All posts by Debbie Sears

Individual U65: Grandfathered/grandmothered (GF/GM) special enrollment events and process

Health Insurance

To follow-up to a Special Enrollment event changes article that was published in the Nov. 22 BBO, an updated special enrollments chart has been published on Producer Connection.

Important changes to guidelines include:

  • Loss of coverage has been changed to only allow previously enrolled dependents back onto the policy.
    • Any dependent over the age of 26 must be a full-time student and unmarried.
  • Birth of a child is only a special enrollment event for the baby being added to the policy.
  • Marriage is only a special enrollment event for the new spouse and new dependents of the spouse.
  • Removing dependents 19–25 is not considered a special enrollment event in which they can move onto their own GF/GM plan.
    • Dependents aging off or dependents who are 26 and older, but no longer a fulltime student, will continue to have SEP rights to move to a like GF/GM policy.
  • Effective date rules will return to the first of the month following the special enrollment event unless the special enrollment period is one that honors the date of the event (i.e. birth).

Please call me with you questions and concerns, I will be happy to assist you.

Better Business Bureau

Health Insurance

I was invited by the BBB to be a guest on KCWI on December 27 and explain to folks where they’re at as far as opportunities for insurance, now that the year end has passed. This is about a 7-minute clip, but hopefully you’ll find it worth your while. Please call or email me if you have any concerns that I can help you with, whether you’re an employer looking out for your employees or an individual under 65.

Are You Medicare-Eligible And Still Employed?

Medicare

If you are Medicare-eligible and still employed (you’ve turned 65 somewhere along the line), the social security administration automatically enrolls you in Medicare Part A.

You continue to be full-time employed, you participate in the Group or Employer health benefit plan and perhaps you opted for the HSA, deferring your Medicare Part B enrollment.

If you further opted to make contributions to an HSA account, you may have gotten yourself in a pickle and could set yourself up for some unexpected HSA tax penalties. The IRS does not distinguish between Medicare Part A and Part B enrollment as being eligible for Medicare. It states, “beginning the first month you are enrolled in Medicare, your contribution limit is zero.” (IRS publication 696, page 6)

Normally, this does not cause a problem because when they get Medicare, their contributions cease, and they take their qualified distributions. But, if an employee does not realize that they’re making ineligible contributions to HSA, this is where things get sticky. You cannot opt out of Medicare Part A. If part of your sound financial play includes you or your spouse taking social security retirement benefits early and you have an HSA account and are working beyond the age of 65 and desire to continue receiving favorable tax benefits by contributing to the HSA.

If you continue to work beyond age 65, my advice would be exercising one of these two options. Do not take social security benefits during the time that you or your employer contribute to your HSA account. This will avoid automatic enrollment in Medicare Part A as well as B when you turn 65. Cease making contributions to your HSA account the month your Medicare Part A begins. Be sure that you instruct your employer to do the same. The whole idea is to help you work with your tax professionals to avoid costly and unnecessary tax penalties.

My Health Insurance Coverage is Ending and I’m Not Medicare Insurance Eligible Yet

Healthcare updates

I am counseling more and more people that are in the position of retiring prior to age 65, exhausting COBRA benefits with their employer and yet not ready/eligible for Medicare.

The big question remains, what should I do/what can I do?

My job is to problem-solve with you. I ask that you tell me your story, explain your needs as best you can, whether that be pharmacy needs, specialty care facilities, etc. And my best help is to put on the table every option that I know of that you could explore.

Let me give you some examples. I have talked to people that had VA benefits that wouldn’t require as much coverage as somebody who would not. I’ve had some folks who have had HSA accounts. People that are part-time employed (but not eligible for employer benefits). I have talked to people that are interested in short-term health insurance options. Others that could not underwrite to short-term that might need another alternative and those who have been self-employed most of their lives, but were placed on an individual contract not knowing all of their options.

So, as you can see, I work with many scenarios. Each family has its own uniqueness and budgets and we show all options and by process of elimination find the best fit for you. Please call me for an appointment.

ACA Affects on Small Businesses

Healthcare updates

If you are a small business owner, it’s important to know how the Affordable Care Act (ACA) affects small businesses. To highlight a few of the responsibilities for the business owner, please note the following:

Required reporting about the marketplace to your employees:

The department of labor (DOL) requires the business owner to make notice of coverage options and facts regarding the health insurance marketplace to the employees. With the ACA, we do have a little bit of overlap and involvement from the Department of Labor and the IRS. Due to the fact that there is a little overlap of the counseling required from any of these points, I always make sure to mention items that I’m fully aware of with the intention of keeping you compliant. This marketplace letter is something that we can give you a sample template of what would go out on your letterhead to your employees. I always encourage you to have a receipt from the employee in your employee files documenting your compliance with this portion of the ACA law.

SEP

Healthcare updates

You may have a special enrollment period (SEP) due to a life event like losing other coverage, getting married or having a baby. If you qualify for this special enrollment period, or anyone in your household has lost coverage in the last 60 days OR expects to lose coverage in the next 60 days, your coverage loses create this open enrollment period when you may make a change to an existing plan, choose a new plan, add people, etc.

Here’s a link for your review from healthcare.gov that provides in depth details about your special enrollment period. Know you can always call me and we’ll go over the details as each person has a different set of circumstances. It would be important to know your options.

 

 

Acronym Number Two OEP

Uncategorized

The open enrollment period (OEP) for Medicare is November 1 – December 15 for 2017. During this timeframe, you may make a change in your Medicare supplement coverage for the upcoming year.

Your health needs may change from year to year, your budget may change from year to year, premiums may also change. This is your opportunity to put yourself in the right position for you for January 1 of the upcoming year. Please call me and I will explain your options to you.

Health Care Insurance Choices – Understand Your Options

Health Insurance

Health Care Insurance Choices – Understand Your Options

We are faced with more confusion, more compliance, fewer choices and higher premiums than ever before. However, I have FREE consultations and 39 years of experience to assist you with understanding your options.

Many individuals are receiving a notice that their insurance will end this year. The individual market choice, presently, will be Medica. Their rates were comparable to the industry trend (high) and have requested a 57% premium increase in an effort to continue.

Governor Reynolds, Senator Grassley, Senator Ernst and State Insurance Commissioner Ommen have requested a Stop Gap measure to help Iowans sustain the collapse of the individual health insurance market in Iowa. The collapse is a result of the failure of the Affordable Care Act. We have experienced unprecedented premium increases and higher out of pocket maximums than ever before.

I’m sharing the verbiage from Wellmark explaining the measure. I use them because they have a 95% market share in Iowa and the information is in an easy to understand format.

What is it?

“The State of Iowa has proposed a one-year emergency program for individuals and families who may not have access to health insurance in 2018.

If approved by the federal government, consumers can expect:

1. One plan for everyone who is eligible
2. Financial assistance for everyone based on age and income
3. The same essential health benefits provided under the Affordable Care Act
4. A reinsurance program covering the high-cost of care for Iowa’s sickest members—keeping costs down for everyone

To put it simply, Iowa’s Stopgap Measure will provide a health insurance option for Iowans in the individual health insurance market.”

A decision from Federal government is not expected until late October. I will keep updates on my website with blogs and newsletters.

The small, midsize and large group markets are still strong. It is possible that you are eligible to be considered for the group market, taking you out of the confusion and uncertainties of the individual market all together. I have worked with many Iowa farmers, Veterans and others that could have benefited from this option all along.

As we enter the fourth quarter the over-65 individual market enters the Medicare annual enrollment period, which runs from October 15 to December 7. Wellmark’s MedicareBlue RX plan has received five stars – the highest possible rating – from the 2015 Centers for Medicare & Medicaid Services (CMS) StarRating system. It is the only prescription drug plan offered in Iowa and South Dakota – and was only one of three plans nationwide – that received the five-star rating representing “excellent performance.” Please visit my website for more details. Call me for an appointment. I’m working with existing clients and their Rx lists to ensure their plan choice for 2018 is best suited for their needs.

I can’t stress enough how important it is to know all of your options. You need an experienced agent more now than ever. How you manage your health care risks and liabilities is essential to you and your family’s financial / asset protection.

If you are a current client, we thank you for your business, the professional confidence you’ve placed in us and generations of referrals. If you haven’t consulted with us before, we welcome you with personalized service.

Happy Thanksgiving to you and your family!

Health Insurance Acronyms

Health Care Reform, Medicare, Part D, RX drug

The AEP (Annual Enrollment Period) takes place each year between October 15 and December 7.

This annual enrollment period was designated by the Centers for Medicare and Medicaid services (CMS) for people to enroll in their Part D prescription drug plans for the upcoming year.

What does this mean to you? You may call me, sign what’s called the “scope of appointment” (SOA) form, giving me permission to discuss your options for Medicare Part D with you. This is the only thing that I will be able to talk to you about in the appointment that we schedule.

However, pharmacy needs change throughout each year. Pharmaceutical products can be reclassified and new drugs enter the market. By having me verify your options per your individual drug list, you can ensure a plan that is a best fit for you for the upcoming year. Please call me for individualized and personal guidance.

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