Menu
There is one thing everyone can agree on when it comes to health insurance:
it’s expensive.
And as a business owner, it’s easy to feel conflicted about offering it and determining the quality of coverage. On one hand, offering health benefits can be a big line item cost. On the other, you care about your staff’s health and want them to have protection in case of a medical emergency.
With a little savviness, you can make sure your employees are protected without breaking the bank.
To find the right health insurer, it’s necessary to shop around and see what plans are available in your area—usually through an insurance broker.
You may find that you can save money by offering new health plan options. Generally, HMOs (health maintenance organizations) and EPOs (exclusive provider organizations) are cheaper than PPOs (preferred provider organizations).
Of course, not all PPO plans are the same. You can have a large network (which is much more expensive), or a narrow network (which is cheaper, but provides less coverage). Making a choice between the two networks can be difficult—but not always. In Illinois, Blue Cross Blue Shield offers a hybrid plan called the Blue Options Plan, which gives you the ability to take advantage of the large PPO network with costs similar to a narrow network plan.
It is worth considering changing to a new health plan type upon assessing the kind of access to care that your employees need. If you need help in finding the best plan, you can also contact a consultant from IXSolutions who can help show you all the plan options available.
Education can lead to better healthcare spending, such as visiting a walk-in clinic or urgent care, instead of the ER. A walk-in clinic or urgent care is usually a good option to consider for non-life threatening symptoms, such as a sore throat, a headache, rashes, or allergies. The ER is best equipped to see people with unexpected and intense symptoms or injuries, such as chest pain, difficulty breathing, or severe bleeding. As many as one in four ER visits can be handled at an urgent care center. Knowing where to go can save you time and money.
HSAs (Health Savings Account) and FSAs (Flexible Spending Account) are pre-tax accounts you can use to pay for healthcare related expenses. With HSAs and FSAs, you can pay for things like co-pays, medical bills, and vision expenses. Both HSA and FSA accounts offer tax benefits and have annual contribution limits. The key differences between them lie in their allowed usage.
If employees opted for a non-HSA eligible health plan (typically lower deductible plans), they can set aside money to pay for health care through a Flexible Spending Account (FSA), where they can put in money pre-tax from their paycheck, and decide what health care bills to pay from their account throughout the year. FSAs also work like a line of credit to cover eligible health care expenses early in the year, as long as you’re on track to make your contribution by the year’s end. However, FSA funds expire by the end of every year, so remind your staff to use their FSA dollars before they expire!
If employees chose an HSA eligible high-deductible health plan, they are eligible for an HSA. An HSA works like a savings account, where the money saved can be rolled year after year. Some HSA plans also give the option of investing funds, which earn profits tax-free.
HSA holders can also contribute to a type of FSA called a Limited Purpose FSA (LPFSA), which work like regular FSAs, but funds can only be used for vision and dental expenses.
Many health plans now include virtual care solutions like telemedicine/telehealth options that are low-cost or even offered at no additional cost to you, and let you talk to a doctor by phone or video instead of visiting a clinic in person.
For routine medical issues such as colds, rashes, UTIs, and pink eye, telemedicine is a great way to get treatment from a medical professional while saving time and money.
Level-funded plans give you the opportunity to save money on premiums and a chance to receive a return of premium following a good claims year.
How it works: you pay a fixed monthly premium based on estimated claims for the year. If your employees don’t meet their expected claim amount, the unused funds go back in your pocket. If your employees do exceed the claim amount, you continue to pay the same fixed monthly premium amount thanks to stop-loss insurance.
Level-funded plans are medically underwritten so it’s a great option for healthy groups. Savings can exceed to over 30%.
Another way to add value to your employees’ benefits plan is through adding voluntary coverage (this includes legal services, worksite benefits, disability insurance, and life insurance), which would otherwise be unavailable or more expensive outside of a group plan.
Offering these is at no cost to you, but adds more products to create better value for your employee benefits plan.
The last practical way to save money? When everyone in the company stays healthy.
By promoting good health and wellness, both employers and employees win. Wellness programs encompass everything from quitting smoking to losing weight to staying active to managing stress. You can even incentivize employee participation—just figure out what works best for your business!
Part A covers hospitalizations and inpatient care.
Part B covers office visits and outpatient care.
Part C combines Part A and B benefits into a single plan administered by private insurance companies. This is referred to as the Medicare Advantage plan.
Part D covers prescription drugs, and many Part C plans also include Part D coverage.
There are also Medicare Supplement plans, sometimes called Medigap plans, which are available to people covered under Parts A and B. These plans cover some of the deductible and out-of-pocket expenses associated with Medicare.
Usually, if the employer has fewer than 20 employees, Medicare will be your primary insurance coverage. Likewise, if the employer has 20 or more employees, the group health plan will usually be your primary insurance coverage. Check with the employer to be certain.
Generally, you’ll need to sign up for both Medicare Part A and B even if you continue the group health plan. The group health plan usually won’t pay for what Medicare would otherwise cover
Yes. Enrolling in either Part A or B will eliminate your ability to contribute to an HSA.
Not if you delay enrollment because you are covered by a group health plan based on your current employment or your spouse’s employment. However, once employment is terminated, you must sign up for coverage within 8 months even if you elect COBRA. Failure to sign up for Medicare Part A and/or B during this time could limit when you can enroll and/or result in a penalty.
Your acceptance is guaranteed with every insurance company within 6 months of enrolling in Part B. Even if you’ve been enrolled in Part B for more than 6 months, most plan options will be available to you at a later date provided you delayed enrollment in a Medicare Supplement plan because you were covered by a group health plan. You’ll need to act quickly after losing coverage under the group health plan. You’ll have 63 days to sign up.
You’ll have a 7-month initial enrollment period that starts 3 months before you’re eligible for Medicare, includes the month of Medicare eligibility, and concludes 3 months thereafter. If you delay enrollment in either plan because you were covered by a group health plan, you’ll have at least 60 days to sign up for either plan after you lose the group health plan.
Please be aware that if you delay enrollment in Part D you could be charged a late enrollment penalty unless you have creditable prescription drug coverage elsewhere. The employer is supposed to provide you with a notice prior to October 15th of each year which indicates if the drug coverage on the group health plan is creditable. The term creditable means the prescription drug coverage on the group health plan is at least as good as the standard Part D plan. Most group health plans provide creditable prescription drug coverage.
IXSolutions brings over 30 years of combined experience to the market as Employee Benefits Consultants. We’ve been bringing creative solutions and alternatives to the market since the inception of the Affordable Care Act.
Today, we work with companies, individuals, and Medicare eligible individuals to provide solutions to the complex insurance industry. We are a trusted partner to thousands of clients, brokers, and associations across the country.
