On Friday Medicare announced the Part B rates that most Medicare enrollees will be responsible for paying in 2020. Effective January 1, 2020 the standard monthly premium for Medicare Part B enrollees will be $144.60. This represents an increase of $9.10 from the $135.50 enrollees paid in 2019.
Starting in 2007, a beneficiary’s Part B monthly premium has been based on income. Income-related monthly adjustment amounts (IRMAA) affect approximately 7 percent of all Medicare beneficiaries. The 2020 Part B premium levels adjusted for income as well as the Part D (Prescription Drug Plan) are shown in the following tables:
2020 Medicare Part B Income-Related Monthly Adjustment Amounts
Part D (Prescription Drug Plans) IRMAA in 2020
And, If your modified adjusted gross income is above a certain amount, you may also pay a Part D income-related monthly adjustment amount (Part D IRMAA). Those amounts for 2020 are listed below.
‘Tis the season for open enrollment in the world of health insurance! Open enrollment for Medicare 2020 has already begun (October 15th – December 7th, 2019). Additionally, individual open enrollment is underway (November 1st – December 15, 2019). Lastly and most important to this article is the fact that many employers are in the midst of their group health plan open enrollment. Many group plans renew January 1st so it’s a busy time of year for employers, brokers, and insurance carriers.
This article is designed to assist employers in knowing what to focus on during this busy season.
The most important thing we need to focus on is the premiums that you pay to the insurance carriers. We know this is a huge expense and we work with you to keep this competitive to what’s available in the marketplace.
Most of the January 1st group health insurance renewals are out. Perhaps your increase is palatable enough to forgo shopping and just renew as is. However, that is more the outlier than the norm. Typically, it’s best to assist us with the necessary data needed in order to shop your policy with the competing carriers in the marketplace. By now, your account managers at BBG have been working hard to gather the necessary data for shopping. These items include:
- Current Census
- Average Total Number of Employees (ATNE). This is based on how many total employees you employed each month and dividing by 12. Estimates are used for the remaining months of the year.
- Names of your employees who are eligible but waive off the plan
- The reason they are waiving
- If you are a 51+ group we’ll need what is called an Employer Risk Assessment Form (ERAF)
The above will allow us to obtain street rates in the small group market place and potentially underwritten rates in the 51+ marketplace. Street rates are off the shelf rates that are based on your group’s census alone. They are still subject to underwriting but give us a good benchmark to know if we should pursue underwritten rates
Medical Health Questionnaires (MHQs)
The dreaded MHQs need not be so dreaded anymore! Most insurance carriers prefer to receive electronic MHQs via programs like FormFire. Some carriers now require FormFire MHQs. BBG has dedicated team members who can assist your employees in completing this process. We’ve worked hard this year to streamline the process to allow us to help a larger number of you in a shorter amount of time.
So when are MHQs needed? This answer is different depending upon what market segment you are in…
1-50 Small Groups
If you have 50 and under total employees, FormFire MHQs will be needed to obtain underwritten rates from any competing carriers. However, BBG is all about efficiency so we first obtain street rates to determine if this is even worthy of your time. If we determine that it is then we highly suggest proceeding with FormFire.
The only exception here is when we obtain community rates. Community rates are different from underwritten rates and are typically more expensive than their underwritten counterparts. We’ve been finding that mostly micro groups and other groups with certain characteristics that may adversely impact underwriting are served best by community rates.
51-99 Mid-Size Groups
If you have between 51-99 total employees some carriers require MHQs to release any underwritten rates. However, there are a few carriers who will release underwritten rates if your renewal is <25% and you’ve completed an ERAF.
100+ Large Groups
Typically MHQs are not needed in the 100+ market segment; although, there are exceptions where MHQs can be helpful. Your account manager will assist to know when this applies to you.
When Not to Shop the Market
There are only two instances when it makes sense to not shop the market. 1.) If you are in the 51-99 market and your incumbent carrier asks for your “no shop” number. A no shop number is an increase you are willing to accept in agreement for not shopping.
In our experience, if a carrier is asking for your “no shop” number, they are willing to play ball and negotiate. If you are not sure what a reasonable no shop number is, talk to your account manager and they can assist you with this. However, you can always be aggressive and ask for a flat increase. What’s the worst they can say? No? If the carrier cannot meet it, we can always shop your policy.
2.) Or if you are in the 1-50 market your incumbent carrier may be able to provide some rate relief in an agreement to not shop your policy. The amount of rate relief available in the small group market is much smaller but if you received a favorable renewal a few points of rate relief may be enough for you to decide to stay put. Your account manager and BBG will let you know if this is a feasible option for your specific group.
At BBG, we are fully aware that the most important work we do is to assist the employers we work for in keeping healthcare costs and the coverage your employees receive competitive to what’s in the marketplace. The most important benchmark number we look at is your average cost per employee per year. This number is found by taking your total costs and dividing by your total employees enrolled in the health plan. We realize your enrollment can fluctuate and by looking at this number we are looking at a comparable number year over year.
Open enrollment is always a busy time of the year but the exercise of shopping, completing FormFire, and allowing BBG to negotiate with the carriers on your behalf is the important work. This work allows you to maintain strong benefits year after year.
Don’t get me wrong, I completely support the notion of promoting positive health behaviors and healthier lifestyles. Encouraging such things as regular exercise, good and balanced nutrition, the proper amounts of sleep, and all the things associated with taking better care of ourselves is all good. No question about that.
It’s just that for the most part you could color me the doubting Thomas when it came to believing the narrative that wellness programs definitively lead to lower insurance premiums and other healthcare-related cost savings.
And, it seems that most often that’s how wellness programs have been sold to employers. “Implement a wellness program and you will lower your company’s insurance premiums and other employee health-related costs” has commonly comprised a major part of the wellness sales pitch made to employers.
And many employers, especially large employers, have been buying this cost savings aspect of it. (80% of large employers in the U.S. offer wellness programs*).
I’ve long wondered if these corporate wellness programs provided any direct return on an employer’s investment (Workplace wellness is an $8 billion industry*). We sure haven’t witnessed it either in the way of lower insurance premiums or a decrease in the consumption of medical services and medical claims.
Harvard provides an answer via a major study on the Health and Economic Outcomes of Workplace Wellness Programs.
Results of the Harvard study were recently published in The Journal of the American Medical Association (JAMA). In a nutshell the Harvard study concluded that while there were significantly greater rates of some positive health behaviors among participating employees, there were no significant effects on health care spending.
In other words, when it comes to wellness programs and savings, the Harvard study verdict is in. Under-deliver.
For more on the Harvard study click here.
Buried far below the most recent headlines related to eliminating the ACA, The Centers for Medicare and Medicaid (CMS) once again announced that employers in the small group market still enrolled in Transitional Relief Plans (pre-ACA) may keep their existing policies and plans for another year. CMS stipulates that ultimately the discretion for granting an extension again rests with state regulators and the respective participating insurance carriers who continue to make those plans available. As we learned last year a few insurance carriers (e.g. Aetna) elected not to extend the Transitional Relief Plans beyond 2018. They instead chose to eliminate the option of renewing the old plans thus requiring impacted employers to move to ACA plans or one of the market compliant alternatives (e.g. level funding, MEWA, etc).
For more info click on the link below:
Extended Non-Enforcement of Affordable Care Act-Compliance With Respect to Certain Policies
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- Tom Barrett
- March 28, 2019
- ACA, affordable, affordable care act, cost, costs, coverage, DOL, employees, employers, federal, health plans, healthcare, healthcare reform, HHS, insurance, IRS, medical, Obamacare, ruling, states
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