Premium increases are forcing practice owners into hard choices. Here's what to review during open enrollment before absorbing another hike or cutting benefits.
For many practice owners, the premium renewal letter has become the most stressful document of the year. Absorb another increase, trim benefits, or drop coverage altogether. Those three options look like the whole menu, and none of them is attractive. But they aren't the only choices, and open enrollment is the window to check that.
Doctors Feel the Squeeze Too
Physicians don't always get credit for feeling cost pressure. Dr. W. Ramirez recently dropped his practice's insurance in January because premiums had climbed beyond what the budget could handle. He then spent months looking for something that fit the budget without gutting the coverage his staff and family relied on.
His view of the situation is worth hearing. "A lot of folks assume doctors are rolling in money, but the truth is physicians and their families are dealing with the same economic realities and rising healthcare costs everyone else faces." That's a fair description of what many practice owners describe: they run a business, pay staff, and buy coverage in the same individual and small-group markets as everyone else, while also carrying overhead that doesn't shrink when premiums rise.
What Open Enrollment Actually Gives You
Open enrollment is the annual period when you can review what you're paying and whether a different plan or carrier would serve your practice better. Treat it as a comparison exercise rather than an automatic renewal. Renewing by default is easy, and it's also how practices end up paying for the same plan year after year as premiums rise.
The process generally starts with a clear picture of your current coverage: which deductibles, copays, and out-of-pocket maximums apply, which providers are in network, and which benefits your employees actually use. From there, the useful question is which benefits matter most to your team. A plan with a lower premium can still cost more if it shifts expenses onto staff through higher deductibles or narrows the provider network your employees depend on.
Some practices work with a benefits advisor to make that comparison. In the source material, the advisor's role is described as researching plans and carriers and explaining the differences, with the practice making the final decision. That division of labor is worth keeping in mind, whether you use an advisor, a broker, or your own research. The goal is a decision you understand, not a pitch you accept.
Level-Funded Plans: What They Are and Who Looks at Them
For some small employers, the conversation eventually turns to level-funded health plans. The source mentions them as one possible path to savings for some practices, and it's a structure worth understanding before you consider it.
In a typical level-funded arrangement, the employer pays a predictable monthly amount. Part of that money funds a claims account used to pay employees' medical bills, and the employer typically carries stop-loss insurance to cap exposure if claims run unusually high. If claims come in below expectations, the unused portion of the claims fund may be returned or credited, depending on the plan's terms. If claims exceed the fund, the stop-loss coverage and the plan's terms determine what the employer owes.
That structure can appeal to a practice with a healthy, relatively predictable employee population. It also means the practice takes on more claims risk than it would with a fully insured plan. Whether that trade-off makes sense depends on your headcount, your claims history, your appetite for variability, and how the stop-loss terms are written. Ask for the specific stop-loss attachment point and what happens in a high-claims year before you compare the monthly figure against a fully insured quote.
Questions Worth Asking Before You Sign
Whatever route you take, a few questions tend to separate a useful comparison from a superficial one:
How is the advisor or broker paid? The source states that its advisors don't work on sales-based commissions, which is a point the practice can verify directly. Ask any adviser whether compensation varies with the plan you choose, and get the answer in writing.
What does the plan cost in a bad year, not just the first year? A lower premium that depends on a low-claims assumption can look different after one large claim.
Who helps when problems come up mid-year? The source notes that its advisors remain available throughout the plan year. Whatever provider you choose, confirm how questions about claims, billing, or enrollment changes get handled.
Are your staff's actual providers and prescriptions covered? Pull the network directory and formulary for the specific plan and check them against what your team uses.
Where This Leaves Practice Owners
Rising premiums are a real pressure, and Dr. Ramirez's experience shows that the pressure reaches practices of every size. But the decision in front of most owners isn't binary. Comparing current coverage against alternatives, understanding how advisors are compensated, and looking at structures like level-funded plans can reveal options that a simple renewal would hide.
If you're heading into open enrollment, start by pulling your current plan documents and this year's total cost, then request side-by-side quotes before the deadline. The practices that come out ahead tend to be the ones that did the comparison early, when there was still time to change course.
