Understanding Pre-Payment Health Plans

Posted on October 2, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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Classic: A pre-payment plan refers to health insurance plans that provide medical or hospital benefits in service rather than dollars, such as the plans offered by various Health Maintenance Organizations. A method providing in advance for the cost of predetermined benefits for a population group, through regular periodic payments in the form of premiums, dues, or contributions including those contributions that are made to a health and welfare fund by employers on behalf of their employees!

Modern:  A Prepaid Group Practice Plan specifies health services are rendered by participating physicians to an enrolled group of persons, with a fixed periodic payment made in advance by (or on behalf of) each person or family. If a health insurance carrier is involved, a contract to pay in advance for the full range of health services to which the insured is entitled under the terms of the health insurance contract.

Examples:

  • Pre-Paid Hospital Service Plan: The common name for a health maintenance organization (HMO), a plan that provides comprehensive health care to its members, who pay a flat annual fee for services.
  • Pre-Paid Premium: An insurance or other premium payment paid prior to the due date. In insurance, payment by the insured of future premiums, through paying the present (discounted) value of the future premiums or having interest paid on the deposit.
  • Pre-Paid Prescription Plan: A drug reimbursement plan that is paid in advance.

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MEDICAL EXPENSES: Out of Pocket and Out of Network Fees

Posted on September 9, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

By A.I. and Staff Reporters

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OUT OF POCKET [OOP] EXPENSES

Classic: The portion of medical expenses a patient is responsible for paying.

Modern: Refers to the maximum you will pay during your policy period, which is typically a year, before your plan starts to pay 100% of your allowed amount. The costs of your deductible, co-pay, and co-insurance are included here, but not your premium.

CO-PAYS: https://medicalexecutivepost.com/2025/05/17/cleveland-clinic-controversial-new-health-insurance-co-payment-policy/

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OUT OF NETWORK [OON] EXPENSES

Classic: “Out-of-network” health care providers do not have an agreement with your insurance company to provide care. While insurance companies may have some out-of-network benefits, medical care from an out-of-network provider will usually cost more out-of-pocket than an in-network provider. 

Modern: The amount that a health care insurance plan will contribute toward out-of-network services will vary by your insurance company and is often based on a “reasonable and customary” amount that the service should cost

Example: If you go to an out-of-network dentist and are billed $300 for the service, your insurance company may contribute $200 toward paying this cost because $200 is the amount it has decided is “reasonable and customary” for this service. When out-of-network, any remaining cost above this amount ($100 in this case) may have to be fully covered by the person receiving care. When out-of-network, the usual coinsurance rates that apply in-network may not apply out-of-network. Additionally, out-of-network service costs may not count toward an annual deductible.

CHARGE-MASTER: https://medicalexecutivepost.com/2024/11/20/charge-master-medical-bills-paradox/

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DAILY UPDATE: Both ACA Premiums and Stock Markets Rise

Posted on July 24, 2025 by Dr. David Edward Marcinko MBA MEd CMP™

MEDICAL EXECUTIVE-POST – TODAY’S NEWSLETTER BRIEFING

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

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What’s up

  • Krispy Kreme and GoPro got caught up in the new meme stock craze—the donut maker jumped 4.60%, while the wearable camera company leaped 12.41%.
  • Nintendo rose 2.36% after the company’s new Switch 2 console sold 1.6 million units in June, making it the fastest-selling console in US history.
  • GE Vernova gained 14.58% thanks to an impressive beat-and-raise earnings report for the power equipment manufacturer.
  • USANA Health Sciences soared 12.37% after the nutritional supplement maker crushed earnings estimates.
  • Cal-Maine Foods, the biggest egg producer in the country, added 13.80% after profiting from the high cost of eggs over the previous quarter.
  • Lamb Weston sizzled 16.31% higher as shareholders applauded the french fry giant’s strong earnings report and new cost-cutting program.

What’s down

  • Texas Instruments tumbled 13.34% after the semiconductor company revealed a disappointing third-quarter earnings forecast.
  • Enphase Energy plunged 14.16% thanks to weak earnings guidance, with the solar company’s management blaming tariffs for squeezing its margins.
  • SAP lost 5.03% after the enterprise software company missed Q2 revenue estimates.
  • Fiserv may have beaten analyst forecasts last quarter, but the fintech still sank 13.85% due to weaker-than-expected financial guidance.
  • Going down: Otis Worldwide dropped 12.38% after the elevator manufacturer lowered its fiscal guidance due to weak demand.

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Insurers selling plans on ACA exchanges are expected to hike premiums next year as subsidies on them are set to expire, with the average person expected to be paying 75% more, according to an analysis from the nonpartisan research group KFF.

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Visualize: How private equity tangled banks in a web of debt, from the Financial Times.

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PODCAST: Healthcare Costs are Crazy!

Posted on March 28, 2024 by Dr. David Edward Marcinko MBA MEd CMP™

By Eric Bricker MD

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On Health Insurance Premiums and Deductibles RISING!

Posted on March 19, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

 

2020 Employer Health Benefits Survey – Summary of Findings

Filed under: Health Economics, Health Insurance, iMBA, Inc. | Tagged: , , | 1 Comment »