enrollment

Health FSA Limit Will Increase for 2018

The ACA imposes a maximum dollar limit on employee contributions to health flexible spending accounts (FSAs).  Although the ACA set this limit at $2,500, the limit is indexed for cost-of-living adjustments each year.  On Oct. 19, 2017, the IRS announced that, for taxable years beginning in 2018, the dollar limit on employees’ salary reduction contributions to a health FSA will increase to $2,650.


Employers may continue to impose their own dollar limits on employee contributions to health FSAs, as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year.  For example, an employer may decide to continue limiting employee health FSA contributions for the 2018 plan year to $2,500.


Go here for more information.

Health FSA Limit Will Increase for 2018 10-19-17

Executive Order Ends the “Out-of-Pocket” Subsidy Only; the “Premium” Subsidy Remains in Place

Some folks may think that Friday’s Executive Order did away with Obamacare subsidies altogether.  It didn’t.

There are two subsidies. One was cut.  One wasn’t.

In a nutshell, one subsidy lowers the cost of premium (aka premium tax credits) for those qualified individuals and families enrolled through the exchange and making less than 400% above the poverty level.  This stays in place.

The other covers a reduction in the out-of- pocket expenses or claims costs paid to the medical provider by the patient (aka cost-sharing reductions). This subsidy applies to those earning below 250% of the poverty level and covered by a plan issued by the insurance company through the exchange.

It’s this out-of-pocket budget appropriation that was cut by Friday’s Executive Order.

From what we hear, despite Friday’s Order most of those enrollees who qualify for the out-of-pocket assistance will continue to receive it as part of their coverage at least through 2018.  Many of the insurance carriers still participating on the exchange expected the subsidy cut and planned for it when they filed their rate increases and established their pricing for 2018.

You can read more here.

Medicare Eligible Employees/Dependents…. Don’t Assume You Can Waive Part B

Medicare can be tricky when it is coordinating with Group Health Coverage.

This is especially true when Medicare enrollees WAIVE Part B coverage, thinking that they don’t need it because they have Group Health Coverage.

Our message to those people is BE CAREFUL. You must be certain that if you waive Part B coverage that you are not opening yourself up to claims exposure.

Never assume that a Group Health Plan will step in and cover claims.

Since CMS clearly states that the INDIVIDUAL is responsible to know (not the employer nor the insurance company) the Medicare coordination with other coverage, it is critical to be careful and do the research.

Here are some examples where things get tricky:

  • When an employer has fewer than 20 employees, Medicare is primary. With some insurance companies they do not even pay claims if Medicare does not approve. If one does not enroll in Part B, that means NOTHING is approved by Medicare. Translation: Costs that would have gone to Part B are not approved by Medicare and not approved by the insurance company. This is a big problem.
  • When an employer has fewer than 100 employees, Medicare that is DUE TO DISABILITY is primary. The same rules apply.
  • When someone is on COBRA and Medicare, Medicare is primary no matter how many employees the employer has. If the member on COBRA waives Part B, they face potential liability. People could easily assume that the rules would be the same as when they were active on the plan (vs COBRA), but that would be a mistake.

While we at BBG will help our clients get the right answer and try to fix things if someone has assumed the wrong thing, we urge everyone who is Medicare eligible to engage to find the right answers. We are not responsible for errors in Medicare enrollment, but we can be a resource for assistance.

No one should assume that waiving Medicare Part B coverage will be just fine. Getting the right answers and keeping the documentation is critical if you waive Part B.

Medicare 101

MEDICARE PANIC SETTING IN AS EMPLOYEES APPROACH 65th BIRTHDAY??? LET’S CLEAR UP THE CONFUSION ABOUT INITIAL ENROLLMENT

Can’t tell you how many calls and emails we get from panic-stricken employees nearing that magic 65th birthday and Medicare eligibility.  It happens a lot.  A whole lot.

Some folks think if they don’t sign up three months before they turn 65 they’ll be in trouble. Others think the drop dead date to sign up is their birthday.  And, many, many people think if they don’t enroll in Medicare by those dates they either won’t be eligible at all, or they’ll be penalized and get socked with much higher premiums.

Here’s the scoop:

THE MEDICARE INITIAL ENROLLMENT PERIOD IS 7 MONTHS LONG.  IT INCLUDES YOUR BIRTHDAY MONTH, THE 3 MONTHS BEFORE AND THE 3 MONTHS AFTER.

Here are some basics, courtesy of Medicare Made Clear, that employees approaching their 65th birthday may want to know and save them from hitting the panic button:

1.)  You Have a Set Time to Enroll in Medicare

Your Medicare Initial Enrollment Period (IEP) is 7 months long. It includes:

  • The 3 months before the month you turn 65
  • The month you turn 65
  • The 3 months after the month you turn 65

Medicare Enrollment Date Calculator.

2.)  You Can Delay Medicare Part B

Most people get Part A (hospital insurance) premium-free because they or a spouse worked and paid taxes. Part B (medical insurance) has a monthly premium.

You can delay signing up for Part B if you have other health care coverage like employer-sponsored health coverage.  Having employer-sponsored health coverage gives you to the option to delay signing up for Part B, qualifies you for a Special Enrollment Period, and precludes you from getting hit with Late Enrollment Penalties if you elect to delay Part B.

3.)  There Are Two Ways to Get Medicare

Medicare gives you two Medicare Coverage Options:

  • Original Medicare (Parts A & B), the traditional way
  • Medicare Advantage (Part C), an alternative to Original Medicare

Original Medicare is administered by the federal government. Medicare Advantage plans are offered by private insurance companies approved by Medicare. They must provide all the same benefits as Original Medicare Parts A and B. Many plans include additional benefits, such as prescription drug coverage and more.

4.)  Medicare Doesn’t Cover Everything

Original Medicare doesn’t include coverage for prescription drugs. You may buy a standalone Prescription Drug Coverage (Part D) plan to get this coverage.

Some people also buy a Medicare Supplement Insurance (Medigap) plan to help with some costs not paid by Original Medicare.

Generally, you don’t need additional coverage if you choose a Medicare Advantage plan.

 

7 Months. That should make some breathe easier.

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