Choosing Your Health Insurance Doesn’t Have to Suck! | Open Enrollment | 080

Choosing a health insurance plan doesn’t have to suck — and this week, we’re proving it.

In this episode of The Extreme Personal Finance Show, I get to sit down with Mike Anderson, owner of Anderson Benefit Partners, and one of the rare humans that make health insurance actually make sense.

Open enrollment is here, premiums are totally skyrocketing, plans are changing, and one major carrier just announced it's shutting down. Mike breaks down:

• What the UCare → Medica transition means for 300,000 people
• How to compare plans like a pro (without losing your mind)
• Why networks matter more than you think
• How GLP-1 drugs, rising claims, and post-COVID care are driving costs up
• What families should evaluate first when choosing a plan
• Why HSA plans are changing big time in 2026
• The hidden traps in “preventive care” visits
• How small employers are saving 20–30 percent with level-funded plans
• What Medicare users need to know if they travel or snowbird
• How to avoid paying thousands more because of billing errors
• And why using a licensed broker is free — and massively valuable
• 
  

This episode is loaded with clarity, strategy, and real-world advice for anyone choosing their own insurance, supporting a family, running a small business, or stepping into Medicare for the first time.

If you’ve ever thought health insurance is confusing, expensive, and impossible to understand, this episode could change everything. Choosing your health insurance doesn’t have to suck. Let’s break it down!

Contact Chris:

https://heavymetal.money

https://www.facebook.com/MoneyHeavyMetal

https://x.com/MoneyHeavyMetal

https://www.instagram.com/chrisluger

https://www.tiktok.com/@heavymetalmoney

email: chris at heavymetal.money

Connect with Mike Anderson
https://www.andersonbenefitpartners.com

Email Mike Anderson

mike@andersonbenefitpartners.com

Resources and Links:

CPT Codes

https://www.aapc.com/codes/cpt-codes-range/

Estimate your healthcare expenses

https://www.fairhealthconsumer.org

The National Association of Benefits and Insurance Professionals (NABIP)

https://nabip.org

Contact Chris:
https://heavymetal.money

https://www.instagram.com/heavy_metal_money/

https://www.youtube.com/@heavymetalmoney

https://www.facebook.com/chrisluger

email: chris at heavymetal.money

Transcript

SPEAKER_01 0:00

Choosing your health insurance doesn't have to suck with Mike Anderson this week on the Extreme Personal Finance Show. Alright, so if you're anything like me, choosing a healthcare plan is like stressful and kind of confusing. Well, today I'm joined with Mike Anderson. He's the owner of Anderson Benefit Partners, and he's an expert in health insurance. And I'm really curious how Mike is gonna break down and simplify these crazy complex decisions around your benefits. We're gonna do things like navigate, you know, open enrollment, some of the plan changes. There's actually some pretty crazy changes that have happening, and how to avoid some some hidden traps in there. So I'd like everyone to welcome Mike Anderson. Mike, thanks for joining me today.

SPEAKER_02 0:52

Thanks for having me, Chris.

SPEAKER_01 0:53

Absolutely. I mean, I will say insurance probably isn't my favorite topic to talk about, but it's it's a necessary one though, right?

SPEAKER_02 1:02

Yes, yes, and you're not alone. It's most people's least favorite thing to talk about. And sometimes we get in the habit of of giving it that same amount of attention, right? Is we don't give it enough attention. And I help our clients make informed decisions and kind of try to simplify uh the complicated.

SPEAKER_01 1:21

I love that. I love that. And so usually every year there there are changes that kind of catch people off guard, right? And I know we've got some pretty crazy changes happening, at least here locally in in Minnesota, and it's kind of timely because actually just today we learned that one healthcare provider, UCARE, is gonna shut its doors. And it they service like 300,000 people in Minnesota and Wisconsin. So what can I mean, you know, if if I have UCare as my as my insurance provider, I'd kind of be freaking out a little bit, right?

SPEAKER_02 2:00

Yeah. Well, so to make that even maybe one step more complicated, um, in late September, so UCARE has individual family plans for people that are under age 65 that buy their own insurance. They also had a Medicare Advantage plan for seniors or people who are eligible for for Medicare. Um, and then they also do uh like servicing for the county or state public programs. Well, in September, they had uh notified the public that they were closing their Medicare Advantage plan. So that was like about 180,000 uh Medicare beneficiaries that were losing access to their plan through UCARE because their plan was closing or they were going out of business for that part of their plan. Now, to date, they had said until today, they were saying, yep, we're gonna, our individual family plan is still solvent, we're still gonna operate, we're doing all those things, and then today, whammy, they say, Oh nope, that's not gonna happen. Medica is gonna take over our plan. So what it sounds like is Medica's acquiring the individual family plans at UCare. So UCARE members will become Medica members, but there's still a question mark, I think, on the time frame when that happens. So the acquisition is supposed to happen in early uh 2026. So everything that I saw today says that UCARE members are still UCARE members through through 2026. That if you have UCAR, you'll still use your U Care card through 2026. During open enrollment, you can still select a U Care plan. I don't know that I would recommend that necessarily, but it's still gonna be sounds like they're still gonna be functioning through the next year.

SPEAKER_01 3:50

But how would that I mean I'm just kind of curious, and maybe maybe we don't know the answer yet, but I mean, I wouldn't think that the plans, like if all of a sudden those individuals, like let's say you're a family plan like me, right? I I'm self-employed, I buy my own plan, and now um I'm now gonna be a Medica customer from UCare. Plans aren't like apples to apples. Like, how do you know you're gonna go to the right plan? Or would you just have to evaluate the plans and enroll just like you would any other new plan?

SPEAKER_02 4:20

Right. So generally speaking, they'd call that like a crosswalk, right? Just like your plan now, it can change every year. Sometimes carriers will sunset or end a plan and they would crosswalk you into what's most similar. My guess is is that whenever they whenever they merge the actual block of business, if you will, when they whenever they take the UCARE members and turn them into Medica members, they're gonna put them into whatever they think is closest to your existing plan. But to your point, networks and benefits are different. So for most people, they're gonna want to at least reach out to their broker or whoever their advisor is to help them make an informed decision to make sure that whatever their plan turns into is what they should be on.

SPEAKER_01 5:07

Yeah, totally, totally. And and I do want to talk a little bit about how people can start to compare plans, you know, side by side and what things people can look at when they're comparing the plans. But I think it's really important, and something that I learned too is the importance of leveraging someone like yourself, like a broker. I you know, explain a little bit how that works because I think it's it's like I didn't really realize too that it's not like you're gonna pay more or get different kinds of plans going through a broker. Can you explain that a little bit?

SPEAKER_02 5:44

Yeah. So in our underage 65 marketplace, so if you're shopping through Minsure in another state through like healthcare.gov, all of the insurance companies have to file their rates with their state's Department of Commerce who regulates insurance, right? So when our insurance companies file those rates with the state of Minnesota, they're filed with a broker service fee. Um, if the person doesn't use a broker, the insurance company just keeps the fee. But if if all is equal, right? If you and I are working together and you work with me and we land on, you know, whatever plan you enrolled in, versus you doing all that work on your own, you pay the same. So the job of the broker is really to help you navigate through all the noise to make sure that you're picking the right plan for you and your family for their coverage here.

SPEAKER_01 6:36

I love that. I love that. So let's um so let's talk about that a little bit. Like for families, what are some features or some things to start with when you're comparing those plans, right? Is it just out-of-pocket maximum? Is it deductibles? Is it prescription coverage? How do you start walking those families through those decisions?

SPEAKER_02 6:58

Yeah. So we would go through a questionnaire, but I think it's really important. One thing that's different in the individual family plans versus like employer coverage is the networks are vastly different. So if you're enrolled with a Blue Cross plan through your employer, the Blue Cross name doesn't mean a whole lot or translate, if you will, into from group to individual to Medicare. So the provider networks are all different. So we always start with where do you like to go to the doctor? Because if you are, you know, if you have a relationship with a provider, you might want to, you might not want to change, right? You might want to not have to change your doctor. And in family specifically, if you have providers across multiple healthcare systems, that can get pretty complicated. So if you go to Fairview and Alina and health partners, and you know, if you want to go to Mayo, you can be in tough shape in the individual family plan market. So we always start there and then talk about household income because that can play a factor in if maybe you qualify for a tax credit and how do you use your health insurance? Uh do you doctor often or not so much, or do you like to see maybe a counselor or a therapist? That can play a big impact in to how somebody would uh maybe share in the cost, whether that's a co-payer towards their deductible. Um, and then prescription drugs. So we we want to review all of those things and then give somebody you know a few options that they can make an informed decision on on what maybe is gonna fit them the best.

SPEAKER_01 8:29

We keep on hearing um, you know, and it's all over the news and it's everywhere you look. People are using these um GLP1 weight loss drugs, and sometimes they're like$1,300,$1,500,$1,700 a month. And and just today, um, the owner of one of them, I can't remember, said, Oh, we're gonna offer it for$200 a month. Maybe you have a chronic care condition or you have a very expensive prescription that you'll continually use. What are some of the main things you're gonna look at? Like out-of-pocket maximum or something like that?

SPEAKER_02 9:03

Yeah, so depending on the plan, you know, those prescriptions may be subject to deductible and coinsurance, or they may be just subject to a copay. So depending on the type of plan, we'd want to know in advance, you know, how that person's cost sharing would be applied. So we'd show that somebody, you know, if you did X, this is what your prescription drug costs would be every month. If you did this other type of plan, maybe it's a different, you know, different type of cost sharing. The GLP1 drugs are a whole other animal because there's a lot of people that that take them. To my understanding, they're only approved in the individual market for a diabetes diagnosis. So you have to be diabetes type two to get the drugs covered underneath your health plan as a as a general rule.

SPEAKER_01 9:53

Got it, got it. Okay. We keep on talking about all these changes that that continually happen. And, you know, we talk about it, you know, uh on the podcast. I've had several episodes. We also, you know, I do meetups in person, like monthly meetups, where I give have, you know, people get together at our Stacking Benjamins meetup group, and we talk about inflation, we talk about rising costs, and insurance always comes up. And so these deductibles and out-of-pocket maximums and everything keeps creeping up. What can we do about it? I mean, there's really I guess I'm asking, is there anything we can do to help combat their just insanely rising costs?

SPEAKER_02 10:36

Yeah, and it's it's this year, you know, it was crazy before, right, Chris? I mean, it was it's been it's been this road of like madness uh in our health insurance. And this year, you look at our local market and all the carriers filed between 20 and 30 percent rate increases. I mean, it's and you look at like uh an out-of-pocket maximum on most of our plans, and they can exceed ten thousand dollars for an individual. There's a lot of families out there that that's just functionally uninsured, that if you got sick or hurt, you'd never you'd never dig out of just your out-of-pocket expenses for one year. Sure. Right. So, you know, depending on who you talk to, and our insurance rates are filed through the state of Minnesota. So the state of Minnesota has to validate the that the increases are adequate or reasonable, I should say, for the insurance companies. So there's just there's that, you know, are I think people are utilizing more care, and the insurance companies all are looking two years in the rearview mirror, right? So I think they're still looking at claims that are kind of post-COVID catch up, sure. Where you know, everybody kind of came back to real life. So there's an influx in in overall claims. There's uh new drugs like the GLP1 medications that are that are more expensive that people are requesting to take. Um, treatments for you know cancers or uh rare conditions are really expensive, and there's a ton of other drugs that are really expensive. So all those factors, right, are an increase in cost, what we pay to our insurance premiums. Then you know, you take into consideration maybe like our federal legislation, where in the individual market we had all these enhanced tax credits that are now expiring at the end of this year, and the local markets as well as nationally, they're expecting because of that increase in cost that 20% of the market will fall out, right? That the people are just gonna say it's too expensive, I'm not gonna take coverage. So the actuaries all account for that in their next year premiums, and so that's how we end up at like this 30% rate increase. It's you know, I think that we're at a tipping point where how much more how much more are people willing to take before the whole thing falls apart?

SPEAKER_01 13:01

Right, right.

SPEAKER_02 13:02

Right?

SPEAKER_01 13:03

Yeah, and and just uh just to confirm, when you say individual plan, that's something that's not offered by your employer, for example, right?

SPEAKER_02 13:09

Correct, yep. So if you're under age 65 and you buy your own health insurance, now where that could get confusing for somebody, right, is if your employer offered uh uh an ICRA or a QCERA, a benefit allowance for you to buy your own individual plan, sometimes those are acquired through work, but you're still in the individual market.

SPEAKER_01 13:28

Oh, interesting. I didn't realize there was that type of arrangement there.

SPEAKER_00 13:34

Yeah.

SPEAKER_01 13:35

Interesting. So in some of the changes, you know, one thing that I realized too is that there was some changes to like HSA plans coming in 2026. How has that changed? And then most importantly, uh how do you think someone should kind of choose between the a lower deductible plan and choosing an HSA plan? Is there a good rule of thumb on how to evaluate that?

SPEAKER_02 14:04

Yeah. Well, uh so uh to unpack the first part of your question, so inside the one big beautiful bill that changed they changed the requirements of an HSA plan. So previous to 2026, to have a an HSA qualified plan, the plan itself couldn't provide first dollar coverage if you got sick or hurt or taking prescription medications, right? You had to fund the entire deductible, and that's what made it HSA qualified. In 2026, all bronze level plans through the exchange are considered HSA eligible. So those plans are are the bronze plans, generally speaking, are gonna have like your higher deductibles higher out of pockets. But what you know, some of the plans in that category can have co-pays for office visits or prescription drugs, so you get more first dollar coverage, if you will, that before would have kicked that out of being compliant with a health savings account, where now you can have uh an HSA qualified plan or an HSA account to go with the plan.

SPEAKER_01 15:08

Got it, got it. I mean, you know, if if you are relatively young and healthy and want to use because I've talked about HSA plans a lot on the podcast about this triple tax advantage secret retirement account, right? It is. I guess is that kind of the thing? I mean, one exercise I did is kind of go back and looked at, well, how much do I actually pay in healthcare over the last couple years and I broke it out, you know, per year. I mean, is that some of the things we can do to figure out if an HSA plan would work for me and my family?

SPEAKER_02 15:44

Yeah. So you know, like previous to this year, it's always been the HSA plans generally were the lower cost insurance plans. And I guess I'm a I'm a pretty firm believer that your insurance, if possible, should not have a hugely negative impact on your standard of living, right? It's you know, I would hate to to have somebody go into a plan and think that, well, I need to have this really rich benefit, but then you, you know, if if you have to, if it's gonna have a really negative impact on your life, well, maybe we should look at affordability first, right? So the insurance shouldn't change your lifestyle if you if we can help it. So I would always start with affordability, and then it's it's it's understanding how the person uses their insurance or what would they like to do, what are their planned events, and then picking a plan, and and you can kind of math the system, right? We can determine, you know, would you be better off saving on your insurance premium? Maybe, you know, you know that you're gonna spend less, but then having maybe using some of that savings towards like an unplanned office visit, or if you know that you're gonna go or you know that you see a counselor therapist, maybe it makes sense to be in a plan that offers first dollar coverage for office visits or or your prescription drugs, etc.

SPEAKER_01 17:03

Right, right. I just think it's so crazy that the cheap plan, the cheap plan can have like a$9,000 deductible or something crazy, right?

SPEAKER_02 17:14

Yeah, and none of it's cheap. I know none of it's cheap. Yeah.

SPEAKER_01 17:18

It's just it's amazing to me. So I've I've never really thought of my healthcare needs in the future, what I can plan for. So you mentioned like, oh, well, maybe if there's something you have planned, like how much you kind of budget, how much that's gonna cost. What are some things people can think about as a planned? I guess in my head I'm thinking maybe like go to the eye doctor or something, but is that different insurance? I don't even know. In my head, I think of the doctor is always something you get hurt, then you go. You get sick, then you go.

SPEAKER_02 17:46

Sure. Yeah. So um when you're talking about like planned events, so like depending on uh maybe somebody's uh medications that they take, they might have to visit their doctor like semi-annually or quarterly to do like a medication review, yeah, right? So that could be something that you know that you're gonna have to go to the doctor for.

SPEAKER_01 18:05

That makes sense.

SPEAKER_02 18:06

It could be, you know, if you're like in some sort of like therapy, that could be like occupational therapy or physical therapy where you know that you're gonna have to doctor X amount of times per year. Uh, it could be something like that. Think of somebody maybe with like uh durable medical equipment. Uh, they might have the same projected costs each year. So to understand like some of those things can help us project maybe what plan would be the best for them to be on.

SPEAKER_01 18:33

Got it. So one thing that you mentioned earlier was about employers, and I know that I do have listeners and people that watch my YouTube that are you know small business owners, maybe they have you know a dozen employees or whatever. Do you see that there's trends that those employers are adopting to help manage the rising costs of some of this stuff?

SPEAKER_02 18:57

Totally. Um, so our you know, our like our traditional age-based plans for small employers. So if you had less than 50 employees, you kind of end up in that you know traditional bucket, if you will, um, where you know those rates have kind of followed the individual market where they're just escalating at this really fast clip. Um, so we're seeing a lot of our small employer groups move to what's called a level-funded health plan, which is self-insured for small businesses. It's kind of like taking a step back in time. Really, what's happening is that the health insurance company, rather just looking at everybody's age in the group and you know, using the insurance company's state-filed rates, they're actually looking at the health of the employee population to determine an expected claim rate, if you will. And so when those plans are a good fit, usually we're seeing uh reductions in premiums like 20 to 30 percent over the traditional fully insured alternative. So I think the statistic is now in Minnesota that like 30 or 35 percent of small employers are on that type of plan. Um, and almost all of the new business that we write is a level funded product.

SPEAKER_01 20:13

Interesting. Okay.

SPEAKER_02 20:15

Yeah. Including like at my office, we there's two of us on the plan and we're we're on a level funded plan, and it's you know, substantially less expensive than the traditional market.

SPEAKER_01 20:25

Got it. Got it. You know, one thing that I've always kind of wondered is especially if like even if you are on a Medicare plan, right? You're your traditional retirement age, but you travel a lot, right? You're down, maybe you're a snowbird and you're down in Arizona or Florida in the wintertime. I know I'm thinking of doing that starting in just a couple years. How does insurance travel with you? I've always been I've always been curious about that, you know?

SPEAKER_00 20:52

Mm-hmm.

SPEAKER_02 20:54

So if you are on an employer plan, almost always the coverage extends nationally. Almost always. There's there's some uh some exceptions to that rule, but almost always you'd have national coverage on your employer plan. Um if you're on an individual plan, so under age 65, you don't get service or you don't get coverage outside of your service area unless it's for an emergency. So, like if you, Chris, if you were snowboarding down in Florida right now on your plan and you wanted to go get your physical, or you know, if you maybe you didn't have an emergency, but you just weren't feeling well and you wanted to go get care, you're out of network, there's no there's no coverage. So you pay the full cost. On Medicare, everything kind of changes again. So then you go back, and then most of our our Medicare Advantage plans are going to offer national networks and original Medicare. You can see any doctor that will accept original Medicare. There is no provider network. So you can see any, and if you're on like a supplement with your original Medicare, the supplement covers everything that the original Original Medicare covers. So you can literally see any doctor that you'd like to see that accepts original Medicare, which is most providers across the country.

SPEAKER_01 22:07

Yeah, I was always curious on how that would work. You know, and I think going back to one of the very first things that you said, you know, that was one of the things that really helped me determine or narrow down my selection was who my doctor was, right? I had the same primary doctor for twenty three years or something. And so I'm like, he has my history, he knows me. Like it just makes so much sense to stick with him. So that's where I started. Then I started evaluating the plans that he was part of. So like you said, I think that's a huge, I think that's a win. Like, I mean, some people they just don't care. They'll just see whoever.

SPEAKER_02 22:47

For me, you just want the lowest right. For most of those people, it's just it's all about I just want the lowest cost plan. Right. Right. And it doesn't matter. Um, but there's a lot of people that you know that do have a relationship with their doctor or doctors. You know, if you had a if you have a health condition that you're treating, um, you know, I talk to we talk to a lot of people about their health. And, you know, people that have maybe like heart issues or, you know, cancer history, all those types of things, you want to you want to be able to see the people that are important to you. Sure. You know, that you have a relationship with. Um, so it's really important. And when you go out and you start shopping and looking at plans, a lot of them can look the same.

SPEAKER_01 23:27

What what do you find when people are selecting a uh a plan? What are those I guess those things that people don't realize they're walking into? Like, you know, they're like, oh, this was kind of hidden in the fine print or something. Like, is there some sort of traps that people kind of fall into?

SPEAKER_02 23:48

Oh man. I mean, I think that generally speaking, people think that insurance doesn't cover what it's supposed to, right?

SPEAKER_00 23:55

Sure.

SPEAKER_02 23:55

So, you know, there's probably that probably happens more often than not. You know, I think maybe the the one thing that comes up like over and over and over again that's maybe like a routine thing that people don't catch is when you go in for your annual physical and your doctor says, Well, Chris, we're gonna we want to do a a blood panel on you just to make sure everything's good, that's not part of your preventive visit.

SPEAKER_00 24:21

Oh.

SPEAKER_02 24:22

That's diagnostic. So then you get a bill, you know, you'd perceive that as you now I have this bill for my preventive care. I thought my plan covers that. And that's really your labs are not considered preventive, it's considered diagnostic. So if there was one thing that people often are frustrated about or don't understand, that's probably the one of the number one things.

SPEAKER_01 24:44

Got it. That makes sense. Do you think some of the supplemental type benefits, like I know some plans offer, you know, gym membership or something? I don't know. Do you think all that is just like I'm not trying to say that they're trying to distract you, but they're trying like is it a distraction from like what the core like benefits are?

SPEAKER_02 25:04

Yeah. I think that there maybe is only one plan now that offers the gym membership. They all have you know a version of some way to try to, you know, help somebody be healthier, whether that's like coupons for the grocery store or whole food, you know, like that kind of stuff. But I don't I think that those benefits are largely underutilized, people aren't paying any attention to them. So it's that's like the frills stuff that you know in your fancy pamphlet, you know, the stuff that can fill up the extra pages.

SPEAKER_01 25:36

Right, right. I know that I tried to I elected to join this thing and then I connected it with my health app on my phone, and if I got, you know, so many steps, so many steps out earned points, and it they gamified it, and it was like it was just so much you know, excuse me, just effing around, and I'm like, I didn't get any value out of it. Yeah. Is there like one thing that after you're working with your clients, you know, you're working with people and you get them, you know, into a healthcare plan that that fits them, fits their family, or fits their need, even if it's like Medicare, what's like the biggest aha moment for them? Like, I didn't realize this, or you helped them, you know, because you're down to like simplifying the complex. I love that. What are some of the main things that you kind of break down in the simplest form?

SPEAKER_02 26:25

Yeah, you know, I think like I was on a call with uh a guy earlier today, and when you break down maybe the definitions of the plan, right? Like people don't always understand the basics. They don't understand what the deductible is or what does that mean, right? Or what is a copay and what does that mean, or what is co-insurance and and what does that mean in like in their actual utilization? Sure. So like this this conversation that I had with uh a guy earlier today, they've always been in a high deductible plan, always chose the lowest cost plan. Him and his wife had uh their second baby, and the wife had said, you know, I don't really I don't think I like the copays. You know, I want just a hundred percent coverage after the deductible. Well, when we break that down, you realize, well, the copay is payable before you're deductible, and now you can visit the doctor at zero dollars, or if you had to see your specialist, maybe you pay eighty dollars rather than paying, you know, two or three hundred dollars towards that entire office visit, that's an okay deal. So the copay is not a bad thing, the copay is a good thing.

SPEAKER_00 27:33

Sure.

SPEAKER_02 27:34

And so understanding, you know, just those basic definitions and what does that mean in the plan and how that applies to somebody's life, I think is is really important. And that's when you see the light bulb go off, right? And they're like, well, Mike, that would save me, you know, the premium is like$200 left per month, but it would cost me like thousands of dollars less every year.

SPEAKER_00 27:54

Sure.

SPEAKER_02 27:54

You know, if we each went a few times, that's gonna save me a ton of money. It's like, yeah.

SPEAKER_01 27:59

That's huge. That's huge. Yeah, and I still, even to this day, I don't really understand how coinsurance works, right?

SPEAKER_02 28:06

Yeah, so coinsurance is uh, you know, typically you're if you looked at like your summary of benefits, you'd have things that are subject to deductible and coinsurance, right? And so what that means is your first, if I if my planet is a$7,500 deductible and then 50% coinsurance, that means each year I have to pay the first$7,500 in charges, that things that are subject to deductible and coinsurance. So I pay the first$7,500. Then after that's met, if I had$50 coinsurance, a bill, if I got another bill for$1,000 after my deductible, and I had$50 coinsurance, I pay$500, the plan pays$500. So you're splitting the coinsurances where you're paying a portion and the plan's paying a portion of a charge.

SPEAKER_01 28:57

You know, it they just make it so confusing. I think I think the biggest thing too is that I'll always wait until I get the bill from the provider and then to see what actually I was truly did I get billed for. Sometimes I'll even ask for like an itemized bill. Because sometimes it'll just say diagnostic services, but you have no clue of what that was. Okay, well, let's get an itemized bill. And I make sure that okay, is this truly what I had happen? Right? And then I match up the explanation of benefits to to the I match up, you know, the actual statement to the explanation of benefits, and if they match and the doctors are match and stuff, then I pay the bill. But it's and sometimes it happens weeks after the fact, and it just I just wish it was easier.

SPEAKER_02 29:50

And you I think that you hit on something that most people don't recognize, that the your if you were gonna reconcile a bill from the provider, it should match your explanation of benefits. So if if you had to pay more, if your provider's billing more than what your explanation of benefits is dictating, there's a problem somewhere. Either there's they're miss billing or something they're billing for something that wasn't covered. Uh, but generally speaking, those two things should match. And if they don't match, then you need to don't just pay the bill, you know, reach out to somebody who can help you understand what it is that you're looking at, or or talk to your provider about why they don't match.

SPEAKER_01 30:32

That's awesome. Yeah, we've had some great discussions on ways that you can save on your healthcare expenses, and I've actually walked through people on how to look up the actual codes on your statement to find out what those were. Like, was that a blood draw? Was it this? Was it that? And then you also I mean, this is a conversation for another time, but Mike, I know one thing that I'm a huge fan of is truly shopping around, even if it's covered by insurance. You know, I had I had a bunch of shoulder stuff done last year. Um I had a couple, if you had different injections, but you know, to do that they did a bunch of different imaging. And I could do an MRI at this clinic and it was seventeen hundred dollars. I could do it at this clinic and it was nine hundred dollars, and it's just driving like another few miles down the street. I man, I just it's a bigger conversation, but I just I feel as though even at the individual level, if we can do whatever we can to not have them bill our insurance so much to keep those healthcare costs down.

SPEAKER_02 31:39

I you know what, I I totally agree, and I think one of the biggest issues or problems in our healthcare system is that there's zero transparency because you don't you can't there's uh where do you go? You don't know you don't know what your you don't know what most providers charge, right? You don't know what the allowed amounts are in your contract for your health insurance, and so and there's no standardization when the market doesn't know what things cost, how do you create competition to drive down the cost of services? And it's you know, so it's it's really it's one of the things that needs to be addressed, I think, in our our healthcare system as a broad national, you know, healthcare system is how do we fix this transparency issue?

SPEAKER_01 32:26

Yeah, absolutely. And I'm gonna I'm gonna put a couple links in the show notes that um I have there is um there's a couple sites that you can go to to get an estimate based on geography, based on where you are, what type if you're gonna have this type of procedure done, what is the average they should be charging the insurance company? At least it gets you in the ballpark. But that's the thing, man. Like if I go to a place and say, okay, I'm gonna get this procedure done, how much would that cost? They don't know.

SPEAKER_02 32:56

They don't know. Right. They don't know. So so to your point about maybe like shopping, but also there is this like element of negotiation. So if you like in the healthcare world, a lot of times things will be referenced in a percentage to Medicare because Medicare is like the largest, you know, the largest payer of claims in the you know healthcare space. So when you talk about like the commercial plans, usually the commercial plans will pay like two to three hundred percent of what Medicare reimburses.

SPEAKER_01 33:27

Interesting. Okay.

SPEAKER_02 33:28

So if you had somebody that had, you know, catastrophic health year, there can be ways to negotiate the price down from whatever price they were charged to a percentage of Medicare, usually. And there's some health plans on the group side that will just pay rather than having a negotiated contract, the plans will just pay 150% of whatever Medicare pays for a service. And on those plans, you'll see that the premiums come way down because we're they're reimbursing the doctors and hospitals so much less.

SPEAKER_01 34:01

Sure. Because I'm kind of in the space, sometimes I'll have TikToks or Instagrams show up, and they're they're actually they'll show like the cash price for this is way cheaper, right? And if you have insurance, like they won't let you just go and pay the cash price. Is that true? Like if I tell you, it can be. Yeah, it can be true. Yeah, I don't want to use my insurance, and they're like, well, you have to.

SPEAKER_02 34:28

And I I think that it's you know, that's one of the elephants in the room, right? Like when again, when we don't know what things cost, and but you're like, how could your cash like how how can the cash price be less than what your insurance discounted amount is? I think again, I think that there's a transparency issue because that shouldn't happen, right? But it does, but it does happen. So I guess I have two thoughts there. I'll see if I can remember both of them. My first thought is that, you know, if you said, okay, so if I go to my doctor and I just sit tell him you get you have a cold and you go to the doctor and you say, Well, I'm just gonna pay cash for this because I know that it's less than if I use my insurance. Technically, you could file a reimbursement claim with your insurance company, it would just apply whatever you paid towards, like your deductible, or if you had a co-pay, it would reimburse, you know, part of that office visit. So you could do you could do that, right? I think the larger, you know, where people kind of head down that path, they're like, well, if I just didn't have insurance, I'll pay cash for everything.

SPEAKER_01 35:32

And there are people that do that.

SPEAKER_02 35:34

Right. So my question is is well, what happens if you have the cancer diagnosis or the heart attack or stroke or the major health event? Because it can be hard to get appointments at a specialist or your cardiologist or whatever without the insurance, because that's the provider's guaranteed payment, right? So I think we I think sometimes people forget that the insurance can also is what's securing your appointment. So if you had a major health event and you didn't have insurance, it could be really difficult, I think, to do maybe the care after an emergency.

SPEAKER_01 36:14

Got it. No, that's good to know. I just I always think too, like you mentioned, like a cancer diagnosis or something catastrophic where you know it's hundreds and hundreds of thousands of dollars, you know. We help families that have babies in the NICU, and you get a baby that's in the NICU for eighty days, a hundred and ten days, it's three thousand dollars a day just to have those babies in the NICU. Like, are you kidding me? Sometimes it's over a million dollars.

SPEAKER_02 36:41

Right.

SPEAKER_01 36:42

So it's like, what would you possibly do? I I don't know. Right. But yeah, so I'm not saying that people should just go without, but I'm like, there's gotta be ways that we can collectively as a society bring this stuff down.

SPEAKER_02 36:54

Figure it out, yeah. Figure it out and and do better, agree.

SPEAKER_01 36:57

Yeah, I think that always happens with um with medications too, like how you were saying how what they the the discounted price insurance, right? 'Cause I've heard like some pharma like independently owned pharmacies, if they're not going through big pharma, they can get you the same med a lot less expensive than if they were going to charge the insurance company for the same medication.

SPEAKER_02 37:24

Yeah.

SPEAKER_01 37:24

So yeah. Like I said, that's a much bigger discussion.

SPEAKER_02 37:29

Mm-hmm. Right. You know, and and the government's involved in a lot of that at some level too, right? That they're negotiating with manufacturers, and now there's in Medicare, they've got these list of drugs that will be, you know, they're focused on reducing costs for um, you know, our we're a capitalist society, so there's a profit center in all of the things, right? Both on the care delivery side, on the insurance side, every every piece of that there's there's a a profit center. So, you know, I think that there's a lot of uh bloat and fraud, waste and abuse in our healthcare system, that there's a lot of things that um we're probably spending money on as a society that we really shouldn't be that are inflating our costs as well.

SPEAKER_01 38:19

Sure, absolutely. I would really like those listeners or people watching on YouTube, if there's some like key takeaway that you want them to leave with today, maybe it's about uh, you know, I know things get crazy and it changes all the time, but what would you what advice would you give them?

SPEAKER_02 38:41

Yeah. You know, I think maybe a couple of things. I think first I would say take a few minutes every year to like review your plan and make sure that it it fits your needs. Um and I think people that you maybe utilize that go to the doctor more often than not are maybe more prone to at least reviewing their insurance, but but definitely take a few minutes to look every year. Now's the time, right? If you're if you buy your own insurance or a lot of employer plans, Medicare is happening right now. So now's the time for most people to to look at your plan and and make sure that what you're doing for the next year is adequate for yourself or your family. And then I'd say leverage the the advice of a professional, right? You don't pay any more or less when you're when you're working with a broker. Find somebody that's local to you in your area. You know, depending on where you're at, you're there's a lot of resources to find a good broker. If you had a listener that was outside of Minnesota, I'd tell them to go to nabip.org. That's the n-a-b-ip.org, National Association of Benefit and Insurance Professionals. They've got an agent finder on there. Those are the people that are highly engaged in their profession. So to be confident that if somebody needed to find a broker, uh, if you're in Minnesota, call me the shameless plug. But you know, find somebody locally or or go to nabip.org and and look for a broker there. Um and you don't pay any more less the broker. So I'd say leverage the advice of a professional and don't take on the burden of trying to figure out all your doctors and your meds and all that stuff on your own. Use somebody that does it for a living, and you know, then you just have to focus on what really matters. It's awesome.

SPEAKER_01 40:21

Yeah, and and I I I think you should go ahead and let people know where they can find you or get more information about what you do.

SPEAKER_02 40:27

Yeah, right on. Probably the the best place um to get a hold of me is our website, uh Anderson Benefitpartners.com. Um, you know, we work in uh really three main market segments. So uh employer benefits, uh, under age 65, if you have to buy your own health insurance, then we also uh serve the senior community or Medicare eligible people.

SPEAKER_01 40:48

Well, look, let's say I have my current coverage that I have right now in 2025 and I don't do anything. Yeah, what what happens?

SPEAKER_02 40:58

Well, that's a good question. A lot of times it will automatically renew, but not always. So if um you know, if you're on the exchange, minture or healthcare.gov plans can do weird stuff. Sometimes if you're on the cusp for eligibility between like a public program and a tax credit, they may push you to the county or the state for information. So you might not automatically renew. Almost always you do, but not always. So I would say if you are buying your own insurance, log into wherever you get your insurance from, or log into Minsure, and make sure that you have a new plan for the next year in there. Or if you work with an agent or broker, reach out to them and ask them to confirm your enrollment for the next year.

SPEAKER_01 41:43

That's great advice. And I know it's just recently because I was going through a lot of my stuff and I wanted to look up some EOBs and I logged into my Medica portal. It wouldn't let me go anywhere without selecting the plan. Like, select what I had or do this other thing, and I'm like, well, I don't know yet. I haven't really evaluated them. And I'm like, I'm stuck. Their website literally was stopping me anyway. That was funny. Mike, thank you so much for your time today. I really do appreciate it. Thank you everyone for listening and following along. Please like, subscribe, and share with someone that you think would find value. Again, health insurance, man. Choosing a healthcare plan doesn't have to suck. We'll see you next time on the Extreme Personal Finance Show.

SPEAKER_02 42:35

Coming back to me, Chris. Do you want to see my plant, Chris? I'll show you my plant. This is Steve. This is Steve. He's my money tree. Uh when I got Steve, he was a little itty bitty type. He came from Target. And now he has moved one office with me, and he's much larger than what he was when he was very small. Because he's he's a big money tree now. Uh he got repotted, so he's in a different pot now than he was before. Hey Chris, you're back. I was uh I don't know if it kept recording, so I was like, well, I'm just gonna do weird stuff.