Self-Funded Health Plans: Are Mid-Sized Employers Taking on Too Much Risk?

How Small Businesses Can Use Better Benefits to Win the Talent War

Recruiting and retaining great employees has become one of the biggest challenges facing small businesses today. While large corporations often attract talent with extensive benefits packages and deep resources, many small business owners assume they simply can't compete. On the latest episode of The Cutting Edge Benefits Podcast, Anthony McMahon of ClaimLinx explains why that assumption may be quietly costing companies their best people, and how a smarter approach to healthcare benefits can level the playing field. Anthony begins with a problem he sees every week while working with employers across the country: healthcare costs have grown so expensive that many small businesses are forced to shift more of the burden onto employees. In many cases, employers can only afford to cover the employee portion of coverage, leaving workers responsible for thousands of dollars each month if they need family coverage for a spouse or children. The result is mounting financial strain on employees and a serious competitive challenge for employers. Anthony explains that workers increasingly weigh healthcare benefits as a major factor in deciding where to work, whether to stay, and how they view their employer overall. Businesses that offer stronger, more affordable benefits often gain a real edge in both recruitment and retention. A central thread of the conversation is the myth that small businesses can never match larger organizations. Anthony argues that simply isn't true. Through smarter healthcare purchasing strategies and customized benefit structures, smaller employers can often provide benefits that rival, and in some cases exceed, those offered by major corporations. Affordability anchors much of the discussion. Anthony explains how reducing overall healthcare costs creates flexibility for employers. Rather than spending every available dollar on premiums, companies can redirect savings toward lowering deductibles, reducing employee contributions, improving coverage levels, or increasing the employer-paid portion of the package, a genuine win-win for both businesses and their teams. The episode also turns to employee education and communication. Great benefits, Anthony emphasizes, only deliver value when employees understand how to use them. ClaimLinx works directly with employees through onboarding support, educational meetings, service resources, and dedicated assistance to ensure workers get the most out of their coverage. That connects naturally to a discussion of employee experience, as many workers grow frustrated navigating insurance carriers and complex benefit plans. Providing dedicated support, Anthony explains, can significantly improve employee satisfaction while easing the administrative burden on HR teams and business owners alike. Throughout, Anthony returns to a consistent message: rising healthcare costs do not have to force employers into a painful choice between affordability and quality. By approaching healthcare strategically, companies can often lower costs while simultaneously offering better benefits to their workforce. As he puts it, it doesn't have to be a choice between helping your employees and controlling costs, because with the right strategy, you can do both. For business owners looking to improve retention, attract stronger candidates, and build a more competitive workplace, this episode offers practical insight into how healthcare benefits can become a powerful recruiting and retention tool rather than just another line-item expense. To learn how your business can lower healthcare costs while building a benefits package that attracts and retains top talent, visit ClaimLinx.com.

Why Your 2027 Paycheck Could Take Another Hit: The Healthcare Cost Crisis Employers Can No Longer Ignore

Healthcare costs continue to rise at an alarming pace, and both employers and employees are feeling the pressure. On the latest episode of The Cutting Edge Benefits Podcast, Tom Quigley of ClaimLinx joins Neil Haley to discuss new survey data showing that two-thirds of large employers expect to increase employee healthcare contributions through payroll deductions by 2027. The conversation explores why costs keep climbing, what it means for workers, and why so many businesses are approaching benefits planning the wrong way. Neil opens by highlighting recent industry research showing that employer-sponsored health insurance costs reached nearly $17,500 per employee in 2025 and are projected to exceed $18,500 in 2026. In response, many employers are shifting more of that burden onto employees through higher premiums, deductibles, copays, and payroll deductions. Tom explains that rising healthcare costs are not simply the result of inflation. The problem, he argues, is baked into the structure of the system itself, where insurance carriers, prescription drug spending, and benefit financing methods all contribute to escalating costs. Too many organizations continue relying on outdated benefit strategies while expecting different results. A major theme throughout the episode is cost shifting. Rather than solving the underlying problem, many employers simply pass rising expenses directly to their workers. Tom warns that increasing employee contributions creates a new set of challenges, including lower morale, financial stress, reduced productivity, and greater difficulty attracting and retaining talent. The conversation also examines the deepening affordability crisis facing American workers, citing research that nearly one-third of households at or below median income are uncertain whether they can afford necessary healthcare. As medical expenses consume a larger share of household budgets, families are forced into difficult tradeoffs involving housing, transportation, savings, and care. From there, Tom shares his perspective on how business owners can take back control of healthcare spending by rethinking how benefits are structured. Instead of choosing between absorbing higher costs or passing them to employees, he advocates for a smarter approach centered on better benefit design and tax strategies that have existed for decades. The discussion digs into one of the biggest drivers of current healthcare inflation: prescription drug costs, fueled in part by the surging popularity of GLP-1 weight-loss medications. Tom explains how employers can evaluate alternative purchasing strategies, manufacturer assistance programs, and prescription savings resources to help rein in these expenses while still supporting employee health. Another key takeaway is the role leadership plays in healthcare decisions. Tom suggests that healthcare planning should be treated as a financial and strategic business decision rather than simply an HR function. Business owners who grasp the long-term impact of healthcare expenses are far better positioned to protect profitability while strengthening their benefits. Looking ahead, Tom believes costs will keep climbing unless employers begin adopting different strategies. The real question, he says, isn't whether change is necessary, but how much financial pain businesses and employees will endure before they decide to make it. As he puts it, the question isn't whether employers need to change their healthcare strategy, it's how much pain they'll endure before they decide to do it. For employers hoping to reduce healthcare expenses without sacrificing employee satisfaction, this episode offers a thought-provoking look at the challenges facing today's workforce and the opportunities available to organizations willing to rethink their approach. To learn how your business can explore healthcare cost-saving strategies while improving employee benefits, visit ClaimLinx.com.

The Hidden Prescription Drug Strategy That Can Lower Renewals and Save Employers Thousands

Prescription drug spending has become one of the fastest-growing healthcare expenses facing employers today. While many business owners focus on premiums, deductibles, and provider networks, few realize that how prescription drugs are processed can significantly affect both current costs and future renewals. On the latest episode of The Cutting Edge Benefits Podcast, Anthony McMahon of ClaimLinx joins Neil Haley to unpack an often-overlooked strategy for controlling prescription drug expenses while helping employers reduce long-term healthcare costs. Anthony begins by explaining the role of a Medical Expense Reimbursement Plan, or MERP, a type of health reimbursement arrangement authorized under Section 105 of the tax code. He outlines how these plans can deliver tax advantages for employers while offering valuable benefits to employees, and notes that many businesses simply aren't aware these options exist, leaving substantial savings on the table. The discussion then turns to prescription drug spending and the traditional approach most employees follow when filling medications. In a standard plan, employees present their primary insurance card for all medical services and prescription purchases. While that seems straightforward, Anthony explains that this process can create unintended consequences when prescription claims become part of the insurance carrier's renewal calculations. That insight anchors much of the episode. When carriers see ongoing prescription claims for chronic conditions, specialty medications, or high-cost therapies, those claims may feed directly into renewal assessments, quietly driving up future costs. Anthony discusses how businesses can benefit from alternative prescription management strategies that focus on controlling costs while still helping employees access affordable medications. A major focus of the conversation is pharmacy benefit management. Anthony explains how third-party pharmacy benefit managers, or PBMs, can help identify lower-cost alternatives, generic substitutions, manufacturer coupon programs, and other discount opportunities. Tools like GoodRx, manufacturer assistance plans, and similar prescription savings solutions are becoming increasingly important weapons in the fight against rising healthcare costs. Rather than accepting medication prices at face value, Anthony encourages both employers and employees to actively explore the resources available to lower out-of-pocket expenses and improve overall plan performance. One of the most important takeaways is that healthcare strategy extends far beyond premiums. Employers often pour their energy into negotiating insurance rates while overlooking prescription utilization patterns that can dramatically influence future costs. By addressing prescription spending proactively, organizations can improve both immediate affordability and long-term financial stability. Anthony shares examples of recent client outcomes where lower prescription spending contributed to improved claims experience and more favorable renewal results, reinforcing the broader message that real cost management requires a comprehensive approach rather than a focus on any single piece of the plan. As he puts it, it's two birds with one stone, helping employees save on prescriptions today while helping employers control healthcare costs tomorrow. Whether you're a business owner, HR professional, benefits administrator, or an employee trying to make better sense of healthcare costs, this episode offers practical insight into one of the most impactful and most misunderstood areas of employee benefits management. To learn how smarter healthcare strategies can reduce costs while improving employee benefits, visit ClaimLinx.com.

Trump's Healthcare Plan vs. Reality: What Would Actually Lower Healthcare Costs?

Healthcare costs continue to dominate conversations across America, and political leaders regularly propose new solutions. On the latest episode of The Cutting Edge Benefits Podcast, Tom Quigley of ClaimLinx joins Neil Haley to break down a proposed healthcare reform framework associated with President Trump and examine whether these ideas would truly reduce healthcare costs for businesses and consumers. The discussion begins with proposals focused on lowering healthcare costs and prescription drug prices. Tom acknowledges that efforts to improve awareness of drug discount programs and prescription savings resources can be beneficial, while pointing out that many existing tools such as GoodRx, NeedyMeds, and other assistance programs have already been helping consumers reduce prescription costs for years. The opportunity, in his view, is less about inventing new programs and more about getting people to actually use the ones already available. A major topic centers on insurance subsidies and the idea of directing healthcare funding straight to consumers rather than insurance companies. Tom shares real concerns about whether such an approach would actually lower premiums, and he questions how consumers would navigate increasingly complex healthcare purchasing decisions without additional guidance and education. Handing people money does not automatically hand them the knowledge to spend it wisely in a system this complicated. The conversation then explores healthcare transparency initiatives, including proposals that would require insurance companies and healthcare providers to publicly display pricing information, coverage details, claims ratios, and other financial metrics in plain language. While Tom views transparency as a genuinely positive step, he argues that transparency alone does not solve the underlying structural issues driving healthcare inflation. Knowing the price of something does not fix why the price keeps climbing. One of the most significant portions of the episode focuses on hospital pricing practices and provider networks. Tom explains why he believes narrow networks limit competition and reduce consumer choice, and he makes the case that allowing broader provider participation, combined with real pricing transparency, could help create a more competitive marketplace for healthcare services. From there, the discussion widens into broader reform concepts. Tom outlines several ideas he believes could meaningfully reduce healthcare costs, including increasing competition, improving price transparency, reforming reimbursement structures, expanding access to direct primary care, and rethinking how catastrophic healthcare risk is managed throughout the system. Listeners come away with a clearer picture of how healthcare costs are shaped by multiple stakeholders, including hospitals, insurance carriers, pharmaceutical companies, government programs, brokers, and healthcare networks. As Tom argues, meaningful reform requires addressing incentives throughout the entire system rather than tinkering with individual components in isolation. In his words, the real challenge isn't just lowering premiums, it's fixing the incentives that drive healthcare costs higher in the first place. Whether you are a business owner, HR professional, healthcare consumer, or simply someone interested in healthcare policy, this episode delivers a practical, clear-eyed discussion of the challenges facing the American healthcare system and the potential solutions being debated across the country. To learn how your business can reduce healthcare expenses while providing better employee benefits, visit ClaimLinx.com.

How to Save Thousands on Prescription Drugs in 2026: Hidden Strategies Most Americans Never Learn

Prescription drug costs continue to climb, leaving many individuals, families, and employers wondering how to afford the medications they need. In this episode of The Cutting Edge Benefits Podcast, Tom Quigley of ClaimLinx joins Neil Haley to discuss practical strategies that can dramatically reduce prescription drug costs—and in some cases eliminate them entirely. Tom explains one of the biggest misconceptions in healthcare today: many people are purchasing health insurance plans that actually prevent them from maximizing available prescription savings programs. While most consumers focus on low deductibles and traditional copay structures, Tom discusses how certain high-deductible health plan designs can work alongside manufacturer assistance programs to create significant financial advantages. The conversation dives into manufacturer copay assistance programs and rebate cards that are often available for expensive brand-name medications. Many specialty drugs used for conditions such as rheumatoid arthritis, psoriasis, and other chronic illnesses may come with substantial manufacturer assistance programs that can significantly reduce out-of-pocket costs for eligible patients. Tom explains how understanding these programs and coordinating them properly with insurance coverage can potentially create major savings opportunities. Listeners will also learn about valuable resources such as NeedyMeds and GoodRx, along with other discount programs that can help consumers compare prices and identify available assistance opportunities. Tom emphasizes that many patients never investigate these options and simply pay whatever price is presented to them at the pharmacy counter. By taking the time to research alternatives, compare pharmacies, and explore manufacturer programs, consumers may uncover substantial savings opportunities. The episode explores strategies for both generic and brand-name medications. Tom discusses why generic drug programs can be valuable in certain situations, while also noting that consumers should carefully evaluate membership fees and program costs to determine whether they are truly saving money. The key message throughout the discussion is that prescription costs should be approached as a math problem rather than simply accepting the first price presented. The conversation also covers specialty medications, weight-loss drugs, cancer treatments, and other high-cost therapies that often create financial stress for patients. Tom shares insights into how manufacturer assistance programs, clinical trials, nonprofit assistance organizations, and various healthcare resources can help reduce these costs for eligible individuals. Another important theme throughout the episode is personal responsibility and research. While many consumers spend significant time researching purchases such as vehicles, electronics, or household items, few devote the same effort to understanding prescription drug pricing. Tom argues that patients who take the time to explore available resources, compare pricing options, and investigate assistance programs can often achieve dramatically better outcomes. Whether you're an individual managing chronic medications, a family facing rising healthcare expenses, or an employer seeking ways to improve employee benefits while controlling costs, this episode provides practical insights into navigating the complex world of prescription drug pricing. If you’ve ever wondered whether you’re paying too much for your medications, this episode is a must-listen. * Prescription drug savings strategies * Manufacturer copay assistance programs * High-deductible health plans * Brand-name medication rebates * GoodRx savings opportunities * NeedyMeds assistance programs * Generic drug discount programs * Specialty medication costs * Weight-loss medication coverage * Visit ClaimLinx.com to learn more about healthcare cost-saving strategies and employee benefit solutions.