Healthcare Reform

65Plus Is The Hottest Labor Market Demographic. Here Are Key 2019 Medicare Costs That Employees And Employers Should Know.

Some say it’s the hottest demographic in the labor market — men and women ditching traditional retirement age to work into their 70s, 80s and sometimes beyond.   According to the Bureau of Labor Statistics the 65 and over crowd will make up the fastest-growing segment of the workforce over the next decade.  With that in mind, over the next few months we’ll be providing key bits of information that employers and employees may find helpful as they navigate the best and most cost effective options for health coverage for the 65Plus workforce and their dependents.

First off, 2019 cost considerations for “traditional Medicare”:

2019 Medicare Costs + Coverage

PART A PREMIUM (Hospital Insurance)
Most people don’t pay a monthly premium for Part A (paid Medicare taxes for more than 39 quarters.  If 39 or fewer quarters worked they’ll pay a premium of up to $437).

PART A DEDUCTIBLE + COINSURANCE
– $1,364 deductible for each benefit period
– Days 1-60: $0 coinsurance for each benefit period
– Days 61-90: $341 coinsurance per day for each benefit period
– Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
– Beyond lifetime reserve days: all costs

PART B PREMIUM (Medical Insurance)
The standard Part B amount is $135.50 (or higher depending on your income).

PART B DEDUCTIBLE + COINSURANCE
– $185 deductible per year
– After deductible is met, enrollees typically pay 20% of the Medicare-approved amount for most doctor services, outpatient therapy, and durable medical equipment (DME).

2019 PART B + PART D (Prescription drug coverage) INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (*IRMAA PREMIUMS)
An additional amount that some individuals whose modified adjusted gross income (MAGI) is above certain thresholds will pay for their monthly Part B and Part D premiums.

  • 2019 Medicare Part B (Medical Insurance) Income Related Adjustments
FILE INDIVIDUAL TAX RETURN FILE JOINT TAX RETURN FILE MARRIED + SEPARATE TAX RETURN MONTHLY PREMIUM IN 2019
$85,000 or less $170,000 or less $85,000 or less $135.50
above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $189.60
above $107,000 up to $133,500 above $214,000 up to $267,000 Not applicable $270.90
above $133,500 up to $160,000 above $267,000 up to $320,000 Not applicable $352.20
above $160,000 and less than $500,000 above $320,00 and less than $750,000 above $85,000 and less than $415,000 $433.40
$500,000 or above $750,000 and above $415,000 and above $460.50
  • 2019 Medicare Part D (Prescription drug coverage) Income Related Adjustments
FILE INDIVIDUAL TAX RETURN FILE JOINT TAX RETURN FILE MARRIED + SEPARATE TAX RETURN MONTHLY PREMIUM IN 2019
$85,000 or less $170,000 or less $85,000 or less your plan premium
above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $12.40 + your plan premium
above $107,000 up to $133,500 above $214,000 up to $267,000 Not applicable $31.90 + your plan premium
above $133,500 up to $160,000 above $267,000 up to $320,000 Not applicable $61.40 + your plan premium
above $160,000 and less than $500,000 above $320,00 and less than $750,000 above $85,000 and less than $415,000 $70.90 + your plan premium
$500,000 or above $750,000 and above $415,000 and above $77.40 + your plan premium

 

Next Up:  The eligible employee’s three main options when it comes to their employer-sponsored plan and/or Medicare coverage.

 

2019 Medicare_and_You_2019

 

Highlights from Wide-Ranging Interview with Atul Gawande, Head of the New ABJ (Amazon/Berkshire/JP Morgan Chase) Healthcare Endeavor, Provides Glimpse of Vision and What They Hope to Accomplish

(Note: In keeping with our 2 Minute Drill mantra, we’ve broken this into two parts. Today in Part 1 we’ll highlight Gawande’s view of the three big systemic problems with healthcare. Tomorrow in Part 2 we’ll summarize his vision for the ABJ-HCE.)

Last week Amazon/Berkshire/JP Morgan Chase announced the appointment of renowned author, surgeon, and researcher Atul Gawande to head up their ambitious new “Amazon/Berkshire/JP Morgan Chase healthcare endeavor” (still unnamed, we’ll refer to it as ABJ-HCE for now). In a long form interview at the Aspen Ideas Festival Gawande expounded on his view of the problem facing the U.S. healthcare system and his thoughts on what the ABJ-HCE can do to make the whole system work better.

Here are few of Gawande’s thoughts that struck me as I watched the interview:

  • While healthcare comprises 18% of the U.S. economy, 30% of those expenditures are of no benefit to the patient.
  • The three biggest sources of waste are:
    • Very high administrative costs. He said there are a lot of “middlemen” in the system some of which must be taken out of the system to simplify the equation.
    • Pricing (I think he’s referencing the price of healthcare services and the method of paying providers for the services)
    • Mis-utilization of treatment. This is identified as by far the biggest of the three buckets. He defined mis-utilization as the wrong care, delivered at the wrong time, and in the wrong way.
  • On the reality of our healthcare system:
    • It was built in the 1940’s and 1950’s when there were only a handful of treatments.
    • Then: A system where the clinician could be expected to do it all – administer the right medicine and treatment. Add in some staff and a place for the patient to recover otherwise leave the clinician alone to do it all.
    • Now: We’ve discovered in the last century that the number of illnesses we can have and the number of ways the human body can fail exceeds 70,000 (covering 13 organ systems).
    • And, in the last fifty years we’ve generated 4,000 new surgical procedures and 6,000 new drugs.
    • Yet, we’re still deploying all these new discoveries and capabilities on a 40’s and 50’s system where the clinician will take care of it.

Gwande points to a broken system. Healthcare is now so complex “that everybody involved feels it’s out of their control – payors, patients, and providers — with no real influence over the end results. “Obamacare is on life support” and “even though I’m going to work for a bunch of employers, employer-based care is broken”.

Tomorrow in Part 2, Gawande on what’s needed, what ABJ-HCE brings to the table, and achieving his goal for the endeavor:  “Scalable solutions for better healthcare delivery everywhere”.

Deja Vu: CMS extends Transitional Relief Plans (pre-ACA) Through 2019

The Centers for Medicare and Medicaid (CMS) recently announced that employers in the small group market that are currently still enrolled in Transitional Relief Plans (also known alternatively as Keep Your Plan, Grandmothered Plan, Pre-ACA Plan, etc.,) may keep their existing policies and plans for another year.  

CMS stipulates that ultimately granting the extension is left to the discretion of state regulators and to the respective participating insurance carriers. Most — if not all – states and carriers are expected to grant the extensions and allow employers to keep the Transitional Relief Plans in place for another year.

The CMS announcement also noted that the Transitional Relief Plans will not be considered out of compliance.

This extension, first granted in 2014 and granted every year since, runs through December 31, 2019.

We’ll be following this closely with the insurance carriers and will keep all of our clients who currently have Transitional Relief Plans informed.

For more info click on the link below:

CMS_Extension-Transitional-Policy-Through-CY2019

As Expected, States Will Have More Control and Greater Flexibility in Regulating Obamacare Starting in 2019

In a CMS press release the Trump Administration announced yesterday, as expected, that beginning in 2019 individual states will have more control and greater flexibility in regulating the individual health insurance market and the Obamacare Marketplace (aka the Exchange). In a summary of the “final 2019 Payment Notice Rule” CMS highlighted provisions that were intended to increase flexibility, improve affordability, and decrease administrative burdens.

 

It’s likely that changes made at the individual state level will ultimately have some impact either directly or indirectly on employer sponsored health coverage, particularly the small group market. We will be monitoring this very closely for our clients and will report back, especially as we get closer to 2019 and more information becomes available.

In the meantime, here’s a sampling of the headlines and links to the respective articles following yesterday’s announcement by CMS:

Here’s a link to the CMS press release:

 

Facebook Iconfacebook like buttonTwitter Icontwitter follow buttonVisit Our LinkedIn Profile