Category Archive

Benefit Spotlight

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

Tobacco Surcharges Burn

2022 November, Benefit Spotlight September 26, 2022

It’s that time of year for benefits enrollment, and many people have gotten materials outlining the next year’s benefits. Some of you may notice a line item in your medical benefits page that reads “Tobacco Surcharge.”

By the terms of the Affordable Care Act, group health plans and self-insured employers can upcharge tobacco users up to 50% for their health insurance premiums. (Tobacco use in this case includes smoking, vaping, and chewing tobacco.) Why do some plans include this surcharge? It hasn’t been a mystery for decades that tobacco use is bad for the human body. It is responsible for nearly half a million deaths in the US each year and is the leading preventable cause of disease and death.

Not only is tobacco use harmful and potentially fatal, it is expensive. The CDC estimates that smoking-related illness costs more than $300 billion dollars annually in the U.S., including both medical care and for lost productivity. Group health plans and employers include this surcharge both to help cover tobacco-related medical expenses and to encourage people to quit using tobacco products.

However, if an employer plan implements a tobacco surcharge, it must also provide a tobacco cessation program. If you are a tobacco user and want to quit and to avoid the surcharge, you can sign up for a tobacco cessation program, or, in some cases, submit confirmation of being under a physician’s care for tobacco or nicotine use to HR. To find out exactly what you need to do to avoid the surcharge, talk to your Human Resources Department.

What is a Tobacco Surcharge and How Does My Company Offer One? (theexprogram.com)
What You Need to Know About Smoking and Health Insurance | HealthMarkets
Economic Trends in Tobacco | Smoking & Tobacco Use | CDC

Resolving Insurance Issues

2022 October, Benefit Spotlight September 25, 2022

It’s never fun to get bills in the mail. It can be additionally frustrating when they’re medical bills for a procedure you thought was covered.

Health benefits can be confusing to sort through, and alarmingly, insurance billing errors are not uncommon. Depending on the source, it’s estimated that between 7% and 80% of medical bills contain errors.

If you receive a bill that you think is incorrect, start by asking the provider to explain the exact charges submitted to your insurance carrier. For example, if you went to your primary care provider (PCP) for what you thought was a routine preventive visit but see additional charges, call your PCP’s office and ask what those charges were for. You can also check the bill against the Explanation of Benefits (EOB) that your insurer is required to send you after your medical provider has filed a claim. An EOB will detail exactly what your medical insurance covers and what it has paid toward this claim.

If you see discrepancies between your bill and your EOB, talk to your doctor’s office, explain the discrepancies, and ask them to review and fix the charges. If your insurance provider has not covered something they are supposed to, you should also contact them to review your case. You may need to file an appeal – make sure to do this as soon as possible to avoid your bill going to collections. See HERE for a more detailed, step-by-step outline.

You may not have to do this on your own. Check to see whether your employer provides access to third-party vendors like Health Advocate or Alight. These companies will help you review your benefits and dispute charges you think were made in error.

What to Do if Your Medical Bill Has Mistakes (webmd.com)
This simple form can keep you from overpaying for medical care (cnbc.com)

Aging Out: Finding Insurance At 26

2022 September, Benefit Spotlight September 2, 2022

With the passage of the ACA, health plans and insurers that offer dependent child coverage are legally required to let children under the age of 26 stay on their parents’ health care plan, regardless of whether the adult children have gotten married, had a child of their own, or are no longer tax dependents.

After their 26th birthday, however, in most cases adult children are no longer eligible for their parents’ plans. If you have a child who is nearing 26, now is the time to help them take steps toward getting their own healthcare benefits.

If you live in Florida, Nebraska, New Jersey, New York, Pennsylvania, or Wisconsin, you may have a little more time. These states allow your adult child to apply for a health insurance rider, which would allow them to remain on your insurance a while longer. The rider requirements and extensions vary by state – see HERE for more information.

If you don’t live in one of those states, or your child is not eligible for a rider, and you have employer-sponsored health insurance, your child has until the end of the month that they turn 26 to sign up for a plan of their own. There are several options for your child:

Employer-sponsored coverage: if your child works full-time (or even part-time, in some instances), they are likely eligible for their company’s health insurance plan.

School coverage: many universities offer student health insurance coverage, so if your child is attending a university, they should check out this option.

Private health insurance: your child can check out any healthcare provider to see what private plans they offer, though these can be more expensive than employer- or state-sponsored plans.

State/federal health insurance: your child may seek coverage through their state health insurance marketplace or the federal marketplace. After turning 26, they will have a special enrollment period of 60 days to sign up for a plan through their state health insurance marketplace.

This transition can seem like a stressful venture, but it doesn’t have to be. Researching the best option ahead of time will make this process much easier for you and your adult child.

Health Insurance Coverage For Children and Young Adults Under 26 | HealthCare.gov
Turning 26: Health Insurance Guide for Those Aging Off Their Parents’ Plan – HealthCareInsider.com

Student Loans

2022 August, Benefit Spotlight July 19, 2022

There is no doubt that the subject of student loan debt has become incredibly contentious over the last few years.

The U.S. Department of Education has once more extended a pause on student loan payments in light of the ongoing Covid-19 pandemic. Before we dive into ways to address student loan debt, let’s take a look at the big picture.

The average cost of full-time college at a four-year institution (tuition, fees, room, and board) in 1980 was $3,167 for one year, or $9,307 (adjusted to 2019-20 dollars). The average cost in 2019-20 was $25,281. See HERE for a further year-by-year breakdown, which also includes tables differentiating private and public institution costs.

Student loan debt in the US totals $1.747 trillion. In a regular year, the total debt grows 6 times faster than the nation’s economy (like everything else, the pandemic has affected this rate in 2020-22). The U.S. Department of Education holds 92% of outstanding student loan debt, totaling over $1.611 trillion.

43.4 million people have federal student loan debt. The average federal student loan debt balance is $37,113, or potentially as high as $40,904, including private loan debt. The average public university student borrows $30,030 to attain a bachelor’s degree. The average interest rate for federal student loans is 4.12%, and 5.8% when factoring in private loans.

It is projected that for 2021 graduates, it will take the average four-year undergraduate degree borrower 7-9 years to pay off their loans, and the average graduate degree borrower 13-18 years. The average doctoral degree borrower will take 13-38 years.

Unlike other kinds of loans, it is extremely difficult to have these loans discharged due to bankruptcy. The U.S. Student Aid website says one may have some or all of one’s loans forgiven only if paying them off will leave a borrower unable to maintain a minimal standard of living, among other qualifications.

It is possible to chip away at student debt over time. Consider enrolling in autopay to ensure your monthly payments are made. Check to see whether your company has any programs to help pay employees’ student loans. You can also refinance your loan to secure a lower interest rate (though note that this path may entail a shorter repayment period and bigger monthly payments). Click HERE for additional strategies to help pay off student debt more quickly.

MeasureOne Research and News-Private Student Lending | Research Report
Student Loan Debt Statistics [2022]: Average + Total Debt (educationdata.org)
MeasureOne Private Student Loan Report Q3 2021 (hubspotusercontent00.net)
Average Student Loan Interest Rate [2022]: New & Existing Loans (educationdata.org)

FMLA: Ensuring You Can Take Time Away

2022 July, Benefit Spotlight June 30, 2022

If you’ve been in the workforce for a while, it’s likely you have a set number of sick and vacation days. The average American worker has 7-8 paid sick days, but some years that just isn’t enough time. Between prolonged sickness, birth or adoption of a child, or family illness, you may need a longer block of time away from work.

In 1993, Congress recognized the need for extended time away from work and passed the Family and Medical Leave Act (FMLA). This act allows eligible employees to take up to 12 unpaid weeks off from work with the guarantee that they will be reinstated at the end of their leave or be given an equivalent position. It also guarantees that employees keep any benefits they had before the leave period began (for example, you would not lose your medical coverage if you had accrued it before taking leave). The FMLA applies to all public agencies, public and private elementary and secondary schools, and companies with 50 or more employees.

There are multiple reasons one may qualify to take FMLA-covered leave (this list is not exhaustive, but a full list of requirements can be found HERE):

  • The birth, adoption, or foster care placement of a child within one year
  • Taking care of an ill spouse, child, or parent
  • Being too ill to properly do one’s own job
  • Emergencies related to the employee’s spouse, child, or parent being a covered military member on active duty

Additionally, in order to be eligible, one must:

  • Have worked for their employer at least 12 months
  • Have worked at least 1,250 hours over the past 12 months
  • Work at a location where the company employs 50 or more employees within 75 miles

If you need to apply for FMLA, the best place to start is your company’s Human Resources department. They can let you know whether you are eligible and help you through the application process if you are.

Fact Sheet #28: The Family and Medical Leave Act | U.S. Department of Labor (dol.gov)

Private industry workers with sick leave benefits received 8 days per year at 20 years of service : The Economics Daily: U.S. Bureau of Labor Statistics (bls.gov)
The Family and Medical Leave Act (FMLA): The Basics | Bipartisan Policy Center

Traveling Health

2022 June, Benefit Spotlight May 26, 2022

Everyone likes to think of vacation as a break from everything – work, regular life, responsibilities – but sometimes things happen, and you or a family member get sick.

So, be prepared. Before you travel next time, look into your medical insurance’s telehealth options. The beauty of telemedicine is that you don’t need to sit in a physical waiting room or pay high costs for an urgent care visit. As long as you have a suitable electronic device, you can take advantage of telehealth from almost anywhere.

There are many benefits to using telehealth while traveling. A telemedicine visit is generally cheaper than an in-person visit. Many telehealth providers have physicians available 24/7, so it doesn’t matter what time zone you’re in or what time of day it is. Some physicians can even write scripts that can be filled at a pharmacy near you. Bonus: If you’re in physical discomfort, you don’t have to pile into a rental car or onto public transportation to see a doctor.

Every telemedicine provider is a little different and operates under different rules. Some can provide help internationally, but others can only operate in the United States. Make sure you check with your telehealth provider before traveling to see what services they provide while you’re away.

RESOURCES

Telemedicine Benefits: 17 Advantages for Patients and Doctors (healthline.com)
Benefits of Telemedicine | Johns Hopkins Medicine

HSAs: Health Nest Eggs

2022 May, Benefit Spotlight April 27, 2022

Retirement life is the stuff dreams are made of. So many of us have been socking away money each month in 401(k)s, 403(b)s, or any flavor of IRA for years. Those types of accounts, however, are not the only options. Health Savings Accounts are also an excellent way to save for specific retirement needs. Let’s look at a few reasons why.

Rollover. While there is a fixed annual amount you can set aside in an HSA (limits for 2022 are $3,650 for an individual and $7,300 for a family), you keep any amount you don’t spend. Unlike other healthcare-specific accounts, you never lose the money you put in an HSA.

Tax advantage. Other traditional retirement accounts require you to pay taxes on the funds, whether it’s now or later. As long as the funds contributed to an HSA are used to pay for qualified medical expenses, they are never taxed. It is especially likely that you will need increased medical care in your retirement years, making this an excellent way to provide for yourself down the road.

Investing. If you are in a financial position where you can pay some medical expenses in cash, you may be able to save enough funds in your HSA to invest. Even if you’re only investing half of your HSA contributions annually, over the years the money earned on the investment will stack up.

It’s important to note that you must elect an HSA-compatible medical plan in order to open an account (although if you change plans down the road, the funds in the account are yours to keep). At your company’s next Open Enrollment period, check to see whether you have an HSA-compatible plan available to you.

RESOURCES

The Power Of Health Savings Accounts For Retirement Planning (forbes.com)
5 ways HSAs can fortify your retirement | Fidelity
4 ways to use an HSA in retirement | Principal

Helping Hands for Parents

2022 April, Benefit Spotlight March 29, 2022

Having adequate childcare has been a struggle for many in the workforce even before the COVID-19 pandemic, with the greater toll often falling on women. Employers have taken note, and many are offering or expanding childcare and tutoring benefits to assist their employees. These benefits, which can help reduce your stress levels by providing care when you need it most, range from back-up care to after-school tutoring assistance.

Programs such as Bright Horizons offer multiple services, including on-site childcare and back-up care. This allows you to have a plan in place if your regularly planned childcare falls through. They also offer elder care services, so if you have adult dependents who need a little extra help, you don’t have to worry about them. Bright Horizons also features the Sittercity app, which provides an easy way to find thoroughly vetted, local child and elder care.

Companies such as Varsity Tutors provide a wide variety of services for K-12 students. This includes one-on-one tutoring on many specific subjects, small group classes, SAT preparation, and live online learning classes. Their tutors are highly qualified and vetted and are ready to help your child learn.

More employers than ever are offering and expanding their childcare benefits. Typically, your employer pays the cost of providing access to the service, but there will be a cost to you at time of use. Contact Human Resources to see what is available to you.

RESOURCES

Women in the Workplace | McKinsey
Employers sweeten child-care benefits to win over workers (cnbc.com)
Welcome to Bright Horizons | Bright Horizons®
Sittercity: Find Local Child Care, Senior Care, & Pet Care
Online Tutoring, Classes, and Test Prep – Varsity Tutors

Easy Medical Answers

2022 March, Benefit Spotlight February 9, 2022

Sometimes we need a little bit of quick, basic medical advice to guide us rather than hopping into the car and driving to the doctor.

A nurseline is one such service. Available through many medical plans, a nurseline provides 24/7 access to trained healthcare professionals (often nurses and sometimes doctors) who help address basic healthcare questions and help you figure out what your next steps should be — whether you can safely manage your condition at home or whether you need to go to the doctor or emergency room. These can be questions about symptoms you are experiencing, medication side effects, and what you should do to care for yourself after basic injury or illness. You can also ask about medications you are currently taking and side effects you may be experiencing. Some nurselines can also help you find care nearby. Exact services may vary based on your insurance provider, so be sure to check your provider’s website to see what nurseline services are available to you.

RESOURCES:

Call the nurse line for expert advice – Mayo Clinic Health System
24 hour nurse line: Your access to healthcare information | Blue Cross Blue Shield (bcbs.com)
CareLine: 24/7 nurse line for members and patients | HealthPartners

‹  Older posts Newer posts  ›