Category Archive

Benefit Spotlight

Medical Transportation

2024 December, Benefit Spotlight November 18, 2024

Ambulance and helicopter services are crucial components of emergency medical response in the United States.

However, insurance coverage for these services can vary depending on several factors, including the type of insurance plan, the specific provider network, and the circumstances surrounding someone’s need for transport.

Ambulance Services Coverage

Most health insurance plans, including Medicare and Medicaid, cover ambulance services when they are deemed medically necessary. This typically includes transportation to a hospital in case of a medical emergency.

Like other medical services, ambulance companies may be in-network or out-of-network with specific insurance providers. In-network providers usually have negotiated rates with insurance companies, leading to lower out-of-pocket costs for the insured individual.

Some insurance plans may limit the number of ambulance rides covered per year or require pre-authorization for non-emergency transportation.

 

Air Ambulance (Helicopter) Services Coverage

Air ambulance services, often provided by helicopters, are typically used for transporting patients in remote or inaccessible areas or for rapid transport in critical medical situations. These services can be costly.

While many health insurance plans provide coverage for air ambulance services, there can be significant challenges. Some plans may only cover some of the costs, leaving patients with substantial out-of-pocket expenses. Additionally, air ambulance providers may not always be in-network with insurance plans, leading to higher patient costs.

Ambulance and helicopter medical care are typically reserved for situations where rapid transportation to a medical facility is necessary due to the severity or urgency of the medical condition, including:

  • Heart attacks
  • Stroke
  • Hemorrhaging
  • Severe trauma (car accidents, falls)
  • Spinal cord injuries
  • Respiratory failure
  • Injuries from natural disasters
  • Wilderness emergencies
  • Transfer of patients between hospitals for specialized care not available at the initial facility (e.g., transfer to a stroke center or a cardiac care center)

In these situations, ambulance services are typically utilized for ground transportation to the nearest appropriate medical facility.

Helicopter medical transport is often deployed when ground transportation is too slow or impractical due to distance, traffic conditions, or terrain obstacles.

Individuals should review their insurance plans carefully and understand the coverage limitations and potential out-of-pocket costs associated with ambulance and air ambulance services.

Source:

https://www.medicare.gov/coverage/ambulance-services

https://www.forbes.com/advisor/health-insurance/insurance-for-ambulance-rides/

https://www.thebalancemoney.com/does-your-insurance-cover-an-air-ambulance-2645679

https://www.opic.texas.gov/news/air-ambulances/

Medicare 101

Kaylon Walton 2024 November, Benefit Spotlight October 12, 2024
Older man talking with younger doctor

Medicare is a federal health insurance program in the United States primarily serving people over 65 and certain younger individuals with disabilities or specific medical conditions.

Medicare plays a vital role in providing healthcare coverage to millions of Americans by covering a wide range of healthcare services, including hospital care, medical services, and prescription drugs.

Medicare is broken down into different types of coverage:

  • Medicare Part A: Hospital Insurance, which covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
  • Medicare Part B: Medical Insurance, which covers doctor visits, outpatient care, preventive services, and durable medical equipment.
  • Medicare Part C: Medicare Advantage Plans are offered by private insurance companies that Medicare approves. These plans provide all the benefits of Parts A and B, often including additional benefits such as prescription drug coverage (Part D) and dental, vision, and hearing coverage.
  • Medicare Part D: Prescription Drug Coverage, which helps cover the cost of prescription medications. Part D plans are offered by private insurance companies approved by Medicare.

Eligibility

Most people become eligible for Medicare when they turn 65 years old. Individuals may also qualify for Medicare before age 65 if they have specific disabilities, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease). Enrollment in Medicare typically occurs during specific enrollment periods, including the Initial Enrollment Period, the Special Enrollment Period, and the Annual Enrollment Period.

Senior woman consulting female doctor through video call using laptop at home
Senior couple medicating at home with medical prescription

Coverage Coordination

Medicare may work alongside other types of health coverage, such as employer-sponsored insurance, Medicaid, and Veterans Affairs (VA) benefits. Coordination of benefits ensures that healthcare costs are covered appropriately, with Medicare often serving as primary or secondary insurance depending on the situation.

The Future of Medicare

Various factors will likely influence Medicare. As the population ages, the number of Medicare beneficiaries is expected to increase significantly. This demographic shift will strain the Medicare program and may necessitate adjustments to funding, benefits, and delivery models to meet the healthcare needs of an aging population.

Healthcare costs, including those associated with Medicare, are expected to continue rising due to medical inflation, advances in medical technology, and the growing prevalence of chronic diseases. Controlling healthcare costs while maintaining access to high-quality care will be a crucial challenge for Medicare in the future.

Happy senior couple looking at medical plans with their home caregiver

Medicare has been moving toward value-based payment models that reward healthcare providers for delivering high-quality care and achieving positive health outcomes, rather than simply reimbursing for the volume of services provided.

Policy reforms may be necessary to address the Medicare program’s challenges, such as funding adequacy and disparities in access to care. Potential reforms could include changes to the eligibility age, adjustments to benefit design, modifications to payment mechanisms, and efforts to reduce waste, fraud, and abuse.

Sources:

https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare
https://www.usa.gov/medicare
https://www.investopedia.com/terms/m/medicare.asp
https://www.ama-assn.org/about/research/trends-health-care-spending
https://www.cms.gov/medicare/coordination-benefits-recovery/overview/coordination-benefits
https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/what-does-medicare-cost

Airrosti vs. Massage Therapy

Kaylon Walton 2024 August, Benefit Spotlight July 7, 2024
Man getting massage

The primary goal of manual therapies, such as Airrosti and massage therapy is to alleviate pain, improve mobility, and promote overall physical wellbeing to avoid pharmaceutical or surgical intervention.

Through individualized treatment plans, practitioners use a variety of techniques, including joint mobilization, soft tissue manipulation, and muscle energy techniques to address specific musculoskeletal issues and promote recovery.

Airrosti

Short for “Applied Integration for the Rapid Recovery of Soft Tissue Injuries,” Airrosti utilizes a unique blend of hands-on manual therapy and personalized exercises to address musculoskeletal issues at their source. While Airrosti is often described as painful, it targets the root cause of your pain with pinpoint accuracy, offering rapid relief and lasting results in just a few visits. At each visit, the patient will receive a thorough, detailed assessment, hands-on manual therapy, and active care exercises/stretches designed to restore function and eliminate pain.

Massage Therapy

Through the gentle manipulation of soft tissues and muscles, massage therapy stimulates blood flow, relieves tension, and promotes relaxation on a profound level. Whether you prefer the soothing strokes of Swedish massage, the targeted pressure of deep tissue work, or the energetic flow of shiatsu, there’s a massage modality to suit every need and preference.

Both types of treatments can be applied to injuries such as back, knee, hip, shoulder and neck, as well as IT band issues, plantar fasciitis, and even migraines and tension headaches.

Many insurance carriers are covering treatments like Airrosti and massage therapy as part of comprehensive physical therapy benefits. Read your plan to see if these benefits are available to you.

Picking a Plan

Lynn White 2024 September, Benefit Spotlight July 1, 2024

Choosing a Plan that is right for you and your family can seem like a daunting task.

You should consider any medical needs you foresee for the upcoming year, your overall health, and any medications you currently take. The following scenarios may also help you make an informed decision.

If you are single or married with no children and in good health with no medical needs outside of preventive care…

A Consumer Driven Health Plan (CDHP) or similarly, and High Deductible Health Plan (HDHP) may be a good fit. These plans offer lower premiums and most preventive care is covered at 100% if using an in-network provider. You may also be able to use a Health Savings Account (HSA) with these types of plans, a tax-advantaged account that provides a safety net for unexpected medical costs.

If you are single or married with children and/or have major medical concerns or anticipate a pregnancy or surgery…

A Preferred Provider Organization (PPO) may be the right answer for you. These plans come with higher premiums, but less costs at the time of service and a smaller deductible, meaning your out-of-pocket maximum may be reached earlier in the year. These plans allow you to choose from a network of providers, typically without the need for a referral or use of a Primary Care Physician (PCP).

What about an HMO?

A Health Maintenance Organization (HMO) may be your best option if lower costs are most important, and you don’t mind the restriction of seeing a PCP first for any referrals to specialists that you might need. HMOs will generally not cover any out-of-network expenses unless it is an emergency.

In-Office Maternal Benefits

Lynn White 2024 October, Benefit Spotlight June 13, 2024

It’s no secret that being a working mom has challenges, and that’s especially true for women who are returning to work after giving birth.

On top of the emotional and logistical obstacles they face, many post-partum women have the added challenge of needing to express breastmilk throughout the day.

The PUMP Act— which stands for Providing Urgent Maternal Protections — is a law that requires employers across the nation to provide reasonable break time and a private, non-bathroom space for an employee to pump breast milk.

The location must be shielded from the view of others and free of intrusion from the public or coworkers, and the employee must have access to these accommodations for one year after childbirth.

It was signed into law at the end of 2022 and helped close gaps in the Break Time for Nursing Mothers law that left 1 in 4 women without pumping protection during the workday and expanded the legal right to teachers, registered nurses, farmworkers, and more. The PUMP Act also clarifies that these breaks count as working time and allows an employee to take legal action against the employer if the law is violated. On April 28, 2023, The PUMP Act expanded its enforcement provision to allow employees to file a lawsuit for monetary remedies.

A lawsuit can be filed under the following circumstances:

  • Violations of the break time requirement
  • The employer indicates no intention of providing private space for pumping
  • If an employee is terminated for requesting break time or space

Complaints can be filed with the U.S. Department of Labor Wage and Hour Division (WHD) at the toll-free number 1-800-487-9243 or by visiting www.dol.gov/whd. Employees may also contact the free helplines from the Center for WorkLife Law and/or A Better Balance to understand their legal rights and options.

Source:

COBRA Benefits

Lynn White 2024 June, Benefit Spotlight May 15, 2024

With COBRA, you can avoid a lapse in coverage for up to 18 months (coverage can be extended to 29 months if you are considered disabled by the Social Security Administration).

According to the U.S. Bureau of Labor Statistics, more than half of Americans have healthcare coverage through their employer. Should you leave your employer, one option for continuing healthcare coverage is COBRA, which stands for the Consolidated Omnibus Budget Reconciliation Act.

While COBRA is a convenient continuation of your job-based coverage that would otherwise be terminated, it isn’t a permanent solution, and it comes with certain considerations around eligibility and costs.

 

Eligibility

Not everyone is eligible for COBRA. According to the Department of Labor, you are entitled to elect COBRA continuation coverage if the following apply:

  • You experience a qualifying event, such as:
    • Job loss (for anything other than gross misconduct)
    • Reduction in employment hours
    • Divorce or legal separation from a covered employee
    • Covered employee passes away
    • Covered employee becomes eligible for Medicare
    • You lose your status as a dependent child
  • Your health plan is covered by COBRA (organizations with fewer than 20 employees are not required to offer COBRA), and you were covered by the plan the day before the qualifying event.

 

The Cost of COBRA

Oftentimes when you have coverage through your employer, they share the monthly premium costs. However, a COBRA coverage premium will be more expensive than what it was under your group health plan because you pay both your portion of the premium and what the employer paid. For example, if you only paid 20% of the premium and your previous employer paid 80%, under COBRA you will be financially responsible for 100% of the premium.

It’s important to be aware of what you will be responsible for paying each month if you elect COBRA coverage because you risk losing your COBRA coverage immediately if you are late making a payment. If you have an HSA, you can use those funds to pay COBRA premiums.

 

Enrolling in COBRA

You have a 60-day window from when you are given notice whether you want to enroll in COBRA. Even if you initially waive your coverage, you can still enroll later if it’s still within the 60-day window (for example, on day 57), however, the coverage is retroactive, meaning you would have to backpay those first 57 days.

 

Alternatives to COBRA

  • Enroll in a spouse’s plan — If your spouse has health coverage offered through their job, you (and your dependents who were covered by your coverage) can enroll in their employer’s plan since your coverage loss is a qualifying life event.
  • Enroll in a parent’s plan — You can enroll in a parent’s employer’s coverage (due to your qualifying event) if you are under 26 years of age and lose your coverage.
  • Purchase a federal or state marketplace policy — After losing your coverage, you have 60 days to purchase new coverage through the federal government’s marketplace (healthcare.gov) or your state’s marketplace (if your state offers one).
  • Purchase private insurance — If you want to explore more plan options than what the public marketplace offers, you can work with insurance companies, a local health plan agent or broker, or health insurance seller to find plans from multiple carriers.

Health coverage is necessary for most Americans, and it’s important to weigh all your options and find the solution that fits your and your dependents’ needs.

 

Sources:

https://www.dol.gov/general/topic/health-plans/cobra
https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/cobra-continuation-health-coverage-consumer.pdf
https://www.usa.gov/cobra-health-insurance
https://www.forbes.com/advisor/health-insurance/what-is-cobra-insurance/

Education Benefits

Kaylon Walton 2024 March, Benefit Spotlight February 12, 2024
Man on laptop

Education benefits are employee perks that help you enrich or learn new skills.

They may also help you go back to school to earn your degree, GED, or in rare cases, assist you with paying back your student loans. The goal of any education benefits program is to improve the organization’s overall skill set, which boosts productivity and autonomy. It can also help attract top talent for open positions.

Education benefits aren’t uncommon, especially for larger organizations. According to the International Foundation of Employee Benefit Plans, more than 92% of the organizations that responded to their survey offered an educational benefit.

Check with your Human Resources department to see if any of these common types of education benefits are offered at your company:

  • Tuition assistance/reimbursement
  • In-house training seminars
  • Attendance at educational conferences
  • Continuing education courses
  • Coverage for licensing courses and exams
  • Personal development courses
  • 529 college savings plans

In-Network vs. Out-of-Network

Lynn White 2024 February, Benefit Spotlight January 23, 2024
In-Network vs Out-of-Network

The distinction between in-network and out-of-network for medical plans lies in the coverage of healthcare services. In-network refers to healthcare providers and facilities that have established agreements with the insurance company, offering services at discounted rates. Choosing in-network options typically results in lower out-of-pocket costs for the insured individual. On the other hand, out-of-network providers have no agreements, potentially leading to higher costs for the insured, as the insurance plan may cover a smaller percentage of the expenses. Understanding and selecting the right network is crucial for optimizing healthcare coverage and managing financial responsibilities.

401(k) Retirement Plan

2024 January, Benefit Spotlight December 27, 2023

Contributing to a 401(k) plan is a way to help you build savings for your future self and financial security later on in life. One of its benefits is its automation (often deducted straight from your paycheck), and it can make investing easier. It also comes with different tax benefits, depending on the type of plan you elect.

Types of 401(k) Plans

  • Traditional 401(k): These contributions are made with pre-tax dollars, which lowers your annual taxable income and grows on a tax-deferred basis. You won’t pay taxes on this money until you begin withdrawing during retirement.
  • Roth 401(k): Contributions to this option are deducted after taxes. You pay the tax now, but you won’t be taxed down the line when making withdrawals during retirement.

A good rule of thumb is to opt for the traditional plan if you expect to be in a lower marginal tax bracket during retirement. That way you can take advantage of the immediate tax break. Another consideration is if your budget is extremely tight, the traditional 401(k) doesn’t reduce your immediate spending as much as a Roth will.

If you think you may be in a higher bracket come retirement, the Roth option can help you maximize your savings and avoid higher taxes later on (especially since the Roth can grow over the years and that earned money will be tax-free).

There’s also the option to contribute to both plan types and hedge your bets — just don’t exceed the contribution limits!

2024 Limits

The contribution limits for a 401(k) periodically rise year-over-year due to rising inflation. For 2024, individuals can contribute up to $23,000 to their 401(k) plans, which is a $500 increase from the 2023 limit.

The catch-up contribution limit for employees (aged 50+ years) remains at $7,500, for a total of $30,500. The catch-up contribution helps accelerate the progress for those closer to retirement.

Contributing to a 401(k)

Industry standards suggest saving 12-15% of your income, but it’s important to look at your own financial situation and needs. You don’t want to reduce your take-home pay so much that you end up in a bind and need to withdraw early (before age 59 ½) from your 401(k) — something that comes with a penalty from the IRS.

If your employer offers a company match, make sure you contribute up to the match amount so you’re not leaving free money behind. For example, if your company offers a 3% match, be sure to contribute 3% of your income (which will result in a 6% contribution total).

Another important consideration if you’re participating in your company-sponsored 401(k) is vesting. It’s necessary to understand your company’s vesting schedule so you know what money is yours to keep should you leave your employer. The money you contribute will be 100% yours to keep (or rollover into another employer’s plan), but the contributions made from the employer may take some years before they’re your dollars to keep.

https://www.nerdwallet.com/article/investing/what-is-a-401k
https://www.nerdwallet.com/article/investing/what-is-a-401k
https://www.nerdwallet.com/article/investing/what-is-a-401k
https://www.nerdwallet.com/article/investing/what-is-a-401k
https://www.nerdwallet.com/article/investing/what-is-a-401k

Cost Comparison Shopping

Kaylon Walton 2023 December, Benefit Spotlight November 22, 2023
Man in suit talking to woman

There are so many different providers and varying costs for healthcare services — how do you choose?

Online services called healthcare cost transparency tools can help. Available through most health insurance carriers, these tools allow you to compare costs for services, from prescriptions to major surgeries, to make your choices simpler. Ask your Human Resources team for more information.

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