Health Insurance

New IRS guidelines for employees’ family members to receive health insurance premium assistance

Posted on by McGriff Williams in Health Insurance, Human Resources |

Editor’s note: This post was originally published in October 2022, when the IRS finalized this rule. Rules can change, so check HealthCare.gov or call us at (352) 371-7977 for current details.

The state of the health insurance market is constantly changing and those that are business owners or group plan administrators have seen how difficult it can be to keep up and remain compliant. We are committed to helping everyone stay informed to take good care of their employees. Most recently, as of October 11th, there were new guidelines released from the Internal Revenue Service (IRS) regarding premium tax credits for individuals that may not be the right fit on an employer-provided group health plan.

This change is intended to fix the so-called family glitch by extending marketplace subsidies to an employee’s household members that may not have been eligible before. In the past, eligibility was determined by whether or not the premium for single group medical coverage offered to an employee was affordable. Now, it is based on whether the premium for a FAMILY group medical coverage is affordable. For example, if the family plan offered by the employer to an employee is not affordable for them, their spouse and children may be eligible to receive a subsidy and the employee can remain on the group plan.

Subsidies are determined by the Marketplace, established by the Affordable Care Act, and are based on total household income. The plans, as far as coverage, remain the same but the premium may be discounted in tiers depending on their income level. This is reevaluated every year based on their projected income and tax filings.

So what does this mean for an employer? It doesn’t change anything for the group plan administration but it does provide another option for employees’ family members to obtain health care coverage that they can afford. Because this new regulation is focused on the family members of employees, it does not change anything with mandates for large employers to offer coverage to employees or their family.

If you are an employer that offers health insurance benefits, we recommend sharing this information with your team. We are happy to help guide them through the individual health insurance market, should they choose to pursue it for their spouse and/or children. Here is a copy of this new regulation if you’re interested in reading more.

 

A little homework assignment before filling your next prescription

Posted on by McGriff Williams in Health Insurance, McGriff-Williams News |

Health care is a hot topic of conversation lately in politics since the Affordable Care Act and now numerous methods of reform are being discussed. But also with regard to the economy since the cost of care seems astronomical lately. Many argue that one of the drivers behind a lot of that cost increase is prescription drugs.

According to data analyzed by 3 Axis Advisors (a health care research firm), retail prices for 460 prescription drugs are increasing by an average of 5.2% in 2020 – more than double the projected rate of inflation for the year. Many manufacturers are raising the prices on existing drugs as well, so it isn’t just new therapies being introduced.

While patients typically don’t have a say in the diagnosis or treatment plans they receive from medical professionals, they do have a choice (and a right) to look into where they get prescription medications from. You, as the patient, owe it to yourself to do a little bit of research and get your drugs at the lowest cost possible to you.

Here are a few ideas to explore so you can be sure you’re doing all that you can as an advocate for yourself:

– Sourcing for lower cost – A common misconception is that one drug will cost the same regardless of where you have the prescription filled Publix, CVS, Walgreens, Winn Dixie, etc. There are tools such as GoodRx that allow you to search specific drug names and find the cost at different retailers in your area.

– Coupons – There are websites online, the manufacturer itself, and retailer coupons that can provide significant savings. Some pharmacists will check for coupons on your behalf but not always.

– Websites such as Drug Store Unlimited that get drugs from other countries can also save money.

– Patient assistance programs – Ask your doctor about programs available in your area that may offer advice and guidance, more so with Medicare but also for individual health plans.

Just a few minutes of your time before you fill your next prescription could be very beneficial to you.

 

Why We Want to High Five You at 64.5!

Posted on by McGriff Williams in Health Insurance, Medicare |

Medicare has been so closely associated with the age of 65 for so long now that many people think they can wait until they actually turn 65 to address their health insurance needs and begin that transition. With regard to eligibility and actually enrolling in Medicare, that’s perfectly fine since you have a 7 month window surrounding your 65th birthday to do so. However, there are several things to consider as you approach 65 that make it really beneficial to do your research and get things moving in that direction in advance. This being said, we encourage that you start this process at 64.5.

We do not offer every plan available in your area. Currently we represent 1–2 organizations which offer 4–8 products in your area, depending on your county. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

If you are still working, there are things to consider such as comparing your employer provided group coverage to that of Medicare for both coverage and cost. Another important factor is if you are contributing to an HSA, you must stop at least 6 months before going on Medicare for tax purposes. Also, if you currently have a spouse and/or family members on your plan that will need to come off, you’ll want some time to quote that and make arrangements financially as it can be much more costly than what you’ve been used to.

Whether you are working with a financial advisor or not, you will want to plan for Medicare financially and weigh out your options. Gathering all of the information on Advantage plans vs Supplements and those cost differences will help you decide what aligns with your budget. There are also many prescription drug plans you can shop in order to make the right decision for you.

All of this can take time and there is no need to wait, which will only add more stress to an already somewhat overwhelming process. Give us a call at (352) 371-7977 and we’ll walk you through the steps we advise taking at that time. And of course, we’re always ready and willing to hand out some high fives for being on top of your Medicare at 64.5!

For official Medicare information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

 

What if I lost my job and health insurance and don’t know when I’ll be employed again?

Posted on by McGriff Williams in Health Insurance |

If you lose your job and the health benefits that came with it, you have options. The following information is from HealthCare.gov:

– If you lost your job-based health plan: You may qualify for a Special Enrollment Period if you lost health coverage through your employer or the employer of a family member in the past 60 days OR you expect to lose coverage in the next 60 days, including if you lose health coverage through a parent or guardian because you’re no longer a dependent. Note: Losing coverage you have as a dependent doesn’t qualify you for a Special Enrollment Period if you voluntarily drop the coverage. You also don’t qualify if you or your family member loses coverage because you don’t pay your premium.

– If your employer reduced the hours you work and you’re enrolled in a Marketplace plan: Update your application immediately within 30 days to report any household income changes. You may qualify for more savings than you’re getting now.

– If you were furloughed: In some situations depending on the status of your health coverage from your employer, you may qualify for a Special Enrollment Period. You may be eligible for a premium tax credit to help pay for Marketplace coverage too.

– If you have COBRA continuation coverage:

– If you’re entitled to COBRA continuation coverage after you lost your job-based coverage, you may still qualify for a Special Enrollment Period due to loss of coverage. You have 60 days after your loss of pre-COBRA job-based coverage to enroll in Marketplace coverage. You may also qualify for premium tax credits if you end your COBRA continuation coverage.
– If you’re enrolled in COBRA continuation coverage, you may qualify for a Special Enrollment Period if your COBRA continuation coverage costs change because your former employer stopped contributing, so you have to pay full cost.

– If you lost your job, but didn’t also lose health coverage, because your former job didn’t offer coverage: You generally won’t qualify for a Special Enrollment Period. By itself, a job loss (or a change in income) doesn’t make you eligible for a Special Enrollment Period to enroll in Marketplace coverage It’s the loss of coverage that does.

If you don’t qualify for a Special Enrollment Period, Open Enrollment for 2027 Marketplace plans runs November 1, 2026 to January 15, 2027 (enroll by December 15, 2026 for coverage starting January 1). Questions? Call us at (352) 371-7977.

 

COBRA and Medicare… Oil and vinegar or two peas in a pod?

Posted on by McGriff Williams in Blog, Health Insurance, Medicare |

There are lots of things that are consistent when it comes to Medicare. It runs very smoothly, is a pretty well-oiled machine, and policy holders are overall very pleased. But we also see a lot of uncertainty or overwhelm when trying to fully understand it all. It can be intimidating with the regulations and guidelines to follow that could result in financial penalties if not abided by appropriately. But it doesn’t have to be scary or stressful. That’s what we’re here for.

We do not offer every plan available in your area. Currently we represent 1–2 organizations which offer 4–8 products in your area, depending on your county. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

One of the areas that can seem confusing is when people are approaching age 65 (Medicare eligible) and planning to no longer work. There are options to select COBRA coverage, essentially extending the employer’s group coverage, or enroll in Medicare. Here, we’ll break this down as simply as possible to provide a little guidance.

First, let’s be sure we’re on the same page with what exactly COBRA is. COBRA (Consolidated Omnibus Budget Reconciliation Act) gives employees the right to choose a continuation of the previous employer’s group health plan for a limited time. Usually, that time frame is 18 months but may be extended up to 36 months in some situations. There may be some instances where the coverage changes slightly and the premium is usually a little higher than it was for an active employee prior to retirement, up to 102% of the cost of the plan. Employers with 20 or more full time equivalent employees are generally required to offer COBRA. Spouses can also be eligible for COBRA if:

– The covered employee either voluntarily or involuntarily leaves the job
– The covered employee’s number of hours are decreased making them ineligible for benefits
– The covered employee becomes eligible for Medicare
– Divorce or legal separation from the covered employee
– Death of the covered employee

A commonly used term when entering the Medicare world is creditable coverage. This is referring to coverage outside of Medicare being qualified to take the place of Medicare so that there are no late enrollment penalties if you don’t enroll on time. Creditable also means that the coverage is expected to pay on average as much as the Medicare coverage would. COBRA is NOT considered creditable for Part B of Medicare. Only active employer group coverage for an employee still working would suffice for that. Regarding Part D prescription drug coverage, it is plan specific whether or not it’s creditable.

Real life example: Bill decides to retire right at age 65. He’s been on his employer’s group plan for 25 years. He can elect COBRA to keep that plan but also needs to enroll in Medicare, now that he’s eligible. Medicare would then become his primary. If he didn’t enroll in Medicare and stayed just on COBRA, he could face a substantial gap in coverage. Let’s say he sees a doctor, they bill Medicare A&B for the standard 80% payment but he doesn’t have any Medicare. So then they bill COBRA, who could pay just 20% of the total cost or possible nothing at all, since they’re secondary with him being 65+ now and he technically doesn’t have any primary coverage. Bill could now be stuck with a bill (see what we did there?) for 80-100% being his responsibility to pay out of pocket. So, Bill, lesson learned what he should have done is upon retirement, enroll in Parts A&B as soon as he stopped working and then compared his COBRA coverage and premium to that of a supplement or advantage plan to decide on the right secondary coverage.

A few things to consider if you’re going to stop working or are 65+ with COBRA:

– What are the options for your spouse or family?
– Is your employer’s COBRA coverage creditable for Medicare?
– What is the cost of COBRA vs a Medicare supplement or advantage plan?
– You have 8 months from when you stop working to enroll in Parts A&B without penalty

It may seem like a lot but this is a big transition from working to not, so don’t take it lightly. We can help work through the details and relieve some of the stress. The positive part of it all is that there are options for care and you get to pick the right fit for you. Call us at (352) 371-7977.

For official Medicare information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.