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  • Open enrollment may feel like it’s far off in the future, but the smartest business owners know that preparation starts months in advance. Taking the time now to review your benefit offerings allows you to make informed decisions about your company’s health care plan, identify opportunities to reduce costs, and ensure your benefits remain competitive for attracting and retaining top talent. Waiting until renewal season is in full swing can lead to rushed decisions, missed opportunities for savings, and increased stress for both you and your employees. 

    Early preparation is critical when it comes to health care costs. For many employers, these costs represent one of the most significant annual expenses. By reviewing your plan well before open enrollment begins, you can compare options, evaluate whether your current coverage still meets your employees’ needs, and consider alternative solutions that could reduce expenses without sacrificing quality. This is also your chance to address any feedback you have received from employees over the past year and explore benefits that support overall well-being, such as mental health resources or expanded preventive care options. 

    Continue reading to learn why early preparation matters, how a group health plan through Group Management Services (GMS) can help you lower health care costs, and what steps you can take now to position your company for a smooth open enrollment season. 

    Why You Should Start Preparing Now 

    Open enrollment is one of the most important periods in the human resources (HR) calendar. It’s the time when employees can review and select benefits for the coming year, but for employers, the groundwork starts much earlier. By beginning your review process now, you give yourself the time to: 

    1. Assess your current offerings and identify gaps or redundancies 
    2. Gather employee feedback on benefits usage and satisfaction 
    3. Research and compare plan options for cost and coverage value 
    4. Develop a clear communication plan so employees can make informed choices 

    The sooner you begin, the more negotiating power you have with carriers, and the more flexibility you have to adjust your offerings to meet both your budget and your employees’ needs. 

    The Impact of Rising Health Care Costs 

    For most businesses, health care is one of the largest and fastest-growing expenses. According to recent industry trends, premiums and out-of-pocket costs continue to rise, and small businesses often struggle to secure affordable coverage without sacrificing quality. Employers who wait until the last minute to review their plans often end up renewing existing coverage by default, even if better options exist. 

    By reviewing your benefits early, you can explore strategies to manage costs, such as adjusting plan structures, offering multiple coverage tiers, or introducing wellness incentives to encourage healthier lifestyles and reduce claims. These proactive steps can result in significant long-term savings. 

    How Group Health Plans Lower Costs for Businesses 

    One of the most effective ways to reduce health care costs is to join a group health plan through a certified professional employer organization (CPEO) like GMS. When you partner with GMS, your business becomes part of a much larger benefits pool made up of many small and midsize companies. GMS is the only CPEO that provides an in-house master health plan that helps you avoid large swings in usage, trends, and renewal rates.  

    Here’s how it works: 

    1. Economies of scale: By spreading risk across a larger group, premiums become more stable and affordable. 
    2. Access to top carriers: You can offer high-quality plans that may otherwise be out of reach for small businesses. 
    3. Reduced administrative burden: GMS handles compliance, enrollment, and employee communication, freeing your team to focus on operations. 

    Building a Communication Plan for Open Enrollment 

    Even the most competitive benefits package will fall short if employees do not understand how to use it effectively. That’s why early preparation should include a benefits communication strategy. Employees who receive clear, timely information are more likely to select plans that meet their needs and take advantage of the resources available to them. 

    Consider how you will educate employees about: 

    1. The value of preventive care 
    2. How to choose in-network providers 
    3. Ways to use telehealth and urgent care instead of costly ER visits 
    4. Wellness resources included in their plan 

    Bridging the communication gap not only increases employee satisfaction but can also contribute to lower overall health care costs by encouraging smarter benefits usage. 

    Steps to Take Now for a Successful 2026 Open Enrollment 

    To make the most of this early preparation period, start with a thorough review of your current benefits package. Look at enrollment trends, claims data, and employee feedback from the past year. Work with a trusted partner like GMS to benchmark your offerings against similar businesses in your industry and region. From there, you can explore cost-saving opportunities through a group health plan, adjust coverage to match your workforce’s needs, and develop a timeline for employee communication. 

    By acting now, you position your business to enter renewal season with a clear plan, competitive rates, and benefits that support both your employees and your bottom line. 

    Partner with GMS for Affordable, Competitive Benefits

    GMS helps business owners prepare for open enrollment with expert guidance, competitive group health plans, and end-to-end administrative support. The decisions you make about your benefits now will impact your business for the entire year ahead. Don’t wait until the last minute. Start reviewing your benefit offerings today, and contact GMS to secure coverage at competitive rates for 2026 and beyond. 

  • Accidents and illnesses can occur without warning, despite our best efforts to avoid them. While health insurance covers many medical expenses, it may not cover everything, especially during extended recoveries. Supplemental insurance is an option for individuals seeking more peace of mind and assured support during a crisis. While employees can find this insurance on their own, adding them as options to your benefits package can benefit your business in the long term. It not only supports your employees but also enhances productivity and retention and reduces absenteeism.

    What Is Supplemental Insurance?

    Supplemental insurance is an additional type of insurance that provides coverage beyond a standard health insurance plan. Some of the main benefits for your employees are financial protection from out-of-pocket costs like deductibles and copayments, flexibility in choosing plans that fit individual needs, and peace of mind knowing there’s extra coverage for unexpected health issues or accidents.

    There are also benefits for you as an employer. Supplemental insurance enhances your benefits packages and helps attract and retain top talent. Today, 46% of professionals are considering quitting their roles. Of course, it takes more than monetary benefits to attract and retain top employees. For the best results, supplemental insurance should work in tandem with other nonmonetary initiatives.

    Enhancing Employee Financial Security

    While you may offer your employees the best health care, oftentimes, employees must cover themselves. Supplemental insurance for small businesses helps cover gaps in primary health insurance, providing financial support for medical expenses not covered by standard plans.

    In the event of a severe health condition, supplemental insurance, such as critical illness insurance, can offer lump-sum payments, providing financial aid for recovery and rehabilitation. Additionally, supplemental insurance ensures continued income for employees during long-term medical leave, bridging the divide between short-term and long-term disability benefits.

    This reduces financial stress during recovery periods, helping employees maintain economic stability while they focus on getting better. This support gives employees and their families peace of mind, knowing they have additional resources to cope with critical illnesses and accidents.

    Improving Organizational Productivity

    Many employers struggle with absenteeism. While you know your team best and the specific reasons that might be hindering full engagement, a common reason for absenteeism is financial stress. When employees face financial stress due to unexpected medical expenses, it can lead to increased absences as they struggle to manage their health and economic situations simultaneously. By providing supplemental insurance, you can minimize these financial stress-related absences.

    This support enables employees to access necessary medical care without worrying about the costs, leading to quicker recoveries and a faster return to work. As a result, employees can remain more present and productive, contributing to your organization’s overall efficiency and performance.

    Reducing absenteeism not only benefits individual employees but also helps maintain smooth operations and reduces the burden on other team members who might otherwise need to cover for absent colleagues.

    Additionally, offering supplemental insurance can:

    Enhance employee focus and performance

    Financial and health-related worries can be significant distractions for employees, impacting their ability to concentrate on tasks. Supplemental insurance alleviates these concerns by providing a safety net that covers additional medical expenses and supports income protection during illness or injury.

    Employees who are less preoccupied with personal financial issues can dedicate their energy and attention to their professional responsibilities, fostering a more productive and high-performing work environment.

    Strengthen employer-employee relationships

    Providing these benefits demonstrates your commitment to your workforce’s well-being and financial security. This commitment helps build trust and loyalty among employees, who feel valued and supported.

    Additionally, supplemental insurance encourages open communication and support within the workplace. Employees are more likely to express their needs and concerns when they know you’re invested in their overall health and well-being. This open communication fosters a positive and productive work environment where employees feel comfortable and motivated to perform at their best. By creating a supportive and inclusive workplace culture, you can cultivate long-term relationships with your team, boosting retention and establishing a cohesive workforce.

    Enhance corporate reputation

    Providing supplemental insurance also enhances the corporate reputation of your organization. Employees are looking for companies that prioritize the well-being of their team, and word travels fast. While there are many ways to improve your organizational culture, offering comprehensive benefits, including supplemental insurance, signals that your organization cares about your team. This positive perception can improve employer branding and enhance customer loyalty and stakeholder trust. Overall, investing in supplemental insurance not only benefits employees but also strengthens your business’ standing in the market and community.

    Types Of Supplemental Insurance

    There are many kinds of supplemental insurance to consider. Individuals will likely have different needs and can select the right options for them and their circumstances. Continue reading to learn about the types of supplemental insurance.

    • Accident insurance: Accident insurance provides benefits in case of accidental injuries. It covers medical treatments, hospital stays, and accident recovery costs, reducing the insured’s financial burden and helping them recover more comfortably.
    • Critical illness insurance: Critical illness insurance offers a lump-sum payment if an employee is diagnosed with a specified critical illness such as cancer, a heart attack, or stroke. The funds can be used for medical expenses, travel for treatment, or everyday living costs.
    • Disability insurance: Disability insurance replaces a portion of an employee’s income if they are unable to work due to injury or illness. This coverage ensures financial stability during recovery periods, helping employees manage their living expenses and maintain their standard of living while they are unable to work. Separate from short-term and long-term disability benefits, it helps offer continuous support throughout recovery.
    • Hospital indemnity insurance: Hospital indemnity insurance pays a fixed amount for each day an employee spends in the hospital. This coverage helps cover costs like deductibles, copayments, and other non-covered expenses that can accumulate during a hospital stay. By providing a daily benefit, hospital indemnity insurance alleviates the financial burden of hospitalization, allowing employees to focus on getting well.
    • Dental and vision insurance: Dental and vision insurance covers routine dental and vision care, which standard health plans may not fully cover. This includes benefits for exams, treatments, and corrective lenses.
    • Cancer insurance: Cancer insurance often provides a lump sum to cover expenses related to cancer treatment. In most cases, primary health insurance does not cover all associated costs, so cancer insurance can be an invaluable resource for some individuals.
    • Life insurance: This isn’t always considered supplemental; however, it provides financial protection for beneficiaries in the event of your death. Many options include term life, whole life, and universal.

    Supplemental Insurance With GMS

    Offer your team the best resources possible with GMS. Navigating supplemental insurance can be confusing. Juggling multiple vendors and price points when you have a business to run is not always possible, but you need to provide exceptional benefits to remain competitive. 

    Partnering with a professional employer organization (PEO) like GMS is one way to offer the best benefits without all the stress. Supplemental health insurance helps employees find health coverage that meets their specific needs, which is why GMS offers a variety of health coverage options. Contact us today to speak with one of our HR and Benefit experts.

  • New York businesses are bracing for significant health insurance premium increases in 2024. The New York State Department of Financial Services (DFS) has approved average rate hikes of 13.5% for individual plans and 7.4% for small group plans. While these increases are lower than insurers initially requested, they still represent a substantial burden for businesses and employees alike. 

    Three Factors Driving Premium Increases: 

    1. Rising medical costs: The cost of medical care, including hospital stays, physician services, and pharmaceuticals, continues to rise. This is compounded by increased utilization of these services as patients seek more care post-pandemic. 
    2. Economic inflation: Broader economic inflation has put additional upward pressure on health care costs, including administrative expenses for insurers. 
    3. End of public health emergency (PHE): The unwinding of the PHE has led to changes in coverage, such as the reintroduction of cost-sharing for COVID-19 testing and the commercialization of COVID-19 vaccines, which increase insurers’ costs. 

    What This Means For Business Owners: 

    Increased costs 

    Higher insurance premiums will impact New York businesses’ overall operating costs. This is particularly challenging for small businesses, which may struggle to absorb these increases. 

    Administrative challenges 

    The process of navigating these changes and ensuring compliance can be administratively burdensome. This includes managing renewals and understanding new coverage options for employees. Businesses may need to invest more time and resources into understanding the changes and communicating them effectively to their employees. 

    Employee impact 

    Rising premiums may lead to higher contributions from employees or reduced benefits, potentially affecting employee satisfaction and retention. Employees may also face increased out-of-pocket costs, which could affect their financial well-being and job satisfaction. 

    Strategic decisions 

    Business owners may need to revisit their benefits strategy. This could involve considering different insurance carriers or plans, exploring self-insurance options, or increasing the focus on preventative care and wellness programs to help control costs. 

    Navigating Changes In Health Insurance Premiums 

    As businesses face rising health insurance premiums, it’s crucial to explore various options to manage costs while still providing quality coverage for employees. Here are some strategies to consider: 

    1. Explore GMS’s master health plan:
    • GMS offers an in-house master health plan that helps businesses avoid large swings in usage trends and renewal rates. 
    • Our plan provides access to one of the largest national networks. 
    1. Leverage group buying power:
    • By partnering with GMS, small businesses can access the buying power of a large corporation. 
    • GMS represents more than 50,000 employees, allowing for more competitive rates. 
    1. Consider different plan options:
    • Evaluate various plan types, such as preferred provider organizations (PPOs), health maintenance organizations (HMOs), or high-deductible health plans paired with health savings accounts (HSAs). 
    • Each option has different cost structures and benefits that may better suit your business and employees. 
    1. Implement cost-sharing strategies:
    • Adjust deductibles, copayments, or coinsurance to balance costs between the employer and employees. 
    • Offer voluntary supplemental insurance plans to cover gaps in primary coverage. 
    1. Promote wellness programs:
    • Implement wellness initiatives to improve overall employee health and potentially reduce long-term health care costs. 
    1. Educate employees:
    • Provide comprehensive education on plan options and how to use the benefits effectively. 
    • Help employees understand how these changes might affect their contributions and benefits. Transparency can build trust and reduce anxiety. 
    • GMS offers a dedicated team of experts to assist with employee training and answering complex health plan questions. 
    1. Regular plan reviews:
    • Conduct annual reviews of your health insurance plans to ensure they still meet your business needs and budget. 

    By exploring these options, particularly GMS’s master health plan, businesses can work towards managing premium increases while still offering competitive benefits to their employees. 

    Navigate Change With GMS: 

    As New York businesses navigate these challenging premium increases, GMS offers a valuable solution. Our in-house master health plan helps businesses avoid large swings in usage trends and renewal rates. By leveraging the collective purchasing power of over 50,000 employees, GMS enables small businesses to access group health insurance at significantly lower rates—24% lower for employee premiums and 21% lower for family premiums compared to the U.S. average.  

    By working with GMS, you can navigate these challenges more effectively, ensuring that your business remains competitive and your employees are well supported. Partner with GMS to better manage your health care expenses, support your employees, and maintain a competitive benefits package that supports employee retention. 

  • For small business owners, providing comprehensive employee benefits is vital to attracting and retaining employees. Whether it’s health insurance, paid time off (PTO), or retirement plans, these perks can make a big difference in an employee’s decision to join or stay with a company. Among these benefits, Flexible Spending Accounts (FSAs) stand out as a valuable tool for employees to manage their health care expenses. Complementing health insurance coverage, FSAs give employees greater flexibility and control over their medical spending.

    FSAs offer more versatility than just paying for doctor’s visits and medications. While many people use FSAs to cover general health care costs, there are creative ways to use these accounts that are often overlooked. From chiropractic treatments to sunscreen for vacation, various health care services and products are eligible for reimbursement through FSAs. By exploring the full range of eligible expenses, you can maximize the benefits of FSAs for both you and your employees.

    How FSAs Work

    An FSA is a type of savings account that allows employees to allocate a portion of their paychecks for designated expenses. By depositing pre-tax funds, FSAs help you and your employees save money. Additionally, as an employer, you have the option to contribute to your employees’ FSA, but it is not mandatory.

    To utilize FSA funds, individuals must submit a claim along with proof of an eligible expense, such as a receipt, in order to be reimbursed.

    Different types of FSAs determine how FSA funds can be spent:

    • Health Care FSA: The accounts can be used to pay medical costs not covered by insurance, including deductibles, copayments, prescription medications, over-the-counter health care items, and more.
    • Dependent Care FSA (DCFSA): A DCFSA is used to pay for costs associated with care for children or a dependent adult, enabling parents and caregivers to work with less financial strain.
    • Limited Purpose FSA (LPFSA): Funds in an LPFSA are designated for dental and vision costs. This type of account is a favorable choice for individuals with a High Deductible Health Plan (HDHP) and a Health Savings Account (HSA).

    Common Uses Of An FSA

    FSAs are valuable because they can address a variety of medical expenses that may not be fully covered by health insurance. They can assist with the following costs:

    • Medical: You can use an FSA to pay for doctor’s visits, procedures, surgeries, and treatments, as well as cover co-pays and deductibles.
    • Vision: FSAs can cover eye exams, prescription glasses and sunglasses, contact lenses, and even corrective procedures like LASIK.
    • Dental: An FSA can be used for routine teeth cleanings, fillings, braces, and other necessary dental treatments.
    • Prescription medications: FSAs can help with the costs of both prescribed brand-name and generic drugs, including insulin, antidepressants, birth control, and more.
    • Over-the-counter health care items: Bandages, antibiotic ointments, allergy medications, and pain relievers are items frequently purchased with an FSA.

    Creative Ways To Use FSAs

    The funds held in an FSA do not roll over and must be used by the end of the calendar year. From stocking up on first aid supplies to trying out alternative therapies, there are many ways your employees can make the most out of their FSA funds.

    By offering creative suggestions for how your employees can use their FSA funds, you not only help them maximize their benefits but also demonstrate your commitment to their well-being. The potential uses of FSAs extend far beyond conventional health care needs and can be used for the following:

    Mental health and self-care

    FSAs can support numerous mental health and self-care needs. Employees can use the money in their FSAs to cover various costs related to mental health services, such as therapy appointments, counseling sessions, or psychiatric care. In addition, FSAs can be used to purchase self-care items such as skincare products, acne treatments, or even relaxation aids including essential oils.

    Health and fitness

    Employees can use their FSAs to aid in their health and fitness journeys. Gym memberships, health clubs, and weight loss programs can be reimbursed through an FSA with a letter of medical necessity, allowing individuals to prioritize their fitness goals. Health trackers and nutritional supplements such as vitamins and minerals can be purchased with FSA funds to further assist in maintaining physical health. Items that support recovery and pain relief, such as orthopedic shoe inserts and knee braces, can also be covered by an FSA.

    Professional services

    Whether an employee is seeking treatments for pain relief or pursuing a holistic approach to health, there are numerous professional services that can be paid for with an FSA. Physical therapy, chiropractic care, and acupuncture are all FSA-eligible services that can help manage chronic pain and improve overall wellness. An FSA offers employees a range of options to address their individual health needs.

    Travel essentials

    An FSA can offer unexpected benefits when it comes to purchasing travel-related items. For example, travel essentials such as sunscreen, insect repellent, and travel-sized first aid kits are eligible purchases. Using an FSA to buy necessary supplies for travel not only ensures a safe and healthy trip but also helps with spending FSA funds before they expire.

    Advantages For Small Business Owners

    Small business owners can gain numerous benefits by offering FSAs to their employees. Since FSAs allow employees to use pre-tax dollars to cover specific costs, payroll taxes are reduced for both employers and employees. Contributions made to an FSA are also tax-exempt for employees and tax-deductible for employers, offering mutual benefits.

    Providing your employees with the option to enroll in an FSA can also enhance employee satisfaction and retention, as it is a valuable perk on top of health insurance. By offering this benefit, you not only save money on taxes, but you also display your commitment to your employees’ health and overall well-being.

    Employee Benefits With A PEO

    As a small business owner, it’s crucial to offer a benefits package that’s appealing to current and prospective employees. However, administering benefits can be costly and time-consuming. Partner with a PEO like GMS to save money and streamline your benefits management. We can assist in processing group health insurance, retirement plans, wellness programs, and more. Additionally, individuals with an FSA can visit our FSA Store to explore eligible products that can be purchased with their accounts. Contact us today to optimize your employee benefits offerings and ensure your business stays competitive in attracting top talent.

  • Inflation continues to rise, increasing health insurance premiums for Americans. Employer-sponsored insurance (ESI) is the largest source of health insurance coverage in the United States. Employer health insurance premiums have continued to rise quicker than wages and inflation.

    According to The Los Angeles Times, two in five adults enrolled in employer-sponsored coverage find it difficult to afford health care and insurance costs. Commercial rates for hospital care are averaging 224 percent of Medicare rates.

    The Cost Of Employer-Sponsored Insurance

    According to a recent analysis from the Kaiser Family Foundation, in 2021, the average ESI premium for single coverage was $7,739 per year, and the average ESI premium for family coverage was $22,221 per year. Additionally, with those plans, the average deductible for single coverage was $1,669, and the average aggregate deductible for family coverage was $4,705.

    To combat the increasing costs of ESI, it’s vital to take immediate action to bring down costs. As an employer, it can be challenging to negotiate prices on plans. However, many consider the option of joining other firms to combine buying power to obtain fair provider prices.

    Those with lower incomes may find it increasingly challenging to keep up with the ESI rates. In 2020, the Commonwealth Fund survey defined the word, “underinsured” as being covered by a plan with high out-of-pocket costs, the findings were that one-fourth of working-age adults in employer plans were underinsured.

    How GMS Can Help

    A partnership with GMS allows you to provide the best healthcare benefits to your employees. When it comes to medical coverage, this is a necessity for your employees. As the economy fluctuates, your health insurance pricing cannot. With GMS, we give small businesses the buying power of a large corporation. GMS represents over 40,000 worksite employees, allowing businesses to receive a lower rate. Retake control of this essential benefit, and contact GMS today!

  • The Healthcare Literacy Takes One Step Forward, and Two Steps Back consumer report created by Optavise has revealed data showing that consumers are still struggling with healthcare literacy. The organization surveyed 1,055 employees with employer-sponsored health insurance in the United States. Survey results show that 65 percent of respondents stated that they do not usually compare prices before getting healthcare. As a result, they may be overpaying. Only 10 percent of respondents stated they check whether a medical provider or facility is in-network whenever their health plan changes (down from 25% in 2021).

    By partnering with health benefits educators and digitizing education, more employers can help employees improve their financial well-being and healthcare literacy.  

    Additional Key Findings: 

    • Avoid surprise medical bills (39%)
    • Understand how their deductible, copay/coinsurance, and out-of-pocket maximum (OOPM) impact their wallet (33%)
    • Review an explanation of benefits (EOB) and medical bill for errors (30%)
    • Research healthcare costs and why they matter (29%)
    • Choose a plan and where to get care (22%)

    How GMS Can Benefit Your Business

    Here at GMS, we understand that it is important for you and your employees to have a better understanding of healthcare costs. We provide our clients with various tools and resources to find a coverage solution tailored to your needs. Furthermore, partnering with GMS will provide you with access to a team of experts who will be there to answer any questions you may have. Contact us today to learn more.

  • The cost of prescription drugs in the United states continues to rise which has become a source of concern for everyone from patients to policymakers.  According to a study published in the Journal of the American Medical Association (JAMA), “Prescription medications now comprise an estimated 17% of overall personal health care services in the U.S.”  

    We don’t want to think that we overpay for any goods or services. Taking time to do some research can help you save substantially on your prescriptions. Here are some tips to help save on costs.

    Image of costly prescription drugs. Learn tips to save on prescription drug prices.

    Take Advantage of Generic Drug Options

    Learn your prescription drug copays or co-insurance. Talk to your doctor about prescribing drugs that have generic equivalents. According to the U.S. Food and Drug Administration website, “When a generic drug product is approved, it has met rigorous standards established by the FDA with respect to identity, strength, quality, purity, and potency.” If your medication doesn’t have a generic form, or if it may not be covered under your prescription drug plan, ask your doctor for a generic alternative.   

    Consider Pill Splitting

    Many medications can be split, so talk to your doctor about doubling the strength (40mg instead of 20mg for example) and cutting the pills in half. You would then be charged for 15 tablets instead of 30. 

    According to Kevin Schulman, MD, Professor of Medicine and business administration at the Duke University Medical Center in Durham, N.C., “Sometimes it makes a lot of financial sense to split pills, but if you try to split the wrong sort of medications, that could be potentially dangerous.” So, this is a good option for some people, but as always, check first with your doctor to make sure if it can work for you. 

    Do Your Homework

    Shop around. Prescription drug prices vary from pharmacy to pharmacy, so if you have the time, take your prescription to more than one pharmacy to find the best price. This will help you if you have a high deductible plan with your out-of-pocket costs. 

    Try and Find Discount Cards

    Prescription discount cards sometimes provide even better discounts than what insurance can provide, especially on generic drugs. Websites such as www.goodrx.com and www.blinkhealth.com also provide drug discount information in your area. Pharmacies also have discount cards available.  

    If prescription drug prices are a problem area in your company, contact Group Management Services today. We can help you learn more about the coverage options we can provide for your employees along with our other outsourced HR services.

  • A recent article written by the Wall Street Journal  outlines some startling financial data in regard to our domestic health insurers and their cryptic billing process established by CMS (Center for Medicare/Medicaid Services). Although GMS typically focuses on the private insurance markets—as they are the most relevant for businesses—examining the continued failures of CMS may provide some insight as to why our domestic healthcare system operates so poorly and why prices for both public and private health insurance markets are sky-rocketing.  

    Costs associated with the U.S. healthcare system. 

    A Look into the Market’s Rising Prices

    Medicare is a socially-funded program meant to provide health benefits for tax-paying citizens age 65 and older and permanently-disabled individuals of all ages. Medicare, a majority of the CMS which also splits some funding with state and federal Medicaid programs, is typically divided into four parts, coined Medicare parts:

    • A (Hospital insurance)
    • B (Supplementary Medical insurance)
    • C (Medicare Advantage)
    • D (Medicare prescription drug benefit(s)) 

    Medicare is funded primarily by tax-payers and Medicare subscribers who are required to pay a monthly premium to utilize the benefits provided through CMS policies.

    What most citizens don’t know is that CMS is the largest buyer of healthcare policies in the world and files enough fraud, waste, and abuse statistics to land itself within the Fortune’s 500 top 50 based solely on the amount of money lost each year. That’s right, the fraud waste and abuse of Medicare in 2017 was enough to top revenue for entire organizations like Best Buy, Disney, and Fed-Ex. The figure also dwarfs the full budgets for programs like Homeland Security, the EPA, and NASA by tens of billions of dollars, if not more. 

    As astonishing as those statement may be, these trends have continued almost every quarter, year, and decade since 1965:

    Healthcare loss trends. 

    Contributing to this $60 billion eyesore is an antiquated billing system that largely remains confidential. What the WSJ highlighted (and what we’ll continue to discuss for the remainder of this article) are the overpayments made to Medicare Part-D insurers for inaccurate estimations of cost for upcoming fiscal years (FY). As detailed above, Part-D handles the Rx benefits for Medicare subscribers and is interestingly administered 100 percent by private insurers. 

    These “overpayments” surpassed the $9 billion mark from 2006-2015 and were paid out to private insurers on top of existing revenue for administering these Part-D plans. The question as to how $9 billion seemingly slipped through taxpayers’ hands and into the revenue stream of top-insurers is what’s intriguing… or maybe infuriating is the right word to use here. 

    The Bidding Process for Private Insurers

    In order to address that question, we’ll need to take a brief look into the bidding process for these private insurers and how re-payments by CMS are made on an annual basis.

    Every summer Part-D insurers send detailed cost-projections for what it would take to fund all Medicare Part-D subscribers’ prescription costs for the following year (about 40 million people). These projections are split into two main categories: Direct Subsidies and Reinsurance Subsidies.

    Direct Subsidies contain projections for the majority of services through Part-D. When insurers submit these bids and real costs fall below what was originally projected, CMS allows insurers keep a portion of the difference. Keep in mind that these “projections or bids” are what Medicare bills to taxpayers to ensure proper coverage. In this case, insurers are seemingly incentivized to inflate their bids (by an obvious but overlooked billing loophole) knowing they’ll get to keep some of what isn’t used by the Medicare Part-D population while taxpayers get to bear the financial brunt of these egregious errors. 

    Reinsurance Subsidies are siloed for Medicare subscribers that have extremely high-costing medications. These high-costing medications, sometimes referred to as “specialty” meds, can often times be upwards of $5,000 for a 30-day supply. Humira, a popular drug that’s used to treat Rheumatoid Arthritis among other chronic illnesses and is often advertised on television, will run you about $6,409 for a 28-day supply without applicable medical or prescription insurance. For these subsidies, insurers must pay back any overages in cost projections should they fall above what was actually spent. However, if insurers’ projections fall below what was actually spent, Medicare will fund the remaining amount. 

    Imagine you’re the controlling party for one of these large private insurers. If you could legally receive billions of dollars simply by “over-projecting” one of your bids and legally save billions of dollars by undercutting a different bid with the sum of those earnings or savings being pushed off to the subscribers you’re insuring and American tax-payers, what would you chose? 

    The Grave Reality of the U.S. Healthcare System

    Given the above details, the first question that comes to mind might sound something like this: “So Medicare Part-D allows 100 percent administration of a federally subsidized program by private insurance companies, but also allows said companies to submit their own budget forecasts and allows them to keep some of that allocated money if they’re wrong in creating those budgets?” With an 11 percent error rate in 2016 Medicare payments, it’s not hard to see how this staggering $9 billion figure is only a fraction of what the programs wastes annually. Applying these malpractices to a $3.5 trillion-dollar industry (the United States healthcare system, which is showing steady annual spending growth and will likely eat over 25 percent of the GDP within the next decade) and the grave reality of what’s at stake is easily recognizable. 

    I would highly encourage anyone interested to read more about the WSJ’s findings, but will conclude with the following:

    As the economic epidemic of our healthcare system continues to worsen, it’s articles like this from the WSJ that bring to light how much taxpayer money is truly wasted through an irresponsibly administered system like CMS. The issues found here can be replicated time and time again throughout various programs in our healthcare system and are a big piece of why healthcare costs, specifically insurance premiums, continue to climb. 

    Although it’s not always enjoyable to put these concerning statistics and unsavory business practices in frame for our readers, the transparency that GMS owes to our clientele will always reign. If you’re interested in working with realistic brokers to create modern solutions for your group’s health plan, contact GMS to speak with a dedicated healthcare professional.

  • As we approach the 2020 political season, healthcare remains an eternal “hot topic” issue; one that acts as an economist’s reoccurring bad dream. Much like a bad dream, the obvious warning signs of our domestic system’s atrophy disappear into the cognition of the economist’s mind and are forgotten by mid-morning. The economist, much like the rest of the country, has an eerie feeling due to this reoccurring healthcare nightmare, but can’t quite seem to pinpoint the root of their discomfort or begin to answer the lingering paradox of “How can we make healthcare in the U.S. financially sustainable?”

    The answer to that question is a large, complex, and convoluted issue to tackle. An alternative approach is to look at our ongoing mistakes as an industry and start to peel back some of the fraud, waste, and abuse at least long enough to get our collective head above water to propose a semi-legitimate long-term solution. 

    A doctor pocketing money from a staggering healthcare bill. 

    Diagnosing a Questionable Healthcare Diagnosis

    Individuals, facilities, insurance entities, CMS, and providers are just some of the key players necessary to stop the financial hemorrhaging. Not often enough do we evaluate the role of the physician from an economic standpoint and their direct effect on the industry. A recently released edition of “Bill of the Month,” a crowdsourced investigation of medical bills by Kaiser Health News and NPR, allows us to do just that. 

    To paraphrase the article: A New York City patient went to a PCP (Primary Care Physician) with symptoms of a head cold. About to leave on vacation, this individual thought nothing of a typical provider visit to address some minor discomforts before traveling. A throat swab, a quick round of antibiotics, and a $25 co-pay sends this patient (aka consumer, customer, client, etc.) seemingly out the door without a hitch. 

    Upon returning from vacation, this healthcare consumer has a staggering $28,395.50 bill from their provider relating to the previous “head cold” visit. This physician ultimately sent the throat swab (claiming to test strep, among a myriad of other unlikely diagnoses) to a non-network lab facility with which this patient’s insurer (BCBS) did not have an established contracted rate. Normally, these tests run through an in-network provider would run the same insurer about $653 – a 191 percent price difference coordinated through the discretion of this physician. 

    As I read through the article, a handful of painfully obvious questions came to mind. Namely:

    1. Why intentionally use an out-of-network lab service?

    a. The physician office had applicable and valid insurance info from the patient and could easily check for a list of in-network providers. They chose to use an out-of-network facility.

    2. Why were so many unnecessary tests run for likely influenza (common cold) diagnosis?

    a. “In my 20 years of being a doctor, I’ve never ordered any of these tests, let alone seen any of my colleagues, students, and other physicians, order anything like that in the outpatient setting,” said Dr. Ranit Mishori in Kaiser Health News. “I have no idea why they were ordered.”

    b. “There are about 250 viruses that cause the symptoms for the common cold, and even if you did know that there was virus A versus virus B, it would make no difference because there’s no treatment anyway.”

    3. Why were antibiotics prescribed for a viral infection? 

    a. There’s a lesser-known, but just as frightening scenario where continued unnecessary antibiotic use within the general population will lead to widespread antibiotic resistance that will affect not only our healthcare industry but veterinarian and agricultural industries as well. Antibiotics cannot effectively treat viral infections. 

    Here’s the kicker from Kaiser Health News: “The third reason for the high bill may be the connection between the lab and Kasdan’s doctor. Kasdan’s bill shows that the lab service was provided by Manhattan Gastroenterology, which has the same phone number and locations as her doctor’s office.”

    Undoubtedly, this physician or practice is getting a kickback from the lab’s profit by billing this patient’s insurer an absurd and unnecessary amount. Coincidentally, Kaiser Health News points out that “Manhattan Gastroenterology” (the out-of-network lab running these tests) “is registered as a professional corporation with the state of New York, which means it is owned by doctors.” Maybe this primary care doctor in particular? 

    Now the point of this blog isn’t to uncover fraudulent billing practices. Those occur every minute of every day within our healthcare system. Rather, its aim is to point out that if we want anything close to a sustainable system for the baby-boomer generation’s progress into older age, or for the generations that follow, we’re all responsible to do our part in turning this thing around. That means you too, physicians. 

    Regardless of which individual ends up settling the $28,000 bill from this PCP, the moral of the story is that billing tens of thousands of dollars to the healthcare system opposed to hundreds, by choice, are the decisions that, when multiplied and repeated over decades, gets us to where we are today: a seemingly insurmountable amount of debt. Furthermore, and most important to employers, high claims like these that could and should be otherwise avoided will ultimately lead to higher insurance premiums in future years for the employer and its employees. 

    What can we (healthcare consumers) do to mitigate national healthcare debt?

    Staying informed, asking the right questions, and taking ownership of our personal health habits are surefire ways to reduce the expenditure and volatility of our health system. Working with consultants from an employer-centric company like GMS can only help educate employers on the successes and failures within our system and how those points can be used towards the advantage of those offering benefits while mitigating unnecessary financial loss. 

    GMS is an employer for employers, constantly striving to provide transparency and sustainability for those we serve. Contact a local office today to begin your healthcare partnership with GMS.

  • Cybersecurity threats are real for businesses across the country, but one state is making an effort to make its citizens more knowledgeable about these dangers. Georgia Attorney General Chris Carr announced the release of Cybersecurity in Georgia to inform business owners and other individuals about potential cyber threats and how they can reduce the likelihood of these attacks. 

    While the 24-page guide was aimed at business in Georgia, its message is relevant for businesses all across the country. Here’s a breakdown of what you can do to protect your business from cyber threats.

    A small business owner in Georgia using a smart phone and computer set up with proper cybersecurity practices. 

    The Dangers of Cyber Attacks

    Just how common are cyber attacks? According to Cybersecurity in Georgia, “67 percent of small and medium-sized businesses in the United States were the victims of a cyber attack in 2018.” These attacks come in a variety of forms, as any of the following intrusions can result in the loss of valuable data and sensitive information.

    • Data breaches
    • System hacking
    • Email phishing
    • Malware/Ransonmware
    • Distributed denial-of-service (DDoS) attacks
    • Keylogging
    • Tech support scams

    In addition to the attacks above, cyber intrusions can be made possible by internal issues as well. Whether your software is out of date or a user error led to a misconfigured server, there are several ways that intruders can compromise your cybersecurity if you don’t take action against these threats.

    What You Can Do to Improve Your Business’ Cybersecurity

    A potential breach can come in many forms, but there are steps you can take to limit or prevent their effects. Here are some measures you can take to improve your business’ cybersecurity.

    Take inventory of sensitive information

    Over time, your business collects a lot of sensitive information. This data can come in several forms – credit card information, Social Security numbers, home addresses, tax documents, etc. – and all of it is at risk of being lost or stolen during an attack.

    Before you can protect this information, you’ll need to recognize where it is. The first step toward securing your data involves identifying where any sensitive details are stored. Cybersecurity in Georgia suggests taking stock of the following sources of information.

    • Computer systems
    • Backup and storage systems
    • Websites
    • Laptops
    • Employees’ home PCs (if used for work purposes)
    • Cell phones and tablets
    • Flash drives
    • Paper files
    • Information shared with third-party vendors

    Once you’ve determined all the places you store sensitive information, you’ll want to evaluate how it’s being used and streamline the number of places this information is stored. It’s also good practice to clean out any old software, apps, file folders, and other sources of information if you can. If you find that you have sensitive data on file and don’t need it, it’s best to destroy that data in a secure manner instead of holding onto it. 

    Improve your safeguards to control access to data

    It’s absolutely critical to make sure your passwords are secure. The new cybersecurity guide suggests using passwords with “at least 12 characters that combine upper and lowercase letters, numbers, and symbols.” It’s also good to change these passwords at regular intervals. If you want to add another layer of security, certain logins will allow you to set up multi-factor authentication. This will send you a text, an email, or some other message with another password or code to help ensure that the person logging in is really with your company.

    There are also occasions where certain information is accessed via physical devices such as a workplace laptop, flash drives, or paper backup files. In this case, it’s important to lock up any of these items so that they can only be accessed by an approved member of your team both during and after business hours.

    Protect your network beyond passwords

    In addition to passwords, there are many other ways to protect your overall network. To start, every network should have a firewall, anti-virus software, anti-malware software, and a pop-up blocker. Any other software, systems, or other devices you use should stay up to date with any required updates and patches – old versions can lead to ways into your system for cyber attacks. You should also consider the following:

    • Encrypt any devices that contain sensitive information
    • Protect your wireless network by ensuring that your router offers WPA2 or WPA3 encryption to prevent outsiders from reading your information
    • Create means for remote access to your company’s network through a corporate VPN access or some other secure connection
    • Invest in email authentication technology to prevent scammers from using your domain name
    • Use an online payment provider that complies with Payments Card Industry Data Security Standards if you have an ecommerce site
    • Vet any vendors for security concerns if you share any sensitive data with them

    Review employee access

    Another important consideration you’ll want to make is who has access to your data. In general, some employees shouldn’t be privy to sensitive information. Restrict that access only to people who have a specific business need for it to help limit the number of people who may – knowingly or not – create a security threat. 

    There may also be occasions where someone may not need complete access. For example, someone may need access to customer emails, but not financial documents. Restrict access where appropriate so that your employees only deal with the data they need. Regardless of access level, you should also provide some degree of cybersecurity training. Cybersecurity in Georgia suggests regular education about the following issues.

    • Password safety procedures and tips
    • Suspicious emails
    • Software downloading procedures
    • Proper use of mobile devices and other items
    • Handling sensitive data (both electronically and physically)
    • Social media policies
    • Visitor guidelines
    • Reporting suspicious activity

    It’s also important to have a plan in place for when you hire new employees and terminate old ones. If a potential new employee will have any access to sensitive data, it’s important to conduct background checks and call references to identify if there are any past concerns or other issues that may make them unsuitable for that responsibility. As for departing personnel, make sure to remove login privileges and change any necessary passwords to prevent them from accessing data in the future.

    Plan ahead for potential breaches

    As Attorney General Carr said during the release of Cybersecurity in Georgia, “In today’s world, it is not if, but when, an attempt will occur.” At some point, there will likely be some form of cyber attack against your business. The advice listed above can help you limit the chances of a successful attack, but you should still have a plan ready just in case.

    A good response plan will give you a guide to help you following a breach. Swift action can help you limit any losses or damages and can help the investigation process. The U.S. Department of Justice’s Cybersecurity Unit provides a cyber incident preparation, response, and reporting guide that offers some best practices following an attack.

    • Appoint decision makers for different elements of your organization’s cyber incident response (public communications, law enforcement engagement, etc.)
    • List a means of contact for critical personnel for all times of day (and provide next steps if a decision maker is unavailable)
    • Create a prioritized list of data, networks, or other information and assets that demand special attention during an incident
    • Maintain a list of other parties – commercial data centers, etc. – who host affected data and how to contact them
    • Keep a timeline of when and how to restore back-up data
    • Determine the criteria that will determine if customers, vendors, and other entities need to be notified about an intrusion
    • Have a guide on when and how to notify any necessary law enforcement or other government agencies

    Consider cyber insurance

    A data breach can have a significant financial impact on a company. From the time spent dealing with an incident to the potential for a lawsuit from an affected customer, an intrusion can deal severe damage to the wellbeing of your business.

    While general liability insurance policies may cover tangible property, that may not include electronic data and other important digital information. Cyber insurance can help you protect your organization from some of the financial ramifications of a breach. If interested, Cybersecurity in Georgia suggests investing in a cyber insurance policy that covers the following acts.

    • Data breaches (such as incidents involving theft of personal information)
    • Cyber attacks (such as breaches of your network)
    • Cyber attacks on your data held by vendors and other third parties
    • Cyber attacks that occur anywhere in the world (not only in the United States)
    • Terrorist acts

    Protect Your Business from Potential Threats

    There are countless hazards associated with running a business, including cyber attacks. The time it takes to protect your business can be substantial, which means less available time in your schedule to try and grow your company. Fortunately, you don’t have to carry the burden of protecting your business alone.

    As a Professional Employer Organization, GMS has the experts and means available to help simplify your various administrative needs, including risk management. We can help you identify ways to protect your company while also offering services like payroll administration and other time-consuming tasks. 

    Ready to prepare your business for the future? Contact GMS today to talk to us about how we can help you protect your business through professional HR management.