Keeping You in the Know

Health Tips and Information


Health Insurance Affordability Expands in California

Since the Affordable Care Act revamped the health insurance marketplace as we once knew it, legislators have instigated various changes at both the state and federal level in order to keep pace with “growing pains” within the new system. Our marketplace here in California, called Covered California, has received praise for expanding healthcare coverage to millions of Californians who otherwise would not be able to afford a policy.

We have accomplished this goal by offering health insurance subsidies to those in lower income brackets, to help them afford monthly premiums. Subsidies were based upon those provided by the federal government, as described by the ACA.

However, coverage rates still have yet to reach 100 percent, and some middle income Californians were unable to take advantage of the subsidy program. In an effort to extend coverage to even more state residents, our legislature passed the State Individual Mandate and Penalty, which goes into effect on January 1, 2020.

Under the mandate, coverage under an approved healthcare plan is now mandatory, and enforced by a penalty for each uncovered household member. This penalty will amount to $695 per uncovered adult and $347 per child, or 2.5 percent of the household income (whichever is greater).These penalties will be assessed when you file your state tax return, and are paid to the state.

However, the state is also extending subsidies so that more Californians can afford their health insurance premiums.

Now, those who earn up to $75,000 (for individuals) or $150,000 (for a family of four) can also receive a premium subsidy from the state. These income caps are calculated to fall at 600 percent of the federal poverty level. Check with a licensed insurance representative to discover whether your family is eligible, and for a calculation of your estimated subsidy based upon your household income and family size.

Keep in mind that this law is different from the federal Individual Mandate, which has not been overturned, but for which the penalty was set at 0 dollars. Californians don’t have to worry about being doubly penalized for failing to enroll in health insurance. But, with premiums now more affordable for extended income brackets, we expect to see enrollment increase this year.

In order to comply with the new law, make sure to select a health insurance plan during Open Enrollment this year (November 1 through December 15). If you have questions about the state mandate law, or want to learn more about state-provided subsidies for health insurance, please contact our office and we’ll be happy to assist you.



Get Ready for Health Insurance Open Enrollment

As the month of August winds down, we prepare to say goodbye to summer. With Autumn quickly approaching, pumpkin spice lattes are featured in coffee shops, and those of us in the insurance industry get ready for the Open Enrollment season.

If you want to enroll in a health insurance policy for 2020, you need to get ready, too. Yes, we’re a couple of months away from the official opening date, but now is the time to gather medical records, review this year’s expenditures, and consider your insurance needs for the coming year. Take the time to weigh your options, because the right health insurance plan can save you money.

What you need to know about 2020 Open Enrollment…

Open Enrollment for health insurance begins November 1 and lasts through December 15, 2019. Plan and benefit information will be released on October 26, so that you can begin comparing different policies. As long as you enroll on or before December 15, your coverage will take effect on January 1, 2020.

It’s tempting to skip the research and decision-making, and simply opt into the same policy you had in 2019. However, new plan offerings might suit your needs better, so it makes sense to investigate them. If you’ve experienced certain life changes this year, such as marriage, divorce, adding a new child to the family, new health conditions, or a change in financial circumstances (among others), you should definitely take the time to consider this decision carefully.

If you miss the December 15 deadline, in most cases you won’t be able to make changes to your health insurance policy until Open Enrollment 2021. Some exceptions to this rule exist, if you experience a qualifying life event.

As for Medicare recipients…

Medicare’s Annual Election Period begins October 15 and lasts through December 7, 2019. If any changes have been made to your current plan, you will receive a notice in the mail. You can choose to allow your plan to automatically renew; however, in many cases it does pay to review your options.

If you need assistance with either health insurance enrollment or Medicare’s election period, please give us a call. We can help you identify your needs and then match you with a policy that suits you.


7 Things to Consider for 2020 Benefits Planning

As you plan for next year’s group benefits, you will juggle a variety of compliance issues, contribution strategies, benefit offerings, communications, and more. This guide should help you to plan around top priorities.

Health savings accounts (HSAs) or health reimbursement accounts (HRAs). Determine whether you might be eligible to participate in either of these programs, which can help you employees manage out-of-pocket healthcare expenses. Update plan documents to account for new savings limits. Two new types of HRAs are available (individual -coverage HRAs or excepted benefit HRAs); investigate whether one of these plans might be a better fit for your needs.

Review plans for compliance. The Mental Health Parity and Addiction Equity Act (MHPAEA) sets forth new guidelines with regard to mental health coverage. Prepare, also, for compliance issues regarding the Employee Retirement Income Security Act (ERISA) and disclosure requirements.

Wellness programs.  The Equal Employment Opportunity Commission’s (EEOC)’s incentive limit rules were lifted, which might trigger the need for benefit design changes.  Wellness plans must also comply with HIPAA rules, the Americans with Disabilities Act (ADA),and the Genetic Information Nondiscrimination Act.

Paid leave. Assess your needs for paid sick, disability, or family leave programs. Check for new state and local mandates with regard to these benefits.

Prescription drug coverage. Monitor changes at the federal and state levels, regarding the prices of prescription drugs. Evaluate the impact on your prescription drug benefits, and reassess plans as needed.

Preventive services. Modify preventive care benefits for the 2020 plan year to include the latest recommendations from the CDC, Affordable Care Act, Health Services and Resources Administration (HRSA) and the US Preventive Services Task Force (USPSTF). Revise benefit plans with regard to HIV prevention, cervical cancer, osteoporosis, skin cancer, obesity, alcohol use, perinatal depression, and vitamin D supplementation in older adults. Employers with moral or religious objections to contraception should monitor developing court cases. Plan documents, summary plan descriptions (SPDs), summaries of benefits and coverage (SBCs) and other materials must be updated to reflect changes in preventive care.

Data security. Evaluate all tech vendors, wellness tools, mobile apps, and artificial intelligence for HIPAA and data protection compliance.

If you need help evaluating your 2020 benefits plan, or have questions about compliance issues, please contact us. We can help you determine where changes should be made, and assist in making those changes with regard to current laws and professional standards.

Statewide Individual Mandate Now Applies to Most Californians

Beginning in 2019, the federal Individual Mandate that requires most Americans to enroll in a health insurance plan will be effectively voided. Stumped by their inability to simply overturn the law, lawmakers who authored the Tax Cuts and Jobs Act set the penalty at zero dollars instead. However, many state legislatures have responded by drafting their own individual mandate laws. With the passage of the Minimum Essential Coverage Individual Mandate, California will now impose a requirement for most state residents to enroll in a qualified health insurance plan. 

Right now, about 93 percent of our state’s residents are covered by a health insurance plan. The Individual Mandate law aims to improve upon that number, and achieve nearly 100 percent enrollment. Some exceptions to the law do exist, such as those for financial hardship and religious belief (as defined by Covered California). The law does expand upon current subsidy provisions, to help more Californians afford their coverage.

Currently, those stipends are available to individuals whose income falls between 100 and 400 percent of the federal poverty level. The new law raises the income limit to 600 percent of the poverty level, offering even more assistance to state residents.

The law also allows for more undocumented residents to enroll in Medi-Cal, by raising the age limit for eligibility from 18 to 26.

Beginning on January 1, 2020, all Californians (and their spouses and children) will be required to maintain enrollment in a qualified health insurance plan for each month of the year. Failure to comply with the law will result in a Shared Responsibility Penalty, imposed by the Franchise Tax Board. The exact amount of this penalty is yet to be determined.

,We expect to see a ripple effect upon other health insurance requirements. Already, the reporting requirements under Internal Revenue Code 6055 have been expanded, so that insurance companies and businesses which provide group health insurance plans must provide proof of coverage to the Franchise Tax Board each year. Those that do not fulfill this requirement will be subject to a penalty.

As the effects of the new law continue to ripple outward, we will keep you updated on new policies and procedures that might affect you. In the meantime, please contact us if you have any questions. Enrollment will open later this year, and at that time we can walk you through the requirements to help ensure that you are in compliance with the law.



Preparing For the Cost of Healthcare in Retirement

For many people, a mortgage payment is our largest monthly expense. So it might surprise you to learn that in retirement, that can change dramatically. In many cases, healthcare is the number one expense faced by retirees. And since your health can change at any time, so can your budget.

That’s why retirement planning should always account for the cost of healthcare, and the various risks associated with medical bills. According to the Center for Retirement Research at Boston College, the average retiree spends $4,300 annually on out-of-pocket healthcare costs. That’s because, contrary to common belief, Medicare does not cover everything you might need. You’re still subject to co-pays, deductibles, the cost of some prescriptions and equipment, and so on. And, that figure does not include the cost of long-term nursing care, which can cost several thousand per month. 

Are you surprised by these facts? Most people are, and that’s why it’s important to prepare for the cost of healthcare before retirement, rather than risking an unpleasant surprise later.

Your Medicare options. Medicare is actually divided into different parts, and it’s important to understand them and their coverage limits. Medicare Part A covers hospital bills, whereas Part B is used for doctor visits and preventive care. Most people won’t pay for Part A (assuming they worked and paid Medicare taxes for at least ten years) but they will be subject to a deductible for hospital services. Right now that deductible is $1,364 per benefit period (from the time you enter the hospital to 60 days afterward).

Part B currently charges a standard premium of $135 per month, although it can be higher for those with higher incomes. You will be subject to a deductible of $185 per year.

Neither of these Medicare plans cover prescription drugs, so you might wish to enroll in Part D for that (for a premium, of course).

Want it all? Medicare Part C, also known as a Medicare Advantage Plan, includes Parts A and B. Many plans also include Part D coverage. You will pay one monthly premium for an Advantage plan, that is typically higher than you’d pay for those plans separately, but these plans are designed to lower other out-of-pocket costs.

Dental and vision coverage. But wait! Medicare doesn’t pay for routine dental and vision care, so you will need to plan for those expenses, too. Everyone needs dental, of course, and even those with perfect vision find that their situation changes past age 65 or so.

Long-term care. Finally, because Medicare pays for only a very limited amount of long-term nursing care, you will be responsible for that expense should you ever need it. Long-term care insurance is one option, or you can establish a retirement budget that accommodates that monthly bill.

For more information on the different Medicare options available to you, please give us a call. We can help you run the numbers and decide which Medicare plan is a good fit for your budget.

New Legislation Provides a Unique Way for Employers to Offer Health Insurance

Two Problems: Millions of workers in the United States lack health insurance coverage, often because their employers don’t offer it.

Hundreds of thousands of businesses, mostly smaller ones, would like to offer healthcare benefits to employees but can’t because of the high cost and/or lack of options.

What would you say if we told you that new legislation could provide an answers for both of these issues?

The Potential Solution: On June 13, 2019,  the departments of Labor, the Treasury, and Health and Human Services released news of a new rule, allowing employers of all sizes to offer ICRHA (Individual Coverage Health Reimbursement Arrangement). Under this type of plan, employers can contribute funds to a Health Reimbursement Arrangement, while enjoying certain tax benefits. Employees can then use the funds within these accounts to purchase their own health insurance plans, including those offered on state exchanges formed by the Affordable Care Act (or the federal exchange, where state exchanges are not available).

Benefits for employers. Once the new rules go into effect, it is estimated that 800,000 employers will offer this form of healthcare coverage to more than 11 millions workers and their families. Most of those employers will be those with 20 or fewer workers, allowing small companies to better compete in the labor market.

Benefits for employees. The ICRHA policy will allow employees to shop around and select their own health insurance plan. Workers and their families will attain greater control over their healthcare plan options, by selecting a provider and plan that suit their specific needs.

Tax benefits. With an HRA, employers contribute pre-tax dollars to a fund, which can then be used for healthcare expenses. Until now, those funds extended only to expenses uncovered by a health insurance plan. Now, under the new rule, those funds can be used to pay for health insurance premiums if the employee purchases their own plan.

An HRA differs from an HSA (Health Savings Account), in that HSA funds stay with the employee when employment status changes. With an HRA, unused funds go back to the employer in the event the worker is fired, laid off, or quits.

This new provision is exciting, as it potentially allows for millions of uncovered Americans to gain health insurance. Meanwhile, it also benefits employers (particularly smaller companies). But of course, the new ICHRA rules are complex and require the guidance of an insurance professional. Give us a call to learn more, and we will show you the numerous ways in which ICHRA can benefit both your company and your employees.



Guiding Your Medicare-Eligible Employees

Because eligibility begins at age 65, we tend to think of Medicare as health insurance for retirees. But because plenty of people are still working when they reach their 65’th birthdays, that isn’t exactly true. Medicare also covers workers who have reached this milestone, even if they are already covered by a group health insurance plan. So, you might be wondering what exactly to tell your older workers about Medicare…

Yes, they do need to enroll. As long as they (or their spouse if married) have worked at least ten years and paid taxes into the system, all workers are eligible for premium-free Medicare Part A. Your employees might also be interested in Part B or D (prescription drug coverage) for a premium.

Yes, they can have Medicare along with another healthcare plan. For those who work for smaller companies, Medicare will become the primary plan and group health benefits will provide secondary coverage. Those workers will usually enroll in both Part A and Part B, since Medicare is their primary coverage.

For those employed by larger companies, their group healthcare plan remains primary with Medicare providing secondary coverage.

In most cases, having these two forms of insurance will mean lower out-of-pocket costs for the Medicare-eligible employee.

They can delay Parts B and D. For retirees, failing to enroll in Parts B or D at age 65 can result in higher premiums later if they change their minds. However, those who are still working at age 65, and covered by a group health insurance plan, can delay enrollment in Parts B and D without incurring a penalty. They just need to provide confirmation of coverage by an employer.

They must remember the deadline. Medicare will only remind your employees of the deadline if they are receiving Social Security or Railroad Retirement Board benefits, so in most cases this means the responsibility for remembering the deadline falls upon the individual. Remind older workers that they can enroll in Medicare beginning three months before their 65’th birthdays. That initial enrollment period lasts for three months afterward as well.

If you have questions about Medicare enrollment, and how those benefits work alongside a group health insurance plan, please give us a call. We can explain the rules in more detail, so that you can communicate accurate information to your employees.


Envisioning Greater Benefits for Your Employees

A quality health insurance plan is often cited as the most valuable benefit you can offer to your employees. But what happens if that healthcare plan doesn’t cover absolutely every service they want or need? Most employees appreciate the opportunity to choose from a menu of add-on benefits, to help close any gaps in coverage.

Since health insurance plans rarely cover eye exams, glasses, or contact lenses for adults, optional vision insurance can add value to your group health benefits plan. You can establish the plan as an add-on option, at no extra cost to you, while still allowing your employees to access a vision care plan at a desirable group rate.

The value of vision insurance. Health insurance plans do offer eye exams for minors under age 19, but this coverage doesn’t apply to your employee, their spouse, or children over age 19 who have decided to stay on their parents’ insurance plan. A vision care plan can close this gap, and make annual eye exams, glasses, and contact lenses more affordable for the family.

Eye exams are necessary for everyone. It is commonly believed that some people have eye troubles, while the rest of us don’t, and that this situation becomes permanent at some point during late childhood or early adulthood. That actually isn’t true! Adults can develop vision problems, particularly far sightedness or astigmatism, at any time. In fact, this is becoming more common as we all spend more time in front of computer and phone screens. Other eye health problems can develop over time, too, and affect anyone.

Added “insurance” for health. As for those other health problems, conditions like glaucoma and macular degeneration can impact adults regardless of a lifetime of perfect vision. Therefore, we all need to attend regular vision screenings, particularly as we get older, so that we can seek early treatment. And believe it or not, optometrists and ophthalmologists are often the first to notice signs of health conditions such as diabetes, high cholesterol, high blood pressure, and even brain tumors. Attending annual vision screenings is yet another way to detect potential health problems early.

Safety matters. Since vision impacts workplace safety, offering optional vision insurance to your employees can benefit you, too. Fewer workplace accidents means greater productivity and possibly even savings on various liabilities.

To learn more about vision insurance, give us a call. We will discuss how you can add this valuable benefit to your menu of options, at a great rate for your employees.



Keeping an Eye on the Measles Outbreak

Lately, it might seem as though everywhere you turn, news outlets and social media posts remind you of the recent measles outbreak. If you’re feeling concerned about the illness, or your chances of catching it, hopefully we can offer some reassurance.

Why is this year’s measles outbreak such a big deal? Contrary to common belief, measles has never been completely eradicated in this country. Even in the year 2000, the year measles was declared “eradicated” in the United States, the CDC recorded 86 cases. Every year since, outbreaks of the virus have ranged from 37 cases (in 2004) to 667 cases (in 2014).

According to the CDC, more than 700 measles cases have been reported in the United States in 2019.

This year’s outbreak seems like a big deal because it is the largest we’ve seen in 25 years. However, keeping in mind that our population totals more than 327 million, your odds of contracting measles are still quite low.

Protecting yourself from measles. It’s important to remember that in developed nations, measles patients require hospitalization in about 7 of 1,000 cases. Due to proper nutrition and access to healthcare, only rarely does measles contribute to death (about 1 in 10,000 cases in the United States). But because even mild viral illnesses can cause inconvenience, and occasionally more serious symptoms (mostly in the immunocompromised), you probably want to avoid contracting the measles.

Take care to wash your hands regularly, especially in public places, and boost your immune system by eating a healthy diet. In fact, because the majority of more serious measles cases result from depleted vitamin A in the body, consuming foods high in vitamin A can confer a protective effect.

How would you know if you contract measles? About 10 to 14 days after exposure, you might notice symptoms such as:

  • Fever
  • Runny nose
  • Dry cough
  • Sore throat
  • Conjunctivitis (inflammation in the eyes)
  • A flat, blotchy red rash that begins on the face and gradually spreads to the rest of the body

Avoid spreading measles to others. Given the overall low prevalence of measles in the United States, symptoms such as a fever, runny nose, and sore throat are much more likely to signal a run-of-the-mill sinus infection. But if you know or suspect that you were recently exposed to measles, then you should see your doctor for testing. Wearing a surgical mask in the waiting room can help protect those around you.

If you do test positive for measles, your doctor will advise you on your next steps. In most cases, treatment with vitamin A and plenty of rest will have you feeling better in about a week.

In the meantime, since you might be contagious, stay away from crowded places and avoid contact with young children or anyone who has a compromised immune system.


Helping Your Employees Navigate Their Benefits

We all know that employee benefits packages help business owners to recruit the best workers, while also contributing to worker satisfaction and retention. But there is a big difference between offering valuable benefits, and employee usage and appreciation of them. If your workers aren’t well versed in the options available to them, and aren’t selecting the benefit options that are best suited for their situations, then they aren’t reaping the full value of those benefits… And neither are you.

That’s why communication between HR departments and employees can be so critical. In order to help your employees understand their group benefits and select the best options for their situations, take the following steps.

Provide expertise. Does your HR department or provider give employees access to the information they need, in order to make informed decisions? Are they accessible by phone, email, or appointment? Are written materials, pamphlets, etc clear, and do they accurately give necessary information on benefits without added clutter?

Help employees ask the right questions. Sometimes employees are so unfamiliar with their own benefits, that they don’t even know which questions to ask! Then they make benefit selections based on what appears the easiest, or they simply continue with last year’s choices.  Encourage them to ask the right questions, such as:

  • Are my favorite doctors and facilities in-network?
  • Has the benefit plan administrator, or insurance carrier, changed?
  • Are alternative medical practitioners covered?
  • Has prescription drug coverage changed?
  • Are there any new benefit options that weren’t available last year?
  • Are there any voluntary benefits I should know about?
  • Do we have a wellness program or incentives?
  • How can I learn more about my benefit options?

Streamline the enrollment process. If you haven’t already, elect an online benefits software program that employees can access at their leisure. This will allow them full access to benefits information, and make the enrollment period more convenient for everyone.

Continue to reach out to employees throughout the year. The conversation regarding benefits should be an ongoing one, throughout the year. Regularly issue reminders about topics such as:

  • Using flex spending account funds before the year ends
  • Formulary changes (for prescription drug changes) and the opportunity to save money by using generic drugs
  • Information on voluntary benefits programs, like wellness programs and additional insurance options
  • Updates on retirement savings options, such as updates on employer matching funds, all required notices, the summary annual report, or information on taking advantage of income tax benefits

These ideas should get you started, but give us a call for more information on communicating employee benefits. We can help you ensure that your employees (and you) reap the maximum amount of satisfaction from your group benefits package.



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