The Cost-Plus Solution
Wholesale vs. Retail Pricing — The Power of Transparency
Every rate benchmarked against Medicare (100%).
The Problem
- ◆Traditional PPOs pay ~254% of Medicare nationally — and over 300% in California, Florida, and New York (RAND Hospital Price Transparency Study).
- ◆Self-funding alone doesn't fix it. Rented PPO networks still pay ~250% of Medicare. Changing who holds the risk doesn't change the price of care.
The Cost-Plus Difference
Cost-Plus Pricing changes the math. Instead of paying a discount off an inflated "retail" charge, your plan pays the greater of Medicare + 25% or Cost + 20% — a fair, transparent margin above the provider's actual cost.
Same $10,000 claim
$25,400 → $15,000
Payment as % of Medicare
Medicare = 100% benchmarkMedicare100%
Cost-Plus Pricing150%
Self-Funded w/ PPO Network250%
Traditional PPO254%
Sources: RAND Hospital Price Transparency Study (Round 5.1); Milliman 2025 Commercial Reimbursement Benchmarks.
What Cost-Plus Membership Delivers
Wholesale, pre-negotiated facility rates
Minimal employee disruption — your team keeps a top-five provider's card.
Advocate / Auditor / Litigator on your behalf
99% success rate in executing pre-negotiated rates in 2025 on behalf of clients across the US.
Full transparency
Complete access to your claims data — every payment traceable to a benchmark and a margin.