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Sunday, August 16, 2026 In case you missed it . . . . . The WSJ reported Monday (“Insurer Payouts for Car Crashes Get Less Likely” written by Jean Eaglesham and Jaclyn Jeffrey-Wilensky) “auto insurers didn’t pay out on 45% of auto liability and medical claims they resolved last year.” To be fair, liability and medical claims tend to be far more complicated (e.g., litigation). However, only one in four claims for collision and/or comprehensive coverage were paid. C

Sunday, August 9, 2026 At a recent exam, my blood pressure (systolic) was a little high. Doc asked if I monitored my BP at home. “Well, thanks to you, I already have a fingertip pulse oximeter in my bedtable drawer and wear an Oura ring, but no BP monitor.” Even though a second reading during the exam was much better, the next day I picked up “an automatic, cuff-style, upper arm monitor (as recommended by the American Heart Association).” Then followed a couple of days

Sunday, August 2, 2026 Employers sponsoring group health plans are considered fiduciaries under the Employee Retirement Income Security Act (ERISA, 1974) whenever they exercise discretionary control over the management, administration, or financial assets of the plan. About this time last year (TIP # 685 HERE), I wrote about a client who had managed to somehow absorb a 39 % premium increase, on top of the 46 % increase the year before. This year it’s even worse; 67%!! G

Sunday, July 26, 2026 Doris received a $900 bill from her hospital. Knowing she had reached the Out of Pocket max of her insurance plan months ago, she tried calling her provider. Long story short; the provider had billed her before submitting the claim to Doris’ insurer. Why? And why did she have to spend hours on the phone, getting transferred from department to department, to get this settled. Then there’s Larry. Like Doris, he knew the balance on his hospital bill

Sunday, July 12, 2026 “Surging” health insurance premiums made headlines again this week, as ACA Marketplace Insurers proposed a median increase of 14% for 2027. That’s down from 20% for 2026. (Hey, have they retired “skyrocketing?!”) It was a local headline, however, that piqued my interest: ‘11 Hospitals Cited for Price Transparency Violations.’ Why? CMS Price Transparency rules (summarized HERE) took effect years ago. I’m under the impression there’s a ton of pricing

Sunday, June 21, 2026 Tired of hearing about Health Savings Accounts? Don’t blame you. Almost done . . . . . . As recently noted, employers contributing to HSAs can choose the levels and frequency of contributions, but must treat all employees the same and, once paid out, those employer contributions are owned by the employee. Health Reimbursement Arrangements (HRAs) are a little different. We frequently use them to back-fill even higher deductibles than the minimum

Sunday, June 14, 2026 After reading last week’s Tip (HERE), one ‘subscriber’ commented the average Health Savings Account balance (~$2,700) seemed low. I agree, (Doubting) ‘Thomas' and thanks for so carefully reading my Tips. (But, get a life!) Factors in play here: It’s been widely reported 40-57% of Americans have less than $1,000 of savings, so unless the employer contributes to the HSA, uptake is limited. (More on that next week.) For people living paycheck to payche

Sunday, June 7, 2026 Long before Tip # 1 (2010), we (snail) mailed The Rauser Review newsletter. (Catchy title, huh?!) Each RR included ‘A View from the Crow’s Nest’ predicting employee benefits trends. One CN column described our modest success selling Golden Rule MSAs; Medical Savings Accounts (aka Archer MSAs), authorized as a pilot program under HIPAA (1996). That caught the attention of RR ‘subscriber’ Congressman Paul Ryan. He came to our office to learn more. (Trul

Sunday, May 31, 2026 One requirement for renewing my insurance license every two years in June (birth month), is the completion of (coincidentally) 24 continuing education credits. (Get it?) Like those who wait until April 15th to file tax returns, yours truly was online just this week reading course materials, then taking exams. Friday was the last (“Medicare Coordination with Employer Health Plans”); a tedious review of regs I should already know, followed by 50 (intent

Sunday, May 24, 2026 HUMBLED BY THOSE WE REMEMBER AGAIN TOMORROW, MEMORIAL DAY, 2026. 25,000; Revolutionary War (1775 - 1783) 20,000; War of 1812 (1812 - 1815) 13,283; Mexican - American War (1846 - 1848) 620,000; Civil War (1861 - 1865) 2,446; Spanish - American War (1898) 116,516; World War I (1917 - 1918) 405,399; World War II (1939 - 1945) 36,516; Korean War (1950 - 1953) 58,209; Vietnam War (1965 - 1973) 7,078; War on Terror 2001 - present)

Sunday, May 10, 2026 We’re still working our way through two lengthy and sobering reports on health care spending. One of those reports is paired with a follow up virtual meeting Wednesday. Until I gather my thoughts and or get permission to share links to this data, here are a few highlights: $5.6 trillion was spent on health care in 2025. Hospital services account for ‘only’ 30% of that total. One of every four employer health care dollars are spent on pharmacy. 55% of th

Sunday, May 3, 2026 Meet 'Katie.' Teacher, single mother of three making $57,330. Her health plan has a $2,500 single deductible plus copays, coinsurance, etc. capped at $5,000/year. Double per family. That’s a decent health plan. Her share of the family premium is only $225.70/month. That’s outstanding! (Woefully short on pay, school districts often rock on benefits!) Here’s the problem. On top of the occasional sports injuries, Katie and one child have chronic healt

Sunday, April 26 Perhaps because I’ve recently flown “the friendly skies,” this WSJ headline caught my eye. “Senators Warn United, American on Merger” The article quoted a letter written by Senators Elizabeth Warren (D, Mass) and Mike Lee (R, Utah), noting “a combined United-American air carrier would be able to exploit its market power to harm consumers in a number of ways.” Like, “higher airfares!” Here’s a question for these two Washington Watchdog Wizards; where

Sunday, March 29, 2026 Best Bud’ had another health episode this week. I say another because he’s dodged one bullet after another fighting cancer for over a decade. Tough as nails! This time it was a bad case of the chills (well actually, rigors) that sent him to UC, where they ran a few tests and prepped him to go home. Turns out he was flirting with sepsis, the result of an abscessed gall bladder. Without the intervention of an advocate - who sent him to another hospi

Sunday, March 22, 2026 Sure, but . . . . . Under age 65 and not covered by an employer sponsored group plan? You can shop for and buy individual (family) coverage on the ‘Obamacare’ Marketplace: https://www.healthcare.gov/ Note the URL ends .gov. Search engine algorithms (rankings) for ‘Individual’ or ‘Marketplace’ health insurance often lead consumers to one or more .com private websites. There, you’re likely to get high pressure/low information sales pitches. That

Sunday, March 15, 2026 The platform used to send these email blasts (aWeber) collects minimal but useful data; e.g., your number of opens, clicks, etc. The independent accounting firm of LiceWaterbowlPoopers (LwP) has tabulated the ‘ballots.’ The nominations for best Insurance Tip – Short Subject – are: Tip # 627 “There Is No Joy In Mudville” Tip # 12 “A Pool Is a Pool Is a Pool.” Sadly, the earliest Tips were lost. But, a brilliant (COUGH) article with the same title w

Sunday, March 8, 2026 Business owner and friend – knowing what I do for a living – changed the conversation to his health insurance. He asked, “Is a Level Funded Health Plan a good deal?’ Need a little context, Pal. What are you paying and what/who does it cover? He pulled up a copy of the last invoice on his phone; the February premium was $13,000 and listed 21 employees, split about 50/50 between single and family coverage. I asked him if he was happy with his cur

Sunday, March 1, 2026 Some of the key drivers of health care inflation were explained in a 45-minute webinar entitled “2026 State of the Industry” earlier this week. A few highlights. Drug spending from 2023 to 2024 increased by 11%; 47% of that is for GPL-1 weight loss therapies that cost $11,000 - $16,000 per person per year. And the ROI for that spend? (Ya might want to sit down.) A 91% increase in the cost PMPM (Per Member Per Month); from $930 to $1,774. Most of tha

Sunday, Feb 22, 2026 There are many factors to consider when choosing a health plan. Provider networks are usually at the top of my list, but for today, let’s focus on plan design. A $5,000 deductible HSA Plan (i.e., one with no co-pays) has a monthly premium of $573; a $5,000 deductible plan with first dollar coverage for office visits and drugs (i.e., co-pays) $660. The annualized savings is $1,044 or about 13%. Interestingly, the savings is only about 4% for plans with and

Sunday, Feb 15, 2026 There were six of us at breakfast Friday morning; guys just ‘chewing the fat’ (literally and figuratively). Turns out, two of us had colonoscopies this week! That defies the odds, considering 40-44% of Americans (all ages) don’t even get an annual exam! BTW, colonoscopies at a free-standing ambulatory surgical center (ASC) run about $1,600 - $3,100. Coincidentally, I have a client's EOB on my desk; his wife’s colonoscopy at a local hospital was $6,5