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Employee Benefits

The Switch to Small Business Health Insurance

The Switch to Small Business Health Insurance

How the ACA has drastically impacted the group health insurance market.

The Old School way of Offering Benefits

Change is inevitable—and with health insurance it’s become predictable.

For the first few years after the Affordable Care Act was implemented, it was more cost effective to give your employees dollars to shop individual health insurance exchanges instead of offering employer sponsored health insurance.   There were multiple carrier options to choose from, plans were lower in cost and individuals were potentially eligible for a subsidy meaning the government would pay a portion of their plan so their employer didn’t have to. There was an ease of employer administration. Employers would hand their employees money and the weight was off their shoulders. The benefit of these individual health insurance exchanges was unbeatable—until the insurance carriers no longer benefited.

Many carriers weren’t able to sustain a consistent cash flow this way and quickly went out of business. This year in the state of Illinois, Land of Lincoln Health was forced to close its doors for this very reason. Other carriers like United Healthcare simply did not have a product offering for individuals but are still successful in the group health insurance market (i.e. employer sponsored health plans).

The Shift Back to Group 

The shift has gone back in favor of group health insurance for the following reasons:

  • Limited carriers in the individual market,
  • Of the participating carriers, very limited plan options,
    • In Illinois, Blue Cross Blue Shield is only one carrier in the individual market that is offering access to a PPO and it is a narrowed network,
  • Of plan options available, extremely restricted access.
  • Certain hospitals and doctors will not be available to you,
    • For example, Blue Cross Blue Shield of Illinois does not offer coverage at major teaching hospitals in the Chicagoland area such as Rush University

By law, individual premiums must be paid for with post tax dollars, making individual monthly premiums more expensive.
Carriers filed for up to a 50% rate increase in 2017.

On the other hand, Group Health insurance allows employees to pay for premiums with pre-tax dollars, direct from their paychecks before they are taxed.

Overall, individual plans versus plans that are run through a business are just not as accessible today. Our advice is to get onto group coverage or (if you are in a position to) offer an employer sponsored health plan to your employees.

Large Group vs Small Group

A large group is defined as greater than 50 employees.  For small groups made up of less than 50 employees—rates are based on age similar to individuals. Groups 50+ use a tiered rating system with 4 tiers:

  • Single rate
  • Family rate
  • Employee spouse rate
  • 21-65 rate

Numbers are factored into blended rates based on medical history of the company. If you have someone on staff who is very ill—they will drive up everyone else’s rates.  50 + is also not guaranteed issue as it is in the small group market. Carriers can rate up more than in small groups or even decline the whole company.   Pre Affordable Care Act even 2 life groups were medically underwritten—they wouldn’t decline you but they would max rate you at extremely high premiums.

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Individual and Family

Medicare Advantage vs Medicare Supplement

Medicare Advantage vs Medicare Supplement

What you need to know before turning 65.

Nearing retirement, most of us would rather spend our days debating between a destination in the sun or in the snow.   However, there are still some important healthcare decisions to be made before traveling. Will you enroll in a Medicare Advantage, Medicare Supplement and/or prescription drug plan, or will you stick with Original Medicare coverage.

In the world of Medicare, terminology is thrown around like a basketball in the middle of March Madness. It can be challenging to keep up—allow us to break things down to help you understand the key differences.

There are four different parts of Medicare: A, B, C, and D:

  1. Part A covers hospital visits
  2. Part B covers doctor visits and outpatient care    
  3. Part C is something different known as the Medicare Advantage program
  4. Part D is a prescription drug program

Original Medicare is comprised of Part A and Part B and is administered by the federal government.

Medicare Advantage (Part C)

Here’s where things get a little more complicated. Medicare Advantage plans cover Part A and Part B benefits. They often cover extra benefits not included with Original Medicare, such as vision, hearing, and dental care. Medicare Advantage plans are provided and administered by private insurance companies who have been approved by the Centers for Medicare and Medicaid Services (CMS), a government entity who oversees the Medicare program.

 

With Medicare Advantage plans, you still need to continue paying Part A and/or B premiums as you would with Original Medicare. However, the amount you pay for a doctor’s visit, hospital stay or other medical expenses is different between Medicare Advantage plans and Original Medicare.

 

For example: Original Medicare covers most doctors’ visits at 80% after you fill a small deductible. With a Medicare Advantage plan, there is usually a small copay and then the plan covers the rest of the cost.

 

Medicare Supplement

Medicare Supplement plans, also called Medigap plans, require you to be enrolled in Original Medicare. These plans are offered by private companies, but they act as a secondary insurance policy—covering deductibles, copays and other out-of-pocket expenses that Original Medicare would make you pay. Original Medicare also does not cover health care costs while traveling outside of the United States, but Medicare Supplement plans usually will.

 

These are the basic differences—there are many additional factors that differ between Medicare Advantage and Medicare Supplement plans.

 

Differences to Consider

Network Access

When it comes to Medicare Advantage plans, more times than not you will need to see a doctor in the plan’s network established by the carrier. You may see a doctor outside of the network—keep in mind it will cost more if you choose to do so. For Medicare Supplement plans, if your provider accepts Original Medicare, you don’t need to worry. You may visit any doctor or hospital that accepts payment from Medicare.  

Prescription Drug Coverage

Most Medicare Advantage Plans include benefits for prescription drug coverage. These are referred to as Medicare Advantage Prescription Drug plans (MAPDs). Medicare Supplement plans do not cover prescription drugs. If you choose to go with a Medicare Supplement plan, you can enroll in a Part D plan which specifically covers prescription drugs. Part D plans are available through private insurance companies.

Long-Term Care

Medicare Advantage and Medicare Supplement plans do not cover long-term care.

Vision & Dental Care

Many Medicare Advantage plans cover vision and dental care benefits. Medicare Supplement plans usually don’t cover vision and dental care benefits. But some Medicare Supplement plans do offer a discount program to help reduce vision and dental care expenses​.

 

Hearing

Some Medicare Advantage plans include hearing benefits, such as regular hearing exams and hearing aids. Medicare Supplement plans don’t cover hearing aids or exams.

Eligibility

Medicare Advantage plan options vary state to state and in some cases county to county. Keep in mind you may only enroll in plans that are available in your network or area. You must first be enrolled in Medicare Parts A and B and must not have End-Stage Renal Disease. With Medicare Supplements, you must also be enrolled in Medicare Part A and Part B. In some instances, eligibility for Medicare Supplement coverage may depend on your current health status or other factors.  

 

Which one is right for me?

Regardless of what route you choose, it’s important to weigh the benefits and downfalls of both Medicare Advantage and Medicare Supplement plans. Because you must enroll in one or the other—you cannot have both.

 

Questions? Talk to one of our Certified Medicare Specialists.

Call us at (855) 563-6993 or have us call you.

 

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Individual and Family Medicare

On-Exchange vs Off-Exchange

On-Exchange vs Off-Exchange

Where should you shop for insurance, on or off-exchange?

There are lots of buzz words and terminology associated with the Affordable Care Act (ACA).  One of the most common questions asked when shopping for health insurance is “where do I shop for plans?”, “should I shop on-exchange or off-exchange?”, and really, “what’s the difference?”

Here we will uncover the common misconceptions about on-exchange and off-exchange plans and guide you on how to make the best decision when shopping for health insurance. 

Before shopping for health insurance, first ask yourself: do I qualify for financial assistance? The answer to this question will direct you to the appropriate insurance plans — on-exchange or off-exchange.

What is a Health Insurance Exchange?

A health insurance exchange is an online portal containing information, plan choices and enrollment capability for health insurance. There are two main types of exchanges — public and private. A public exchange is sponsored and run by a government entity, such as healthcare.gov. A private exchange is sponsored and run by a private entity or business, such as IXSolutions.  

No matter which exchange you choose, the prices of health insurance will always be the same.  The main difference is accessing financial assistance. 

On-Exchange vs Off-Exchange

The terms “on-exchange” and “off-exchange” can be confusing. Here is the key difference:

On-exchange means those plans that are available on the public exchange only.  If you qualify for a subsidy, and choose to use it on your health plan, then shopping on-exchange is your best option.  Roughly 3.5% of the population in the USA qualify for financial assistance.   

Off-exchange means those plans that are available outside of the public exchange environment, or in the open market.  The number one benefit of shopping off-exchange is greater plan choice.  If you don’t qualify for a subsidy, the advantages of shopping off-exchange is substantial.  

With IXSolutions, you will get access to both on-exchange and off-exchange plans, and we work with you to determine where you should shop for coverage. We offer online resources and licensed insurance professionals, who can calculate whether you are eligible for financial assistance. Either way, our job is to find the best plan to suit an individual’s unique needs and circumstance. 

Qualifying For Financial Assistance

You should always find out if you qualify for any financial assistance. Eligibility depends primarily on annual household income and family size. Your annual income will likely be the biggest factor of how much financial assistance you get.

In fact, the less money you make, the more savings you can get. In this case, on-exchange plans are for you. IXSolutions will help you determine savings and get you shopping for the right plans in the right place.

Healthcare.gov is a web site of the federal government that supports enrollment in only on-exchange health insurance plans. Many think it is the only place to get access to individual insurance under the ACA, but that’s just not true.

IXSolutions offers access to the same on-exchange plans as healthcare.gov, and we also provide off-exchange plans. There is no difference in the on-exchange insurance plans offered by either web site.

If you want more than just health insurance, IXSolutions also offers access to dental and vision plans from leading insurance companies. Our licensed professionals will help you find the additional coverage you need.

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Employee Benefits

2023 Health FSA And Other Benefit Limits

The Internal Revenue Service (IRS) recently published Revenue Procedure 2022-38. The Revenue Procedure includes the inflation-adjusted 2023 contribution limits for certain employee benefit programs. Below is a summary of some of those contribution limit adjustments.

Medicare

The Great Unwinding

The Great Unwinding is the undoing of several health coverage requirements that were implemented by legislation, regulation, and executive order because of COVID-19. The following provisions are particularly noteworthy.

Categories
Individual and Family Medicare

Healthcare Reform 101

Healthcare Reform 101

Learn the basics of the Affordable Care Act and how it affects you.

Whether you know it as Obamacare or the Affordable Care Act (ACA)—these names refer to the same thing. And contrary to what many people believe, the ACA does not mean free health care or government-provided health insurance. The ACA is a law that impacts everyone who utilizes healthcare today. 

No one can be denied basic coverage.

Before the ACA, health insurance carriers could easily refuse coverage if they felt you were “at risk”. Either too old, too sick, overweight; or you suffer from what’s called a “pre-existing condition.” Not anymore. Carriers can no longer refuse to cover the sick or increase rates based on medical history.

You are legally required to have it.

Another big change brought on by the ACA is what’s called the Individual Mandate. This means that practically everyone is now legally required to have health insurance unless you’re one of the few who qualify for an exemption. Just like we need car insurance to be on the road, we now need to insure our health or pay a penalty to the Internal Revenue Service (IRS). 

And there’s a timeline for getting it.

In order to get insured, we all need to purchase health insurance during the Open Enrollment Period. This year’s open enrollment period runs from November 1, 2018 – December 15, 2018.

Once open enrollment ends, we won’t be able to sign up for coverage for the rest of the year unless we experience a life changing event that effects our health care needs. The government refers to these as qualifying life events and include having a baby, getting married or a death in the family.

You may be eligible for government assistance.

To help make health insurance more affordable, the government now offers a way to get lower health care costs for those who qualify.

Depending on what you qualify for, you could receive special discounts on your monthly health insurance premium or the amount you pay when you visit your doctor’s office.

Insurance must cover basic health care needs.

The government has determined 10 basic categories that all insurance plans must now cover. They call these, the essential health benefits, and include things like doctor visits, hospitalizations and pediatric care. When we have health insurance, we’re now guaranteed care to treat and prevent illness or injury.

Essential benefits covered by every plan.

Obamacare requires every health plan sold in the insurance marketplaces to provide coverage for ten essential health benefits.

So, no matter what plan we choose, it’s guaranteed to cover:

  • Outpatient Care
  • Emergency Room Services
  • Hospitalization
  • Maternity & Newborn Care
  • Mental Health Services & Addiction Treatment
  • Prescription Medication
  • Laboratory Services
  • Preventive Care
  • Pediatric Care

It’s important to note that not this does not mean all of these services will now be completely free. Health insurance carriers aren’t required to take on the entire cost for these benefits. Rather, the carrier will pay a percentage of these costs. The percentage that is covered can vary from plan to plan.

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Questions? Speak with a licensed agent today
for more information on short term

Call Us at 855-563-6993

More To Explore

Employee Benefits

2023 Health FSA And Other Benefit Limits

The Internal Revenue Service (IRS) recently published Revenue Procedure 2022-38. The Revenue Procedure includes the inflation-adjusted 2023 contribution limits for certain employee benefit programs. Below is a summary of some of those contribution limit adjustments.

Medicare

The Great Unwinding

The Great Unwinding is the undoing of several health coverage requirements that were implemented by legislation, regulation, and executive order because of COVID-19. The following provisions are particularly noteworthy.

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