Send us a text

Saving for your health is actually a tax advantage!

An HSA (or Health Savings Account) is a savings account that is used purely for medical services. Unlike other accounts, you get a deduction on your taxes when you put money into the HSA and you don’t get taxed when you take money out of the HSA. It’s also not a use it or lose it system, it keeps “rolling over” forever. However, because of its tax advantages, there is a limit on how much you can put in. Depending on your health insurance, an HSA is a great supplemental tool to have.

Keep an eye out for your HSA options next open enrollment!

A few technical things: For 2026, the HSA contribution limits are $4,400 for self-only coverage and $8,750 for family coverage. Individuals aged 55 and older can make an additional $1,000 catch-up contribution.

Also, if you are taking any form of social security (Medicare Part A at 65 etc) you can no longer contribute to an HSA unless you are on an employer plan and actively waive Medicare Part A.

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.

Send us a text

Your Deductible!

Depending on how your insurance plan is structured, your deductible could play an important role alongside your out of pocket maximum.

Your deductible is the amount of money you would pay for your (covered) health care before your insurance starts to pay ("you pay first").

Usually the only thing that is not subject to your deductible is your annual physical (and some blood tests that your doctor would do in a annual physical).

Keep an eye on your available deductibles next open enrollment!

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.

Send us a text

The most important thing in picking out an insurance plan is...

Your maximum out of pocket!

All of your costs related to your health will be stacked up against that maximum out of pocket before your insurance covers it. In other words, all the other things under your insurance plan: the deductible, the coinsurance, the copay, etc, all apply to that out-of-pocket maximum. Once you hit that maximum, it caps the amount of money that you will be spending in that calendar year.

Keep an eye out for it next open enrollment!

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.

Send us a text

What to Do When Your Health Insurance Costs Are Skyrocketing

Vinny Catalano tackles the anxiety-inducing reality of rising health insurance premiums as ACA subsidies face elimination, explaining what individuals and families need to know to make smart coverage decisions for 2026.

Vinny addresses the widespread panic as people receiving plans from ACA exchanges worry about losing subsidies that kept their premiums affordable. With subsidies disappearing, lower-income individuals are facing multi-thousand-dollar annual bills they weren't previously paying, creating a crisis that has everyone freaking out—not just consumers, but insurance companies and hospitals too.

The episode focuses on a concept most people overlook: the annual maximum out-of-pocket. Vinny explains that this is the magic number where insurance pays 100% of costs for the remainder of the year—typically around $7,000 for individuals and $14,000 for families. Understanding this number is crucial for evaluating whether to buy insurance at all and which plan level makes financial sense.

Vinny walks through the real math of insurance decisions. For example, a family bronze plan costing $2,000 monthly represents $24,000 annually. Add the $14,000 maximum out-of-pocket, and you're looking at a worst-case scenario of $38,000. He discusses the temptation to go uninsured and adopt a cash-pay strategy, warning that while emergency rooms must treat you regardless of insurance status, this approach has serious limitations for chronic illnesses and long-term care. Unpaid medical bills can lead to asset seizure if you own a home, car, or have bank accounts.

The conversation shifts to plan selection strategy. Vinny challenges the assumption that gold and platinum plans are always better, noting that many bronze, silver, and gold plans have identical annual maximum out-of-pockets. The only difference is that you pay more premium on higher-tier plans to reach that maximum slower—essentially throwing money away if you're relatively healthy.

For prescription drugs, Vinny strongly advocates for Mark Cuban's Cost Plus Drug Company for generics and GoodRx for price comparison across local pharmacies. He shares that he often pays less through Mark Cuban's platform than through his own high-deductible health plan, demonstrating how dramatic pharmacy price variations can be.

The episode concludes with a pragmatic message: buy the lowest-cost insurance you can afford, be strategic about drug shopping, and maintain the perspective that this situation will eventually work its way through the political system—though probably not in time for 2026 coverage decisions.

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.

Send us a text

Why Health Insurance Costs Keep Rising—And What's Really Broken in the System

Chris Moyer, President & CEO of ASR Health Benefits, reveals why healthcare costs continue their unsustainable climb and why most employers still don't understand their options for controlling them.

Vinny and Chris discuss the role of third-party administrators (TPAs) in self-funded health plans, explaining how TPAs handle claims processing, network contracting, and customer service for employers who choose to self-fund their benefits. Chris notes that approximately 75% of mid-sized and larger employers in the United States self-fund their health insurance, yet most employees remain unaware their benefits are self-funded.

The conversation explores why self-funding expertise remains uncommon among brokers and consultants, creating a significant market gap. They discuss the challenge of consultant training and how many are incentivized to stick with large insurance companies rather than providing strategic advice to clients. Chris and Vinny examine the lack of price transparency in healthcare, noting the irony that healthcare executives rarely focus on cost reduction despite its direct connection to insurance premiums.

Value-based care emerges as a potential solution—shifting from fee-for-service models to rewarding better health outcomes—though both agree it's not a complete answer. They acknowledge that addressing healthcare costs requires collective effort from all stakeholders, including insurance companies, hospitals, networks, and TPAs, but note significant lobbying efforts maintain the status quo.

The discussion concludes with the shifting dynamics between finance and HR functions in employer healthcare decisions. Chris predicts that over the next five years, employers will continue seeking incremental solutions to manage costs, though significant industry-wide changes remain uncertain.

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.

Send us a text

Why Your Employees Are Overpaying for Prescriptions—And How Pharmacy Navigation Tools Can Fix It

Ferrin Williams, PharmD, MBA, Chief Pharmacy Officer at Scripta Insights, reveals how pharmacy care navigation tools can help employees save thousands on prescriptions while working within existing PBM systems.

Vinny and Ferrin discuss pharmacy benefit managers (PBMs), comparison shopping tools for prescription medications, and how employers can optimize their pharmacy benefits. Ferrin shares how Scripta partners with Mark Cuban's Cost Plus Drugs to help patients navigate prescription costs, highlighting the significant savings she personally experienced using the service. They explore the challenges of prescription drug pricing, including brand protection strategies and the impact of generic alternatives.

The conversation covers the role of PBMs in managing prescription drug costs, why physician prescribing practices often miss formulary gaps, the importance of pharmacy navigation tools, and emerging medication trends including GLP-1 drugs (now covered by 60% of self-funded employers for weight loss) and specialty medications. Ferrin emphasizes that navigation tools work alongside existing PBMs to help employees find better prices without disrupting current systems, potentially reducing costs and improving member satisfaction.

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.

Send us a text

Beyond Self-Funding: Why Reference-Based Pricing Is the Solution Hiding in Plain Sight

Mike Trent, VP of Business Development at ClaimDOC, reveals why self-funding alone doesn't solve healthcare costs—and how RBP can save employers $150,000 per 100 employees annually.

Vinny and Mike discuss reference-based pricing (RBP) as an alternative to traditional PPO networks for self-funded employers. Mike shares how his wife's $67,000 hospital bill became a $7,000 claim through RBP—with no balance billing to employees. They explore the reality that most self-funded employers still pay PPO prices (250% of Medicare) without realizing it, while RBP typically reimburses at 150% of Medicare.

The conversation covers balanced billing concerns (85% of hospitals accept RBP immediately), which employers are best suited for RBP, why CFOs need to lead healthcare financing decisions, and the skills gap among brokers. Mike emphasizes his mission to educate employers on all funding options, while Vinny announces plans for the Clear Benefits Academy launching in 2026.

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.

Send us a text

Building a Culture of Health: The Competitive Advantage Employers Miss

Dr. Raymond Fabius, co-founder, president and chief medical officer of HealthNEXT and co-author of "Population Health: Creating a Culture of Wellness," reveals why mid-market companies lack the healthcare expertise to tackle rising costs—and what C-suite leaders need to do about it.

Vinny welcomed Dr. Raymond Fabius, physician executive and co-founder of HealthNEXT, to discuss population health management and strategies for controlling healthcare costs in organizations. Drawing from his extensive experience working with major corporations like GE and his transition from practicing medicine to healthcare leadership, Raymond shared insights on how employers can influence employee health and flatten cost curves.

Raymond explained how companies with a strong culture of health, safety, and well-being achieve moderate medical trends while simultaneously outperforming the stock market. His published research shows companies with a culture of health outperform the market by an average of 2% per year. He emphasized that combining strong negotiating skills with expertise in reducing healthcare needs leads to sustainable cost management, noting that a small percentage of workers account for the majority of healthcare expenses.

The conversation explored the role of employers in promoting wellness through intentional environmental design and incentive structures, the critical importance of having physician executives guide healthcare strategy, and the challenges mid-market companies face when HR departments lack necessary clinical expertise. Raymond highlighted HealthNEXT's assessment tool that compares employers to best practices and provides customized strategic plans.

Vinny and Raymond discussed generational health trends, noting Gen Z's healthier behaviors including reduced alcohol and tobacco use, and the essential role of AI in augmenting healthcare professionals. Raymond emphasized the importance of C-suite involvement in health strategy as a core business initiative and shared his commitment to advancing the field through book royalties donated to Thomas Jefferson University's College of Population Health.

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.