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Benefit Spotlight

Palliative Care: A Supportive Option to Help Patients and Their Families

2024 May, Benefit Spotlight April 22, 2024

Navigating a serious illness can be challenging. Palliative care lessens the burden.

When you, or someone you care about, are diagnosed with a serious illness, it takes a massive toll on all aspects of your life. Navigating care options and figuring out your new normal can be overwhelming, and many are unsure how to find support — or if it’s even available. That’s where palliative care comes in.

Palliative care (which stems from the Latin word palliare, meaning “to cloak”) offers supportive care in many forms to lessen the burden and strain felt when you’re dealt a life-altering diagnosis. It acts as an additional layer of care to enhance your well-being alongside the current treatment plan that may already be underway.

Palliative care can be a good option if you are impacted by one of the following conditions: ALS, Alzheimer’s, cancer, chronic obstructive lung disease, heart disease, stroke, Parkinson’s, multiple sclerosis, AIDs, cystic fibrosis, and diseases of the kidney, liver, or lungs.

Palliative Care Differs from Hospice

Palliative care and hospice are not interchangeable terms. Hospice focuses on end-of-life care, whereas palliative care aims to improve a person’s quality of life and alleviate stress at any stage of an illness.

Unlike hospice care, palliative care does not signify an end of treatment or a terminal diagnosis — in fact, it is often done in tandem with curative treatment. Palliative care can help relieve issues such as breathing difficulties, pain, nausea, anxiety, loss of appetite, depression, constipation, fatigue, and lifestyle stressors.

Palliative Care is Needs-Based

Palliative care varies depending on the available resources in your area and your or your loved one’s condition. A palliative care team may consist of medical professionals and specialists—such as doctors and nurses — who help with symptom management, as well as social workers, chaplains, and financial advisors.

The demands on your mind, body, finances, and relationships may be overwhelming, but a palliative care team helps with weighing treatment options and better understanding your condition, empowering you to address important decisions surrounding:

  • Medical expenses: concerns around insurance coverage, Medicare plan, and financial planning for ongoing treatment
  • Living arrangements: a person can receive palliative care in their home, a clinic or hospital, a nursing home, or other setting
  • Legal documentation: setting up a power of attorney or creating a living will

Social support is another important component of palliative care. Because a serious illness can uproot your life, it often feels isolating. A palliative care team helps by connecting you with support groups, organizing and coordinating caregiving responsibilities, and seeking out community resources. Review your medical plan documents to see what palliative care options are covered by your plan.

Getting Started

There isn’t a set time when palliative care is offered, so you can seek out care early on (often once a diagnosis is received) to help plan for what is to come. The World Health Organization states, “early delivery of palliative care reduces unnecessary hospital admissions and the use of health services.”

Receiving care on your terms is of the utmost importance, and a palliative care team can communicate a patient’s preferences, goals, and wishes. Ask your provider for a referral, whether you are a candidate for palliative care, and what support resources are available to you.

Sources:

https://www.nhpco.org/
https://my.clevelandclinic.org/health/articles/22850-palliative-care
https://www.mayoclinic.org/tests-procedures/palliative-care/about/pac-20384637
https://www.nia.nih.gov/health/hospice-and-palliative-care/frequently-asked-questions-about-palliative-care
https://www.healthline.com/health/palliative-care
https://www.who.int/news-room/fact-sheets/detail/palliative-care

Benefits Lifecycle

2024 April, Benefit Spotlight March 27, 2024

Employee benefit expirations mark the termination date of benefits provided by employers, including health insurance, retirement plans, and wellness programs. These benefits often run on a yearly cycle. Some may auto-renew while others require you to physically reenroll each year. Failing to utilize or renew these benefits within the specified timeframe may result in loss of coverage or access to services. Importantly, if you leave the company or retire, some benefits terminate immediately, while you might have access to others through the end of the month. Employers typically communicate such deadlines annually to ensure that employees can make informed decisions about their benefits and take necessary actions before expiration, promoting employee well-being and satisfaction.

Wellness Programs

2023 August, Benefit Spotlight July 31, 2023

Employer-sponsored medical benefits are provided to help you stay healthy. But some employers go a step further by implementing wellness programs.

Wellness programs provide various tools and incentives for you to keep an eye on your overall health. These incentives often take the form of discounts off your medical premiums (or even a surcharge), fitness trackers, or gym memberships. If your spouse is on your insurance, they may also be eligible.

Often times these programs will require an annual biometric screening that checks certain standard health factors, such as blood pressure, cholesterol levels, height, weight, and glucose levels. These are helpful in the short-term because they may reveal health issues that you can address with your doctor. These screenings are helpful long-term because they will provide your doctor a consistent medical history — if some of your benchmarks change suddenly from one year to the next, it may indicate a health problem. You can usually get these biometric screenings done at your doctor’s office, though some employers will offer onsite screening opportunities as well.

Many wellness programs also include health education modules and mental and financial wellbeing resources. Overall, wellness programs help you become better informed about your own health, which keeps you healthier and could save you money in the long run. Check your benefits information to see whether your employer has a wellness program and what its benefits are.

Extended Leave

2023 July, Benefit Spotlight June 23, 2023

Life happens, and sometimes you need to take an extended period of time away from work outside of what your standard PTO and sick time off cover.

This is where the Family and Medical Leave Act (FMLA) steps in. It provides employees up to 12 weeks of unpaid leave in a 12-month period to handle the birth, adoption, or foster placement of a child, care for oneself or an immediate family member due to severe health conditions, or qualifying emergency due to a spouse, child, or parent being a covered member of the armed services on active duty. The FMLA ensures your job is protected while you are away (i.e., you cannot legally be let go due to your absence) and you keep your health insurance during the leave.

Some states, such as California and Colorado, also require employers to provide certain forms of paid sick leave or paid family and medical leave. In some instances, this paid leave also applies to employees affected by domestic violence or assault. These provisions vary widely by state, and not all states require employees to put paid sick leave provisions in place. Click HERE and HERE to find your state and any provisions it has made. If your state has both FMLA and paid sick/family leave, your employer must follow the law that benefits employees most.

Extra, Extra! Understanding Supplemental Insurance

2023 June, Benefit Spotlight May 7, 2023

Maybe this is a familiar scenario.

You’re reviewing your annual enrollment materials to figure out what coverage is best for you and your dependents. Medical, dental, and vision coverage are pretty straightforward. Now you’re looking at the extra kinds of coverage, and they all sound similar. Accident coverage, hospital indemnity coverage, and critical illness – what’s the difference? While exact coverage varies per provider and employer, these are the general differences between plans.

  • Accident coverage provides benefits for you and your covered family member for expenses related to an accidental injury that occurs outside of work. This coverage can help pay deductibles, copays, and even typical day-to-day expenses such as a mortgage or car payment.
  • Critical Illness coverage pays a lump-sum benefit if you are diagnosed with a covered disease or condition (the exact diseases and conditions will be specified in plan documentation). You can use this money however you like. You might pay expenses not covered by your medical plan, lost wages, childcare, travel, home healthcare costs, or any of your regular household expenses.
  • Hospital Indemnity coverage pays you cash benefits directly if you are admitted to the hospital or an Intensive Care Unit (ICU) for a covered stay. This can help pay for your medical expenses such as deductibles and copays, travel cost, food and lodging, or everyday expenses such as groceries and utilities.

While these coverages may overlap at points, they are definitely not all the same. Before your next benefits enrollment, consider whether you might want to enroll in any of these coverages for a little extra peace of mind.

Doc On Retainer: Concierge Medicine

2023 May, Benefit Spotlight April 27, 2023

If you’ve moved recently or had to find a new primary care physician (PCP) for any reason, it might have taken you much longer to get an appointment than expected.

Even getting a regular appointment could take weeks longer than it used to. You’re not imagining it – due to a growing shortage of PCPs, Americans are having to wait significantly longer to see doctors than we used to.

An alternative to long waits at traditional doctors’ offices is concierge medicine, or its cousin, direct primary care (DPC). To access this kind of care, you’ll pay an annual or monthly fee that gets you direct physician access. Each practice will vary, but generally you can expect to receive the following benefits:

  • Guaranteed access to care 24/7
  • Same-day or next-day appointments
  • Coverage of standard care like blood work, preventive screenings, and physicals
  • No copays or deductibles for office visits
  • More personalized care
  • On average, twice as much time with your doctor per visit

It’s crucial to note that there are drawbacks as well. DPC practices typically do not accept insurance and are entirely fee-based, while some concierge systems do accept insurance. You’ll still need regular health insurance to cover hospitalization and specialty referrals. If cash is tight, concierge medicine may not be a good choice – annual fees can run from $1,200 to $10,000. However, if your finances are in a good place, and you want guaranteed access to care, there is a growing number of concierge and DPC providers you can investigate today.

What Is Concierge Medicine? A Complete Guide – Forbes Health
Advantages and Disadvantages of Concierge Medical Care (aarp.org)
Many Doctors are Switching to Concierge Medicine, Exacerbating Physician Shortages – Scientific American

Broadening Benefits for Your Health: Lifestyle Spending Accounts

2023 April, Benefit Spotlight March 30, 2023

While your medical insurance covers much of your bodily health, and many companies have Employee Assistance Programs to help you out with mental health, there’s more to your overall wellbeing.

Employers realize this, which is why more and more companies are adding a new acronym to the fold – the LSA, or the Lifestyle Spending Account.

Health Savings Accounts and Flexible Spending Accounts help cover specific IRS-approved expenses such as copays, glasses, or dental care, Lifestyle Spending Accounts have fewer restrictions. They can be used to pay for a broad variety of services and products that promote your own physical, mental, or financial wellness. Below are just a few examples:

  • Exercise equipment and nutritional supplements
  • Personal trainer
  • Entry fees for races or sports leagues; sports lessons
  • Spiritual retreats
  • State or national park passes
  • Camping equipment
  • Spa treatments
  • Estate planning costs
  • Financial planning services

The crucial difference between LSAs and other health-related spending accounts is that expenses submitted for reimbursement through a Lifestyle Spending Account are taxable to you. The reimbursed amount is considered income and is subject to the same taxes as your normal wages. If you’re looking to further your health and wellness, see whether your employer offers an LSA. It can be a helpful tool in taking care of yourself.

Qualifying Life Events

2023 March, Benefit Spotlight February 24, 2023

Signing up for benefits usually only occurs during your company’s open enrollment period, or when starting a new job at a new company. But did you know that these are not necessarily the only times you can elect or change your benefits?

Sometimes there are changes in your life, planned or unplanned, called Qualifying Life Events (QLEs), that allow you to add or change benefits. These QLEs are determined by the IRS, and when they occur, QLEs can allow you to enroll in health insurance or make changes to your benefits outside of the regular windows

When a qualifying life event occurs, you typically have 30 to 31 days to request changes to your coverage. Common QLEs include:

  • A change in the number of dependents (through birth or adoption or if a child is no longer an eligible dependent)
  • A change in a spouse’s employment status (resulting in a loss or gain of coverage)
  • A change in your legal marital status (marriage, divorce, or legal separation)
  • A change in employment status from full time to part time, or part time to full time, resulting in a gain or loss of eligibility
  • Eligibility for coverage through the Marketplace
  • Changes in address or location that may affect coverage
  • Entitlement to Medicare or Medicaid

Some lesser-known QLEs are:

  • Turning 26 and losing coverage through a parent’s plan
  • Death in the family (leading to change in dependents or loss of coverage)
  • Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)

If you have recently experienced a QLE or expect to in the near future, reach out to your company’s Human Resources for questions regarding specific life events and your ability to request changes.

Legal Assistance

2023 February, Benefit Spotlight January 26, 2023

For most of us non-experts, legal matters can be confusing, whether it’s dealing with paperwork for adoptions, ensuring that estate-related documents are in place in the event of your passing, or even dealing with traffic tickets. The idea of hiring a lawyer for help with these matters is also daunting given the potential cost.

The good news is that many employers provide access to affordable legal help for your personal needs, often paid for with per-pay-period deductions directly from your payroll, just like your medical coverage. It’s like having your own lawyer on retainer for a very reasonable cost. These attorneys are licensed and experienced, able to help you (and usually your dependents) with:

  • Estate planning, wills, and trusts
  • Real-estate matters
  • Identity-theft defense
  • Financial matters, such as debt-collection defense
  • Traffic offenses
  • Document review
  • Family law, including adoption and name change
  • Advice and consultation on personal legal matters
  • Divorce

This is not a comprehensive list, as plans differ slightly between employers and vendors. Check your benefits guide or with your HR department to see whether this is an optional benefit your employer offers. While most of us don’t plan on needing legal help, it may be worth the peace of mind knowing you have immediate, affordable access to it should the occasion arise.

Copays, Coinsurance, and Deductibles

2023 January, Benefit Spotlight December 27, 2022

If you’re new to having your own medical insurance plan (or maybe even if you’ve had one for a while), the terminology surrounding how much you have to pay for a given service can be confusing. Let’s look at some of the most important terms that will help you better understand your benefits:

Deductible: A deductible is a fixed amount of money that you have to pay before your insurance starts paying benefits. For example, if your deductible is $2,000, you’ll pay out-of-pocket until you reach that amount, and then your coinsurance will kick in. This amount varies by plan, but typically plans with higher monthly costs have lower deductibles and plans with lower monthly costs have higher deductibles. (Side note: some plans have separate deductibles for prescription benefits, so make sure to check your plan details for this.)

Coinsurance: Coinsurance kicks in once you’ve reached your deductible. Now whenever you have a covered medical expense, you’ll pay coinsurance, which is a set percentage of the total cost, and your insurance will pay the rest.

Copay: This is a set amount you’ll pay for a covered service and varies per service. You may pay copays before you hit your deductible and after; this varies by plan.

Out-of-pocket maximum: This one is a little more self-explanatory. Once you’ve paid this set amount out-of-pocket, your plan will pay 100% for covered services for the rest of the year. Depending on your plan, your deductible may or may not include to your out-of-pocket maximum.

Each plan has different deductibles, coinsurance, copays, and out-of-pocket maximums. It’s important to review your benefits carefully to make sure you know what you’re on the hook for when you receive medical care. Consult your summary plan description for more information.

How do deductibles, coinsurance and copays work? | bcbsm.com
Your total costs for health care: Premium, deductible, and out-of-pocket costs | HealthCare.gov

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