Cutting-Edge Benefits Podcast

Claimlinx
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Are you a business owner or HR leader tired of skyrocketing health insurance premiums and confusing benefits packages? Welcome to the Cutting-Edge Benefits Podcast, where we break down the smartest, most cost-effective ways to offer high-quality employee healthcare — without breaking the bank. Each episode, our experts at ClaimLinx reveal insider strategies to help you: ✅ Cut hidden costs in your current health plan ✅ Understand the difference between self-funded and fully insured models ✅ Build competitive benefits packages that attract and retain top talent ✅ Stay ahead of healthcare trends

  1. 14H AGO

    Trump Administration Healthcare Proposal: $31,000 Deductibles — Smart Strategy or Scare Headline?

    In this episode, Tom tackles a headline that sparked outrage: “New healthcare plans could slap families with $31,000 deductibles.” Sounds terrifying. But Tom breaks it down with one simple question: Are we reacting to the word deductible…Or are we ignoring the math? This conversation dives into how high deductibles, tax strategy, employer savings, and individual behavior all intersect — and why most media coverage misunderstands how healthcare plans actually work. The core argument: Most Americans never hit their deductible. Tom explains: Only a small percentage of people reach even a $5,000 deductible. Of those, many qualify for grants or supplemental coverage programs. That leaves a tiny fraction truly exposed to full deductible risk. So what’s the bigger financial threat? Guaranteed monthly premiums. You must pay premiums every single month.Deductibles? Only if you use the coverage heavily. That’s a very different risk profile. Tom flips the conversation from politics to business math. If deductibles rise: Premiums drop significantly. Employers reduce guaranteed costs. Savings can be used strategically. He emphasizes that businesses can: Allow employees to purchase individual ACA-compliant plans. Use tax-advantaged reimbursement structures. Capture massive EBITDA impact. If a company saves $100,000 annually and operates at a 7x valuation multiple? That’s a $700,000 increase in company value. This is not political.It’s arithmetic. The proposal discussed in the episode involves: Higher deductibles Lower premiums Greater tax deductions Increased use of Health Savings Accounts Tom’s key insight: If structured correctly, lower premiums create taxable income shifts that can: Increase federal tax revenue Increase take-home pay Reduce employer burden Improve business valuations The controversy isn’t about feasibility. It’s about public perception. Under current structures: Employer and employee health premiums are tax-free. Large premium costs create zero taxable income. If premiums drop significantly: That difference becomes taxable compensation. Federal revenue increases. Employees may net more money. Employers regain financial flexibility. Tom’s stance: This only works if structured properly — especially through HSAs and Section 105 plans. Otherwise, Americans might misuse direct cash incentives. Tom also highlights: For high deductibles, supplemental policies like: Hospital indemnity Critical illness Gap coverage Can often be purchased inexpensively and dramatically reduce exposure. Meaning: The headline number ($31,000) doesn’t equal real-world risk. A recurring theme: Most employers are: Overpaying for premiums Not using tax law strategically Leaving value on the table Accepting increases without scrutiny Tom argues the system rewards: Commission-driven brokers Carriers benefiting from premium volume Lack of financial literacy around healthcare purchasing And punishes: Employers who don't get involved Employees who don’t understand plan design One of the most powerful analogies from the episode: Some families pay $5,000 per month for health coverage. That’s equivalent to: A luxury home mortgage. Without building equity. Tom’s perspective: If healthcare costs remain this high, employers may eventually find more value in directly compensating employees rather than overfunding carriers.  High deductibles do not automatically equal financial catastrophe Most people never reach their deductible Premiums are guaranteed costs — deductibles are conditional Lower premiums can increase business valuation Tax strategy is central to healthcare reform Supplemental coverage can offset high deductible risk Media headlines often ignore financial structure  The Deductible Myth vs. The Premium Reality Why Businesses Should Pay Attention The Role of Donald Trump and Mehmet Oz Why Lower Premiums Change the Tax Equation Supplemental Coverage: The Overlooked

    12 min

  2. 5D AGO

    Why Your Health Plan Is Secretly a Profit Center — Just Not for You

    n this episode of The Cutting Edge Benefits Podcast simulcast on The Neil Haley Show, Tom Quigley pulls back the curtain on one of the most uncomfortable truths in employer healthcare: Your health plan is a profit center. Just not for you. Employers think they’re buying protection.Employees think they’re buying coverage. But Tom argues the reality is this: the system is built to generate layered revenue streams across vendors, PBMs, carriers, hospital systems, state regulators, and intermediaries — long before the employer ever sees value. This episode breaks down where the premium dollar actually goes, how PBMs generate hidden margins, why hospitals charge 300–800% of Medicare rates, and why employers are unknowingly funding a highly profitable ecosystem. When an employer writes a check for healthcare premiums, it doesn’t just go toward medical care. It flows through: Insurance carrier margins Broker/agent commissions Pharmacy Benefit Managers (PBMs) Dispensing fees Administrative markups State premium taxes Reinsurance layers Carrier-owned provider networks By the time funds reach actual care delivery, multiple hands have taken their share. Tom’s blunt assessment: “It goes everywhere — except back into the employer’s pocket.” Pharmacy Benefit Managers sit between employers and drug manufacturers. Their revenue streams include: Manufacturer rebates Spread pricing Dispensing fees Administrative charges Rebate retention Contract opacity Tom argues that if employers could purchase directly from manufacturers, pricing would be dramatically lower. Instead, drugs move through third-party networks where markups accumulate at every stage. The analogy used in the episode:Buying lobster off the dock versus buying it in the grocery store.Same product. Different supply chain. Massive price difference. One of the most explosive parts of the discussion: Why are employer plans paying several multiples of Medicare reimbursement rates to hospitals? Tom attributes it to: Negotiated network contracts Administrative inflation Lack of pricing controls Market consolidation Regulatory capture Without government rate-setting or structural reform, employers are left negotiating inside a system designed around hospital leverage. Carrier-owned networks negotiate rates with hospitals and providers. Those rates: Often exceed Medicare multiples Are bundled into premium pricing Create predictable profit spreads When insurers control both network access and reimbursement structure, the pricing leverage favors the carrier — not the employer. Under HIPAA regulations, data transparency is limited. Tom argues: Employers receive partial claims visibility. Carriers control broader analytics. Utilization modeling and actuarial projections become proprietary advantages. While employers assume widespread utilization drives cost, Tom cites that: Only a small percentage of employees hit high deductibles. A minority actually pays full deductible amounts. Yet premiums reflect pooled risk pricing at scale. In Tom’s words: “The casino’s winning.” The answer is straightforward: Employers Employees Small business owners Families When premiums rise, someone absorbs the increase: Reduced wages Higher employee contributions Dropped coverage Increased deductibles Uninsured workers The profit doesn’t disappear.It’s funded through the system. Beyond numbers, Tom discusses: Tom Quigley is the founder of ClaimLinx and a healthcare cost strategist focused on helping employers legally restructure benefit plans under existing federal law. His mission:Help employers reduce costs while improving benefits — without relying on traditional commission-driven models. If you want to understand: Where your premium dollars actually go How PBMs generate hidden revenue Why hospitals charge multiples of Medicare What legal strategies exist to lower costs Visit ClaimLinx.com

    5 min

  3. FEB 24

    Why Wellness Programs Don’t Lower Health Costs — The Rigged System Employers Don’t See

    In this high-energy simulcast of The Neil Haley Show and The Cutting Edge Benefits Podcast, Tom Quigley of ClaimLinx delivers a blunt, no-nonsense breakdown of one of the biggest myths in employer healthcare: Wellness programs do NOT lower health insurance costs. Free gym memberships.Step challenges.Smoothie emails.Incentive bonuses. Meanwhile?Claims trend 8–12% annually. Tom explains why wellness initiatives improve engagement and productivity — but fail to impact the real drivers of employer healthcare spend. He dives into ACA rules, HIPAA limitations, ERISA structures, Section 105 plans, captives, reinsurance games, pharmacy rebate manipulation, and the hidden profit mechanics inside traditional insurance models. The takeaway:Behavior change is not the problem.Pricing structure is. If wellness “worked” financially, why are employer premiums still climbing 8–12% per year? Tom explains: The cost explosion is driven by hospital pricing, specialty drugs, medical devices, and system markups. Wellness focuses on behavior. Healthcare pricing is driven by corporate profit structures. They are not the same thing. Tom challenges employers to ask: Are we confusing employee engagement with financial savings? Wellness programs: Improve morale Improve productivity Increase participation Reduce absenteeism But they do NOT: Control hospital pricing Control pharmacy rebates Control insurance carrier margins Change reinsurance structures The financial side operates independently from the engagement side. Tom outlines the real financial winners: Employees (pre-tax incentives, improved take-home pay) Employers (payroll tax savings) Insurance agents (commission structures) Wellness vendors But not: Employer healthcare premium budgets Under ACA structures, wellness dollars are often funded in tax-advantaged ways — meaning Uncle Sam absorbs part of the cost. That doesn’t equal lower claims costs. Under the Affordable Care Act (ACA), carriers must spend 80% of premium revenue on claims. On paper:Insurance companies “only make 10–20%.” Tom argues:That’s not the full picture. Behind the scenes: Pharmacy rebates Reinsurance structures Captive arrangements Data opacity under HIPAA Administrative layering The actual margin can be significantly higher. One major structural issue: Under HIPAA, employers cannot ask medical underwriting questions in traditional group settings. So what happens? You hire 5 employees.One has hemophilia.One has cancer.One has a high-cost dependent. Now your small group premium spikes — regardless of how healthy your existing workforce is. Tom argues that:The way plans are purchased and structured determines cost exposure — not wellness participation. This episode centers around a key philosophical question: Why are we trying to fix employee behavior instead of fixing how healthcare is purchased? Tom’s position:Healthcare costs are pricing problems.Not participation problems. According to Tom: Understanding HIPAA laws Understanding ACA structures Understanding ERISA Leveraging Section 105 properly Structuring plans outside traditional commission models Navigating around flawed pricing pools The system is complex — but it’s navigable. Most employers simply aren’t shown how. Tom openly challenges:Insurance CEOsHospital executivesCarrier leadership He states:The laws are public.The math is public.The structure is public. But industry leaders rarely debate the system openly.

    9 min

  4. FEB 19

    Private Equity Owns Your Doctor: What That Means for Employer Health Plans

    In this episode, Tom Quigley tackles a growing but rarely discussed issue in healthcare: private equity firms buying up medical practices and hospitals — and what that means for employers and their health plans. This isn’t a political conversation. It’s a financial one. Tom breaks down how private equity ownership changes incentives, why emergency room visits feel more expensive than ever, and how employers are unknowingly funding a system that prioritizes flipping profits over patient care. The takeaway is clear: When medicine becomes an asset class, costs go up — and employers pay the bill. Tom explains the core issue: Private equity firms: Acquire practices Cut costs aggressively Increase revenue Flip the business in a few years Doctors become part of a profit machine Negotiations with insurers become more aggressive Tom: “Do you want your doctor flipped every few years like a house?” When margins drive care, pricing pressure increases — and that flows straight into premiums. Neil raises an important concern: Large entities sometimes own: Insurance carriers Pharmacy benefit managers Medical practices Retail pharmacy chains When the same corporate umbrella controls multiple parts of the system: Incentives blur Costs get layered Transparency disappears Tom: “It’s a free market — but the government rules determine who wins.” Tom pulls back the curtain: Many hospitals are now for-profit Administrators are paid based on margin targets New technologies and equipment are expensive Negotiations with carriers raise reimbursement rates Result: Insurance premiums go up Deductibles go up Employees feel it immediately Tom: “The administrators make more than the surgeons now.” Short answer: It can. When reimbursement negotiations increase, Carriers raise premiums to maintain margins, Employers absorb the increase. It’s not the only driver of inflation, but it adds fuel to the fire. Tom outlines several contributors: Private equity ownership For-profit hospital systems Wall Street pressure for earnings Administrative bloat Commission-driven insurance sales Lack of tax strategy awareness But he makes an important distinction: “Technology costs money — but greed costs more.” Tom’s answer: Yes — if you design your plan correctly No — if you just accept renewals and keep doing the same thing Savings come from: Leveraging ACA rules Using Section 105 (MERP) Using Section 125 properly Utilizing tax-preferred financing Eliminating unnecessary premium waste Instead of asking: “Why did rates go up?” Employers should ask: “How do we use the tax code to our advantage?” “Are we financing healthcare with pre-tax dollars?” “Are we structuring benefits logically?” “Are we rewarding brokers who profit from premium increases?” Tom: “If you don’t understand the tax laws tied to healthcare, you’re overpaying.” Many companies: Buy high-deductible plans Make employees pay deductibles with after-tax money Don’t use Medical Expense Reimbursement Plans Tom: “You’re financing claims with after-tax dollars when you don’t have to.” That’s a silent profit shift from employers and employees to carriers. At the heart of it all: Private equity wants return on investment Hospitals want margin growth Insurance companies want profit ratios Brokers want commission stability Government layers regulations on top Employers? Want to retain employees Want affordable benefits Want predictable costs Tom’s position: “If you align incentives correctly, the math works.” Private equity ownership changes medical incentives Hospital pricing pressure feeds premium inflation Emergency room costs reflect margin goals, not just care costs Employers unknowingly fund this through poor plan design Tax strategy is the hidden lever Savings exist — but only if you structure correctly “Do you want your doctor flipped like a house?” — Tom Quigley 👉 Visit: https://www.ClaimLinx.com

    7 min

  5. FEB 17

    Hospitals Are Suing Patients — What That Means for Employers in 2026

    In this episode, Tom Quigley addresses a disturbing trend gaining momentum in 2026: hospitals suing patients over unpaid medical bills. For years, unpaid balances were quietly handed to collections. Now, with higher deductibles, more uninsured individuals, and increased out-of-pocket exposure, hospitals and collection agencies are becoming more aggressive — even taking patients to court. Tom connects the dots between: High deductibles Employer plan design Collection lawsuits And the broken incentives driving the entire system. The message is blunt: This isn’t just a patient problem — it’s an employer problem. Tom explains the shift: Deductibles are now routinely $5,000–$10,000 More people are uninsured Hospitals are owed larger balances Collection agencies work on commission (20–50%) If a hospital can collect even half of an $8,000 bill: It’s worth filing a lawsuit Tom: “If they get half, it’s still a win for them.” Not necessarily. Filing fees are low Collection agencies are incentivized Lawsuits create pressure Many patients settle or enter payment plans out of fear Tom’s practical advice: If you owe money, negotiate directly Set up a payment plan Avoid letting it escalate to collections Tom highlights a key difference: ClaimLinx employers: Buy catastrophic correctly Finance deductibles through MERPs Keep employee out-of-pocket exposure low Result: Employees don’t get slammed with $8,000 surprise bills Fewer collection scenarios Less financial panic When employees get hit with massive bills: They don’t understand coinsurance They think they “have good insurance” They feel betrayed Morale collapses Productivity suffers Tom: “They don’t understand what they bought. That’s the real issue.” Tom calls out hospital pricing: Many hospitals charge 300–800% of Medicare rates Inflated billing structures Administrative overhead Shareholder and executive incentives Some patients qualify for: Financial assistance Grants Income-based forgiveness But hospitals often don’t advertise it. Tom: “They’re not exactly volunteering to reduce your bill.” Even while patients are being sued: Premiums are up 8–10% annually (or more) Insurance carriers still profit Agents still collect commissions Employers keep buying plans incorrectly Tom: “You’re running with thieves.” Tom shifts the focus: Many employers: Buy high-deductible plans Don’t fund out-of-pocket exposure Ask employees to absorb risk Employees: Pay payroll deductions Still face huge medical bills Effectively lose hourly wage value Example: $20/hour worker $400/month premiums $8,000 deductible Real effective wage drops dramatically Tom: “Why would someone work for you just to give back $7 an hour to healthcare?” Tom connects healthcare to tax strategy: Health insurance cost correlates directly with taxable income Smart use of: Depreciation Solar credits Business deductions Retirement contributions Can lower adjusted income Lower premiums Lower subsidy exposure Tom: “The tax code and healthcare are directly connected.” Tom argues that unless employers rethink benefits: Workers will: Leave Go gig Go self-employed Demand better coverage Healthcare design will determine: Retention Recruitment Business survival Hospitals are increasingly suing patients High deductibles drive the lawsuits Collection agencies profit from fear Employers indirectly fuel the problem Proper plan design prevents catastrophe Healthcare costs are tied to tax strategy Education is the missing piece “If they get half the bill, it’s still a win for them.” — Tom Quigley “You’re not just buying insurance — you’re buying risk.” — Tom Quigley “Employees are paying for bad employer decisions.” — Tom Quigley “The tax code and healthcare are directly connected.” — Tom Quigley 👉 Visit: https://www.ClaimLinx.com📞 Schedule a Call: Redesign your health plan before your employees end up in collections🎧 Subscribe: The Cutting Edge Benefits Podcast & The Neil Haley Show

    9 min

  6. FEB 12

    Why Working With ClaimLinx Beats Taking Another Broker Increase (Step-by-Step)

    This episode is a practical walkthrough of what actually happens when a business owner contacts ClaimLinx—and how that process is fundamentally different from the traditional “broker renewal roulette.” Anthony McMahon breaks down the exact step-by-step process ClaimLinx uses to reduce healthcare costs 30–50%, while improving benefits and employee understanding. The contrast is stark: analysis and incentives vs. guesswork and commissions. If you’ve ever wondered what you’re really paying for when your broker sends you a renewal with a 20% increase and says “this is the best we could do,” this episode answers that question. Anthony explains that ClaimLinx does not start with a quote: First step is understanding: Company size and structure Decision makers Pain points Cost-sharing setup What the employer actually cares about Every company is different—there is no one-size-fits-all pitch Anthony: “Every group is different. The dynamics, the priorities, the pressure points—all different.” ClaimLinx requests two core items upfront: Schedule of Benefits The long, confusing plan document nobody reads Deductibles, copays, coinsurance, out-of-pocket maximums Latest Invoice / Bill What the employer pays What employees pay The real monthly cost of the plan This allows ClaimLinx to see exactly where the money is going—not just what the carrier claims. Anthony contrasts ClaimLinx’s process with the traditional broker approach: Traditional broker Collects a census Sends it to carriers Waits Hopes rates come back “good enough” Delivers renewal or small tweaks Collects commission tied to premium size ClaimLinx Uses a HIPAA-compliant health application tool (FormFire) Employees confidentially disclose relevant health info Agency team reviews: High-cost medications Conditions Demographics Groups are strategically presented to carriers to get the lowest fixed premiums possible Anthony: “We do the work upfront so the premiums are as low as possible—before they ever come back.” FormFire allows ClaimLinx to: Avoid blind quoting Identify: Expensive drugs Known risk areas Design the group correctly before approaching carriers Result: Lower fixed premiums Better carrier positioning More predictable outcomes Once the analysis is complete: ClaimLinx secures: National PPO primary insurance High-deductible, low-premium plans Stop-loss protection for catastrophic claims Typical reduction in fixed premiums: ~50% on average Often 40–60%, depending on starting point Anthony: “We’re locking in inexpensive premiums and national networks—then building benefits on top.” With premium savings secured, ClaimLinx designs the Medical Expense Reimbursement Plan (MERP): Tom’s preferred design: $0 deductible feel Simple copays Clear, easy-to-understand structure Employees don’t have to guess: No deductible math No coinsurance confusion Just clear copays for services Anthony: “Gold-level benefits at a fraction of the cost.” Implementation is not slower than traditional renewals: Average onboarding: ~30 days Steps include: Paperwork and plan enrollment Carrier setup Stop-loss confirmation MERP configuration Plus: Admin education sessions (HR, finance) Employee education sessions with ClaimLinx service team Explanation of the two-card system Direct ClaimLinx support contact for employees Neil highlights the bigger picture: Healthcare is often a top 3 expense Reducing it: Improves margins Raises EBITDA Increases company valuation Employees benefit too: Lower payroll deductions Better coverage Indirect pay raises Anthony: “You’re saving 30–40%—that’s real money back into the business and employees’ pockets.” Anthony closes with the most important distinction: Traditional brokers are paid as a percentage of premium Higher premiums = higher commissions ClaimLinx is paid based on savings Lower costs = better outcomes for everyone

    7 min

  7. FEB 10

    2026 Reality Check: Why Group Health Plans Are Exploding—and How ClaimLinx Is Cutting Costs 30–40%

    This episode zooms in on what many employers are discovering the hard way in early 2026: the end of enhanced ACA subsidies didn’t just hit individuals—it detonated group health plans too. Tom Quigley sits down with ClaimLinx consultant Anthony McMahon to break down what they’re seeing across the country: 15–20% average group renewals, 40–60% increases becoming common, and extreme cases hitting 100%+. The fallout is immediate—shrinking margins for employers, higher payroll deductions for employees, and benefits that cost more while covering less. The good news? Anthony explains how ClaimLinx is stepping in after these increases land and bringing costs down 30–40% from the new, inflated baseline—while improving benefits and morale. Anthony confirms what many suspected: Enhanced subsidies disappeared Individual plans spiked Group plans followed right behind What they’re seeing: Average renewals: +15–20% Common cases: +40–60% Outliers: +100–120% Anthony: “It’s widespread. Everyone is getting hammered at once.” ClaimLinx’s core market—10 to 50 employee groups—is feeling the pain most: Cost-sharing models (50/50, 70/30, employer-only) magnify the impact Increases hit: Company margins Payroll deductions Employee morale Anthony: “It doesn’t just hurt the business—it trickles straight down to the employee.” Neil and Anthony outline the employee reality: Family premiums commonly $2,500/month Extreme cases over $5,300/month 50/50 split = $1,200–$2,600/month out of pocket Meanwhile: Raises average ~3% Health costs rising 9–10%+ Net result: paycheck goes backward Anthony: “Even with a raise, people are taking home less.” Many employers avoid changing contribution structures because: They fear backlash They want to avoid morale collapse So instead: They absorb costs (crushing margins), or They keep structures the same and let premiums quietly rise Either way: Retention and recruiting suffer Benefits become a liability, not an asset Anthony highlights why ClaimLinx is accelerating right now: Upgraded tech stack Enhanced claims portal visibility Better employee communication tools (chat, faster updates) Deeper focus on: Manufacturer drug coupon cards Disease- and hospital-based grants High-cost claim mitigation Anthony: “We’re taking client feedback and leveling everything up.” Anthony explains the core difference: Traditional brokers Paid a percentage of premium Higher premiums = higher commissions No incentive to reduce cost ClaimLinx Paid based on savings Lower costs = better outcomes for everyone Anthony: “Our incentives are aligned with the employer and the employee—not the carrier.” This alignment drives: Smarter plan design Ongoing cost management Aggressive pursuit of rebates and grants Tom points out: 2026 feels like a hidden tax increase Costs rose quietly Washington moved on Employers and employees were left holding the bag Anthony agrees: “That’s why people are calling now. They can’t absorb another year like this.” When Anthony first speaks with employers, he focuses on one thing: “Follow the incentives.” If someone makes more when you pay more: You will keep paying more If someone only wins when you save: You finally have a partner Group health increases exploded after subsidy changes Small employers are taking the hardest hit Employees are paying more while earning less ClaimLinx is reducing post-increase costs by 30–40% Incentive alignment is the real differentiator 2026 is forcing employers to rethink everything “This isn’t just hitting individuals—it’s crushing group plans.” — Anthony McMahon “Even with raises, people are taking home less money.” — Anthony McMahon “We get paid based on savings. That changes the entire game.” — Anthony McMahon “Benefits are supposed to retain employees—not drive them away.” — Tom Quigley 👉 ClaimLinx Cost Calculator & Consult:https://www.claimlinx.com/consult Plug in:

    8 min

  8. FEB 5

    2026 Update: New Tools, New Data, and Why Fear-Based Healthcare Is Finally Breaking

    This short but important episode serves as a state-of-the-union update for ClaimLinx in 2026. After weeks of deep-dive education on ACA enrollment, HSAs, FSAs, ICHRAs, MEC plans, COBRA, and subsidy changes, Tom Quigley steps back to share what’s new at ClaimLinx, what the real data is telling them, and why more employers are finally realizing they’ve been making decisions based on fear instead of facts. The message is clear:Healthcare didn’t suddenly get expensive in 2026 — people are just finally seeing the truth. Tom opens with updates on the platform and service side: Employers now have access to Employee Navigator Centralized payroll and benefits administration Cleaner onboarding and employee management Expanded claims portal Clients can track claims in real time Increased transparency Service team continues to: Secure drug manufacturer rebates Assist with grants Resolve claims issues quickly Tom: “It’s an exciting time. We’re saving people millions collectively.” Tom shares internal data that completely changes how healthcare risk should be viewed: Only 8 out of 100 people hit a $5,000 deductible That means 92% never do Only 20 out of 100 hit even a $500 deductible Meaning 80% never do Of the 8% who hit $5,000: Roughly half get grants, rebates, or assistance Bottom line: Only ~4 out of 100 people actually pay $5,000+ out of pocket This data applies to people under 65. Tom: “People are throwing away thousands based on fear — not reality.” Neil reacts strongly to the stats, pointing out: Most people are buying insurance as if they will hit the deductible The data shows the opposite Employers are overpaying to protect against rare events Tom explains: The system is built on fear-based decision-making Insurance marketing thrives on worst-case scenarios Reality doesn’t match the narrative Tom makes a sharp observation about Washington: Enhanced ACA subsidies are gone The government isn’t even talking about them anymore Political focus has shifted elsewhere Costs were quietly passed on to: Individuals Small businesses Group health plans Tom: “Bye-bye enhanced subsidies. Nobody’s even mentioning them now.” Neil frames the issue plainly: Loss of enhanced subsidies Group health premiums exploding Employers shifting costs to employees Small companies dropping coverage altogether Tom agrees: “For a lot of people, this is the biggest tax increase they’ll ever feel.” Healthcare costs now force business owners to choose between: Benefits Payroll Growth Or even taking a vacation Instead of: “What plan do we renew?” They’re asking: “Why are we doing this at all?” Tom notes: Employers are waking up Group renewals are outrageous Agents have no real solutions ClaimLinx conversations are increasing rapidly Tom reinforces a key insight: Under 65, most Americans: Rarely go to the doctor Don’t hit deductibles Don’t utilize expensive care The system prices everyone as if they’re constantly sick Tom: “By the time people hit 65, their health is wrecked — but before that, they barely use the system.” This episode ties together the entire January content arc: ACA walkthroughs HSA/FSA education MEC and ICHRA warnings COBRA strategies Tom: “Healthcare is based on fear right now. I don’t operate that way. I operate on facts.” ClaimLinx enters 2026 with stronger tools and deeper data The vast majority of people never hit high deductibles Fear, not utilization, drives healthcare spending Enhanced subsidies are gone — costs were quietly shifted Employers must rethink how benefits are designed Education beats panic every time “Eight out of a hundred people hit a $5,000 deductible. Ninety-two don’t.” — Tom Quigley “People are throwing away thousands because they’re scared.” — Tom Quigley “This is the biggest tax increase most people will ever feel — and no one’s talking about it.” — Neil Haley “Healthcare right now is built on fear. I’m built on facts.” — Tom Quigley 👉 Visit: https://www.ClaimLinx.com

    6 min
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Are you a business owner or HR leader tired of skyrocketing health insurance premiums and confusing benefits packages? Welcome to the Cutting-Edge Benefits Podcast, where we break down the smartest, most cost-effective ways to offer high-quality employee healthcare — without breaking the bank. Each episode, our experts at ClaimLinx reveal insider strategies to help you: ✅ Cut hidden costs in your current health plan ✅ Understand the difference between self-funded and fully insured models ✅ Build competitive benefits packages that attract and retain top talent ✅ Stay ahead of healthcare trends

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