by admin | Sep 15, 2025 | Health Care Costs, Health Insurance
PwC’s latest annual analysis forecasts that group health insurance costs will increase by 8.5% in 2026—the third straight year at this elevated trend. This sustained rise means health care expenses are now similar to those seen 15 years ago, after a brief dip post-pandemic.
Researchers gathered data from actuaries at 24 major U.S. health plans, covering more than 125 million employer-sponsored members and 12 million ACA marketplace members. The “medical cost trend” refers to the expected annual increase in health plan spending.
Key factors driving this growth include:
Hospital expenses: Wages for healthcare workers, supply prices, and rising operational costs all contribute. Many hospitals are intensifying revenue cycle management activities, increasing inpatient admissions, and pushing more costs onto commercial health plans.
Prescription drugs: Spending is up, notably driven by new therapeutics such as GLP-1 medications for chronic illnesses and rare genetic conditions. Drug spending soared by $50billion in 2024, with GLP-1s poised for further approvals.
Behavioral health services: Inpatient behavioral health claims jumped nearly 80%, and outpatient claims rose almost 40%. One in three actuarial leaders cited behavioral health as a top driver of rising costs, projecting a 10%-20% trend for this segment in 2026.
Offsetting factors, though limited in impact, include:
Biosimilars: For the third straight year, biosimilar drugs are cited as a leading cost deflator. Their adoption continues to grow and may help moderate spending.
Care management: Health plans are finding success with cost management strategies, such as utilization management, pharmacy oversight, and AI-powered claims review—tools that could dampen the medical cost trend.
The report also highlights upcoming federal policy changes, like the One Big Beautiful Bill (OBBB) Act, which may bring more cost pressure through adjustments to Medicaid eligibility, lapsing ACA subsidies, and proposed tariffs on imported pharmaceuticals.
Ultimately, industry analysts anticipate medical costs will keep climbing into 2026 and likely beyond, forcing employers to pursue affordability strategies while managing the growing burden of health coverage costs.
by admin | Sep 8, 2025 | Custom Content, Employee Benefits, Health Insurance
When navigating the world of health insurance, you will likely encounter the term PPO (Preferred Provider Organization). A PPO plan – whether medical or dental – is about balancing the cost and convenience of care. With a PPO plan, you get the flexibility to see a wide range of doctors. You’ll save money by staying within the plan’s network of preferred providers, but you can still choose to go out of network and receive partial coverage. Unlike some other plans, a PPO allows you to see specialists without a referral.
How a PPO Works
A PPO plan functions much like other health insurance plans, but with a key difference in how it handles providers. The plan pays its contracted providers a set, pre-negotiated rate for services. Because of this arrangement, you pay less in cost-sharing—such as copays or coinsurance—when you receive care from an in-network provider.
While PPO plans offer the flexibility to see out-of-network providers, your costs will be significantly higher. You will likely pay more and may need to submit an insurance claim yourself. It’s also important to note that most PPO plans have a separate out-of-network deductible that you must meet before your plan benefits will begin to cover those costs.
Key Advantages of a PPO Plan
PPO plans are often chosen for their flexibility and convenience. Key benefits include:
- No Referrals Needed: You do not need a referral from a primary care provider to see a specialist. You have the freedom to schedule an appointment with any in-network specialist at any time.’
- Out-of-Network Coverage: You can choose to see providers outside of the plan’s network, which is particularly beneficial for those who travel frequently or live in different states.
- Large Provider Networks: Many PPO plans have a broad, nationwide provider network, offering a wide range of choices for care.
- No PCP Requirement: Unlike some other plan types, you are not required to choose a primary care provider(PCP).
PPO vs. HMO: The Main Differences
The primary difference between a PPO and an HMO (Health Maintenance Organization) plan lies in their approach to networks and referrals.
An HMO plan typically provides coverage only for services received from providers within its network, except in emergency situations. You are also required to choose a primary care provider and obtain a referral to see a specialist. HMO plans often come with lower premiums, but they offer less flexibility.
A PPO plan, on the other hand, gives you greater freedom. You can see specialists without a referral and have coverage for out-of-network care (albeit at a higher cost). While premiums are generally higher for a PPO, the added flexibility can be a major advantage for those who prioritize choice in their healthcare.
Ultimately, choosing the right health and dental plan depends on your individual needs and priorities. By understanding the core principles of a Preferred Provider Organization, you can make a more informed decision that aligns with your lifestyle and ensure you get the most value from your benefits.
by admin | Sep 2, 2025 | ACA, Compliance, Employee Benefits
How to position yourself as a trusted ACA compliance advisor
For brokers and benefits advisors, Q4 planning doesn’t start in October. It starts now.
September marks a critical moment in the annual ACA compliance cycle, when employers begin thinking about year-end strategies, benefits renewals, and how to avoid last-minute reporting panic. That makes now the perfect time to deepen your role as a strategic advisor and help clients get ahead of the curve.
Here’s how you can stand out by guiding clients through ACA compliance before it becomes a scramble, and why it will pay dividends well into 2026.
📌 Step 1: Help Clients Take Stock of Their Workforce Now
The foundation of ACA compliance is accurate employee classification. Yet many employers still struggle to determine:
Brokers can add immediate value by helping clients audit their headcounts and hours before Q4 begins. That insight informs both ACA reporting and benefits planning decisions, and helps prevent costly missteps when deadlines hit.
🧠 Step 2: Educate on What’s Changed and What’s Coming
ACA rules don’t change often, but confusion persists. Many clients are unaware of:
- State-specific ACA mandates (California, New Jersey, Rhode Island, Vermont, Massachusetts, and Washington DC)
- Updated penalty thresholds and IRS enforcement priorities
- New reporting formats or system changes that could impact submissions
Providing timely updates and checklists positions you not just as a broker but as a compliance partner. You can even use these touchpoints to introduce solutions like ACA reporting automation or integrated compliance tools.
📊 Step 3: Map Out a Reporting Game Plan Before the Crunch
ACA compliance starts with good planning, and now is the time to get ahead. By August, many employers are wrapping up plan design decisions for the next year, making it an ideal time for brokers to:
- Review last year’s filing process (what worked and what didn’t)
- Flag missing or incomplete employee data
- Identify vendors or tools that can simplify electronic filing
- Offer ACA services or connect clients to trusted platforms
The earlier your clients begin organizing data and confirming eligibility, the fewer errors and penalties they’ll face later. And the more indispensable you become in their eyes.
🎯 Position Yourself as the Solution, Not Just the Messenger
ACA compliance is often seen as a burden. But for brokers, it’s a huge opportunity to differentiate. Instead of only alerting clients to upcoming requirements, step in as the solution:
✅ Offer ACA strategy sessions during annual benefits reviews
✅ Share tools and resources that support self-filing or full-service options
✅ Leverage partnerships with platforms like Mitratech Mineral to deliver expert-backed compliance
When you help clients manage risk and reduce workload, you go from being a benefits provider to a business advisor and partner.
🗓 Ready to Dive Deeper?
Join us for a special webinar:
Beyond the Basics: Mastering ACA Compliance for Multi-State Employers
📅 Thursday, September 18, 2025 | 1:00 PM ET
🎙️ Featuring Angela Surra, Principal Benefits Expert at Mitratech Mineral
👉 Register Now
Final Thought
The best brokers know that compliance isn’t a once-a-year conversation, it’s an ongoing strategy. By helping your clients get ACA-ready now, you’re not just solving a problem. You’re showing up as the expert they trust to protect their business, simplify their operations, and keep them ahead of what’s next.
Looking for the right tool to help your clients stay compliant and stress-free? The ACA Reporting Hub from Mitratech Mineral is purpose-built to support brokers and the employers they serve. Whether you’re offering ACA as a service or guiding clients through self-filing, our platform combines automation with compliance expertise to simplify the entire process.
By Brian Costello
Originally posted on Mineral.com
by admin | Aug 26, 2025 | Custom Content, Employee Benefits, Health Insurance
Ever found a confusing document in your mailbox after a doctor’s visit, wondering if it’s a bill, especially with an “amount you owe” at the bottom? You’re not alone! That document is most likely an Explanation of Benefits (EOB) from your health insurance company. It’s crucial to remember: an EOB is NOT a bill.
Think of your EOB as a detailed receipt or a comprehensive financial statement from your insurance provider. It breaks down the services you received, how much your healthcare provider charged, how much your health plan covered, and any portion you’re responsible for paying. It’s an essential tool for transparency and helps ensure accuracy in your medical billing.
How EOBs Work
The process generally follows these steps:
- Provider Bills Your Insurer: After your medical service, your healthcare provider submits a claim to your insurance company.
- Insurer Processes and Sends EOB: Your insurance company processes the claim, determines coverage based on your plan, and then sends the EOB to you.
- Bill Arrives Separately: You will receive a separate bill from your healthcare provider for the amount you owe after you’ve received and reviewed your EOB. It’s a good practice to wait for your EOB before paying any medical bill to compare the two documents.
What Information Will You Find on an EOB?
While the exact format can vary, most EOBs include similar key sections:
- Account Summary: This lists basic details like the patient’s name, the date(s) of service, and a unique claim number.
- Claim Details: This section provides a breakdown of the specific services you received, including procedure codes, the dates services were provided, and the healthcare provider’s name.
- Amounts Billed & Covered: This crucial part details:
- The total amount your provider charged for each service.
- The amount your health plan paid or approved.
- Any discounts or adjustments negotiated by your insurance company.
- The reason if any portion of the service was not covered (e.g., “not a covered service,” “deductible not met”).
- Your estimated patient responsibility, which is the “amount you owe.”
Remember, insurance rarely covers 100% of costs. Your out-of-pocket expenses will depend on your specific plan’s structure, including:
- Deductible: The amount you must pay for covered healthcare services before your insurance plan begins to pay.
- Copay: A fixed amount you pay for a covered healthcare service, like a doctor’s visit or prescription, usually paid at the time of service.
- Coinsurance: Your share of the costs of a healthcare service, calculated as a percentage (e.g., 20%) of the allowed amount for the service after you’ve met your deductible.
Why Your EOB is So Important
Regularly reviewing your EOB offers several critical benefits:
- Catching Errors: Medical billing errors can occur. Your EOB acts as a window into your medical billing history, allowing you to cross-reference the services listed against what you actually received. You can verify that procedures and diagnoses are coded correctly, potentially saving you money.
- Understanding Your Plan: EOBs provide transparency in the often-complicated world of healthcare finances. By understanding what your plan covers and why certain amounts are or aren’t paid, you gain a clearer picture of how your health insurance truly works.
- Financial Control: Knowing what an EOB is and understanding its contents empowers you to stay in control of your healthcare expenses, ensuring you maximize your benefits and only pay what you genuinely owe.
While an EOB might seem intimidating at first glance, taking the time to understand this document is a vital step in becoming a more informed and empowered healthcare consumer. It’s your financial roadmap to navigating your health plan effectively!
by admin | Aug 18, 2025 | Human Resources
What if employers could capitalize on this current “I quit” mood? If people are leaving jobs for something better, offer something better! Here are some ideas to create an engaged and committed workforce:
1. Understand and Be Responsive to Employee Needs, Motivations, and Priorities
A paycheck may be the reason everyone has a job in the first place, but it’s not the only reason people choose to work or decide to work for one employer over another. Your employees stick with you because there’s something in it for them besides the money. The job is useful to them. Knowing why it’s useful enables you to keep employees satisfied and, better yet, make their jobs even more appealing.
2. Prioritize Employee Development
A work environment in which people gain knowledge, learn new skills, and advance in their careers speaks more clearly and loudly than any marketing message can. People like working where they can grow and develop. According to a LinkedIn report, companies “that excel at internal mobility are able to retain employees nearly twice as long as companies that struggle with it.” And a better trained workforce is also a more productive and profitable workforce!
3. Reward Success
In fact, reward anything you want to see more of. Whether large or small, the rewards have to be meaningful. Ideally, figure out what type of reward speaks to each employee. For some, acknowledgment in a company meeting will make their heart sing. For others, receiving a token of your appreciation, such as a coffee gift card, will be more meaningful.
4. Allow for a Healthy Work-Life Balance
Flexibility is a big selling point for employees looking for better balance between work and life. Your employees have other commitments they need to attend to. Some are caring for young children or other family members while navigating daycare and school closures or multiple appointments. Give employees the time to see to those commitments and have a life outside of work, and you’ll get more from them when they’re on the job. Options may include remote or hybrid work, paid time off, flex hours, four-day workweeks, alternative schedules, and reducing workload. Remember, however, that policies are only as good as the practices around them. Ensure that employees don’t need to jump through hoops to request time off. Remind managers to be responsive to requests for time off and on the look out for signs that employees are feeling overwhelmed.
5. Conduct “Stay Interviews”
Don’t wait until people are leaving to investigate what could have inclined them to stay. Talk to employees now about what’s going well, what pain points they’re experiencing, and what could be done to take the relationship to the next level. Stay interviews enable you to address problems and unfulfilled wishes before they drive people out the door.
By Lisa DeShantz-Cook
Originally posted on Mineral
