Under the Affordable Care Act, annual wellness exams are covered at 100%. I always encourage folks to take advantage of this “freebie”. These exams include your diagnostics and screenings appropriate for age and gender as well. If you have these done, perhaps in August, and the whole family does this, then every August, everybody has done their health due diligence. An advantage that you may be able to get a double play on, is that exam would be comprehensive enough, it may fill the request of the school for sports participation.
Recently, Wellmark filed their proposed rate increases for individual and family plans with the Iowa Insurance Division. Less than 4% of Wellmark’s total business in Iowa are these individual and family plans. Their proposed rate increase is broken down over 4 categories per the department’s guidelines with an average increase across the four of a consistent 12%. In spite of the fact, we didn’t get a 12% pay increase.
This is still a good option compared to what else you have to choose from. If you would like me to lay out all your options so you can go home and consider and make your choices, accordingly, please know I’m here. Give me a call.
Wellmark Blue Cross and Blue Shield of Iowa and South Dakota will require individuals to answer health questions if moving to MedicareBlue Supplement SM Plan G from another MedicareBlue SupplementPplan with an effective date of September 1, 2019, and later. So, for any Plan G applications with a September 1, 2019 effective date, signature dates on or after August 1, 2019, will require health underwriting for anyone who is outside of their initial enrollment period or does not have a guaranteed issue right.
The decision to include health underwriting will help keep
Plan F and Plan G viable plan options in the future. It will also help members
receive stable and predictable premiums – something members know they can count
on with Wellmark Blue Cross and Blue Shield.
Please contact me with any questions you may have.
If you have a Medicare eligible employee, whether it be the employee or the spouse of an employee still on your plan, you may not want to go down that road.
There are advantages for the employer and for the individual to consider Parts A & B of Medicare and Medicare Supplement and an RX plan. On the employer side, they undoubtedly would be the highest premium person on the group. On the individual side, the family with the Medicare eligible person, if they chose to go the Medicare route, would have the Medicare premium, other social security, the premium for the Medicare supplement, the premium for the RX plan which is usually less than their portion of what the employer is paying.
If my premium is $800/month and my employer is paying 50%, if I’m the employee (spouse of the employee), they’re paying nothing, as opposed to ballpark, $200 – $300/month. The cash flow differences are more favorable on the Medicare route. The benefits difference would be, there is no network of providers I need to adhere to on Medicare, there’s no deductibles, co-pays, co-insurances or maximum out of pockets on the Parts A & B coverage of Medicare and Medicare supplement, so I just had a win-win here on premium and benefits as opposed to staying on the employer group. The employer just saved $800/month premium or $9,600/year, if I was the spouse or half of that if I was the employee.
On the Medicare supplement that I would recommend, Plan F will not be available starting January 2020. Other plans are out there, they are fine, but Plan F is King. If you have a Plan F purchased prior to January 1, 2020, it will be grandfathered in and you will be able to keep it indefinitely. This is a huge win for families and an obvious no-brainer for the employer. We are working on several as I speak, because I am constantly auditing the status of employees on each employer group I represent. Quoting and consulting is free at Sears Insurance, please give me a call.
Quoting is free and it pays benefits. I have never charged for my quoting and my consultation fees because my main goal is to help people. This has put me in a position where we are a 100% referral-based independent health and life insurance agency in my 41st year. Why I’m telling you this is the following:
Two cases that I worked recently I would like to use as case studies/ examples for your consideration.
I asked for the opportunity to quote a young, very successful attorney with a payroll of about 20 people plus spouses and children. He informed me that he was pleasantly working with a fraternity brother and had been for many years. He wanted me to know up front that this probably wasn’t going to be in my best interest from a time investment perspective, but, sure, I’ll let you quote. At the end of the day, I brought him back two different companies and about 24 plans to consider. If I’d matched out very closely the benefits he currently has with what I propose that he do, he had a premium savings of $72,000 per year. He about fainted! He also learned that his existing plan with his existing insurance company had a renewal of only 6%, which is excellent. His billing and his census were checked multiple times by both he and myself to be sure we had not overlooked anything. If I was writing him with his same company and his identical plan, my quote would have been cheaper than his renewal. Needless to say, a board meeting is scheduled.
The second case is a non-profit. I was called in to a non-profit that had lost a sizeable grant. So, what they were doing: How can we trim some overhead and what do we need to do to ramp up income. My role here was to see if I could save them money on their benefits for their employees. Current status is, their employees are not their employees, they are employees of a large “employer group” and this non-profit leases their employees back. This happens a lot. As a W-2 employee of this employer group, I have every kind of benefit I can imagine. The non-profit has payroll services, COBRA administration and HR support for a price of $600 per month in fees. My scenario saved $17,000 on the health insurance alone, and did I mention 6 employees? We disbanded the employer group, that was another $7,200 per year, putting us at $24K+ in savings per year. We had a well-respected CPA get us set up on payroll, and the maintenance of that would be handled by a fiduciary that works with non-profits at a rate of $120 per month rather than $600 per month. This was put in place in less than two weeks.
To help you be a better consumer and custodian of your own money, I’d like to share with you how to “plan smart”. You can shop and compare for quality care easier than ever before. I strongly encourage you to download the myWellmark app so it’s handy when the unexpected need arises.
You’ll be able to make informed, cost and quality decisions because not all doctors and not all costs are the same. You not only will be able to check the quality and the pricing, but you’re also going to learn how or what your out of pocket costs could be. Again, here’s a link to the details.
Most of the weddings, dance recitals and picnics may have all happened and it’s time for family vacations before school starts again. I’ve got some valuable information to share from Wellmark Blue Magazine that would help you better know your coverage, your benefits and how to manage your costs particularly while traveling. I want you to be able to get the information you need wherever you happen to be quickly and efficiently.
Always carry your current Wellmark ID card or download it. Know that you’ve got Doctor on Demand as part of your coverage with us and please know that Wellmark has a free information hotline day or night for advice based on your symptoms and recommendations for your care. Here’s a link to Wellmark on the road for your convenience. Have fun, be safe!
There’s a new game in town, commonly known as “concierge medicine”.
It’s also referred to as “retainer” medicine. This is a relationship between a patient and a physician in which the patient pays an annual fee or a monthly retainer. In exchange for the retainer, doctors agree to provide enhanced care to ensure adequate time and availability for each patient.
What this does, is allow you to be able to talk to somebody right now that can order the necessary lab and imaging services quickly rather than on a schedule. Pharmacy items can be prescribed at wholesale prices and picked up at your local pharmacy.
Here’s a website www.exemplar.care and I’d like to introduce you to Dr. John Van Der Veer. I am going to share with you some examples that Dr. Van Der Veer emailed me. These articles are background information (Harvard and Iowa DPC legislation) and strong examples of implementation and recent testimony to the Senate HELP committee with great Q&A on pages 9 – 10.
Below is a cut-and-paste that I received from Dr. Van Der Veer. If this sounds of interest, please call me. My goal in sharing this with you is to take the same money you’re spending now (or less) and redistribute your out of pocket costs to net you greater and more quality outcomes.
I recently opened the metro’s first Direct Primary Care (DPC) clinic. The model is similar to concierge medicine from a service standpoint, but DPC doesn’t bill insurance.
The customer (patient) service benefits include:
24/7 access to their primary physician via text, phone, email, and telehealth
Home and office visits
Unlimited visits with no co-pays
Guaranteed same day or next morning appointments with their primary physician
Additionally, the cost is much lower ($50-110/month) with access to wholesale generic medications, labs, and imaging.
Here are a couple recent examples from my practice:
Lisinopril is on the $4 dollar list for a 30-day supply, but a 90-day supply I filled this week was $1.06.
Annual physical labs at wholesale prices are $9-11 (and included with membership) while a quarterly A1c for diabetes management costs $2.25.
Lastly, and in my opinion, most impressive, is the neck MRI that would cost $1950 now costs $350.
I do encourage folks to carry insurance for trauma, cancer, surgery, etc. Typically, this pairs well with a high-deductible/HSA plans shifting health insurance back toward a more affordable model, like car insurance, with manageable out-of-pocket costs.
Additional examples:
Recent pt with 3 MRIs of brain/neck needed. Radiology offered a cash pay discount of 20% and would have been about $4,400. Family has a deductible of $5,000. My negotiated rate transferred to them is less than $1,400. This difference alone is worth the family of three’s next 20 months of membership and essentially 2 years if they just pay with insurance (i.e.: the entire deductible).
I met a guy at an event tonight who joined because he injured his knee and needs MRI, but doesn’t have a doctor to see: price for MRI list $991 vs. my rate: $217. He had shopped around and had found it for about $775. Either way, yearlong membership nearly covered…plus convenience and access.
Another strategy for managing healthcare costs is to increase the employee cost sharing.
If we restructure your current plan or possibly have two or three plans running concurrently, giving every age and every health employee more options, you will see your premiums being lowered by way of increasing some deductibles and some out of pocket maximums for out of network providers and brand name prescriptions.
This still leaves our traditional “Iowa doctors” and pharmacy items accessible. These minor changes that we may not notice from year to year become big differences looking at the bottom line. Our consultations are free, our analysis data will be eye-opening to you. Please call.
The healthcare industry is complex and as we all would admit, expensive. I feel that it is something employers should make a priority and address with vigorous efforts. The majority of families are dependent on the employer benefit packages for their healthcare coverage according to the Kaiser Family Foundation. Regardless of the industry, the reality is that employers are also in the healthcare business with its expenses and regulations.
I like to partner with the employer in the following areas. Together, we can help make a difference in the lives of the families we serve and the bottom line.
Be a Better Consumer – in the past 10 years, healthcare costs have increased over 50%. I encourage employers to educate the employees on the true costs of health insurance and medical care. I suggest holding them accountable for their medical purchase decisions. This will make them better consumers, being more efficient and lessen the claims incurred. An HSA or CDHP (Consumer Driven Health Plan) with a high deductible has many advantages. I like to provide the tools they need to make the most informed decision like informational programs, wellness programs, disease management programs and apps for their phones that will allow them to “shop” the prices on services such as MRIs, etc. Workplace wellness programs motivate employees to make better choices concerning diet and exercise which has a positive impact on prevention or proper management of certain conditions, i.e. obesity, diabetes, high blood pressure, etc. Believe it or not, this can be fun!
Attracting and Retaining Employees – A well-tailored healthcare plan(s) helps slow down the turnover of employees. With the job market as tight as it has been in decades, it is very common to be serving the needs of four generations in the workplace. Let’s face it – our needs are all different and so is our ability to pay. Baby Boomers, Gen X, Millennials and Gen Z are in different stages of life with many different concerns ranging from maternity coverage to long term care insurance. It is wise to conduct a survey to learn what is most important to them. This better enables us to design plan(s) appropriate for everyone’s needs and budget. I conduct employee/employer meetings to explain the entire cost of the premium, what portion the employer is contributing and how to maximize the benefits.
Becoming and Keeping Compliant – The Federal ACA laws apply to all group health plans, regardless of the size of the employer. This includes ACA market reforms, HIPPA portability, privacy and security rules, Medicare Part D creditable coverage disclosures, mental health parity and minimum hospital stays for maternity patients and newborns. There are shared responsibility rules in the ACA, Form W-2 reporting rules and the FMLA requirements for large groups as defined by the ACA and 50 or more employees. The changes and complexity of the law mean employers must be very diligent on how they report to the government. We insist that we collaborate as necessary with the legal and accounting experts that you have chosen to represent you. This is for your financial safety to become and remain compliant.
Employee Education – Clear and consistent communication is ultraimportant. The HR employee(s) must be trained to protect your company from financial catastrophes. I encourage utilizing the tools of the trade; handouts, videos, emails, training meetings (we conduct those free of charge), face-to-face meetings, presentations, webinars, etc. We partner with many local companies on the wellness education, training and assessments. One example is Aspen Athletic Clubs, LLC. We have a best-kept secret in town – they are amazing. They work with local employers offering group memberships to encourage your employees to become and stay healthy. Call me for all details on your HR needs.
Future Changes and Challenges – Providing the best and the most affordable healthcare for your employees while containing costs and promoting healthier lifestyles is an ongoing task. The strategies that we implement here at Sears Insurance have withstood the test of time. Please let us light the way for a smoother, more cost-efficient experience for you and your employees.
Our consultations are FREE – that’s hard to beat! We care about our clients! We are 100% referral-based. Thank you to everyone for making us successful for the past 45 years. Give us a call 515.285.6766.
