Latest news with #insurancecompanies
Yahoo
2 days ago
- Business
- Yahoo
US insurers' profits double as price rises exceed extreme weather claims
US property and casualty insurers nearly doubled their earnings between 2023 and last year despite costly extreme-weather events, according
Forbes
3 days ago
- Business
- Forbes
Are Drug Prices Really The Problem Behind American Healthcare Costs?
The U.S. healthcare system is the best in the world for complex care. We have the most innovative drug companies, the best medical devices, and incredible doctors and surgeons. The U.S. healthcare system is also the most expensive system in the world. One key component of the medical system that has long been a point of contention is drug prices. U.S. drug prices are extraordinarily high compared to the rest of the world. The exact same medication that's sold in the United States is often sold overseas for a fraction of the cost. This pricing disparity has long been a point of consumer dissatisfaction, but elevated inflation and recent executive actions are putting the topic of drug prices back under the microscope. The history of drug prices in the U.S. and the way in which they've risen could be a much longer essay than the article we are writing here – but there are a few key points that are worth discussing. In particular, we want to call out how the industry has shifted over time to pull pricing power away from the drug companies and to put the power in the hands of insurance companies. The shift involves obvious conflicts of interest, but there are also significant nods to potential efficiency gains and economies of scale. The issue is nuanced and it's difficult to pinpoint what the right balance is to ensure we have access to the best medicine, at reasonable prices, without stifling innovation. If there's any single culprit behind high drug prices, it has to be pharmacy benefit managers (PBMs). For decades, PBMs have quietly amassed power in the U.S. healthcare system. They are the penultimate corporate middlemen - negotiating prices, controlling formularies, and ultimately determining what shows up on your insurance plan's covered drug list. Their influence on drug prices has grown substantially as their parent companies continue to acquire and vertically integrate specialty pharmacies, provider networks, and rebate aggregators into their business models. If you don't know what any of those things mean or how they interact, don't be discouraged. The opacity of the business model is one of the key components that allows PBMs and their parent companies to generate profits and keep drug prices moving higher. So, what is a pharmacy benefit manager? Decades ago, as employer-sponsored health insurance grew to be more complex, insurers needed help managing drug benefits. Patients needed access to a growing number of drugs, and insurance companies needed to know which ones to cover. PBMs emerged to fill this administrative gap, acting as intermediaries to process claims, negotiate pharmacy contracts, and provide 'formularies' - lists of drugs that would be covered under an insurance plan. The job of a PBM, on paper, is to help health insurance plans manage the cost and utilization of prescription drugs. Simple enough in theory – the PBM sits in the middle between doctors prescribing the drugs, pharmacies distributing the drugs, and the insurance companies who are paying for the drugs. Put simply, they were making sure everyone is on the same page. Over time, the economics evolved. PBMs began to consolidate, preaching that bigger scale meant more negotiating power with the drug companies to lower list prices, which in turn meant better deals for the insurance companies and for the end patient. Unfortunately, increased bargaining power also leads to potential conflicts of interest and more opportunities for PBMs to drive profits towards their own bottom lines. Drug companies know that they're going to have to pay the PBMs to get their drugs approved and put on formulary lists. Without being on a formulary list, that drug isn't going to be covered by insurance, which means nobody is going to use the drug. That's where the shenanigans start. Drug companies actually end up being incentivized to increase drug prices, knowing they're going to have to give rebates and concessions to the PBMs. This rebate system ultimately ends up being the biggest conflict of interest, and the biggest hurdle to affordable drug prices. PBMs are supposed to put drugs on formularies because they're effective for patients, not because they're getting big rebates from the drug companies. But you can easily see where the PBM might start to leverage their situation to make a profit. The higher the list price of the drug, the bigger the rebate, and the more potential earnings for PBMs. The PBM has all the leverage, and crucially, end patients aren't really part of the savings equation. And, as if that wasn't messy enough, the PBM's potential conflicts of interest get even messier when the PBM isn't an independent company. Over the years, there's been intense consolidation within the PBM market, with the three major players - CVS, UnitedHealth, and Cigna - now controlling more than 80% of it. Notice anything about those three companies? All three of them aren't really known as being PBMs. They're all actually insurance companies. That's right, the companies who determine what medications are covered or not covered are the same companies who are paying for the medication. If United Health goes to a drug company and says, 'pay us a bigger rebate' and we'll make sure that your drug is on the list of approved drugs for our patients, it's hard to see a scenario where the drug company says no. Tracking the flow of money tied to a single drug transaction can be incredibly complex, given the many interrelated players. Take, for example, a patient buying insulin at the pharmacy. The pharmacy first purchased the insulin in bulk from a wholesaler, who bought it from the manufacturer. Before the pharmacy can even sell the drug to an insured patient, it has to be approved for coverage - placed on the formulary - by the PBM. The PBM is probably only putting the drug on the formulary if they're going to get some rebates from the drug manufacturer. The patient also likely needs to have a prescription for their drug, which means they needed to talk to their doctor – someone preapproved as being in network by the insurance plan. The patient not only pays premiums on their insurance, but then also has to pay a co-pay at the pharmacy when it's time to buy the drug. Given that the pharmacy might be owned by one of the large insurance companies, the co-pay is likely a source of profit for the insurance company as well, either directly or indirectly. If that all sounds confusing, it's because it is! The integration of so many players under one umbrella creates enormous complexity. Of course, the vertical integration of insurance with PBMs and physician groups could also provide scale-based efficiencies. It's natural for these companies to combine like this. Scale brings benefits when you're trying to make sure patients have access to different kinds of doctors, and scale is a huge factor in reducing the cost and risk associated with insurance pools. And theoretically, larger groups should have more bargaining power to demand price cuts from the drug companies. Unfortunately for the insurance companies though, the vertical integration has made it hard for them to redirect the blame for rising costs towards anyone else. In an effort to lower drug prices in the U.S., President Trump recently issued an executive order promoting the Most Favored Nation (MFN) pricing model. This policy aims to align what Americans pay for certain medications with the lowest price paid by other developed countries. The move faced immediate pushback from both drug manufacturers and the parent companies of PBMs, who stand to lose significantly if list prices are slashed. Remember, the rebates the PBMs get are generally going to be higher if the list price for the drug is higher. In our opinion, the move to shake up drug pricing is misguided. The current practice of localized pricing works to find an equilibrium between maximizing access to the drug while also maximizing the drug maker's ability to generate a profit. Artificially lowering drug prices in the United States by benchmarking to international prices simply ensures that the rest of the world has less access to our drugs, while accessibility for Americans is unlikely to change for the better. That's because drug accessibility here in the US is a function of not only price, but also of formulary design and insurance coverage for the medication. Lower list prices could end up meaning smaller rebates and reduced incentives for insurance companies to provide some sort of drug coverage. Forcing drug makers to offer their drugs at lower prices may also stifle innovation. While nobody likes paying high prices, companies need to be able to generate a return on their investment in order for a project to be viable. Keeping that incentive system in place is important. Fortunately, the executive order left room for negotiation; price targets for the U.S. market remain undecided. However, the implications are clear. People are fed up with the high cost of healthcare and politicians looking to garner favor with their voter bases are going to keep on looking for opportunities to attack the space. The opaque profit model and conflicts of interest inherent in the current business structure are easy political targets. PBMs have long profited from the arbitrage between inflated list prices and manufacturer rebates. If MFN-style reforms take hold, PBMs may see their margins compress and rely more on flat administrative fees rather than back-end rebate deals. Increasing bipartisan scrutiny and pressure to lower drug prices generally threaten the opacity of their business model, potentially sparking further consolidation as legacy PBMs scramble to defend market share and margins. Meanwhile, newer market entrants offering direct-to-consumer delivery - effectively bypassing PBMs - could align with the current administration's embedded directive to facilitate direct-to-consumer purchasing programs at MFN prices. Expect some form of rebate pass-throughs or the elimination of spread pricing to try to make it into a bill, both of which would dent margins, but would be substantial undertakings. The rise of rebate aggregators, entities often owned by large PBMs that negotiate rebates on behalf of multiple clients, significantly complicates regulatory efforts to trace rebate flows and the logistics of pass-throughs. PBMs, for their part, maintain that these entities and rebates in general help to lower insurance premiums and fund broader plan benefits, but Americans have grown increasingly skeptical that these benefits ever reach them. For large insurers owning PBMs - like CVS (Caremark), Cigna (Express Scripts), and UnitedHealth (OptumRx) - reform could trigger a shift in profit centers toward more stable revenue sources such as medical services, specialty pharmacy, or basic insurance premiums. But reducing intermediary involvement might also force PBMs to spin off their pharmacy operations entirely. The conflicts of interest clearly run deep in a system where the middleman influences which drugs are covered by insurance while simultaneously owning the pharmacies dispensing those same drugs. Still, reform momentum is building. Increased transparency could usher PBMs into a new era of accountability and structural change - though whether this benefits patients or merely reshapes profit flows remains to be seen. Healthcare stocks have had a rough go this year, but the system is still ripe with subsectors set to benefit from continued innovation in artificial intelligence. Playing the politics game and picking the winning PBMs and insurers is likely to leave investors disappointed, but structural tailwinds like AI and an aging population in the US aren't going away any time soon. Progress in drug discovery and genetic research has been constrained by trial-and-error methods that are extremely cost-intensive. With AI, we're entering an era where whole-genome sequencing can be done in hours instead of weeks, and AI models can predict molecular interactions with stunning accuracy. This leap in computational power means we're not just speeding up what we already do - we're enabling entirely new approaches to medicine. As sequencing becomes cheaper and more accessible, the efficacy of drugs only stands to increase. Think about a biotech firm that sequences the DNA of thousands of cancer patients. With AI, it can quickly identify recurring mutations and design drugs that specifically target those genetic flaws, potentially leading to more effective and personalized cancer treatments. As the traditional PBM model comes under pressure, new pharmacy models emphasizing transparency, affordability, and direct-to-consumer pricing could also gain traction. GoodRx (GDRX) offers cash pay alternatives and coupons that bypass PBMs. Mark Cuban's Cost Plus Drugs also aims to offer radically transparent pricing by selling drugs at cost plus a flat markup. Even Amazon has entered the arena to offer direct-to-consumer shipments and a direct-pay option that's potentially cheaper than using insurance. Amazon Pharmacy is expected to be available to over half of the U.S. by the end of 2025. Ultimately, what was once a sleepy and steady sector of the US economy is starting to become much more dynamic. Drug innovation is accelerating, and established insurer and PBM business models are coming under scrutiny. In a shifting landscape there will be opportunities for savvy investors who look for innovation and can handle volatility and uncertainty.
Travel Daily News
26-05-2025
- Travel Daily News
Why travel insurance has become a necessity for vacations
Travel insurance can be used to cover a variety of possible problems, from serious issues like the cost of medical care if you become unwell to minor inconveniences like delayed or lost luggage. No one heads off on vacation expecting something to go wrong, but this can happen. Whether you lose your luggage, become unwell during your vacation, or a flight gets cancelled, these issues can ruin the entire trip. In some cases, it might even cause you financial losses, and this can turn a bad situation into an absolute nightmare. But this is where travel insurance comes in. Travel insurance is one way to protect yourself if any of these issues, or other common vacation problems, occur. It is wise to do your research before purchasing a travel insurance policy, and this post shares the most necessary information. What is Travel Insurance? There are numerous different types of insurance. Travel insurance is a type of insurance policy that is designed to protect an individual from financial losses that can occur when on vacation. This type of insurance coverage is recommended if you are travelling internationally, and it should be purchased before you head off. Travel insurance can be used to cover a variety of possible problems, from serious issues like the cost of medical care if you become unwell to minor inconveniences like delayed or lost luggage. How to Select the Right Travel Insurance Policy for You Although there might be a belief that any travel insurance policy will do, this is not the case. Instead, you must find a policy that suits your needs and preferences. To find the plan that is suitable for you, you must complete a comparison of travel insurance policies to find the one that provides the best value. However, there are a number of factors to consider when you decide which travel insurance policy is the one for you. Firstly, you should look at your personal circumstances, like age and pre-existing health conditions, before choosing an insurance policy. Both your age, especially if you are over 65, and pre-existing medical conditions can impact what coverage is available to you and the likelihood of claims being denied. You must also think about the destination(s) you will be visiting and any activities you might participate in when selecting a travel insurance policy. The risks can vary depending on the country you travel to, with some locations having higher healthcare costs, such as Switzerland, and more disease outbreaks. Similarly, if you plan on participating in sports that are considered extreme like white water rafting, you might need additional coverage. Three of the Most Common Situations That Can Be Helped by Travel Insurance As briefly touched upon previously, there is a range of issues that can cause an individual to make an insurance claim while travelling. The three situations outlined below are some of the most common you might experience. Cancelled Trips A lot of money can be lost if a trip is cancelled and you do not have any travel insurance. Trip cancellations can happen unexpectedly, whether it is due to a natural disaster or the travel company has gone into financial default. Without insurance, you are unlikely to get a refund on accommodation or flights you have booked for a vacation. It is also worth noting that the right travel insurance policy could reimburse you if you need to cancel your vacation due to a family emergency, illness, or injury. Accidents and Illness With more than half of the Americans surveyed reporting that they have experienced an upset stomach while abroad, it is not unthinkable that you might fall unwell on vacation. This can be a tough situation to deal with when you are in an unfamiliar area, especially if you are unsure if you can access the country's healthcare system. As medical care can be expensive in different countries, you might also avoid seeking care to prevent paying costly bills. Thankfully, travel insurance can help. A good-quality travel insurance policy can cover the costs of hospitalization and medical treatments you might require. Other expenses, like surgery, could be included, too. Lost or Stolen Baggage Bags and suitcases can be delayed, lost, or stolen at any point during a vacation. When this happens, you might need to buy essential items that will see you through the remainder of your trip. This is unlikely to help reduce the stress you have felt during this experience, but your chosen policy might reimburse you for these purchases and any lost valuables. To conclude, travel insurance is clearly a necessity for anyone vacationing overseas or in a foreign country. This type of insurance coverage can protect you from unexpected costs in a number of situations, such as sudden illness and trip cancellations. If the latter occurs, for example, and the trip is costly, then you won't be out of pocket. With the information provided in this post, you will be better prepared to purchase a suitable insurance policy when you next travel. Photo by Ilnur Kalimullin on Unsplash
Health Line
23-05-2025
- Health
- Health Line
Medicare Part C Costs
Medicare Part C (Medicare Advantage) plans are provided by private insurance companies, which means that cost varies by provider, type of plan, and location. Original Medicare (Part A and Part B) and Medicare Part C (Medicare Advantage) are different insurance options with different costs. Medicare Part C might be a good option if you're eligible for Original Medicare but want additional coverage for prescription drugs and other services. Several factors determine Medicare Part C costs, such as: premiums deductibles copayments coinsurance These amounts can range from $0 to hundreds for monthly premiums and yearly deductibles. Most of your Medicare Part C costs will be determined by your chosen plan. However, your lifestyle and financial situation can also have an effect on your costs. Read on for everything you need to know about Part C-associated costs. Deductibles and Premiums While some Part C plans don't have a monthly premium, others do. According to the Centers for Medicaid & Medicare (CMS), the average monthly premium for Part C plans is around $17.00 in 2025. Even with a zero-premium Medicare Advantage plan, you may still owe the Part B premium. That said, some Part C plans may cover your Part B premium. In addition, Medicare Part C plans have a plan deductible and a drug deductible if the plan includes drug coverage. As with premiums, some plans may offer a $0 plan deductible. When the deductible is greater than zero, you'll need to meet this amount first before your plan will offer coverage. Once it does, your plan usually covers a certain percentage of the cost; the rest comes from your pocket. as copayments or coinsurance. Managing Part C costs One of the first things you can do to manage your Medicare Part C costs is to read through the following annual notices from your plan: evidence of coverage (EOC) annual notice of change (ANOC) These notices can help you determine exactly what costs you'll pay out of pocket for your plan and any price changes that will take effect the following year. Other factors affecting costs While Original Medicare covers services nationwide, most Medicare Advantage plans are location-based. If you travel often, you may find yourself stuck with out-of-town medical bills. Other factors that can affect costs include: Plan type: Your plan can also impact how much your Medicare Part C plan may cost. For example, if you're on an HMO or PPO plan but choose to visit an out-of-network provider, this can increase your costs. Spending limit: All Part C plans have an out-of-pocket maximum. This amount varies, but according to one 2021 study, the average out-of-pocket maximum for Part C plans was $5,000. Extra benefits: Many Part C plans offer additional benefits to Original Medicare. For example, in 2025, over 97% of Medicare Advantage plans include dental, hearing, and vision coverage, though extra costs may apply for specialized services like dentures or specific lenses. Income limits Your yearly gross income can also factor into how much you'll pay for your Medicare Part C costs. For people with a lack of income or resources, there are programs that can help lower their Medicare costs. These are called Medicare Savings Programs (MSPs). The federal government funds these programs, but Medicaid administers them in each state. These programs are: Medicare Part C plans have different costs. Your costs may vary depending on your coverage, plan type, and whether you receive additional financial assistance. Below is a small sample of Medicare Part C plan costs from major insurance providers in cities around the United States: Plan City Monthly premium Health deductible, drug deductible Primary doctor copay Specialist copay Out-of-pocket max Anthem Select (HMO-POS) Los Angeles, CA $0 $0 $0 in network $0 in network $800 in network Cigna Preferred Medicare (HMO) Denver, CO $0 $0 $0 $25 per visit $3,550 in network Humana Choice H5216-006 (PPO) Dane, WI $37 •$0 •$250 $0 in network $45 in network per visit •$4,900 in network •$10,100 in and out of network Humana Gold Plus H0028-042 (HMO) Harris, TX $0 •$0 •$300 $0 $20 $3,450 in network Aetna Medicare Value Plus (PPO) Nashville, TN $11 •$0 •$250 •$0 in network •$10 out of network •$35 in network •$45 out of network •$6,750 in network, •$7,750 in and out of network Kaiser Permanente Medicare Advantage Standard MD (HMO-POS) Baltimore, MD $21 $0 •$5 in network •$0 to 25 out of network •$25 in network •$0 to 50 out of network $6,900 in network The estimates above are for 2025 and are only a sampling of the many plan options offered in each area. For a more personal estimate of Medicare Part C plan costs based on your individual healthcare situation, visit this plan finder tool and enter your ZIP code to compare plans near you. Is Medicare Advantage more expensive than Original Medicare? While it may seem that Medicare Advantage plans cost more than Original Medicare, they can actually help reduce medical expenses. A 2017 study that compared Medicare Advantage to Original Medicare found that physician costs were lower for people who were enrolled in Medicare Advantage plans. In addition, Medicare Advantage plan beneficiaries saved more money on things like medical equipment and lab tests. How do I pay my Part C bill? Most companies offering Medicare Part C plans have various ways to pay your premium. These options include: online bill payment automatic withdrawal from your bank account automatic withdrawal from your Social Security or Railroad Retirement Board benefits check check or money order Help paying for Medicare If you're having trouble paying your Medicare Part C costs, there are resources that can help: Medicaid: This program helps people with low-income pay for medical costs. Medicare savings program (MSP): This benefit helps Medicare beneficiaries with low-income pay plan costs, such as premiums and copayments. Supplemental Social Security: Some individuals can apply for Supplemental Social Security benefits, which are monthly payments that help pay for Medicare costs. PACE: This program can help you get coordinated care within your local community. Extra Help: If you meet certain income and resource limitations, you may qualify for this Medicare program, called Extra Help, to pay for prescription drug costs, premiums, deductibles, and more. The takeaway Medicare Part C (Medicare Advantage) is a great coverage option for Medicare beneficiaries seeking additional coverage. Your Medicare Part C costs include premiums, deductibles, copayments, and coinsurance. Your costs will also be determined based on your plan type, how often you need medical services, and what type of doctors you see. If you're age 65 or older or have certain disabilities, you're eligible to apply for Medicare. Visit the Social Security Administration website for more information on how to apply and enroll. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Fast Company
20-05-2025
- Health
- Fast Company
Health insurance is fundamentally broken. Here's how to fix it from the ground up
It's no secret that when it comes to simplicity and convenience, insurance has lagged behind modern businesses across most industries. While many legacy products have been overturned by newer, intuitive solutions or adapted to meet today's consumers' needs, insurance offerings have remained a complex anomaly—built more for business and regulatory needs rather than real people. We already know that healthcare in America is too expensive, and far too many people simply can't afford to get sick. Health insurance deductibles are at an all-time high, while denied and delayed claims payments persist. Insurance companies have continued making money while a staggering number of people are putting off care because of the cost, or pulling money out of their 401(k) plans early to pay for medical expenses. We also know that there is no shortage of people who are fighting for healthcare policy changes, more accountability around business practices, and broader reform. But consumer patience is running out. And with 100 million American adults in medical debt, incremental regulatory changes won't be quick enough to take on the challenges that so many people face today in affording basic, and sometimes unexpected, costs related to their healthcare. Consumer Sentiment It's time we ask the question: Can we start making progress by rethinking how health insurance products are fundamentally designed? In order to do this, we have to accept some consumer truths about health insurance today. First, more than 50% of Americans don't understand their health insurance. That's because, unlike most other industries that have embraced simplicity and ease, insurance remains complex, filled with exclusions, jargon, and unnecessary paperwork. So even with the best of educational tools, we're looking at a large literacy gap. Second, consumer animosity toward health insurance companies is almost as old as the business itself. Even traditional supplemental health insurance offerings like Accident Insurance and Critical Illness that are intended to provide extra support were not designed to cover very much. And the amount of money that goes back to the insured at the end of the day is low for every dollar of premium paid. So it's not surprising that people are tired of frequent claim denials and delays, and don't trust that their coverage will minimize their out-of-pocket exposure as much as they need it to. It's obvious that we have to start with addressing what's covered, and how we pay claims, which is core to any insurance product. We can't just slap technology onto insufficient coverage and hope that it'll improve consumer confidence and trust. But there are some things we can do today to help health insurance catch up with other consumer industries through human-centered design. Here are three: 1. We can set up insurance products like subscriptions Digital simplification across industries has been happening since the dawn of Amazon and Uber, and has taught consumers to have certain expectations around their apps and online experiences. Just for the purposes of this exercise, let's think about insurance in terms of the direct-to-consumer fulfillment model—and treat insurance like a subscription where care is the purchase and benefits are refunds. Thinking of benefits as refunds enables us to align insurance innovation with the digital simplicity today's consumers expect. By removing the complexity wrapped around benefits, we can make claims intuitive and the delivery of benefits seamless. We have to eliminate the common limitations and restrictions as well as the excessive paperwork and evidence required for claim approval to enable quicker benefit decisions. People should be able to track the status of their claim in real time, so they can stop chasing their insurance companies for answers. Payment should be electronic, and take days, not weeks. In doing this, we can start to replicate the standards of efficiency and transparency people today are accustomed to when they buy and return products, and build a modern insurance experience that meets digital consumers' expectations and needs. Treating health coverage like a subscription also provides clear opportunities for engagement. And insurance companies across sectors are just starting to take note. Beam Technologies tracks teeth-brushing habits through a Wi-Fi-connected toothbrush to tailor dental insurance discounts, while Discovery offers its Vitality Program that rewards customers with points for preventative checkups. By encouraging consumers to engage with their coverage, motivating them to use it by offering rewards and discounts like other consumer businesses, these companies drive utilization and deliver value as a result. 2. We can take an (active) back seat Another school of thought tells us that the best insurance companies are the ones that people don't think about at all. Unlike the previous approach, which assumes consumers will use their coverage like they do their subscriptions, this strategy doesn't expect that the modern consumer wants to interact with their insurance company at all. Instead, it offers a simple promise of value without any participation required. This approach provides obvious opportunities for leveraging data and automation to set up a product experience where the claim end-to-end is managed by the health insurance company, with no necessary intervention from the insured at all. Innovators in the space are just getting started automating several, if not all, aspects of the claims process. Current players like ClaimsMinder, Human API, and Claritev are just beginning to unlock the power of data to streamline the notification, filing, processing, and payment of a claim so that employees can get more out of their benefits. Ansel Health offers 'medical claims integration,' which enables them to determine when individuals have a covered condition and are eligible for a benefit, and pays them directly without requiring them to ever file a claim. In doing this, we eliminate coverage disputes, delayed claims payments, or even just make someone's day a little bit easier—and maybe then begin to build some trust. 3. We can become a logical extension of the modern care-delivery revolution When people get sick, they don't see their preventative care or treatment and their health insurance as two separate entities, but rather one experience. Unlike insurance, modern care delivery has evolved at a rapid pace over the past 25 years. Digital and in-person clinics like Wally, Maven, Tia, Omada, Parsley, and One Medical are setting new standards for the way people experience care, and even legacy care providers are mimicking their practices with apps and more. Notably, most of these providers have chosen to offer subscription-based or up-front payment models and to 'cut out the insurance middleman.' Why? Because it just doesn't align with their promise of simplicity and empathy through the provider experience. By applying human-centered design, we can bridge this gap—creating insurance brands that look and feel like a natural extension of the modern care delivery experience. Companies like Oscar, Rightway, and Sana are already proving this is possible, offering an integrated experience that resonates with today's consumers. It's a fair question to ask, but why will business stakeholders care? A part of it will be about finding a set of believers and innovators who are both mission-aligned and consumer-focused. But it's also important to acknowledge that fixing the flaws in the health insurance experience doesn't just address the financial crisis around healthcare, it aligns with business needs too. In fact, there's a clear business case for creating simpler health insurance products. According to the Integrated Benefits Institute, serious illnesses, when not treated, result in an average of 1.5 billion lost work days per year, costing employers $575 billion annually. When employees don't delay or skip care because they're confident in their health coverage, they're less likely to require sick time, workers' compensation, disability, or family and medical leave. Employers see higher retention, insurance brokers and agencies build deeper trust with their clients, and insurance companies see a higher rate of renewals. Established companies can participate too through partnerships with modern solutions, allowing them to stay competitive in an evolving marketplace, benefiting new, innovative players seeking broader distribution. Our goal is simple: In 10 years' time, we want people to be talking about how complex health insurance used to be, and finally build some real trust.
