Making HSAs Work Smarter

In the dynamic world of employee benefits, leaders have come to grasp the immense potential benefits hold in achieving their key goals. One approach that has gained significant traction is the combination of High Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs), a powerful duo that not only reduces benefits costs but also empowers employees with greater control over their healthcare expenses. However, despite the evident advantages, the journey to unlocking the full potential of HDHPs + HSAs is far from over. There lies an untapped opportunity to optimize plan design and elevate employee education, enabling companies to enhance their workforce’s well-being while achieving cost-effectiveness. If you are eager… Read More

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Are Health Insurance Premiums Tax Deductible?

Health insurance premiums can be tax-deductible under certain conditions in the United States. However, please note that tax laws and regulations can change, so it’s essential to consult a tax professional or the latest IRS guideline for the most up-to-date information. Typically, if you are self-employed or have health insurance coverage through your employer and pay your premiums with after-tax dollars, you may be eligible to deduct the premiums on your federal income tax return. This deduction is generally reported on Schedule 1 of Form 1040, which is used to calculate your Adjusted Gross Income (AGI). Keep in mind that there are specific requirements and limitations for deducting health insurance… Read More

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What is Health Insurance for?

Health insurance is a type of insurance coverage that helps individuals and families manage the costs of medical expenses and healthcare services. It provides financial protection against the high costs of medical treatments, hospitalizations, prescription drugs, and other healthcare-related services. Health insurance is designed to help people access the medical care they need without facing significant financial burdens. Health insurance provides a safety net against unexpected and costly medical events, allowing individuals to seek necessary medical care without facing crippling financial burdens. It also promotes preventive care, encouraging people to get regular check-ups and screenings to detect potential health issues early. It’s important to note that the coverage and cost-sharing… Read More

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Will health insurance cover a swimming pool? 

Health insurance typically does not cover the cost of a swimming pool for personal use. Health insurance is designed to provide coverage for medical services, treatments, and supplies that are necessary for the diagnosis and treatment of illnesses or injuries.  Swimming pools are a comfort item and are generally not considered medically necessary. However, there may be some exceptions in certain cases where a swimming pool is prescribed as part of a medical treatment plan for specific conditions such as physical therapy or rehabilitation. In such cases, coverage for a swimming pool may be possible, but it would require a thorough evaluation and approval process by the insurance company.  It’s… Read More

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Navigating Health Insurance for “gig” Economy Entrepreneurs

For self-employed individuals or today’s gig workers, obtaining health insurance can be a bit different compared to traditional employer-sponsored plans. Empower yourself with a range of valuable choices to explore! Take a moment to peruse the document below, where you’ll find a comprehensive list of options available to you. We’re committed to providing exceptional support, so please don’t hesitate to reach out to our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121. We’re here to answer any questions or address any concerns you may have.

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What are the preferred plans for insured employees?

Preferred Provider Organization plans remain the most common plan type. Nearly half (49%) of insured employees enrolled in a PPO in 2022. That compares to 29% enrolled in an HDHP, 12% enrolled in an HMO, nine percent in a Point-of-Service (POS) plan, and one percent in a conventional (indemnity) plan. If you have any questions or concerns about this bulletin, please contact your Total Benefit Solutions Inc health insurance account manager at (215) 355-2121

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How much do employees contribute towards their insurance expenses?

Average Contributions Most employees do make a contribution toward their insurance costs. Covered workers, on average, contribute 17% of the premium for single coverage and 28% of the premium for family coverage. These numbers are similar to those reported by KFF in its EHBS in 2021. The average contribution for workers at small firms is $7,556, which is more than a third higher than the average for those at large firms ($5,580). Workers at private, for-profit firms contribute a higher percentage of the premium versus those at public firms, regardless of coverage type. A fortunate one-third of employees (33%) at small firms are enrolled in coverage where the employer pays… Read More

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Increases in Premium Found in Health Benefits Survey

The latest survey by the Kaiser Family Foundation (KFF) concerning employer-sponsored health benefits found modest increases in employers’ and employees’ costs in 2022. In its 24th Employer Health Benefits Survey (EHBS), KFF found the average annual premiums for employer-sponsored health insurance in 2022 were $7,911 for single coverage and $22,463 for family coverage. These amounts were up from $7,739 and $22,221 in the previous year, respectively – an increase of $172.00 for single coverage and $242.00 for family coverage. The average family coverage premium is up 20% over the past five years and up 43% during the past 10 years. Small vs. Large Employers In 2022, workers insured through their employers at both… Read More

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What Additional Changes Are Being Made to Part D?

As of 2023, the out-of-pocket cost of insulin products is limited to no more than $35 per month in all Part D plans. In addition, adult vaccines covered under Part D, such as the shingles vaccine, are covered with no cost sharing. Starting in 2024, people with Medicare who have incomes up to 150% of poverty and resources at or below the limits for partial low-income subsidy benefits will be eligible for full benefits under the Part D Low-Income Subsidy (LIS) Program. The law eliminates the partial LIS benefit currently in place for individuals with incomes between 135% and 150% of poverty. Also starting in 2024, the calculation of the… Read More

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How Is the Medicare Part D Benefit Changing in 2025?

Changes in 2025 include a new $2,000 out-of-pocket spending cap, elimination of the coverage gap phase, a higher share of drug costs paid by Part D plans in the catastrophic phase, along with a new manufacturer price discount and reduced liability for Medicare in this phase, and changes to plan costs and the manufacturer price discount in the initial coverage phase. Out-of-pocket drug spending will be capped at $2,000 Beginning in 2025, Part D enrollees’ out-of-pocket drug costs will be capped at $2,000. This amount will be indexed to rise each year after 2025 at the rate of growth in per capita Part D costs. (This cap does not apply… Read More

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How Is the Medicare Part D Benefit Changing in 2024?

In 2024, costs in the catastrophic phase will change: the 5% coinsurance requirement for Part D enrollees will be eliminated and Part D plans will pay 20% of total drug costs in this phase instead of 15%. The 5% coinsurance requirement for Part D enrollees in the catastrophic phase will be eliminated In 2024, once Part D enrollees without low-income subsidies (LIS) have drug spending high enough to qualify for catastrophic coverage, they will no longer be required to pay 5% of their drug costs, which in effect means that out-of-pocket spending for Part D enrollees will be capped. In 2024, the catastrophic threshold will be set at $8,000. This… Read More

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What Does the Medicare Part D Benefit Look Like in 2023?

The standard design of the Medicare Part D benefit currently has four distinct phases, where the share of drug costs paid by Part D enrollees, Part D plans, drug manufacturers, and Medicare varies (Figure 1). (The Part D enrollee shares reflect costs paid by enrollees who are not receiving low-income subsidies.) If you have any questions or concerns please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)355-2121.

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The Benefits of Short-Term Health Insurance

Short-term health insurance is a type of health insurance that provides coverage for a limited period of time, typically anywhere from 30 days to 12 months. These plans are designed to provide temporary coverage for individuals who are in between jobs, waiting for employer-sponsored coverage to begin, or who are not eligible for other types of health insurance. Affordable Premiums Short-term health insurance plans typically have lower premiums than traditional health insurance plans. This is because short-term plans are designed to provide coverage for a limited period of time and do not have to meet the same requirements as other types of health insurance. This makes them a more affordable… Read More

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