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We are a few months into the year, which makes this a good time to pause and take a closer look at how you are using your health plan.
Whether you selected new coverage this year or have been on the same plan for a while, this is often when expectations meet reality. You may have filled a prescription, visited a provider, received a bill, or you may not have used your plan at all.
Wherever you are, now is a good time to check in.
Are you actively using your benefits, or are you only thinking about your plan when something comes up? Health insurance is often treated as something you deal with when you need care, but it is meant to be used throughout the year.
Some questions to ask yourself:
- Have you scheduled your annual wellness visit?
- Are you using in-network providers?
- Do you know what your copay is and whether you have coinsurance? Do you understand the difference between the two?
- Do you know how much of your deductible you have met?
- Do you understand what services are considered preventive care?
- Do you know where to go depending on the situation, such as telehealth, urgent care, or the emergency room?
If any of these are unclear, you are not alone. Many people do not fully understand their coverage until they need to use it.
One area that is often overlooked is preventive care. Routine exams, screenings, and labs are often covered at little to no cost when done in-network. Taking care of these early can help you stay ahead of potential health issues.
If you have already used your plan this year, your claims can give you a clearer picture of how your costs work. This includes how your deductible applies and what your copays look like.
Small decisions can affect your costs. Where you go for care, whether a provider is in-network, and whether you ask questions ahead of time can all impact what you pay. Before your visit, consider asking about expected costs, whether prior authorization is required, and whether the service will be considered preventive or diagnostic. Writing your questions down in advance can help you feel more prepared and confident in your decisions.
If you have not spent much time thinking about your health plan yet, that is okay. There is still plenty of time to make the most of it.
Start by taking a look at your plan details, such as your Summary of Benefits or plan documents, so you understand what is covered and how your costs are structured. It can also be helpful to check your progress by seeing how much of your deductible you have met and where you stand in relation to your out-of-pocket maximum.
Scheduling preventive care is one of the easiest ways to use your benefits and stay on top of your health. If you expect to need services later this year, take time to plan ahead by confirming providers and facilities in advance, making sure they are in-network, and understanding what your costs may be.
Your health plan is something you can use to support your health and make more informed decisions about care. Taking a few minutes now to understand how your plan is working can help you avoid surprises and feel more confident in your choices throughout the year.
Helping Lower Your Pharmacy Costs — Automatically
CalCPA Health PPO and HSA medical plan enrollees now benefit from built-in GoodRx prescription pricing (when available) as part of their pharmacy coverage through Express Scripts Rx.
There’s nothing you need to do. No coupons. No discount cards. No separate enrollment.
When you present your CalCPA Health plan ID at the pharmacy, your prescription is automatically processed through your benefit. If the GoodRx price is lower than your plan’s already negotiated cost, you will automatically receive the lower GoodRx price.
What This Means for You
Lowest Available Price on Eligible Generic Medications
Eligible generic medications (excluding specialty generics) are automatically compared to GoodRx pricing to ensure you receive the lowest available price.
Effortless Member Experience
No need to search for GoodRx coupons or present a discount card. The comparison happens automatically through your CalCPA Health benefit.
Supports Medication Adherence
You receive discounted medications without delay, helping you stay on track with your prescribed treatments.
Claims Count Toward Your Plan
Unlike stand-alone discount programs, prescriptions processed through this partnership apply toward your deductible and out-of-pocket maximum.
This program ensures you receive competitive pricing while maintaining the protections and accumulators of your CalCPA Health pharmacy benefit.
Reminder: Mail Order Savings
For many maintenance medications, the Express Scripts mail-order pharmacy offers lower copays and overall drug costs. Be sure to compare your options for additional savings.
Questions? If you have questions about your pharmacy coverage:
- Log in to your Express Scripts member portal
- Log in to Anthem’s member portal if you have CarelonRx for your pharmacy benefits
- Or contact Banyan Administrators, Managers of the CalCPA Health program, for assistance.
CalCPA Health remains committed to helping members access care affordably and confidently.
The holidays are supposed to be about celebration and connection, and some rest (hopefully). But the month of December often feels more like a marathon to get places and check off your never-ending “to-do” list. Between work deadlines, family obligations, travel, and a social calendar that somehow fills itself, the whole season can start to feel overwhelming instead of joyful.
If you’re trying to balance your job, personal life, and a budget that’s getting stretched thin, you’re not alone. A few simple habits can help you get through the season without burning out.
Aim for some balance when it comes to eating and your health. One of the biggest traps this time of year is thinking you need to be super disciplined about health. Small tweaks matter more than you’d think. Grab a protein-rich snack before heading to the party because it will help keep your energy steady and help you avoid overindulging at the party! Drink more water than you think you need, especially if you’re traveling or celebrating. And after a big meal, even a quick 10-minute walk can help your digestion and lift your mood.
Don’t sacrifice sleep. Late nights and early mornings are basically the norm in December. Sleep is one of your best defenses against stress, brain fog, and getting sick. Try to keep your sleep schedule consistent and give yourself a wind-down routine – do some stretching, journal for a few minutes, or put your phone away earlier than usual.
Build in breathing room. Between the gatherings and the pressure to make everything perfect, stress can pile up fast. Taking five minutes to step outside, taking some deep breaths, or sitting quietly can reset your nervous system and support your overall well-being. Mindfulness doesn’t have to be complicated. Sometimes it’s just noticing your breath or feeling your feet on the ground.
Move your body. Exercise in December doesn’t need to be a formal workout. Take a walk around the neighborhood to check out the holiday lights. Stretch between work calls. Choose to take the stairs. These little moments of movement do help—they keep your energy up, lower stress, and improve your sleep and mood.
It’s fine to scale back. There tends to be the expectation that you’re supposed to do it all – attend every event, uphold every tradition, make everyone happy. Remember – it’s okay to say no, to skip things, to protect some time for yourself. The parts of the season that matter most are the ones you have the energy to enjoy.
The holiday season doesn’t have to overwhelm you. With a bit of intention and some realistic expectations, you can end the year feeling good about being grounded, present, and ready for whatever comes next.
What does it mean to live well—after illness, through aging, and across life transitions? In our final episode, we blend the concepts of recovery, longevity, and clean living into one powerful discussion. Learn how to embrace aging with positivity, explore alternative paths to healing, and declutter your environment—inside and out. Whether you’re reclaiming your health or planning for the future, this episode is your roadmap to resilience.
Topics Covered:
- Hope & mindset after health setbacks
- Aging myths vs. facts
- Clean living: food, environment, supplements
- Financial & social wellness in later life
- Creating your own wellness plan
Health insurance premiums are climbing fast, affecting both employers and employees. Rising medical costs aren’t new, but the pace of increase today reflects several powerful forces coming together at once, from high-cost specialty drugs to “nuclear” claims and labor inflation. Understanding why premiums are increasing is the first step to managing them.
One of the biggest drivers is the growing number of extremely high-cost claims – or “nuclear” claims. A small number of cases are reshaping the health insurance landscape. Gene therapies often run $2 million or more per treatment, and other “miracle treatment” technologies come with high price tags. These advances improve outcomes, but their costs flow into premiums.
Prescription drug costs are another major factor. Drug spending continues to grow faster than overall medical inflation. More people are taking medications for more conditions, and specialty drugs, especially cancer therapies, carry steep price tags. GLP-1 drugs, used for diabetes and weight management, are adding additional pressure. They are widely used and carry a high cost, which creates both frequency and cost challenges.
At the same time, people are using more healthcare overall. Rates of obesity, diabetes, cardiovascular disease, and inflammatory conditions are contributing to more doctor visits, more tests, more hospitalizations, and more prescriptions. When utilization climbs, premiums follow.
Healthcare is heavily impacted by labor costs. Hospitals and medical groups face higher wages for nurses, physicians, and technicians. Because provider contracts are typically renegotiated every few years, recent inflation is now reflected in new pricing agreements.
Regulatory changes also play a role. New state and federal mandates, even well-intentioned ones, add cost. California’s requirements for IVF coverage and caps on insulin spending are recent examples. Each mandate contributes to what many call the “regulatory stack,” appearing in the premium cost structure.
Prescription drugs now account for roughly 20% of total medical spending. A small percentage of people drive more than half of all prescription drug costs, largely due to specialty treatments that can run $200,000–$400,000 (or more) annually. GLP-1 utilization continues to expand. Generics and biosimilars provide some relief, but for every drug that comes off patent, a more expensive one often takes its place.
Insurance companies are often blamed for rising costs, but many standard plan elements were originally created by them to control unnecessary spending and protect members from unknown prices and unneeded medical services. Examples include:
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- Prior authorizations and utilization reviews
- Second surgical opinions
- Provider networks (PPOs) with negotiated allowable charges
- Case-rate agreements and billing compliance standards
Out-of-network providers typically avoid these controls, which is why their services cost more.
On the pharmacy side, Pharmacy Benefit Managers (PBMs) use formulary management, generic substitution, step therapy, GLP-1 oversight, and rebates to help contain costs. While not perfect, these strategies are designed to balance access and affordability.
For employers and individuals, the challenge is not just understanding why costs are rising, but how to respond. Many receive just 3–6 months’ notice of annual premium increases. We know healthcare inflation is unpredictable, so having informed estimates can help prevent scrambling at renewal time.
Cost sensitivity continues to drive decisions. Whether selecting a plan as an employer or choosing coverage as an individual, there is often a focus on keeping premiums low. The key is to balance that with the level of financial risk you are willing to take on. Looking at total cost, not just premiums, can help you make an informed decision.
Guidance matters. Employers benefit from internal expertise or strong broker support, and individuals benefit from taking the time to understand their coverage. Health insurance is one of the largest expenses most people will face, and being informed can make a meaningful difference.
Many employers and employees “overbuy” or misjudge the trade-off between premiums and out-of-pocket exposure. Choosing a lower premium option with higher out-of-pocket exposure, or vice versa, should be done with a clear understanding of how the plan will be used. HSA-compatible plans can be effective, especially when used by participants who understand how to use them and take advantage of preventive care and cost comparison tools.
Guidance helps. Employers benefit from in-house expertise or strong broker support or other external resources. Individuals also benefit when they invest time in understanding their coverage and plan options. Health insurance is one of the largest lifetime expenses for most households, and being informed can make a meaningful difference.
When premiums spike, employers often explore alternative solutions. These options can offer savings in certain situations, but they also come with risk and should be carefully reviewed. ICHRAs (Individual Coverage HRAs) are also gaining attention, but in California they have not consistently proven to be cost-effective at scale.
The healthcare system is complicated, and most people have little training in how to navigate it. Being an informed consumer means understanding how your plan works, knowing where to find value, and making informed decisions.
For employers, health insurance is often the second-largest expense after payroll. For individuals, it is one of the top costs in the household budget. Taking the time to build knowledge or access reliable guidance can have a real impact.
Premium increases reflect a mix of breakthrough treatments, rising chronic disease, regulatory mandates, pharmaceutical inflation, and higher provider costs. While these trends are not likely to slow immediately, employers and individuals have options. Through thoughtful planning, proactive decision-making, and access to knowledgeable guidance, it is possible to manage these costs more effectively.
This article reflects data and trends from CMS, KFF, PwC Health Research Institute, and national pharmacy and actuarial reports.
Misinformation is everywhere—and navigating the healthcare system can feel like a second job. This episode is about empowering listeners to cut through the noise. Learn how to identify trustworthy health sources, prepare for medical appointments, and advocate effectively for your needs. We’ll also share tips on having tough conversations with doctors and pharmacists.
Topics Covered:
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- How to spot credible health news
- Red flags in medical misinformation
- Preparing for appointments (health journaling, family history)
- Patient-provider communication strategies
- Questions every patient should ask
In this energizing episode, we dive into the science behind cardiovascular health and the essential role of movement in protecting your heart. We’ll break down how different forms of cardio benefit your circulatory system, boost your mood, and increase longevity. Whether you’re already active or just starting out, you’ll gain actionable tips to build a heart-healthy routine that works for you.
Topics Covered:
- How cardio strengthens your heart
- Debunking fitness myths
- Everyday ways to get your heart rate up
- Motivation for consistency
This episode kicks off your journey toward healthy living. We’ll explore how to build sustainable habits, set realistic goals, and shift limiting belief systems. Learn how to use time management, habit stacking, and the power of small wins to drive lasting change. This motivational episode includes reflection prompts to help listeners take control of their health-starting with that first step.
Topics Covered:
- The psychology of change and behavior
- Habit stacking & micro-goals
- Overcoming common barriers
- The role of belief systems
- Reflective journaling prompts for listener
It’s on every headline in the newspaper and on the news – healthcare costs in the U.S. continue to rise sharply. It is affecting the entire country, and there seems to be no end in sight to the continued rise in costs. In 2023, national healthcare spending surged 7.5% to $4.9 trillion, accounting for 17.6% of U.S. GDP[1] [2]. That’s nearly one-fifth of the economy, and it’s projected to rise even higher in the years ahead.[3]
Prescription drug costs alone rose 11.4% in 2023, resulting in drugs now making up 9.2% of total health spending [4]. According to PWC, “Drug spending in the US grew by $50 billion (11.4%) from $437 billion to $487 billion in 2024 at net manufacturer prices, up from $20 billion of growth (4.9%) in 2023. The trend is expected to extend into the coming years, driven by growth in oncology, immunology, cardiovascular, obesity, and diabetes drugs.”
New for 2026: Copay-Only Alternative Health Plans (AHPs)
To help employers manage rising costs and expand plan options, CalCPA Health is introducing a suite of Alternative Health Plans (AHPs) through Anthem Blue Cross, powered by Coupe Health™. These tiered, copay-only PPO designs emphasize clarity, quality, and cost control, with no gatekeeper required. Members can view provider tiers and their out-of-pocket costs before scheduling care, which enables smarter, value-driven decisions that can lead to savings for both employers and employees.
While AHPs are not new, CalCPA Health’s offerings stand out by including Small Group and HSA-compatible options—a rare find in the market. Learn more about these plan offerings and search for in-network healthcare providers.
Benefits for Employees
- No deductibles* or coinsurance on most plans.
- Access to California’s largest provider network – Anthem Blue Cross.
- Cost transparency tools to view provider rankings and exact costs upfront.
- Tiered provider rankings highlight quality and value.
- Comprehensive coverage of ACA essential health benefits: including preventive care, hospital/urgent/emergency services, specialty care, pharmacy, maternity, behavioral health, and more.
Benefits for Employers
- Premium savings potential, thanks to more efficient plan design and guiding members to high-performing providers.
- Smarter employee healthcare choices—when costs are visible before care, usage aligns with value.
- Plans that align with expectations—transparency, convenience, and choice.
- Improved employee retention by offering flexible, cost-effective options.
With healthcare spending and pharmacy costs continuing to rise, firms seek innovative, value-driven approaches rather than traditional plans with higher price tags. CalCPA Health’s AHPs offer CalCPA member firms a compelling alternative: Anthem’s provider network, combined with Coupe Health’s™ cost-transparency capabilities. These plans deliver what today’s market is looking for: affordability, clarity, quality, and flexibility.
*Two AHPs are HSA-compatible HDHPs, which do include a deductible.
[1] https://www.pgpf.org/article/healthcare-spending-will-be-one-fifth-of-the-economy-within-a-decade
[3] https://www.pgpf.org/article/healthcare-spending-will-be-one-fifth-of-the-economy-within-a-decade
[4] https://www.chcf.org/resource/national-health-spending-almanac
Open Enrollment is the annual opportunity to review your health insurance options and make changes for the upcoming year. For most of us —whether employers, solo practitioners, or employees —open enrollment typically occurs in the fourth quarter, and new benefits take effect on January 1st of the new year.
This period is especially important because outside of open enrollment, you can only make changes to your coverage if you experience a qualifying life event (such as marriage, divorce, birth of a child, or loss of other coverage). That means this is your chance to:
- Reevaluate whether your current plan still meets your needs.
- Compare costs and coverage options, including PPOs, HSAs, EPOs, HMOs, or Alternative Health Plans (AHPs).
- Add or adjust coverage for dependents.
- Research Health Savings Accounts (HSAs) and the tax-advantaged options these plans provide.
- As an employer, evaluate your current plan offerings and consider what adjustments may be needed, and if new options are available that would improve employee retention and satisfaction.
Why It Matters This Year
Healthcare costs and coverage trends continue to shift, with rising pharmacy and claim expenses, as well as evolving provider networks. More employers are introducing an array of choices, including innovative alternatives that emphasize transparency and cost savings. Employees may be seeking ways to get the most value from their benefits and manage their premium costs – and know the cost before a visit. (Learn about the new Alternative Health Plans – AHPs – that CalCPA Health is offering for 2026!)
Reviewing your options before open enrollment deadlines is key, so you have enough time to research and understand what’s available to you, your family, and your firm. Becoming your best advocate on health insurance can lead to lower out-of-pocket costs, access to preferred providers, and greater financial protection for the year ahead.
Tips for Open Enrollment Readiness
- Start early. Don’t wait until the final days of enrollment—give yourself time to compare and select the best plan.
- Review your healthcare usage. Think about your doctor visits, prescriptions, and family needs over the past year – did you use these benefits?
- Look at the long term. HSAs, for example, may offer both immediate premium savings and future tax advantages, allowing you to save now for future medical expenses.
- Ask questions. Your HR team, broker, or plan administrator can help explain plan differences and benefits.
NOTE: CalCPA members can reach out to CalCPA Health with their health insurance benefit questions – whether you are enrolled with us or not – by email info@CalCPAHealth.com or call 866-730-3593.
Open enrollment is an opportunity to align your health coverage with your personal, family, and financial needs. By researching and asking questions, you’ll enter the new year with confidence, knowing you made the best choice available to you.