Why are traditional fully-insured health plans considered broken?

Traditional fully-insured plans hide your actual claims data, charge administrative fees of 20-30% on top of claims, and give you no way to control costs. You pay the same whether your employees are healthy or not, and carriers keep any surplus.

What is an alternative to traditional fully-insured health plans?

Level-funded and self-funded health plans give small businesses access to their own claims data, lower administrative costs, and the ability to share in surplus refunds if claims come in below projections.

Can small businesses in Florida switch away from fully-insured plans?

Yes. Florida small businesses with as few as 5 employees can qualify for level-funded plans. Vantage Pointe Consulting helps Southwest Florida employers evaluate and transition to alternative funding strategies.

How much can a business save by leaving a fully-insured plan?

Southwest Florida businesses that switch from fully-insured to level-funded or self-funded plans typically save 20-40% on total benefits costs, depending on group size and claims history.

What should I ask my broker about my current health plan?

Ask your broker to show you your actual claims data, the administrative fee percentage, and whether a level-funded or self-funded alternative has been quoted. If they can't answer these questions, it may be time to get a second opinion.

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Healthcare Strategy

Why Traditional Fully Insured Plans Are Broken

By Roger Aboytes — Licensed Benefits Consultant

Published February 9, 2026 · Last updated July 29, 2026

Healthcare costs in 2025-2027 are defined by persistent volatility and diminishing predictability. Unit price inflation, pharmacy volatility, and catastrophic claims create sudden cost spikes. Traditional mitigation strategies like higher deductibles and narrower networks produce diminishing returns.

Roger Aboytes

Licensed Benefits Consultant · Vantage Pointe Consulting · Southwest Florida

Roger Aboytes is a licensed independent benefits consultant serving individuals, families, and businesses across Southwest Florida. He helps clients compare health coverage options and design employee benefits strategies that fit their needs. Roger works directly with clients in Cape Coral, Fort Myers, Naples, Bonita Springs, and surrounding communities.

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