As a business owner or HR leader, you’re probably all too familiar with the annual health insurance renewal process. It’s a time of dread, uncertainty, and frustration as you try to make sense of the complex web of plans, networks, and pricing structures.

And even when your renewal looks “fine” on the surface, you can’t shake the feeling that you’re still overpaying for a plan that doesn’t truly meet your needs. Maybe your costs have crept up year after year, or the benefits just don’t seem to deliver the value you expect.

The truth is, you’re not alone. In fact, you’re likely the victim of a rigged system that’s designed to keep employers like you in the dark. In this blog post, we’re going to expose the 5 biggest lies that employers are told about health insurance – and show you how to break free from the cycle of overspending and underwhelming coverage.

Lie #1: “You’re Just Not a Good Fit for Level Funding or Self-Funding”

This is one of the most common lies that employers hear, especially if you’re a smaller or mid-sized business. Brokers and carriers will often tell you that you’re “too small,” “too risky,” or “not ready” to move away from a fully insured plan.

But the truth is, most employers are actually a great fit for level funding or self-funding – it’s just a matter of having the right strategy and structure in place. The size of your company isn’t the most important factor. It’s about having a clear plan, the right partners, and a deep understanding of how the health insurance supply chain works.

So don’t let anyone tell you that you’re not a good fit. With the right guidance, you can absolutely take control of your health plan and move away from the fully insured model that’s been holding you back.

Lie #2: “Your PPO Network is Saving You Money”

When you look at your health plan’s PPO network, you probably see a lot of impressive-sounding discounts – 50% off this, 60% off that. And on the surface, it seems like you’re getting a great deal.

But the reality is, those discounts are based on inflated “sticker prices” that are intentionally bloated. The network is the one that sets the prices and the rules, and they’re not exactly working in your best interest. As we’ve covered in another video, you’re not actually getting a true deal – you’re being “managed” into overspending.

The truth is, you have very little control over the prices and discounts in a traditional PPO network. They hold all the power, and they’re using it to line their own pockets – not to save you money.

Lie #3: “PBMs Were Designed to Help You Control Drug Costs”

Pharmacy Benefit Managers (PBMs) are supposed to be the gatekeepers of your drug spending, helping you keep costs down and get the best prices. But the reality is, most PBMs are actually incentivized to do the opposite.

Here’s how it works: PBMs make more money when you spend more on drugs, because they get paid “rebates” from drug manufacturers to favor high-cost medications. The higher the drug price, the bigger the rebate – and the more the PBM profits.

So even though your PBM might claim to be managing your costs, they’re actually just managing their own margins. Unless you’ve had your pharmacy contract audited line-by-line, there’s a good chance you’re getting played.

Lie #4: “If You Want Better Benefits, It’s Going to Cost You More”

This is one of the most pervasive lies in the health insurance industry. The conventional wisdom is that if you want to improve your benefits – things like lower deductibles, better drug coverage, or access to specialty services – you’re going to have to open your wallet and pay more.

But that’s simply not true. When you take control of the supply chain, how care is accessed, and how it’s priced and paid for, you can actually improve your benefits while reducing your overall costs. We’ve helped many employers do exactly that – adding things like direct primary care, mental health support, and even disappearing deductibles, all while cutting their total health plan spend.

The key is to stop accepting the status quo and start building a health plan that’s designed intentionally to meet your specific needs. With the right strategy and partners, you can have your cake and eat it too.

Lie #5: “You Don’t Really Have Any Other Options”

This is the lie that keeps the entire broken system in place. Year after year, you get the same spreadsheet of carrier options, the same story about rising costs, and the same feeling of helplessness.

But the truth is, you have far more control than you’ve been led to believe. Level funding, group captives, direct contracting, transparent PBMs, direct primary care, cost-sharing strategies – these aren’t fringe ideas, they’re just not being shown to you.

Why? Because they cut out the middlemen and put you back in the driver’s seat. And that’s not exactly in the best interest of the brokers, carriers, and PBMs that have been profiting from the status quo.

The problem isn’t a lack of options, it’s a lack of visibility. But when you have the right guidance and the right partners, you can break free from the lies and start running your health plan instead of just reacting to it.

Taking Back Control of Your Health Plan

So, what’s the next step? The first thing you need to do is get a clear, unbiased understanding of what you’re really paying for – and where the waste is hiding in your current plan.

That’s why we recommend booking a Benefit Cost Containment Consult with our team. We’ll dive deep into your plan, expose the lies and inefficiencies, and show you a clear path forward to taking back control.

This isn’t about switching carriers or chasing discounts – it’s about building a health plan strategy that’s truly aligned with your needs and your budget. With the right structure, the right partners, and a clear plan, you can stop overpaying and start getting the benefits your employees deserve.

So don’t let the lies and the status quo keep you stuck. Take the first step towards a better, more transparent health plan by booking your Hidden Spend Review today.

Key Takeaways

• Many employers are a great fit for level funding or self-funding, despite what brokers and carriers may tell you.
• PPO network “discounts” are often based on inflated prices, not actual savings.
• PBMs are incentivized to drive up drug costs, not manage them effectively.
• You can improve benefits and reduce costs at the same time with the right strategy.
• You have more options than you’ve been led to believe – you just need the right guidance to see them.

Ready to take back control of your health plan? Book your Cost Containment Consult today and let’s get started.