Between the ACA subsidy cliff, rising 2026 employer health costs, newly indexed ESRP penalties, a GLP-1–driven pharmacy spend squeeze, and a growing price-transparency crackdown, the ground is shifting fast for brokers. Below are five developments to watch, what changed, how each one hits your book.

ACA Subsidy Cliff: Extension Push Heats Up

House GOP bill introduced last week would extend the enhanced ACA premium tax credits for one year, while Senate Democrats are pressing insurers to warn members about potential premium spikes if subsidies lapse. The politics are fluid, but both chambers are now openly engaging the issue [Politico] [Axios]

Why it matters for brokers:

• Build two scenarios for Jan 1 renewals: with vs without the enhanced credits.
• Expect client questions on 2026 premiums and subsidy eligibility.
• Prep outreach lists for members most exposed to subsidy changes.

2026 Employer Health Costs: Another Big Jump

Health costs are set to climb again in 2026. Employer forecasts point to 6–7% growth even after plan changes and close to ~9% without them. The push comes from specialty pharmacy (GLP-1s included), higher utilization, and provider wage inflation. For brokers, that means earlier budget talks and a tighter playbook on plan design, funding, and vendor levers. [Reuters]

Why it matters for brokers:

• Socialize plan-design trade-offs early (networks, steerage, site-of-care).
• Pair cost control with behavioral health access and COE programs to avoid false savings.
• Use trend data to justify multi-year funding strategies (level-funded, captives, stop-loss optimizations).

Employer Mandate (ESRP) Penalties: 2026 Amounts Updated

As shared in the newsletter last month, the OBBBA is causing some big industry shake ups. The IRS indexing lifts the Affordable Care Act §4980H employer shared-responsibility penalties for 2026 to $3,340 (a-penalty) and $5,010 (b-penalty) per affected employee. [Thomson Reuters Tax]

Why it matters for brokers:

• Re-run pay-or-play models for ALEs; small affordability misses get more expensive.
• Tighten measurement & offers (95% rule, dependents) and validate affordability safe harbors.
• Align with payroll/HRIS on Form 1095-C data quality to avoid Letter 226-J surprises.

GLP-1 Whiplash + Pharmacy Trend: Cost Pressures Are Real

GLP-1s are now the top pressure point in pharmacy trend. Employers report pharmacy at roughly 24% of total spend, with Rx costs projected to rise 11–12% into 2026. At the same time, coverage is tightening—TRICARE For Life ended coverage for obesity-only GLP-1s as of Aug 31. This is a signal that more plans may add guardrails like prior auth, step therapy, or outcomes programs. Expect continued volatility in access, cost, and member expectations.[Business Group on Health ]

Why it matters for brokers:

• Prepare GLP-1 coverage grids (obesity vs diabetes indications, PA rules)
• Negotiate transparent PBM contracts (guaranteed net cost, audit rights, utilization levers)
• Educate members on clinical eligibility + alternatives (i.e weight-management programs, Centers of Excellence) to manage demand responsibly.

Price Transparency Crackdown: Fines & New Mandates Proposed

A bipartisan Senate bill—the Patients Deserve Price Tags Act—would codify hospital price transparency rules, raise non-compliance penalties, expand requirements to other sites of care, and push payers to offer real-time cost tools for members. [Health Leaders Media]

Why it matters for brokers:

• More usable price data supports steerage strategies (HPCNs, COEs, ambulatory migration)
• Real-time OOP tools improve member decision-making and your client reporting.
• Watch for plan & PBM disclosure duties that may add to employer fiduciary work.

The post 5 End of Summer Broker Alerts: Subsidies, GLP-1s, Penalties & More appeared first on Sana Benefits.

With a career rooted in making healthcare more personal and human-centered, Dr. Hunter is a perfect match for Sana’s mission: simplifying benefits, humanizing care.

About Dr. Grace Hunter

Dr. Hunter holds dual degrees in medicine and business from Stanford University, a Master of Science in Public Health from the London School of Hygiene and Tropical Medicine, and she completed her Internal Medicine residency at UCSF’s Primary Care Track. Her career spans both hands-on clinical care and large-scale system innovation—most recently serving as Chief Medical Officer and founding medical director at Miga, a virtual clinic focused on heart and metabolic health.

Dr. Hunter has led population health initiatives in California, spearheaded holistic care models under California’s CalAIM initiative, and continues to care for uninsured and low-income patients as a primary care physician at the Teton Free Clinic in Wyoming.

Why Sana? A Conversation with Dr. Grace Hunter

We sat down with Dr. Hunter to hear why she joined Sana and what excites her about Sana Care— our member-centric, physician-led virtual care service.

Q: What made you want to join Sana?

Dr. Hunter: I joined Sana because I believe we can take much better care of people when the payor and the provider are aligned, and when we proactively guide members through the healthcare system. Too often, patients are left to navigate a fragmented, opaque system alone. But at Sana, we’re linking benefits, virtual primary care, and care navigation in one seamless experience. That means we’re not just saying we care; rather, we’re showing it, across the full spectrum of someone’s health journey. It’s a rare and exciting opportunity to help reshape healthcare around people, not processes.

Q: How is Sana Care different from other virtual care models?

Dr. Hunter: In most healthcare settings, patients are lucky if they get 15 minutes with a doctor once a year, and follow-up is minimal. As a physician, that always felt deeply inadequate. At Sana Care, we’ve reimagined primary care to be continuous, responsive, and team-based.

We offer both synchronous visits (live phone and video appointments) and asynchronous messaging, so patients can reach out on their own schedule and hear back from us, often within the hour. That kind of timely connection makes a huge difference in building trust and managing ongoing care.

Because we’re physician-led, we’ve custom built our tools and workflows around how clinicians actually want to deliver care. We’re not rushed. We can check back in, manage chronic conditions, review labs, and guide patients to trusted in-person partners, all while staying deeply connected to their journey.

We also have a fantastic multidisciplinary team, including care navigators who help patients access high-quality, in-network specialists, schedule appointments, and make sure nothing falls through the cracks. Our patients see us as their home base, and we see every question, message, and referral as a chance to show that we care, not just about outcomes, but about people.

Q: What does offering Sana Care mean for Sana members?

Dr. Hunter: It means our members have real support—not just when they’re sick, but anytime they need guidance, have a question, or want to feel heard. There’s no cost to use Sana Care and no limit to how often you can reach out. You get a dedicated care team that sees you as a person, not just a patient.

We’ve had members send thousands of messages over a few years—sometimes just to double-check something small, like, “Hey, I noticed this rash—should I be worried?” or “You mentioned white rice might spike my glucose. What about brown rice?” It’s truly like having a doctor in the family you can just text when you think of something without feeling like it has to be “big enough” to warrant a full appointment.

At the same time, we’ve also been by our patients’ sides through major life events like helping navigate cancer diagnostics, coordinating treatment plans, or working with specialists to diagnose something as serious as a brain tumor and get them into expert hands quickly for emergency neurosurgery. We’re here for all of it, both the little questions and the life-changing ones.

A Patient Story from Dr. Hunter

When Marcus, a 42-year-old father of two, woke up with a lingering cough and fatigue, he didn’t want to sit in a waiting room or spend half his day navigating urgent care. So he messaged Sana Care before his first meeting of the day.

Within 30 minutes, a Sana Care physician had responded. By lunchtime, Marcus felt reassured about his symptoms and picked up a prescription.

But the story didn’t end there.

After a few days, Marcus had more questions so he sent another message to his provider. He mentioned rising blood pressure and feeling unusually stressed. His provider suggested a full wellness check. Over the next few weeks, Marcus:

• Started blood pressure treatment with remote monitoring
• Began therapy with a trusted, in-network mental health provider
• Got help from his Sana Care medical assistant and care navigator to schedule recommended cancer screenings and coordinate lab work

Three months later, his blood pressure is under control, he’s sleeping better, and for the first time in years, he feels caught up on his health.

“I messaged about a cough—and ended up with a team that really sees the whole me.”

At Sana Care, we meet you where you are and then stay with you every step of the way. Whether it’s an acute concern, a chronic condition, or preventive care, our integrated team is here to make healthcare feel human again.

What This Means for Sana’s Future

Dr. Hunter’s leadership marks an exciting new chapter for Sana. As we continue to expand Sana Care into more states and enhance our virtual and in-person care offerings, her experience will be invaluable in helping us design care that puts people first.

“We’ve accepted broken healthcare for too long. Sana is rewriting that story—one relationship, one member, and one moment of care at a time.” — Dr. Grace Hunter

About Sana Care

Sana Care is a virtual primary care service available to adult members on a Sana health plan, at no extra cost to them. Sana Care includes:

• Unlimited virtual communication and visits with licensed providers
• Prescription management
• Chronic care support
• Guidance on specialist care and in-person visits
• Help from expert care navigators to coordinate next steps
  

Want to learn more? Learn more here.

Welcome, Dr. Hunter!

We’re proud to welcome Dr. Grace Hunter to the Sana team. Her leadership will help us continue to deliver healthcare that’s simpler, more supportive, and more human.

The post Meet Dr. Grace Hunter, Sana’s New Chief Medical Officer appeared first on Sana Benefits.

A key component, Title II: The American Healthcare Choices Act of 2025, embeds deregulation and tax changes directly affecting benefits markets—elevating broker roles from compliance facilitators to strategic advisors in a competitive landscape. [Congress]

This blog breaks down what’s changing, compares the “before” vs. “after,” and highlights what it means for your clients and commissions.

The ACA and CAA era was about compliance. This next chapter? It’s all about open competition. And as a broker, your role is about to evolve—fast.

Medicaid Changes

The bill’s Medicaid overhaul introduces stricter eligibility rules, including work and income verification requirements. While this shrinks public coverage rolls, it also creates a surge of newly uninsured individuals—many of whom will turn to brokers for help finding new plans.

Before:
Brokers rarely engaged with Medicaid enrollees, as most were covered automatically or through government outreach.

After:
New rules require verification of income and work status, pushing ~7.8 million people off Medicaid by 2034 [KFF]. Many will seek individual ACA coverage, employer-sponsored plans, or short-term options—markets where brokers are essential.

This is a massive opportunity for brokers:

• Displaced enrollees will need help evaluating ACA, ICHRA, short-term, or employer-sponsored options.
  
• State-to-state variations mean local expertise will matter more than ever.
  
• Brokers who proactively build Medicaid offboarding funnels and outreach campaigns can grow their book significantly—especially in rural and low-income markets.

Why Brokers should care:

Medicaid may not have been your market before. But starting now, it absolutely is.

ACA Marketplace Shifts

The ACA isn’t going away, but it’s changing fast. From disappearing subsidies to shortened enrollment windows and heightened fraud enforcement, brokers who rely on marketplace sales must prepare for leaner margins, faster deadlines, and higher compliance standards.

Before:
ACA plans offered enhanced subsidies, broad access, and a long open enrollment season through January 15.

After:

• Subsidies disappear end of 2025, with premiums expected to rise 15–20% [Vox]
  
• Open enrollment ends December 15, cutting the window by 30 days [Enroll Insurance]
  
• Brokers face audits: CMS already suspended 850+ agents for improper enrollments [Washington Post]
  

Why brokers should care:
Expect a surge in client questions, tighter eligibility rules, and an uptick in compliance headaches.

Employer-Sponsored Plans & Telehealth

Employers offering high-deductible plans just got a win: telehealth pre-deductible coverage is now permanently allowed. This change makes HDHPs more flexible—and gives brokers new value to spotlight when designing or pitching group plans.

Before:
The IRS telehealth “safe harbor” for HDHPs had expired in 2024, limiting coverage flexibility.

After:
The bill makes the safe harbor permanent and retroactive to January 1, 2025 [Senior Market Sales].

Why brokers should care:

This opens the door for employers to offer first-dollar telehealth without jeopardizing HSA eligibility—an attractive benefit for cost-conscious groups.

Rural Hospital & Provider Landscape

Rural healthcare access has long been fragile. With new funding allocated to rural hospitals—but deep Medicaid cuts still on the table—the stability of networks in less populated areas remains uncertain. Brokers in these regions should stay alert to shifting coverage landscapes.

Before:
Rural providers were under threat from ongoing Medicaid underfunding and provider consolidation.

After:
A $50 billion Rural Hospital Fund aims to stabilize care access [Health Action Council]. But Medicaid cuts may still undermine rural coverage in the long term.

Why brokers should care:
Brokers in rural markets must stay in tune with network shifts, hospital partnerships, and potential plan exits.

Administrative & Compliance Burden

This bill doesn’t just reshape coverage—it increases scrutiny. With new verification rules and aggressive oversight, brokers now face a heightened risk of audits and suspensions. Operational discipline and documentation have never been more important.

Before:
Brokers dealt with income checks mainly on the ACA side. Medicaid enrollment was largely passive or state-managed.

After:
Both Medicaid and ACA now carry stricter verification requirements and heavy broker oversight. CMS is actively auditing agents and suspending licenses for noncompliance [Washington Post].

Why brokers should care:
Broker operations must modernize. Compliance systems, documentation protocols, and staff training are no longer optional.

Key Broker Takeaways:

These policy shifts aren’t abstract—they directly affect a broker’s book of business. Whether you sell individual ACA plans, worksite benefits, or group coverage, the One Big Beautiful Bill brings both risk and opportunity. This section breaks down the big takeaways—and what smart brokers should do next.

• ~7.8M clients leaving Medicaid will need new plans
  
• ACA premiums rise sharply post-2025
  
• Enrollment window tightens (Dec 15 deadline)
  
• CMS audits rising — documentation matters
  
• Telehealth safe harbor boosts HDHP flexibility
  
• Rural funding helps, but Medicaid gaps may widen

The post Broker Pivot: The “One Big Beautiful Bill” Era is here. appeared first on Sana Benefits.

Many telehealth services come with frustrating limitations: no continuity of care, unclear next steps, and one-off visits with random providers who don’t know your health history. That’s where Sana Care changes the game.

What is Telehealth, and Why Do People Use It?

At its core, telehealth is any form of healthcare delivered remotely—whether through video calls, messaging, or remote monitoring. It skyrocketed during the pandemic, and today, it’s a go-to option for routine check-ups, behavioral health support, and even prescriptions.

For patients, the appeal is clear:

Convenience – No more long drives, waiting rooms, or scheduling hassles.
Affordability – It often costs less than in-person visits.
Better Access – It’s a lifeline for those in rural areas or with mobility challenges.
Mental Health Support – Virtual therapy is discreet and easy to access, removing common barriers to care.

Employers love telehealth, too, because it’s a cost-effective way to offer employees better healthcare access. More engaged employees = a healthier, happier workforce.

The Downside of Traditional Telehealth

Despite its perks, traditional telehealth has some major flaws:

Lack of continuity – Patients often see different doctors every time, making follow-ups tricky.
Limited guidance – Many telehealth services stop at a virtual visit without helping patients navigate their next steps.
Some conditions require in-person care – Many patients end up needing an office visit anyway, which can feel like a waste of time.

In fact, while 89% of patients would recommend their provider after a telemedicine visit, only 76% would recommend a video visit alone. Why? Because most virtual care feels disconnected and transactional.

How Sana Care is Doing Things Differently

Sana Care isn’t just another telehealth service—it’s a fully integrated virtual primary care and care navigation experience included with all Sana health plans at no extra cost to members. Here’s what makes it different:

Dedicated Care Teams – Instead of bouncing between random providers, members work with a care team that actually knows their health history.

Expert Care Navigation – If in-person care is needed, Sana Care helps patients find in-network specialists and guides them through the next steps.

$0 Cost to Members – No surprise fees. No copays. Just high-quality virtual care.

Convenience – Members can reach out anytime, and a care team member will respond during business hours. Having a direct line to medical support provides peace of mind.

Sana Care: A Better Virtual Care Solution

For brokers, offering Sana means providing a premium virtual care experience that businesses and their employees love. It’s healthcare that actually works—seamless, connected, and built to guide patients to the best possible care.

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We have many resources to help make Sana available to your clients seamlessly. If you would like to learn more on behalf of a specific client partner, start by requesting a group quote.

The post Why traditional telehealth falls short–and how Sana Care does it better appeared first on Sana Benefits.

That’s where we come in. With a 93% customer satisfaction rating, our health plans are designed specifically for small businesses—offering cost savings, flexibility, and standout benefits like $0 virtual care and care navigation through Sana Care.

To help you communicate the value of better health insurance to your clients, here’s a quick breakdown of why modern, more affordable health plans are changing the game for small businesses.

1. Real Cost Savings for Small Businesses

Tax Advantages

Many small businesses don’t realize that self-funded health plans like Sana’s can offer significant tax advantages over traditional fully insured plans. Our level-funded plans are taxed less, helping businesses save.

Lower Pharmacy Costs with SmithRx

Sana partners with SmithRx, a transparent Pharmacy Benefits Manager (PBM) that ensures members have access to lower-cost medications. This means predictable prescription pricing and substantial savings for employers.

Fair and Flexible Reimbursement

Unlike traditional insurance carriers, Sana’s reimbursement model blends direct contracts, networks, and single-case agreements to offer members more flexibility while keeping costs in check.

2. Sana Care: A Game-Changer in Virtual Healthcare

One of the biggest reasons small businesses love Sana is Sana Care—our high-quality, no-cost virtual healthcare solution that provides comprehensive care without barriers.

$0 Cost for Members

Unlike some traditional virtual care options, Sana Care is 100% included in Sana plans, members making high-quality care more accessible and affordable for employees.

Beyond Just Virtual Care

Sana Care isn’t just for minor issues. Our dedicated care team can diagnose, treat, and manage ongoing conditions—providing the same level of care as an in-person primary care doctor.

Guidance to Best In-Person Care

If a member needs an in-person visit, our care navigators will guide them to the best available provider—ensuring they receive the right care at the right time.

With Sana Care, businesses get a built-in virtual care solution that reduces costs, increases healthcare access, and improves employee well-being—all at no extra charge.

3. More Freedom and Flexibility

Flexible Network

Unlike restrictive networks, Sana can work with any provider who will work with us—giving employees the freedom to see the doctors they trust.

Customizable Plans for Employees

Employees can choose a plan that fits their needs with different deductible and out-of-pocket maximum options, providing a sense of control and satisfaction in their healthcare choices.

4. Level-funding = Cost Savings and Predictability

For those unfamiliar with level-funded health insurance plans, here’s a helpful definition.

“A level-funded health plan is a type of self-funded health plan where the employer pays a fixed monthly fee to a third-party health services company to cover all of the administrative costs and what they anticipate to be their monthly employee claim costs.”

With Sana’s level-funded plans, small businesses get:

This balance of transparency, cost control, and savings makes Sana an easy sell to small businesses.

4. Plans Designed for Small Businesses

Small businesses have different healthcare needs. That’s why Sana offers multiple plan options—ensuring there’s a perfect fit for every employer.

Unlike traditional carriers, we keep things simple and affordable so businesses can focus on what they do best.

5. Why This Matter for Brokers

As a broker, you want to help small businesses find the best health plans. With Sana, you’re offering:

Cost savings through lower taxes, fair reimbursements, and pharmacy savings.
More choices for employers and employees.
Sana Care and virtual healthcare solutions to improve access to care.
Level-funded plans that provide stability and refunds when claims are low.
Simplified plan options designed specifically for small businesses.

At the end of the day, Sana makes healthcare easy, affordable, and accessible. And that’s exactly what small businesses need.

Final Thoughts

If you’re looking for a health insurance partner that actually works for small businesses, Sana is the answer. By introducing your clients to Sana’s affordable plans, premium virtual care through Sana Care, and transparent pricing, you’re offering real value that keeps employees happy and businesses thriving.

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We have many resources to help making Sana available to your clients seamless. If you would like to learn more on behalf of a specific client partner, start by requesting a group quote.

The post A smarter approach to small business health insurance appeared first on Sana Benefits.

But here’s the good news: Sana does things differently. We’ve put together a list of key facts about our plans to help you understand why Sana is the perfect choice for small businesses. Let’s dive in!

1. Employees can be located anywhere in the U.S.

With Sana, there are no state restrictions for employees using our health plans. For businesses with remote team members, this is a huge win.

The only location rule? Your client’s business needs to be based (or “domiciled”) in one of these states: Alabama, Arizona, Illinois, Indiana, Kentucky, Michigan, Ohio, Oklahoma, Texas, Virginia, or Wisconsin. And the list is growing!

Right now, we’re proud to serve 2,000 businesses, 20,000 employees, and 30,000 members. Your clients can join them!

2. Employee requirements are minimal

All small businesses need to be eligible for a Sana plan are two employees and five total individuals. Of those five, not all need to be employees. Some can be spouses and children.

Including families is seen as a major benefit to many team members, so make sure to champion that point to clients.

3. Under 100

While we could certainly handle larger businesses, Sana works best for small businesses with between 10 and 99 employees. It’s set up to meet their needs and has become a sweet spot we genuinely enjoy servicing.

“We’ve been with Sana Benefits for going on 3 years now. They are the only reason I was able to offer benefits to my team with ease. The platform, the team, the explanation of services and benefits makes giving healthcare as a business owner a breeze.” – Erica Davis

4. 24-48 hours

Brokers can get a group quote quickly with Sana. The process is simple, just submit the following required elements:

• Census – Employees & Dependents
• First & Last Name
• Date of Birth
• Gender
• Zip code
• Relationship (EE, SP, CH)
• Current and Renewal Rates

Then volunteer any plan documents, SPDs, SBCs, invoices, and experience you can provide (these aren’t required, but are helpful).

After that you can typically expect a turnaround time of 48 hours, but sometimes we even get quotes back that same day.

Major benefit: With Sana, no medical questionnaires are required for quoting! We don’t believe in extra steps or invasive procedures like that.

5. More than a network

Sana Care

Adult Sana members get access to Sana Care for free. What’s Sana Care? It’s our virtual primary care and care navigation service that allows members to simply message the Care Team to get personalized and convenient care that’s 100% included in their plan. Unlike other services, such as telehealth, with Sana Care, they get a dedicated care team, that is with them for every step of their care journey.

Sana Care can virtually diagnose and treat patients, facilitate personalized care coordination and/or referrals to trusted in-network specialists, and can even get prescriptions written or refilled. 

See if Sana Care is available in your state.

Service

Our clients love the level of service they receive from Sana. It’s important to us that our customer support options mitigate any issues because we want them to be happy (and they are!)

“In an age of over priced insurance, Sana was a huge surprise! The pricing is amazing and the coverage is even better! Highly recommend Sana for any small business!” – Philip Nelson

6. Preferred doctors

Sana will often set up single case agreements or direct billing arrangements with many providers that aren’t currently in our network to better serve the needs of patients. At the same time, we’re constantly expanding access to more doctors and facilities for members. Together, these two strategies mean patients can see their preferred doctor, as opposed to whatever doctor will see them.

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Our team is always here to help support you in your journey to champion Sana. If you need a group quote, just ask!

The post 6 health insurance facts that help brokers sell Sana appeared first on Sana Benefits.