Keeping You in the Know

Health Tips and Information


Attention Employers: Send Notices of Creditable Coverage by October 15

As Medicare’s Annual Election Period rapidly approaches, employers should take note: Notices of Creditable Coverage must be sent by October 15. These notices must be sent to all employees over age 65, and any other employee or their dependent who is eligible for Medicare.

Creditable coverage means that a healthcare plan is expected to pay, on average, as much as the standard Medicare Part D plan toward a beneficiary’s prescription medications. The plan is equivalent in coverage to what a Part D plan would offer.

A notice of creditable coverage tells the covered individual that the prescription drug policy offered by their healthcare plan qualifies as “creditable coverage”.

These notices must be sent prior to October 15 each year, allowing the covered individual time to make decisions regarding his or her Medicare enrollment before the Annual Election Period. Employers must send a notice of creditable coverage to all Medicare-eligible employees, COBRA-covered individuals, and retirees covered by their group healthcare plan. Additionally, all dependents of these individuals must also receive a notice.

Why does this matter to the employee? Under the Medicare Modernization Act, individuals who do not maintain prescription drug coverage for 63 days or longer, following their initial date of Medicare eligibility, will be charged a late enrollment penalty.

However, if the individual has creditable coverage through a group healthcare plan, they are not required to enroll in Part D or face the late enrollment penalty.

But if the individual’s coverage is not creditable, they should evaluate whether enrolling in Medicare Part D would be a wise choice for them.

So, the notice of creditable coverage gives these individuals the information they need to make responsible decisions regarding their Medicare prescription drug coverage.

Notices must be filed with Medicare as well. In addition to the individual notices, employers must file an online disclosure with Medicare, certifying creditable coverage of their group healthcare plan. This disclosure must be filed

  • Within 60 days of the beginning of the plan’s contract year
  • Within 30 days of termination of a prescription drug plan
  • And within 30 days of changes to the status of creditable coverage

For more information on notices of creditable coverage, contact us and we can answer your questions. We can help you evaluate your situation and ensure that your company complies with the law while protecting your employees.

Understanding the ABCs of Medicare

When you first become eligible for Medicare, it can be easy to feel overwhelmed with all of your options. This brief guide should help you to understand the different parts of Medicare, so that you can make the selections that are right for your needs.

Medicare Part A and Part B comprise Original Medicare, and work together to form the base of your healthcare needs, so we’ll start by explaining those.

Assuming you’ve worked and paid taxes into the Medicare system for at least 40 quarters in your life, you can enroll in Medicare Part A at age 65 without owing a premium. This will serve as your hospitalization insurance, and will cover costs related to inpatient care in a hospital or skilled nursing facility (subject to some limits). Part A also covers Hospice care or home health care.

Medicare Part B provides for non-hospitalization healthcare needs, such as

  • Doctor visits, tests, and other services to diagnose or treat health conditions
  • Preventive services (routine screenings, check-ups, vaccinations, etc)
  • Mental health services
  • Clinical research
  • Ambulance services
  • Medical equipment
  • Some outpatient prescription drugs (limited)

Medicare Part C Plans – also called Medicare Advantage plans – are private health insurance plans designed to offer coverage that is equivalent to Original Medicare. By contracting with Medicare, private insurance companies offer comprehensive health insurance plans through a variety of formats:

  • Health Maintenance Organization (HMO) plans
  • Preferred Provider Organization (PPO) plans
  • Private Fee-for-Service (PFFS) plans
  • Special Needs Plans (SNPs)
  • HMO Point of Service Plans (HMOPOS)
  • Medicare Medical Savings Account (MMSA)

Many Advantage plans also include Part D, or prescription drug coverage. If you choose Original Medicare instead, you can also enroll in Part D to help manage your medication costs.

Now that you’re familiar with the basics, give us a call if you need help making decisions about your Medicare coverage. We can help you understand the benefits and limits of each type of plan, and select the one that is right for your needs and budget.

What to Do If You’ve Lost Your Health Insurance

As the economy continues to struggle toward recovery, job losses due to layoffs and company closings continue to occur. Unfortunately, for some of you that will mean loss of health insurance benefits as well. If you’re wondering what to do, we’ve outlined your options below.

Continue on your current health insurance plan through COBRA. When employees are laid off, federal law requires the employer to allow those employees to continue their group health insurance plans if they choose to do so. However, under the COBRA law you would be tasked with paying the full cost of premiums, including the share your employer formerly covered.

This might be a feasible option for those whose spouses are still employed, and can cover the full cost of premiums. But for many people facing unemployment, continuing COBRA coverage is not a financial possibility.

Enroll in an individual health insurance plan via a Special Enrollment Period. If continuing your group healthcare benefits is not an option, do remember that job loss qualifies you for a Special Enrollment Period through Covered California. You can compare plans and enroll in one that fits your needs and budget. You might also be eligible for a subsidy to help with the cost of premiums, especially if your income is now limited.

Depending upon income, you might be eligible for Medi-Cal at no cost.

If you’re facing this unfortunate situation, do remember that you have options, and you don’t have to go without health insurance. Give us a call to discuss those options, and we can walk you through the different choices that might fit your healthcare needs and budget. In the meantime, we’ll keep you updated with any new provisions supplied by the federal or state government as they continue to adopt measures to help those whose employment has been impacted at this time.

Your Medicare Annual Election Period Opens Soon

Each year, Medicare operates their Annual Election period from October 15 through December 7. During this time, you can make changes to your Medicare plan for the following year. Even those of you who have been satisfied with your plans in the past should do four things:

1.Review your out-of-pocket spending for the past year. Is it in line with your budget? Are you satisfied with your expenses or would you prefer to reduce them?

2. Discuss upcoming healthcare needs with your physician. Do you anticipate needing specific procedures in the next year? Are you satisfied with your prescription medications, or would you prefer to try something new? Are you at risk for any conditions for which you should be screened, or might need treatment in the near future? Will your current Medicare plan continue to meet those needs?

3. Read all notices mailed to you from Medicare or your Advantage Plan provider. Even if you have been satisfied with your plan in the past, you can’t assume that it will stay the same forever. Plan administrators can and do make changes from one year to the next, but you might not learn about them unless you read these notices.

4. Discuss your budget, out-of-pocket spending, changes to your plan, and any other concerns with an experienced Medicare agent.

Give us a call, and we can help you determine whether your current plan is still suited for your present and future needs. We will evaluate your spending, compare plans, and investigate whether a different plan might be a better fit for you. We can also discuss various supplemental coverage at this time, depending upon your interest.

Most importantly, remember that plans do change. What worked for you last year might not continue to work in the future.

We will be holding a free virtual workshop on September 2, to help you investigate these issues and answer your questions. If you would like to attend, click this link to sign up. We can help you take the above steps so that you’re ready when the Annual Election Period opens on October 15.

Research Your Medicare Options Before You Move

When you’re planning a move out of state, health insurance issues might not fall at the top of your to-do list. Many people assume that their Medicare insurance plan will transfer to their new state, or that a similar option will be readily available after the move. But due to differences in some Medicare plan offerings, these assumptions are not necessarily true. Here’s what you need to know about Medicare when you’re planning a move.

Moving qualifies you for a Special Enrollment Period. Moving is one of the special circumstances under which you are granted a Special Enrollment Period to change your plan(s).

Those enrolled in Original Medicare Parts A and B probably don’t need to make changes. Original Medicare is not based upon provider networks, so you can use your insurance anywhere that accepts Medicare. So if you’re enrolled in Original Medicare Parts A and B, you can always access medical care anywhere in the United States.

Those enrolled in Medicare Part C (Advantage) or Part D (prescription plans) should research their options. Part C and D plans are based upon provider networks, which can differ from one area to another. Your plan offerings might not be commensurate between states.

You might also prefer to research providers and facilities in your new area of residence, so that you gain an understanding of your care preferences. Then, speak to an insurance professional in that state to learn about your Medicare options. In some cases your current plan(s), or something very similar, might be available in the new state.

If the Advantage plans in your new area do not meet your needs, you can also return to Original Medicare.

Those with Medigap plans might require a change. Sometimes those who are enrolled in Original Medicare plus Medigap can keep their old plans and use them anywhere. However, a type of Medigap policy, called Medicare SELECT plans, are based on provider networks. That plan might include a guaranteed-issue right to enroll in a new plan when you move out of the provider network area.

Talk to your Medicare plan administrator before you move. When notifying a plan administrator prior to a move, the Special Enrollment Period begins the month before the month of the scheduled move, and continues for two months afterward. When you wait until after the move to notify your plan administrator, the Special Enrollment Period begins that month and continues for two months afterward.

Plan ahead to gain more time to weigh your options, and you can transition more smoothly into your new life. When selecting options such as Medicare Part C or Medigap plans, you will also be able to evaluate premium expenses to accommodate your changing budget.

Next Time You Need Healthcare, Try Telemedicine

Getting sick is bad enough, and most of us can identify with the additional pain endured throughout the process of making and attending an appointment with a doctor. Traditional appointments might require us to leave home or work, endure traffic entanglements, obtain childcare or take children with us, and spend significant time waiting. Often the wait is the most difficult part, and we know that sitting in a waiting room exposes us to numerous other illnesses. Telemedicine aims to address all of these obstacles and more.

Technically, telemedicine is nothing new. It’s been around since the 1950s, in its earliest form, when patients learned that office visits were not always necessary. Depending upon the type of care needed, we could always call to speak with our doctor or a nurse over the phone. In many cases a prescription could be issued or advice given, without the need for an in-person appointment. Now we can accomplish those goals, and more, via telemedicine appointments with the added convenience of video calls.

Today, the need for remote access to medical services is more pressing than ever. As we continue to battle the effects of the coronavirus pandemic, most of us would rather avoid crowded and potentially infected waiting rooms! So the next time you need routine medical care, consider the benefits of telemedicine:

  • No need to travel to a healthcare provider’s office
  • No worried about childcare or time away from work
  • Avoid traffic and other hassles
  • Avoid potential contagions in waiting rooms
  • Save time and money (telemedicine is priced lower than traditional office appointments)
  • Faster and more convenient care
  • Often reimbursed by Medicare and Medicaid/Medi-Cal

A telemedicine appointment proceeds very much like any other doctor appointment. After virtually checking you in, a nurse will ask you about symptoms and other concerns you’re having. Based on your answers to these questions, a doctor will probably join the call and review your medication or treatment options. In some cases additional tests will be ordered, and you might offered an appointment for lab work.

Obviously, telemedicine should never be used for emergency situations, and you should call 911 or go directly to an emergency room in the event of a life threatening situation. But for everything else, contact your primary care physician about the option of telemedicine appointments to see if this type of care is right for you.

What to Expect with Health Insurance Premiums in 2021

Each year, we prepare for the possibility of rising health insurance premiums in the following year. Premiums affect not only individual budgets, but also the bottom line for any business that offers a group healthcare plan. Since this is an issue that truly affects all of us, many of you might be wondering how the Covid-19 pandemic will impact health insurance premiums.

Premium changes are based upon projected spending on healthcare services, and that’s exactly where this issue gets tricky. So far, we know of a few things that might impact future rates, such as…

Decreased demand for routine or elective services. With the demand for routine care and elective surgeries currently very low (due to either hospital policies, fear of contracting Covid-19, or a combination of both) insurers are paying out far less for these services. Typically we might expect lower payouts to result in lower premiums for all, except of course for one complicating factor…

Care for Covid-19 patients can be expensive. You might have seen the news reports about one Washington state man, who survived Covid-19 only to confront a hospital bill amounting to over one million dollars. Most Covid patients won’t incur bills quite that large, but hospital care does not come cheap. Insurers are also footing the bill for widespread Covid testing, in an attempt to identify positive patients and slow the spread.

Looking toward the future (and premium rates for 2021), we will keep an eye on a number of factors:

  • Will decreased routine care result in more illness, and therefore more demand for healthcare services?
  • Will treatment options for Covid-19 prove successful and affordable, increasing odds of survival and lowering hospital bills for those patients?
  • Or will those treatments be very expensive to manufacture and distribute?
  • Will a second (or third) wave of Covid-19 result in overloaded hospitals and higher medical bills?
  • As people lose or change jobs, how will this affect health insurance enrollment in both the group and individual marketplaces?

As you can see, these variables are hardly set in stone, and will likely shift over time. We will continue to track the trends with regard to Covid-19, healthcare spending, and likely impacts upon premiums. In the meantime, do contact us if you have questions or concerns, and we can help you to evaluate your health insurance options.


You May Be Getting a Discount on Your Health Insurance Premiums

During these times of uncertainty, many of us are worried about various factors of our lives, from whether schools will reopen in the fall to what will happen to our jobs. So we wanted to take a moment and give you some potential good news: Many health insurance providers are offering credits toward, or grace periods for paying your health insurance premiums.

For many of you, this news will take one worry off of your already full plates. It makes sense from the providers point of view, too. The numbers of elective procedures being performed right now are way down, and consumers are avoiding both emergency rooms and doctor’s offices due to the pandemic. Many of the larger health insurance providers are seeing a 30 percent drop in healthcare usage. Inpatient care is down 30 percent, outpatient care is down 25 percent, and physician services are down 35 percent.

Since claims have dropped precipitously, and knowing that many consumers are experiencing financial strain at this time, many health insurance providers are extending that savings to their members. Depending upon your insurance carrier, the following provisions might be available:

  • An extended grace period to pay your premiums due
  • A credit for previous months’ premiums
  • A discount on upcoming premium payments
  • Suspension of some out-of-pocket charges

You can discover what your particular insurance carrier is offering by calling them, or giving us a call. We’ll be happy to help you navigate these new rules during this time.

One final note of caution: Even though claims for medical services are down now, analysts have predicted a surge in health care (and of course, claims) in the near future. Those who are postponing necessary preventive care could be in greater danger of developing chronic health conditions. While it’s understandable to be worried, do contact your doctor to discuss alternate methods of receiving care (such as telehealth) or to decide which tests and procedures really cannot wait. Budgets are important, but your health is always top priority.



A Potential Coronavirus Tax Credit for Employers

As you continue to grapple with the effects of coronavirus upon our businesses and livelihoods, we hope to bring you encouraging news in the form of various aid packages from the government. One piece of good news is an employee retention provision within the CARES Act, that offers a tax credit to employers who continue paying the health insurance premiums of furloughed employees.

In the unfortunate event that you do need to lay off or furlough employees, you might not be able to continue paying their salaries. But if you do continue to make payments toward their healthcare plan premiums, in absence of any other wages, the IRS will allow you to treat that expense as qualified wages.

In order to qualify for this special treatment, the premiums must have been paid between March 12, 2020 and December 31, 2020 (if the pandemic lasts for longer than expected and the IRS extends this time period, we will be sure to notify you).

Some limitations do apply. The qualified health expenses paid for each employee cannot include amounts that the employee paid with after-tax contributions. If an employee participates in more than one healthcare plan offered by the same employer, the expenses for each plan are aggregated for that employee. The expenses are limited to $10,000 per employee for all calendar quarters of this year.

This is at least a piece of good news during an otherwise difficult time. If you are forced to take the unfortunate step of laying off employees, know that the government is putting provisions into place that should help you continue their small group healthcare plan. Now is no time for anyone to be without health insurance if we can all prevent it. And of course, employees with a valuable health insurance plan are loyal employees.

For more information on this tax credit, give us a call. We can explain more about the CARES Act and how it relates to your healthcare plan.


A Special Enrollment Period for Some California Workers

As of January 1, California law requires all of us to enroll in a healthcare plan or pay a penalty at tax time. So what happens to those workers who had the opportunity to enroll in a small group healthcare plan, but declined for some reason?

Luckily, the law does provide for a Special Enrollment Period for those workers, if they change their minds (for any reason) and want to enroll after all.

Why would someone change their mind? There are a myriad of reasons, but some small business workers decline their group healthcare plan because they are covered under a spouse’s plan.  This decision might be considered if the spouse loses their job, or a divorce occurs.

In other situations, a worker might enroll in Medi-Cal instead, but later lose that coverage. In that case, a 60-day enrollment period will apply.

These are just some of many reasons that an individual might decline healthcare coverage through a small business group plan, but later change their mind.

You don’t need to experience a qualifying life event. This Special Enrollment Period applies to anyone who previously denied coverage under a small group plan, for any reason.

Coverage and premiums will be equivalent to other members of the plan. Benefits must be equal to those offered to earlier enrollees. Late enrollees cannot be charged higher premiums, either.

Pre-existing conditions cannot disqualify anyone from coverage. Under the Affordable Care Act, healthcare coverage cannot be denied to anyone due to a pre-existing condition, assuming they are otherwise eligible for the plan. A general health questionnaire is sometimes used during the enrollment process, but enrollees cannot be required to undergo a physical or submit a full health history. Premiums cannot be based upon health conditions, either.

If you’ve formerly denied healthcare coverage under a small group plan, but have since changed your mind, get in touch with us for more information. Different plans impose different timelines for this Special Enrollment Period, so do act quickly so that coverage can begin soon.





We welcome you to contact us if you need assistance
or to get a policy quote.