On June 24, 2019, President Trump issued an Executive Order (“EO”) directing the relevant federal agencies to issue regulations or other guidance to make available more meaningful information related to the price and quality of healthcare. This summary highlights aspects of the EO that may be relevant to employer-sponsored group health plans and their covered participants. • By October 22, 2019, the Treasury shall issue guidance to expand the ability of patients to select a qualified high deductible health plan (“QHDHP”) that can be used alongside a health savings account (“HSA”), and that cover low-cost preventive care, before the deductible, for medical care that helps maintain health status for… Read More
Continue ReadingThe Exact Types of Insurance You Need In Your 20s, 30s, and 40s..
Insurance isn’t the most thrilling to think about, but it’s necessary for protecting yourself, your family, and your wealth. Accidents, illness, and disasters happen all the time. At worst, events like these can plunge you into deep financial ruin if you don’t have insurance to fall back on. Some insurance policies are unavoidable (think: car insurance in most US states), while others are simply a smart financial decision (think: life insurance). Insurance is largely personal, though, and the type of policy or amount of coverage that’s right for you and your financial situation usually won’t match your friend’s or relative’s. Plus, as your life changes (say, you get a new job or have… Read More
Continue ReadingIBC: The enhanced Care Cost Estimator tool is now available!
From IBC: The Care Cost Estimator tool is now available for members. This tool is designed to help them better understand their estimated out‑of‑pocket health care costs for a wide range of common inpatient, outpatient, laboratory, and diagnostic procedures, as well as office visits. We are excited to offer members this new tool, which is designed to help them save money and avoid unplanned expenses. Using the Care Cost Estimator, members can search for up to 1,600 procedures and compare providers by estimated price, based on their specific health plan. The tool displays provider details and quality information, such as reviews, allowing members to make more informed decisions about how to… Read More
Continue ReadingUnderstanding Medicare Part D’s True Out-of-Pocket Limit
Of all the reasons to enroll in Medicare coverage, making health care more affordable is perhaps the biggest for millions of beneficiaries. One of the benefits found in Medicare Advantage plans is a maximum-out-of-pocket (MOOP) limit, but is there anything similar that will help with out-of-pocket costs for Medicare Part D? https://living.medicareful.com/understanding-medicare-part-ds-true-out-of-pocket-limit Questions? As always contact your Total Benefit Solutions Inc, health insurance specialists at (215)355-2121!
Continue ReadingCan Employers Pay Medicare Premiums for Active Employees?
Companies with fewer than 20 employees that offer group health coverage that pays secondary to Medicare (those not subject to the MSP rules) may be able to pay for the Medicare Part B, Part D, and Medicare Supplement Insurance premiums for their active employees. This is known as a Medicare Premium Reimbursement Arrangement. However, this is not an option for companies with 20 or more workers that are subject to the Medicare Secondary Payer provisions. All companies, regardless of size, can pay the health insurance or Medicare premiums for their retired employees, but no company can payfor individual health insurance coverage for their active employees . Our best practice: A… Read More
Continue ReadingCourt Strikes Down Association Health Plan Rules
On March 28th, 2019, a Federal District Court in the District of Columbia struck down significant portions of the Department of Labor’s (DOL’s) Association Health Plan (AHP) Final Rule. Specifically, the Court found the DOL “failed to reasonably interpret” ERISA when issuing these rules: • expanding the definition of “employers” to include disparate groups of employers with no other commonality of interest other than geographic location; and • bringing working owners without employees within ERISA’s framework. This ruling effectively eliminates the expansion of AHPs to certain employers and working owners who do not meet the original parameters to be a part of an AHP. Click below to download the complete… Read More
Continue ReadingNew Rules Could Increase Premiums & Out of Pocket Cost
The Wall Street Journalrecently reported on proposed changes by the Trump Administration “that could raise health insurance costs for millions of Americans who get coverage on the job or receive subsidies under the Affordable Care Act.” As they explain, the two sides continue to bicker about the Affordable Care Act: “Republicans say subsidies for consumers are inflated; Democrats see another effort to sabotage the health law.” The proposed changes they are referring to are found in the Notice of Benefit and Payment Parameters for 2020. This is an annual notice released by the Centers for Medicare and Medicaid Services (CMS) that sets the standards for issuers and exchanges for the coming year.… Read More
Continue ReadingIs Reference Based Pricing Good for Your Group Health Benefit?
Choosing an insurance plan for employees can be challenging due to the flood of options now available. One of the biggest decisions you will have to make as an employer is between fully-insured and self-insured health plans. A fully-insured plan is a more traditional option where the company pays a premium to the insurance carrier. With a self-insured (self-funded) health plan, employers can operate their own insurance plan which can save money and give them more control over their funds. Reference based pricing, or RBP is a fairly new method to price claims option for a self-funded plan. Gaining in popularity because the employer is setting the price bar, NOT… Read More
Continue ReadingEmployees Don’t Understand Their Health Benefits
Nearly half (44%) of respondents say their employer doesn’t offer opportunities beyond health benefits for employees to meet their health goals, and 62% say they feel their employer does not serve as a resource for their healthcare-related questions
Continue ReadingAssociation health plan ruling could result in thousands losing coverage
SHELBY LIVINGSTON : Modern Healthcare . A federal judge’s decision to vacate the Labor Department’s 2018 rule expanding access to association health plans could cause thousands of people covered through such plans to lose their insurance. Whether and how soon that happens depends on the Labor Department’s appeals decision and the likelihood of the judge granting a stay of his order in the interim. A Justice Department spokesperson said March 29 the department disagrees with the ruling and is considering all options, but will “continue to fight for sole proprietors and small businesses so that they can have the freedom to band together to obtain more affordable, quality healthcare coverage.” Since the rule was finalized in… Read More
Continue ReadingJudge blocks Trump’s small-business health insurance plan
WASHINGTON — A federal judge has struck down a small-business health insurance plan widely touted by President Donald Trump, the second setback in a week for the administration’s health care initiatives. U.S. District Judge John D. Bates wrote in his opinion late Thursday that so-called “association health plans” were “clearly an end-run” around consumer protections required by the Obama-era Affordable Care Act. Click here to read the story
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