We have all experienced many changes in the way we do business and our personal lives since the pandemic. Some of the technology that we have always had available to us, we have had to learn and utilize and found some great rewards in doing so. On the other hand, the quarantine came with some big price tags shown in the statics below. Because the insurance companies have properly priced products from the no underwriting provision of the ACA to the unexpected consequences of the pandemic, we are experiencing group and individual renewal rates in the single digits. This is a good time to get a free quote on your existing coverages. If you feel benefit changes should be considered, the numbers will tell you what to do.

These statics are for the individual market segment.

TRENDS IMPACTING THE GRANDFATHERED/ MOTHERED PREMIUM INCREASES

Several factors add to the rate increase, the following are key drivers:
• 6% increase in high-cost claimants — the number of members who have greater than $50,000 in claims increased.
• 16% increase in retail pharmacy costs.
• 47% increase in the costs of dermatology treatment.
• 82% increase in costs for a class of high-cost specialty drugs used to treat serious conditions like cystic and pulmonary fibrosis.

RENEWING GRANDFATHERED/MOTHERED POLICIES

Each year, Wellmark assesses the market and members’ needs to ensure they are offering the best options. For 2022, Wellmark will renew grandfathered and grandmothered plans. Members in these plans can keep the health insurance coverage they trust. They get access to plan designs that are unique and provide broader access and benefits than other plans available on the Marketplace.

TRENDS IMPACTING THE ACA PREMIUM INCREASES

For the ACA membership, the medical services and prescription drugs being used by this population is on an upward trend and include these key drivers:
• 15% increase in the use of professional services, such as physician office visits, psychiatric office visits, and physical therapy.
• 18% increase in high-cost claimants — the number of members who have greater than $50,000 in claims increased.
• 83% increase in the use of mental health services.
• 181% increase in costs for ambulance services.

RENEWING ACA POLICIES

It’s important for Wellmark ACA members to know that these are base rate increases and do not consider members’ subsidies. So, members may have no change or even a decrease after their subsidy is applied. And with recent legislation changes, members may qualify for an even larger subsidy, which would result in a lower monthly premium. We encourage members to go to Healthcare.gov to update their member information.

This is the time of the year that we complete many certifications and prepare for the fourth quarter, the busiest time of the year for the health insurance industry. This is the time of the year that is ideal for you to call me for 2022 planning.

Wellmark small groups ACA (Affordable Care Act) clients will receive communication regarding free COBRA/State Continuation administration services. We also have information to share regarding renewal process updates and COVID-19 expirations/extensions effective 7.1.2021. Some other Health Insurance Headlines include IRS Updates and HSA Contribution Limits for 2022. The Marketplace Extends Special Enrollment and New Tax Credit Eligibility and we can assist with these clients as well.

Please call me for a FREE consultation – 515.285.6766

Employer sponsored benefits play a big role in the lives of their employees and families. The Department of Labor and the Bureau of Labor Statistics has conducted many surveys on the importance of employer sponsored benefits. The pay range for a specific job is relatively easy to determine. This can be broken down by industry and location. The majority of workers are focused on the benefits. Pending which source you access will provide some varying results, but 78% of employees reported that they are more likely to stay with an employer based on the benefit programs being offered. Further statistics indicate that 49% of the employees will look for a new job based on their dissatisfaction or the confusion of the benefits being offered.

Employees that are financially stressed lose three hours a week on money worries. They take an approximate 2 days of sick leave and a loss of an approximate month of productivity.

What do statistics say? Benefits are more important than ever!

BENEFITS CAN…

Attract the most talented employees!

If you want to hire the best employees, then a solid employee benefits package is a great place to start. That’s because everyone else is doing it. Most businesses offer some employee benefits. One study found that 50% of businesses with fewer than 50 employees offer health care benefits, and 96% of businesses with over 100 employees do.

In other words, to be competitive with hiring, you really need employee benefits. Otherwise, you’ll probably lose the best candidates to businesses that offer a benefits package. For many workers, a benefits program can be a deciding factor in choosing where to work. It’s an important part of their overall compensation.

Minimize employee turnaround

A good benefits package can keep your workers from getting swayed by other job offers. The end result is lower employee turnover and higher employee retention for your business.

That means you’ll save money on hiring and training, because you won’t have to do either of those as often. It means you’re less likely to have projects and clients fall through the cracks when employees leave. And it means you can build a knowledgeable team that can quickly and expertly tackle all sorts of problems that would trip up a younger team – all thanks to the employee loyalty you’ve built with benefits.

Keep a healthy workforce

You probably know firsthand that when you feel better, you work better. If you want a more productive employee, benefits – especially health benefits – can help.

For example, if you offer dental insurance, a minor cavity never has to become a complicated root canal that distracts your employee and forces them to take several days off work. The same is true of vision insurance and medical insurance.

Save you money As a small business owner, you appreciate any opportunity to save money, especially when it means keeping your employees happy at the same time. A licensed insurance broker can show you how small group insurance plans affect your bottom line.

Not only may your payments be lower on a per-person basis than if you bought individual coverage on your own, but the money you pay toward employees’ monthly health insurance premiums is typically tax deductible.

Boost morale

Having a good benefits package can improve employee morale, leading to a better workplace overall. After all, providing employee benefits will help to show your employees you care about their personal needs. That, in turn, can improve employee loyalty and satisfaction. They’ll bring their best to work.

Happy, loyal employees will speak highly of your business, making it easier for you to attract talent when you have job openings. And then those new employees will stick around because of your great benefits.

We have children, aging parents and may own businesses. The responsibility to know what you don’t know is on you – we are here; just a phone call away to answer questions and help you navigate the complexity of the insurance world.

We have so much to be thankful for and this year is an up-close reminder as to how fast things can change. We must never take for granted our health, our families and our work and just how our actions impact those around us – in good, and in not so good, ways. Health insurance is ever changing on the federal level. The states and the insurance companies follow the mandates, regulations and compliances that are set out. The consumer on the other hand, needs the assistance of a knowledgeable and seasoned agent for guidance and one who is willing to go the extra mile to service and work with clients.

I have had many folks ask me about the Annual Election Period (AEP, the Open Enrollment Period (OEP), what original Medicare covers, and the question, “what is right for me?” Medicare and Medicaid were signed into law July 30, 1965, by President Lyndon B. Johnson, making this year the 55th birthday of Medicare. There are still folks who do not understand exactly how it works, due to the ever-changing expansions. In 1972, Medicare was expanded to cover disabled persons and individuals with end-stage renal disease (ERSD). In 2003, the Medicare Drug Improvement and Modernization Act (MMA) made the biggest changes in 38 years. This was the start of the Medicare Advantage Plans or what is called “Part C.” “Part D” went into effect in 2006, which is for prescription drugs. In 1997, The Children’s Health Insurance Program (CHIP) was created. All 50 states have CHIP plans and serve over 11 million uninsured American children. In 2010, the Affordable Care Act (ACA) brought the Health Insurance Marketplace to consumers. This law had many years and many layers of provisions.

Original Medicare has two parts; Part A is for hospital. This has no monthly premium, but generally you must cover the first $1,408 of every hospital stay. This deductible changes every calendar year. Part B is for doctor visits, medical testing, and other outpatient services. Most enrollees pay a monthly premium of $144.60, but this is indexed based on your income. Medicare provides free preventive care, including mammograms and prostate screenings. Part D covers most prescription drug costs. This benefit is purchased from private insurers, so enrollees need to shop carefully to see which plan best suits their needs, health situation, and budget. This item is very different from one person to the next – it is based on the pharmacy drug list.

There are items that Medicare does not cover. The last year that data was analyzed, original Medicare beneficiaries spent an average of $5,500 out of pocket on medical and long term care services that the program does not cover. You definitely need an agent that will work with you to identify your needs and work with your budget. This is for financial protection as our health changes – not if, but when. In 1990, Congress enacted a law establishing 10 standard Medigap insurance policies – Plans A through J, with adjustments approved in 2016 and taking effect this year.

Our quoting is FREE whether you are an individual or a business owner. As an independent agency, we shop the various companies and the host of plans that they offer.

Our business is built on trust and referrals from three generations of clients. Thank you to all of our clients for your business and your referrals. Be safe and stay well – Merry Christmas and Happy New Year!

2020 has certainly been a challenge for everyone with COVID-19 affecting every aspect of our homes, families and workplace. As we continue to support our local businesses and their employees to keep our economy functioning, health care insurance is more important than ever. We help our business owners with the issues of trying to keep their employees insured when they fall into part-time or laid-off status. They cannot keep employee benefits if they do not show up on the Employers Quarterly Tax and Wage Report. We assist in transitioning them to a short-term policy or to the Marketplace until they can regain full-time status with employer-sponsored benefits.

Small business owners need to rethink their role concerning employee benefits. It’s very important that these benefits reflect the mission statement, needs, goals, values and budget of the company. An independent agent is your best source for quoting, placement, supplemental benefits, compliance, education and service.

SUPPLEMENTAL BENEFITS – To get the attention of the current employees for the sake of retention and to attract young and eager talent, you must offer more than just health benefits. The competition up the street can easily offer wages within the market range, but take the talent with a more robust offering of benefits. Supplemental benefits can include dental, vision, life, long-term care, accident and disability insurance. A recent study by The Guardian reports that since 2015, the number of small businesses offering access to supplemental health coverage has increased by 30 percent. It is further predicted that this will continue to ride in years to come. Sears Insurance offers all of these products and includes them in the FREE quoting.

PROMOTE WELLNESS – A great place to start is to focus on wellness. It is not just a trendy thought, but is a popular business initiative. More employers than ever before are offering workplace wellness programs and athletic club memberships. It has been proven for many years that a healthy workplace, both physically and mentally, can boost the employee productivity and satisfaction. As a result, the wellness programs can lower the number and the cost of the claims for employers’ health plans and workers’ compensation claims, as employees become healthier.

VIRTUAL CARE – Seeing a doctor can be very inconvenient and very costly from the employee and the employers’ standpoint. If an employee lives outside of the metro and has to drive back and forth for themselves or a child, the time, scheduling, copays, coinsurances, and deductibles really add up. The Wellmark plans have a tremendous online toolkit for employees to access. Doctor On Demand is used by many and I train employers and employees on how to download this on their phones and have it ready in a moment’s notice.

As we approach the third quarter, we will be training and preparing for the Open Enrollment process for over-65 clients. There will be choices that you can make for your Medicare Supplement, Medicare Advantage plan and the Part D Prescription Drug plans. This is also an opportunity for you to look at your current plan if you are already enrolled and change it to something more fitting for your health and your budget if necessary. We will be elaborating more on that in the next issues. I am always available for questions if you want to give me a call.

COMPLIANCE – It can be challenging for businesses to stay up to speed on the changes to federal and state regulations concerning the Affordable Care Act. There are also guidelines, timelines, and eligibility requirements that affect healthcare benefits being offered by companies. We are in our 41st year of business and we have this! We have chosen to be a river and not a reservoir – what I mean by that is that I am here to share with you not only information (which is free compliments of Google), but the experience and knowledge to implement the information… ALL FREE! Please give us a call for an audit of your benefits packages. We can create plans for your consideration, saving you dollars and providing more for your money.

In my 41-year career, I have never witnessed a time that a pandemic had such an impact on our health and our finances as we are living today. These are the two things that we cannot sustain without – our health and our cash flow. There are more people utilizing their health care insurance in these times than ever before. It is very important to know what your options are and exactly what they mean. This, in turn, has financial impacts – the ability to pay the premium and the ability to pay out of your pocket the deductibles and the maximum out-of-pocket medical expenses.

The provider networks are extremely important. Let me explain the difference between a PPO and an HMO. A Preferred Provider Organization (PPO) is a term used in my industry that means you can seek any doctor you choose to see nationwide without a referral. When a medical event happens, you have no idea what you may end up needing or where that may be. It’s sometimes not at a bargain price, but there is a way to temper the costs and have the quality that you and your family deserve.

An example that happened to my husband is my closest testament to the importance of this option. Dan was seeking a second opinion regarding a cancer diagnosis. He chose to go to MD Anderson Cancer Center in Houston, TX on the advice of our dear friend and long-time family physician, Dr. Richard Reel. Because Dan was in a life threatening position, a second opinion outside of Iowa was important. The second opinion was a discovery that no one wants to hear. He was misdiagnosed and this ability to seek a greater level of expertise saved his life. If you have college kids outside of Iowa, think about this. If you travel for a living, know your options. I refer to this option as “the Cadillac.”

A Health Maintenance Organization (HMO) is also ok and could require less premium, but understand that the network of providers is limited. If you do not travel, if you have average health, or if you need a lesser premium, perhaps this is appropriate for your needs. I sell plenty of these, but I take the extra step to “fit” your plan selection to your personal needs and budget.

A High Deductible Health Plan (HDHP) has several advantages. You would typically pay all expenses out of your pocket until you reach the maximum out-of-pocket expense, then you would be covered at 100%. Think of your property or auto insurance – you have to meet your deductible before your insurance company will pay your claim. This is somewhat comparable. This is a good option for people that have above average health, want a typically lower premium and can budget accordingly to be able to meet the demand of the high deductible in a year when you may have a health event. The IRS allows you to set money aside in an account to be used only for the approved expenses and in turn gives a tax deduction each year that you fund the account. I have details on this and all plans if you want to explore these options.

Some small employers have called us concerned about their employees that have been laid off or terminated. We can help with individual choices for those individuals until they seek other employment that provides benefits. We offer a short term plan that is inexpensive and can be carried for up to 36 months. These plans do have some health questions and some exclusions. They are not for everyone, but those that it is a good fit for really enjoy them. Another option is agent-assisted coverage through the Marketplace. This is based on several criteria and the premiums are based on that criteria. The subsidies can be very helpful.

My consultations are FREE and we are an independent agent. We can do your shopping for you rather than be exclusively with one company. That ability combined with a lifetime of experience, gives you the best opportunity for a pleasant experience.