If you feel that you are confused each year about your health insurance, particularly at about this time of the year, you are not alone.  I am available for consultations by appointment and can help you decipher the industry jargon.  It is an important time of the year for Medicare enrollees or Medicare eligible people, with opportunities to make changes in your plans for 2019.

Medicare Individuals

Medicare open enrollment (OEP) – also known as the annual election period (AEP) or annual coordinated election period (ACEP)  – refers to the annual period during which Medicare plan enrollees can reevaluate their coverage –whether it’s Original Medicare with supplemental drug coverage, or Medicare Advantage –and make changes if they want to do so.

During Medicare open enrollment, a beneficiary can switch Medicare Advantage plans, change from  Medicare Advantage back to Original Medicare or vice versa, join a Medicare Part D prescription drug plan, switch from one Part D plan to another, or drop Medicare Part D coverage entirely. But, the annual open enrollment does not apply to Medigap plans, which are only guaranteed-issue in most states during a beneficiary’s initial enrollment period (IEP), and during limited special enrollment periods (SEP).

Medicare open enrollment begins on October 15 and ends on December 7, with changes effective on January 1.

The best window of time to buy a Medigap policy begins on the first day of the month in which you turn 65 and have enrolled in Medicare A and B (you have to be enrolled in both Medicare A and B in order to get a Medigap plan). The Medigap enrollment period is three months prior to your birth month, your birth
month, or three months after your birth month. This window of time is known as your Initial Enrollment Period (IEP).

Small and Large Group Employers

Business owners should consider purchasing benefit packages for employees as a group plan.  These plans are a great opportunity for you to attract and retain quality employees.  It is very costly to recruit, interview, hire, train and get an employee productive…if they work out.  This represents a lot of time and cash lay out. To insure that your efforts in attracting and retaining quality employees are most effective, benefits are a must.  They are important to the employer for the ways outlined above.  They are very important for the employees.  The individual market in Iowa is very limited and expensive, creating the need to have benefits available through employment.  So, we encourage employers to look at this option.  We work with CPAs to make sure that this is implemented properly so that you are not faced with eligibility and audit issues from the insurance company mid-term. You will discover that there are tax advantages for both the employer and the employee to explore this as an option. If you do the best for your employees, they in turn will make your business prosper.

Iowa Continuation and COBRA

These are employer laws.  We do not involve ourselves with labor laws, neither do the CPAs.  However, because most employers fail to be compliant without encouragement, we try to be of assistance. We can provide the form letter and the employer must complete and mail it to the last known address of the  departing employee.  There are instructions with these letters including how the envelope should be addressed and the recommended mailing option.  We encourage our business owners to incorporate into
their plan a partnership agreement with the insurance company to assist with the COBRA process.  If an employer does that, after the initial letter goes out, the insurance company will communicate with the departing employee taking all of the responsibility away from the employer.

For groups with 20 or less full-time employees, Iowa Continuation is offered by the employer to the departing employee.  The employee may elect to stay on the employer plan for 9 months, so long as
the payment agreement has been met each month. COBRA laws apply to an employer that has greater than 20 full-time employees.

I cannot stress enough the importance of knowing your options. I have 40 years of knowledge and experience to share with you.  I will help you manage your health care risks and liabilities, safekeeping your family’s financial protection.

First of all, let me define a small business. These are for groups of 50 – 100 employees. Health insurance benefits in the individual market are quite limited and very high priced at the moment. The majority of folks are seeking employment based on a lot of criteria, one in particular is the benefits. There is a need and that also rates an opportunity for both sides. If I were a small business owner wanting to attract and retain quality employees, it’s going to require time and money to get just the right person in the right seat. One of the major things that folks look for is health insurance benefits in the environment we’re in today. So, as a business owner, I would explore what opportunities and pricing I should be considering if I have not already put a plan in place. If I have a plan in place, have I had an unbiased independent agent do a free consultation and assessment? If not, you’re overlooking marketplace opportunity. Please call me.

Because your most valuable assets are your employees, we want to make sure there is a fit for everyone from benefits to affordability. So, I would start by looking at your network of provider options. The second thing I would do: within the networks, I would look at the health plans and there are 3 distinct plan types. Choice of a simple co-pay ($) plan. A traditional plan or a high-deductible health plan. And thirdly, do I want to make available dental and vision plans as ancillary benefits. These are questions that you’re not going to think of first of all and not know what to do about secondly without some qualified coaching.

A co-pay plan makes it easy for your employees to know how much a service or procedure will cost before they go to the doctor. Co-pay always refers to a flat dollar amount.

A traditional plan will hep your employees plan for many common healthcare expenses. Such as in-network office visits. For other expenses, deductible and co-insurance (%) may apply.

The third choice is high deductible health plan (HDHP) with an HDHP, your employees can pair this qualified high qualified deductible plan with a health savings account (HSA). This will give them more bang for their buck in that if they choose to contribute to an HSA account, the IRS will reward them with deductions, they will accrue a balance over time that will take care of their high deductible at a time of catastrophic need. A nice feature that is overlooked, are the built in virtual benefits that come with a Wellmark plan.

Whether on a limited, state-based or national network, your employees can connect face-to-face with a doctor using a smartphone a tablet, or a computer. Understanding your healthcare coverage benefits is something you need to know. There are lot of value-added benefits within these plans that without and employer/employee meaning, your employees won’t understand the true value that you and they are paying for each month. Please call me.