Open Enrollment Season is upon us.
It’s that time of year where employees, self-employed, businesses, and local governments start crunching numbers to see how much health insurance will cost next year—and, surprise of surprises, the answer is almost always “a lot more.”
Worse yet, the Federal Budget impasse and Government shutdown over ACA healthcare subsidies is pouring fuel onto the fire of healthcare in crisis.
Renewal notices often arrive at the last minute, and business CFOs and HR directors do not have adequate time to shop for alternatives, so everyone gets stuck with few choices but lots of fears over losing benefit coverage. All are held hostage to higher insurance premiums and ridiculous deductibles to meet before they have the privilege to even use their insurance coverage.
There is a better way. Transparency and direct contracting bypasses the inflated costs and poor healthcare access caused by the middlemen. Direct Primary Care (DPC) options are far better medical care at a fraction of the cost. DPC combined with innovative options like health cost sharing plans are far better medical care, often for less than employee contributions alone.
Changes with the OBBB this year allow HSAs to pay for DPC membership as well. Further, both businesses and individuals can combine DPC with catastrophic (or major medical) plans for ER or hospitalizations and other high-cost events. Imaginative solutions are available now and families can have very good medical care at a fraction of the cost.
We do not have to wait on the government. There are practical solutions to premium increases.
First, businesses and governments at all levels must shop the market for benefit advisors who can demonstrate complete transparency from their commissions and any kickbacks or other “supplemental compensation” and conflicts of interest – preferably zero conflicts and kickbacks.
Secondly, many new and independent benefit advisors are making direct contracts with hospitals, surgery centers, pharmacy plans, and starting with direct primary care, which includes urgent care.
For example, through traditional insurance, a knee replacement surgery can easily cost $80,000 and up, whereas the cost through an independent surgery center in Austin is $22,000. The co-pays on x-rays are often $50-150, but the direct costs are $50. Co-pays for common generic drugs may be $5-10/month, but the actual direct cost of the drugs are often $1-2, which is 500-1000% markup.
Direct contracts bypass these higher costs and save everyone money—everyone, that is, except the middlemen.
We are held hostage to our own health by traditional insurance plans, but there is a better way. The healthcare economy has options now. If not now, when?
