan can deliver significant savings for employers without sacrificing value.

Brownsville ISD To Entertain Presentations Even Though Top Ranked Vendor Has Been Decided

Could 50 People Be Wrong………………………? All vendors except the anointed one stubbornly cling to hope ……..“It ain’t over until it’s over…………..”

August 18, 2026 at 6:30 PM – Watch Employee Benefits, Insurance and Risk Management Committee Meeting Live………………

Could this be a case of Musical Chairs? Will United HealthCare keep the account or will Blue Cross get it back? Or…….. as they are coming around the corner here they come………. will Dark Horse Curative Insurance Company come from behind for the win? Fifty insurance committee members know the answer. Can they keep a secret?

Why Healthcare’s Future is Direct

By Manny Pastreich, President, 32BJ SEIU and Nick Stefanizzi, CEO, Northwell DirectPosted on May 14, 2026

American healthcare is dynamic and lifesaving – while also becoming unattainable for too many Americans at a price they can afford. For decades, the standard response to rising costs has been to shift costs to workers by raising deductibles, raising premiums, cutting services or shrinking access. The primary payers of American healthcare, employers and workers, now face a staggering $18,500 per employee cost.

Sangamo Therapeutics, Inc.

Sangamo Therapeutics, Inc. is a clinical-stage biotechnology company headquartered in Brisbane, California, that specializes in the development of genomic therapies based on its proprietary zinc finger nuclease (ZFN) technology.

THE ICHRA SHOP

Live it, love it, and wear it! New ICHRA t-shirts coming soon……………..

Brick & Mortar Auto Insurance Agents Face Death By A 1,000 Clicks

More insurance companies have decided retail brick and mortar agents are less relevant these days. There’s a better more economical way to distribute their products.

DPC Malpractice Insurance

We are the program administrator of the only true DPC-specific malpractice insurance policy available.

$10,000 Dental Plan

“With NCD Complete by MetLife, your clients get a high quality dental plan backed by a trusted name, a nationwide provider network, and exclusive savings.”

Mob Rule

By Bill Rusteberg

“Mob rule or ochlocracy or mobocracy is a pejorative term describing an oppressive majoritarian form of government controlled by the common people through the intimidation of authorities.”

PBM Deception

By Eric Bricker, MD

In this ten minute video Eric explains how PBMs take the art of deception to new levels while claiming 100% of rebates are passed on to plan sponsors – the key is three letters: G-P-O

Employers Chase Cost Cuts, Leaving Benefits Brokers At A Crossroads

“When cost becomes the only lever a client is asking about, the broker’s role narrows to running RFPs and comparing quotes, work that’s increasingly easy for a client to benchmark and easy for a competing broker to replicate.”

More Large Employers Are Turning To ICHRA As Group Costs Climb

ICHRA adoption jumped 53% in 2026, but the real story is that applicable large employers are now the fastest-growing segment

How Much Will You Pay Me For My Life Insurance Policy If I Sold It Today?

As life circumstances change, a policy that was purchased for protection may also provide liquidity during the insured’s lifetime. Whether you are facing rising premiums, changing retirement goals, or no longer needs the same level of coverage, your policy could hold more value than they realize.

Become A Published Author For Only $149 (and you may become famous too)

We’ve seen a few in our industry become published authors to good effect. They expose the truth about American health care finance, industry secrets that average plain ole everyday plan sponsors are clueless about. Now here’s your chance to do the same for only $149……………….

Robert Kennedy Jr. Exposes Anti-Fraud Failure

When I came in, there’s only 6 people who are in charge of all program integrity for my department!”

They Hated Health Insurance. So They Started Paying For Each Other’s Care

“What resonates with people is that they’re just tired of health insurance. They’re tired of these bills and these claims getting denied……………..”

Do You Wonder What FY2027 MS-DRG Rates Do To Medicare Inpatient Revenue At Your Hospital?

“This (Free) DRG-Impact tool is designed to quantify the revenue impact of the final FY2027 MS-DRG rates by hospital and DRG. I hope you find this helpful and I welcome your feedback.” – Brian Cotter

The Future of Community Pharmacies

“To survive, community pharmacies are evolving beyond the traditional “product-dispensing” revenue model. The future of local pharmacy relies on diversifying revenue away from product margin alone—shifting toward clinical service delivery, point-of-care testing, specialized compounding, disease state management, and direct-care service contracts with local employers and health plans” – Erin Albert

ICHRA Stories

Watch Real Experiences and Insights from Employers, Employees and Brokers

Wondering what ICHRA looks like in practice? Hear testimonials directly from employers, employees, and brokers as they share real experiences with Individual Coverage Health Reimbursement Arrangements (ICHRAs), offering practical insights, lessons learned, and perspectives on personalized health coverage, employee choice, and cost control.

The Life of a Prescription in the USA in 2026–Drug Formularies, Pricing, and Money at the Pharmacy Counter

This is Part 6 of a 6 Part Series By Erin L. Albert, MBA, PharmD, JD, DASPL

“To understand why a medication costs $10 for one person and $1,000 for another under the exact same plan design, one must examine how drug formularies handle money at the counter—and how modern pricing structures, like the Mark Cuban Cost Plus Drug Company (MCCPDC) bolt-on model, attempt to disrupt that framework.”

100 Best Health Insurance Blogs to Follow in 2026

Psssst……RiskManagers.us is NUMBER TWENTY!

The best Health Insurance blogs curated and ranked based on multiple factors, including content relevancy, subject expertise, posting frequency, and freshness of content.

Greenback Health – Simplifying Healthcare Costs Through Innovative Technology

Greenback Health is a healthcare technology company that partners with insurers, PBMs, and health plans to analyze thousands of drug prices in real time and identify the most cost‑effective payment options at the point of sale.

Amazon Pharmacy RxPass Program

SOURCE: Amazon Pharmacy: RxPass

RxPass has you covered

While other savings programs charge for each individual medication, RxPass is always $5 a month—no matter how many meds you take.

Navigating Cash-Pay Prescriptions: A Guide for Pharmacies

Written byEmily Smith – Product Marketing Manager, RedSail Technologies – April 9, 2024

We know the prescription drug supply chain is complex, shaping medication pricing in complicated ways. As prescription costs continue to rise, and insurance coverage fluctuates, cash-pay prescriptions have emerged as a viable option for many people seeking affordable medication.

Return of Cash Pay for Drugs

Why on earth do we use insurance to pay for a $4 benefit? That makes no sense………

Cash price Rx plans already exist producing significant savings for consumers. Why aren’t more employer sponsored health plans moving to cash pay Rx plans? Do they not understand the economic value or are they welded to status quo strategies fueled by lack of critical thinking skills?

Ruben Cavazos, Willacy County Treasurer Appointed To NACO Committees

Ruben Cavazos is the Willacy County Treasurer in Raymondville, Texas, serving since January 1, 2007 when he became the youngest country treasurer in Texas ever to win office.

Iran’s Healthcare Crunch Forces Patients To Cut Treatment

“One person undergoing tests for an abdominal and pelvic mass said CT and MRI scans, with and without contrast, cost 210 million rials ($113) despite having Social Security insurance.”

The PBM Fiduciary Double Standard?

By Robyn Tikia

Here’s the part of the PBM debate that bothers me…..Employers are increasingly being told, “You’re the fiduciary. You should have known.”

Your PBM Met Every Guarantee. You Still Lost the Money.

SOURCE: siriusb.ai

Every broker promises “savings” and “transparency”. Then renewal comes and the CFO asks: “Where’s the proof?”

RosettaFest 2026: I Didn’t Expect Employer-Sponsored Healthcare to Restore My Faith in American Healthcare

By Matthew Zachary

For most of my adult life, I have looked at American healthcare through a single window.

RBP Claim Repricing For $1 / Claim

My Price Health was formed in 2021…..……….We seek to lower the healthcare costs by 50% by reducing administrative costs…………

Zero Copay Medication

MyFreeMeds members get access to medications included on their selected formulary (list of included drugs) with no out of pocket cost at over 55,000 local pharmacies nationwide.

Dental Insurance Market Report

Affordability pressures drive shift toward voluntary plans

DALLAS, May 18, 2026 — Despite a 2024 dip in U.S. dental plan enrollment, dental benefits companies increased payments per member to dental providers and continued to expand enrollees’ financial protection by raising annual maximum benefit levels, according to the NADP 2025 State of the Dental Benefits Market Report.

Marpai Announces $12 Million Private Placement led by Mitchell Companies

TAMPA, Fla., July 29, 2026 /PRNewswire/ — Marpai, Inc. (“Marpai” or the “Company”) (OTCQX: MRAI), a leader in innovative healthcare technology, Third-Party Administration (“TPA”), and Pharmacy Benefit Management (“PBM”) services, today announced that it entered into securities purchase agreements with accredited investors in a private placement of newly designated convertible preferred stock. The offering was led by Mitchell Companies.

OZEMPIC HORROR SHOW: $2 BILLION LAWSUIT JUST EXPLODED

“Patients are losing DECADES of muscle in a SINGLE YEAR. Bodies aging at warp speed. Hearts weakening. Then the real hell starts: gastroparesis — stomach paralysis so bad food literally ROTS inside you. Weeks of nonstop vomiting. ER visits on repeat. Some say their entire GI tract has completely failed. Teeth falling out from chronic dryness. Sudden PERMANENT blindness. Pancreatitis. Kidney failure.”

Best Benefits Online

Best Benefits Online™ modernizes employee benefits with real choice, and zero admin complexity—all in one platform. A modern, sensible and common-sense solution for employer sponsored health plans and associations.

$278.33 Premium Only Policy vs $550 Claim Paying Policy

By Bill Rusteberg

Large employers typically sponsor ACA complaint claim paying group health insurance policies instead of lower cost government enforced premium only policies.

Loophole City – Weight Loss Drugs Without A Prescription At Your Local Supermarket

“There’s this loophole where you can create a chemical and so long as you say it’s for lab research, it can be sold. It’s not otherwise controlled, he said…………’I don’t think it’s illegal to sell it and I don’t think it’s illegal to take it. The loophole is that everyone is lying about what the original purpose of it is.”

Maintaining The Win – Survival Tips For Insurance Brokers

By Bill Rusteberg

An insurance broker’s financial survival is dependent upon monthly residuals built over time. Winning business is only good for as long as its kept.

Edinburg ISD Considers Move From Free Blue Cross ASO Health Plan

The Edinburg Independent School District is considering a move from Blue Cross Blue Shield to United Healthcare effective January 2027.

School District Changes Health Insurance For 1.25% Premium Savings

The Edcouch Elsa Independent School District believes every penny counts. The district’s insurance consultant recommended a move from Blue Cross Blue Shield to United Healthcare for a premium savings of 1.25%.

Medicare Price Lookup Is Easy

QUESTION: What is the Medicare price for an established patient 10-19 minute office visit?

“Don’t Be Bullied. Be The Bull” Say Doctor Bill

By Bill Hennessey, M.D.

Ballad Health Bills Critical Care Codes Instead of ER Codes for ER Visit – Charges $4,664 for 10 minutes of Face Time with Patient

How Much Is This Going To Cost Me?

By Cam Wynn

I’d bet most of us have asked ourselves “How much is this going to cost me?” That’s what made me wonder how many employees are making healthcare decisions with their wallet instead of their health?

ICHRA Explained In One Picture

Memorial Hermann To Exit Health Insurance Business

SOURCE: Program Closing | Memorial Hermann Health Plan

Memorial Hermann has made the decision to wind down and close Memorial Hermann Commercial Health Plan, Memorial Hermann Insurance Company and Memorial Hermann Health Solutions, known collectively as the “Memorial Hermann Commercial Health Plans” (“MH Commercial Health Plans”).