Allbright Benefits &amp; Consulting

There is a new definition for a small employer for 2014. This “small” change will affect a lot of people.

Let’s review for a minute, before 2014, the “size of a group” was determined by eligible employees. This number came from how many people were full-time (and had satisfied their waiting period), or were COBRA eligible. Out of those that were eligible you could deduct the people that had a legitimate waiver. This could be a person who was covered by their spouse’s insurance, or some companies allowed individual coverage to constitute a legitimate waiver.

In 2014, a “small” employer is one who employed an average of at least one but not more than 50 employees during the prior calendar year, and who employs at least one employee on the first day of the plan year. Employees are defined as individuals employed by an employer and include full-time, part-time, temporary and/or seasonal employees.

As a small employer you must also meet a minimum participation to qualify for group major medical insurance. You have to have at least 50% participation in the insurance.

For example:
In 2014 – if you have 20 employees – 10 must participate.
Before 2014 – if you had 20 employees and 10 were part-time or seasonal, you only needed 50% participation of the remaining 10 which would be 5.

Doesn’t sound too bad huh? Well here is where things it makes the difference.

The small employer has to pay at least 50% of the employee only premium. So instead of paying 50% of 5 people (in 2013) … he now has to pay 50% of 10 people (in 2014).

Not to mention, as long as the group is under 50 total employees in 2014 the rates are community rated (rates not based on health). However, once it goes over 50, it goes thru medical underwriting (rates are based on health).

This is what you will see happen:
More employers laying off people to either stay under that 50 employee mark
Employers will lay off part-time workers because maybe they can’t afford to pay insurance for a part-time employee Employers may not hire a “visibly” sick or older person because unfortunately they will be more costly on their insurance.

I don’t agree or disagree with what is going to happen, I am merely trying to outline the new guidelines and make people aware of what is coming in our near futures because of the “change” in healthcare due to the Affordable Care Act.

Tags: affordable care act, group insurance, health care reform, health insurance, health reform, individual coverage, major medical

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Apr 03

Updated Medicare Publications

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http://medicare.gov/pubs/ebook/pdf/Medicare&You_eBook_2013_FINAL_508_sm.pdf.pdf

Hey guys and gals … sorry I have been out for a bit. I moved! Ugh, don’t you hate that???

Well I wanted to try to get everyone updated a little on some things. First off, real quick, here are some useful links to Medicare Publications that I reference daily. They help me keep things straight, like what is Part A and what is Part B, and then what is that Part C and D … it is like alphabet soup! Crazy I tell you. Hopefully you will find them useful as well.

Your Medicare Benefits – What medicare does / doesn’t pay for
http://medicare.gov/pubs/ebook/pdf/10116%20-%20Your%20Medicare%20Benefits.pdf

Medicare & You 2013

Guide to choosing a Medigap Policy 2012

http://medicare.gov/pubs/ebook/pdf/02110%20Choosing%20a%20Medigap%20Policy_new.pdf

Medicare Basics – good phone #’s

http://medicare.gov/pubs/ebook/pdf/Medicare_Basics_11034.pdf

As always if you have any questions or need a quote for a Medicare Supplement, Medicare Advantage (Part C), or a Medicare Drug Plan (Part D) call 866-756-6199 or go to our website www.eMedigap411.com

Take care! 🙂

Tags: medicare, medicare supplement, medicare.gov, part d

General Insurance, Health Care Reform

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Feb 01

Are you Ready for Affordable Health Insurance?

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That day will mark the start of new health insurance coverage for millions of Americans. You will then be able to TRULY SHOP for health insurance that meets your needs.

For the first time in history people who have never had health insurance, or who had to go without insurance after losing a job or getting sick, or they were turned down because of a pre-existing condition now have OPTIONS. Now all because of these new marketplaces established under the Affordable Care Act, millions of Americans have access to affordable coverage.

Some states will build their own health insurance marketplaces or Exchanges, so that families and small-business owners will be able to get information to make accurate comparisons of private insurance plans and, get information about subsidies that may be available to them to make coverage more affordable. We are hearing that some people may even be eligible for a new kind of tax credit to help lower their premium costs. We are so excited. Finally, insurance companies will compete for your business on a level playing field, with no hidden costs or misleading fine print.

Go to our website www.helpmebuyhealthinsurance.com to keep up with the most current information and keep up with tips for things you can do now to prepare for enrollment. And make sure to sign up for emails updates on our blog, so you don’t miss a thing when it’s time to enroll in October. It will be very similar to the Medicare annual enrollment, which means if you don’t enroll by January 1, 2014 … you are out of luck until the next year’s open enrollment. So don’t loose out on valuable coverage, tax breaks, or subsidies! Stay informed through us and we will be your guide through the reform!

We believe there is still work to be done to make sure the insurance market works for families and small businesses. But, for millions of Americans, the time for having health care coverage, security, and peace of mind they need and deserve is finally within sight.

As always, call, write or comment with any questions that we can help you with during this time of “change”. We are here to help!

Allbright Benefits and Consulting allbrightbenefits@gmail.com Toll Free 866-756-6199

Tags: Affordability, Exchanges, health insurance, Kathleen Sebelius, open enrollment, pre-existing conditions, Pricing, quotes, States

General Insurance, Health Care Reform

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Jan 14

The Rise of Health Insurance Premiums

Categories:

General Health, General Insurance, Medicare

What is this we see … Health Insurance premiums are increasing? And why is this we hear … because of the Affordable Care Act aka ObamaCare! Tell me it isn’t so. Good Morning America, it is exactly as I predicted; health insurance premiums are on the rise because ObamaCare takes effect in 2014, according to a recent post in the Wall Street Journal by Merrill Matthews and Mark Litow. Two very reliable sources I might add: Mr. Matthews is a resident scholar with the Institute for Policy Innovation in Dallas, Texas. Mr. Litow is a retired actuary and past chairman of the Social Insurance Public Finance Section of the Society of Actuaries.

I thought everyone should have seen this coming a mile away. If you have “x” number of healthy people who are insured at one price, then you add “x” number who are unhealthy, someone has to pay more the price isn’t going to go down as it was laid out to us. And did you honestly think that all of those people were going to run out and get health insurance just because Mr. President said so?! Oh no, they will wait until they have to, just like all those uninsured motorists do. So who foots the bill for that? Let’s see, is that why we also have to pay for uninsured/underinsured motorist coverage when we have car insurance? (One, two, three …) That’s why!!!!

I’m going to quote from the article, because they give some interesting facts, and say what I am trying to say better than I ever could:

“The reason: The congressional Democrats who crafted the legislation ignored virtually every actuarial principle governing rational insurance pricing. Premiums will soon reflect that disregard—indeed, premiums are already reflecting it.

Central to ObamaCare are requirements that health insurers (1) accept everyone who applies (guaranteed issue), (2) cannot charge more based on serious medical conditions (modified community rating), and (3) include numerous coverage mandates that force insurance to pay for many often uncovered medical conditions.

Guaranteed issue incentivizes people to forgo buying a policy until they get sick and need coverage (and then drop the policy after they get well). While ObamaCare imposes a financial penalty—or is it a tax?—to discourage people from gaming the system, it is too low to be a real disincentive. The result will be insurance pools that are smaller and sicker, and therefore more expensive.

How do we know these requirements will have such a negative impact on premiums? Eight states—New Jersey, New York, Maine, New Hampshire, Washington, Kentucky, Vermont and Massachusetts—enacted guaranteed issue and community rating in the mid-1990s and wrecked their individual (i.e., non-group) health-insurance markets. Premiums increased so much that Kentucky largely repealed its law in 2000 and some of the other states eventually modified their community-rating provisions.

States won’t experience equal increases in their premiums under ObamaCare. Ironically, citizens in states that have acted responsibly over the years by adhering to standard actuarial principles and limiting the (often politically motivated) mandates will see the biggest increases, because their premiums have typically been the lowest.

Many actuaries, such as those in the international consulting firm Oliver Wyman, are now predicting an average increase of roughly 50% in premiums for some in the individual market for the same coverage. But that is an average. Large employer groups will be less affected, at least initially, because the law grandfathers in employers that self-insure. Small employers will likely see a significant increase, though not as large as the individual market, which will be the hardest hit.

We compared the average premiums in states that already have ObamaCare-like provisions in their laws and found that consumers in New Jersey, New York and Vermont already pay well over twice what citizens in many other states pay. Consumers in Maine and Massachusetts aren’t far behind. Those states will likely see a small increase.

By contrast, Arizona, Arkansas, Georgia, Idaho, Iowa, Kentucky, Missouri, Ohio, Oklahoma, Tennessee, Utah, Wyoming and Virginia will likely see the largest increases—somewhere between 65% and 100%. Another 18 states, including Texas and Michigan, could see their rates rise between 35% and 65%.

While ObamaCare won’t take full effect until 2014, health-insurance premiums in the individual market are already rising, and not just because of routine increases in medical costs. Insurers are adjusting premiums now in anticipation of the guaranteed-issue and community-rating mandates starting next year. There are newly imposed mandates, such as the coverage for children up to age 26, and what qualifies as coverage is much more comprehensive and expensive. Consolidation in the hospital system has been accelerated by ObamaCare and its push for Accountable Care Organizations. This means insurers must negotiate in a less competitive hospital market.

Although President Obama repeatedly claimed that health-insurance premiums for a family would be $2,500 lower by the end of his first term, they are actually about $3,000 higher—a spread of about $5,500 per family.

Health insurers have been understandably reluctant to discuss the coming price hikes that are driven by the Affordable Care Act. Mark Bertolini, CEO of Aetna, the country’s third-largest health insurer, broke the silence on Dec. 12. “We’re going to see some markets go up by as much as 100%,” he told the company’s annual investor conference in New York City.”

So there you have it … For all of you who wanted ObamaCare; you got it. Now can you afford it is the question? It’s like that beautiful wardrobe that you always wanted to have … it is available to you, but can you afford it? Well, time will tell. Until then, you can get a FREE insurance quote here. It is always good to compare your rate with other companies if you are healthy and can switch (until 2014). After 2014 … who knows … who knows who knows (as my voice echos). But seriously, right now, underwriting still applies, so if you are healthy and can save money by switching carriers, why not! Go here to compare your rates.

Tags: aetna, affordable care act, health care reform, health insurance, health reform, individual coverage, individual medical, major medical, obamacare, wall street journal

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Jan 09

“Tis the Season” … of the Flu!

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The holidays have passed, but “Tis the Season” … Flu season that is! As you would guess, my fiance woke up this morning feeling like Wreck It Ralph (looking like him too). But of course, he is Superman and still going to work, like most of us would … we all know we have to show up! If we don’t get fired, we know that no one ever seems to do our work when we are away and we dread the pile of work when we come back … that is a sickness in itself! When you consider the level of productivity and the possibility of spreading germs to others, staying home and resting one day really wins the argument. But us dedicated, hell-bent workaholics decide to spend our dreaded days of coughing, aching and sneezing at the office along with those sweet, wonderful, kind people we spend 40+ hours a week with! So if you are one of those, let’s at least practice some tactics to prevent the spread of germs:

Cough and sneeze into the crook of your elbow, covering your mouth with clothing, rather than into your hand.
Wipe down and clean areas. Keep Clorox wipes around and use them frequently.
Wash your hands and do it frequently (Viruses can live on hard surfaces hours after you’re gone.)
Keep in mind that anti-bacterial gels are a good option when a sink isn’t available, but it is a substitution not a replacement.
Try to avoid touching your face, which provides a direct path for the germs on your hands to get into your nose and mouth.
We so often forget to clean our most used items. Germs may also be lurking on things like cell phones, car keys, and billfolds. Give them a wipe with an alcohol pad regularly.

Make a habit and prevent the spread! Already you are hearing that hospitals are too full because of the flu, it’s too early in the season for this.

If you don’t have health insurance and that is the reason why you haven’t gotten to the doctor, go here for a free quote … we have plans that can fit everyone’s budget! Don’t let that be an excuse that you don’t get the necessary care.

Most doctors advise that you get your flu shot. If you haven’t and want to, it isn’t too late, here is a good website to find a location in your area http://flushot.healthmap.org/

If you have Medicare, your Medicare Part B covers a shot once per flu season in the fall or winter. You pay nothing for a flu shot, and the Part B deductible doesn’t apply.

Stay Healthy & Happy!

Tags: anti-bacterial, clorox wipes, flu, flu season, flu shots, health conditions, health insurance, individual coverage, individual medical, major medical, medicare, medicare supplement, prevention, spread germs, virus prevention, viruses, wreck it ralph

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Jan 07

The History of Medicare

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Medicare

I found an interesting video at http://youtu.be/693XQSujAh8 … So I briefly summarized it for my History buff followers and those of you who are interested in how Medicare became part of our daily lives:

Because of the depression the elderly were so dependent on their children, they were not able to pay for their hospital and doctor visits. Something had to be done.

1945 President Truman proposed national health insurance regardless of residence, station, or race everywhere in the United States. Those efforts failed.

1960 Kerr Mills law enacted that states would receive federal dollars for older poor people. However, only 32 states adopted that bill. It was not successful either because it didn’t really provide sufficient coverage people could afford.

1965 Medicare was passed. Medicare’s main principles were to provide coverage to all people 65 and over regardless of income and health status. It prohibited any federal interference in the practice of medicine. It covered hospital & doctor visits and paid providers for each service given to a patient. 1 million people enrolled the first week. And since only integrated hospitals could be reimbursed for Medicare expenses, Medicare ended racial segregation in hospitals. Other fun facts: Ex-president Truman is the first to enroll in Medicare. Medicare Part B premium is $3 per month.

1988 Congress passed the Medicare Catastrophic coverage act which set limits on out-of-pocket spending and added a drug benefit. It also required only people on Medicare to finance the new benefits. This made a lot of people upset.

1989 Congress repeals the Medicare Catastrophic Coverage Act including the out-of-pocket limit and drug benefit.

1992 Physician services payments are based on fee schedule.

1995 Medicare Officials warn congress that Medicare will not have enough money to pay all hospital bills beginning in 2001.

1997 Congress passes Medicare+Choice under the Balanced Budget Act to reduce Medicare spending growth. Some provisions prove to be so financially restrictive when regulations are unveiled that Congress is forced to revisit the issue in 1999.

1998 Medicare Officials say financial outlook much improved.

1999 Congress “refines” Medicare+Choice and relaxes some Medicare funding restrictions under the Balanced Budget Refinement Act of 1999.

2000 Medicare Part B premium is $45.40 per month.

2003 Congress passes the Medicare Modernization Act adding a new prescription drug benefit offered by private plans only.

2006 Medicare Prescription Drug Benefit aka Part D takes effect.

2010 Affordable Care Act signed into law which added preventative care, reduced Medicare spending growth & extended solvency of Medicare Trust Fund. It reduced Medicare payments to providers, such as hospitals and home health agencies, and it reduced payments to private insurance plans. It also increased Part D premiums for higher income beneficiaries and phased out the doughnut hole.

2011 First Baby boomer enrolls in Medicare. Retirement of he Baby Boom generation, by 2030 is projected to increase enrollment from 48 million to more than 80 million. Medicare spending is projected to increase from $560 billion in 2010 to just over $1 trillion by 2022. They also say that twenty percent of baby boomers alone have five or more chronic conditions which will further add to the future cost of health care (www.cms.gov, 2012)

2012 Medicare Officials estimate that Medicare will be able to pay all hospital bills until 2024. Medicare Part B premium is $99.90

I hope you enjoyed this journey back through history! Visit www.cms.gov and www.medicare.gov for more facts and information.

Tags: affordable care act, affordable coverage, health insurance, health reform, medicaid, medicare, medicare.gov, obamacare, out-of-pocket

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Jan 05

Is Plan F Changing? Prepare now …

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Medicare Supplement Plan F has been under a lot of review lately as regulators question the ever increasing costs to our healthcare system because of insurance plans that offer first-dollar coverage. The Medicare Supplement Plan F is the most popular plan, because it is the most comprehensive. Facts show approximately 20% of Medicare recipients purchase a Medicare Supplement plan, and of that 20% over two thirds purchase Plan F. The reason this plan is so popular is because when you have this plan, you basically have no out-of-pocket medical expenses. So it brings up a big argument with government officials, that this is one of the many reasons our healthcare system is going bankrupt.

Most studies show that when people have to pay a deductible or co-payments, that they use the plan less than others who do not have to pay a deductible or a co-payment. Therefore people would be less likely to go to the doctor unless it is absolutely necessary. However this doesn’t tell the whole story.

Recent studies have found that cost-sharing keeps people from seeking care even when it is absolutely necessary. This creates an even bigger problem, because if health issues are not treated early on, they become more costly and more difficult to manage the longer they have to develop into a more serious problem.

In a letter drafted to the Secretary of Health and Human Services Kathleen Sebelius, the NAIC committee advised regulators to continue to allow Medicare Supplement plans that offer first dollar coverage (Plan F) to be offered to our nations Medicare recipients. Surprised? You shouldn’t be … everyone knows preventive care is very important. Early diagnosis and prompt treatment means people will be healthier, and healthcare costs will be minimized.

Read more about the NAIC saying NO to Medigap Cost-sharing here.

With the trends that we are seeing, we are recommending to our customers and to you … if you have a Plan F now, and have seen your premiums increase every 6 months or every year, look at a Plan G. The only difference between a Plan F and a Plan G is that you pay the Part B deductible each year. In 2013, the Part B deductible is $147. All of the other benefits are the same. See Chart Below. So if you can save at least $13 a month by switching to a Plan G then you are better of by going to a Plan G. We look at it like this. For example, if you are currently paying $185 a month for a Plan F ($2220/year) and you can get a Plan G for $170 a month ($2040/year) then it would be cost effective to switch. You just saved $180 by switching, and you will only be out of pocket $147 for the Part B deductible.

2012 medigap plans from medicare.gov

Go to our website at www.eMedigap411.com to compare rates today to see if you can save!!! Or call us 866-756-6199 and we can help evaluate your situation. When you switch from one plan to another, you will have to qualify, so this may not be an option for you.

Tags: affordable care act, affordable coverage, cost-sharing, deductible, first dollar coverage, health care reform, health reform, HHS, Kathleen Sebelius, medicare, medicare supplement, medicare.gov, medigap, NAIC, out-of-pocket, Plan F, Plan G

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Dec 17

Can I use my Medicare Supplement when I travel?

Categories:

General Insurance, Life Insurance, Medicare, Supplemental Insurance

Yes. If you have a Medicare Supplement plan and you travel, any doctor that takes Medicare, will take your Medicare Supplement. Now, if you travel outside the U.S. some of the standardized plans offer foreign travel for emergency care. See the article below from Medicare.gov.

Now keep in mind, if you have a Medicare Advantage plan aka Part C (hint* if you take anything other than your Red White & Blue Medicare card when you see the doctor) you probably do not have coverage outside of your network and may or may not have foreign travel coverage. Call your insurance provider before traveling. If you need travel coverage click here.

Article below provide by Medicare.gov
Medigap & travel

Your Medigap policy may offer additional coverage for health care services or supplies that you get outside the U.S.Standard Medigap Plans C, D, F, G, M, and N provide foreign travel emergency health care coverage when you travel outside the U.S.

Plans E, H, I, and J are no longer for sale, but if you bought one before June 1, 2010 you may keep it. All of these plans also provide foreign travel emergency health care coverage when you travel outside the U.S. Medigap coverage outside the U.S.

Medigap Plans C, D, E, F, G, H, I, J, M, and N pay 80% of the billed charges for certain medically necessary emergency care outside the U.S. after you meet a $250 deductible for the year. These Medigap policies cover foreign travel emergency care if it begins during the first 60 days of your trip, and if Medicare doesn’t otherwise cover the care.Foreign travel emergency coverage with Medigap policies has a lifetime limit of $50,000.

Find out before you go Before you travel outside the U.S., talk with your Medigap plan or insurance agent to get more information about your Medigap coverage while traveling.

via Medigap & travel | Medicare.gov.

If you need a Medicare Supplement plan, or travel insurance call me 866-756-6199.

Tags: emergency health care, foreign travel, health insurance, individual coverage, medicare, medicare advantage plan, medicare supplement, medicare.gov, medigap plan, medigap policies, part c, travel insurance

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Dec 13

Insurance Companies & Rate Increases

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Ahhh, the dreaded concern … will I have a rate increase and when. Good question.

Speaking in General, of course, and mainly about health insurance companies, here is the scoop.

Most companies including Medicare Supplement and Major Medical generally have a 12 month rate guarantee. They are not required to, but you will want to ask your agent before purchasing the policy and ask if the policy has a “rate guarantee”. Now, if you go up in age during that year, your individual policy is subject to go up in premium, that is not included in the guarantee. After the initial rate guarantee, if any, the companies can basically increase the rates at anytime they want. Generally you will see them increase either quarterly (every 3 months), semi-annually (every 6 months), or annually (each year), or as needed. It all depends on where you live, how the claims in that area are compared to the premiums received, and operating expenses. Individual policies are NOT increased individually … I repeat, you are not singled out just because you had high claims one year. Everyone either in your zip code, or in your “zone” or maybe in your state pays more. You are treated as a whole … kind of like a big group, so to speak.

Speaking of Group medical, that is a little different because there are no guarantees. It can be increased as soon as they start seeing high claim volume. They will increase that particular group’s premiums only to compensate for the claims. They can keep going up until they feel comfortable with the money that they have coming in versus the money that they have going out.

Supplemental carriers such as cancer, heart, critical illness, etc these type of policies have what is called guaranteed renewable; this means that the policy cannot be cancelled as long as you pay the premiums, and the premiums remain the same as when you purchase it, unless they raise the premiums for everyone with that same policy (and this does happen, but not very often – it just depends on the product and the actuaries who priced it).

Life insurance has a couple of different products, I won’t go into all of them, just the main ones. Whole life stays the same price the whole of your life; so the younger you purchase the better off you are. Term life increases at the end of the term to the age you are at that time. Universal life is basically the combination of the two, there is a minimum that you must pay for the insurance, but you can pay more to go towards your cash value.

Please understand, I have used a lot of non-technical words to explain this … and please take into account the date of this post before using this as a source. Healthcare is changing rapidly and this may be outdated before I even get it posted. 🙂 If you need updated information please email me or visit my website at www.allbrightbenefitsandconsulting.com I will always be happy to help you.

Tags: cancer, dreaded disease, group insurance, guaranteed renewable, health insurance, healthcare, individual coverage, individual medical, major medical, medicare, medicare supplement, premiums, rate increase, self-employed, short term, small employer, term life, universal life, whole life

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Dec 06

8 Things to Know About Medigap Policies

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