Medicare Costs

What if I miss the deadline?

Once enrolled in Medicare, if you wish to change or purchase Medicare plans you must act during the open enrollment period.

When open enrollment is closed, there are special circumstances in which one may qualify to enroll outside of the enrollment period. Listed below are the qualifying events:

• You are turning 65
• You move to a new area that is not in your current plan’s service area
• Recently moved back to the US
• You lose your current coverage (either Group or Medicaid)
• You now need a SNP (Special Needs Plan) or you no longer need a SNP

When you can sign up for Medicare, and annual open enrollment

Medicare annual open enrollment is October 15th through December 7th every year.

To sign up for original Medicare Parts A & B, along with Part D, most people will have an Initial Enrollment Period which is a 7 month period around the time they turn age 65. This period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

Once your Initial Enrollment Period is over, if you wish to change or purchase Advantage or Part D Plans, you must act during the open enrollment period.

NOTICE: Once you are eligible for Medicare, do not wait to enroll in a Medicare Part D Plan or you could end up paying a penalty every month.

Medicare Part D (Prescription Drug Coverage)

Prescription drug coverage offered by private carriers contract with Medicare. Because premiums vary greatly, you should carefully weigh your prescription costs against all variables of these plans. Selecting the wrong plan can wind up costing you thousands.  Some Medicare Advantage plans may offer prescription coverage as well.

Please note that you should sign up for Part D (even if you do not have prescriptions) when you first turn 65, as waiting may result in a costly monthly penalty added to your premium.

Medicare Supplement Plans

Medicare Supplement Insurance policies complement your Original Medicare Parts A and B. They cover some, if not all, of the expenses that Part A and B do not cover, like co-pays, deductibles and other charges.

There are many different types of Medicare Supplement policies available, however they are regulated so the benefits for these various policies (known as Plan A through N), are all the same regardless of the carrier. However, premiums can vary greatly among carriers.

Medicare Advantage

Medicare Advantage Plans are offered by private carriers and replace your original Medicare Parts A and B, as they are rolled into one plan.  You can select between an HMO or PPO, and most plans may cover more of your healthcare costs and have additional benefits, such as prescription drug coverage. Some may have dental or vision benefits. Premiums vary based on coverage, carrier and geographical location.

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older. The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Most people will pay a standard Part B premium which varies depending on income.

Gap Insurance

A Gap plan provides benefits that supplement a major medical and comprehensive benefit package. It works by paying a significant amount of the deductible on a major medical plan. More specifically, the additional benefits help to cover out-of-pocket expenses related to coinsurance, co-pays and deductibles for inpatient and outpatient services. For example, if you have a $5,000 deductible on your major medical plan, gap coverage could pay up to $4,000 of that deductible.

Final Expense Plans

Final expense insurance is designed to help protect your employees and their loved ones from the financial burden of funeral costs related to an employee’s passing. Final expense policies have a much lower face value because they are intended to only cover costs related to a person’s final expenses. Therefore, these policies can often be purchased at low or reasonable premiums.

Hospital Indemnity Plans

Unlike a traditional major medical plan that reimburses you or pays directly to a provider for approved hospital stays and medical care, a Hospital Indemnity Plan pays a lump-sum payment directly to the insured. The cash payment helps with out-of-pocket expenses and covers you when you are off work due to a hospital stay. The coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected.

Disability Plans

National surveys have shown that Short Term Disability and Long Term Disability remain of high importance for most employees. Thus, savvy employers attract and retain top talent by offering both STD and LTD insurance as part of the employer paid benefit package or as a voluntary (worksite) benefit.

Short Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), STD generally allows for income payments to the employee to begin after about a two-week waiting period and will continue to pay the employee until he/she recovers or maxes out the benefits–usually anywhere between one month to two years, depending on the policy.

Long Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), LTD generally allows for income payments to the employee to begin after about a 90-day waiting period. However, it could be much longer depending on the policy. The policy will pay the employee far longer than STD–for a few years, up to age 65, or even for life.

Critical Care Plans

This special type of coverage can reduce the personal financial impact of the cost of fighting critical illnesses, helping to keep up with everyday bills through that process. Some key features include cash benefits paid directly to the employee and plans to fit different levels of coverage/budgets.

Accident Plans

Accidents can happen anytime.  Accident insurance helps to protect employees from financial hardship due to a great deal of medical and out-of-pocket expenses that follow accidental injuries. For example, emergency treatment, hospital stays, medical exams, transportation and lodging needs are just a few of the expenses that accident insurance can help cover. In fact, some policies can even pay benefits in as little as one day, based on time of claim submission.

Life Insurance

Employees are more productive when they feel secure that their loved ones will be taken care of, in the event of illness or an untimely death. Thus, you should consider life insurance a key part of the benefit package for your employees. And, also a valuable tool in attracting top talent.

Whether employer paid or voluntary, a good life insurance policy provides for an employee’s final expenses, taxes, and mortgage. Additionally, it may even pay for their children’s education.

Permanent Life Insurance

This type of life insurance builds cash value which is sometimes used as collateral for loans, if needed. However, most employers only offer basic term life insurance (see below), but also offer permanent life insurance on a voluntary basis. Even so, employees appreciate the opportunity to widen their safety net.

Term Policy

This type of life insurance does not build cash value. However, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Additionally, some policies may also make payments upon terminal or critical illness.

When can I buy an ACA health insurance plan?

For Healthcare.gov (the Federal Marketplace), it’s important to know that you can only purchase your health insurance during the annual open enrollment which is November 1 to December 15th of each year, or unless you qualify for the special enrollment period.  Missing this time frame means you’ll have to wait until the next year to buy your coverage.  However, we offer several affordable Non-ACA options that can be purchased year round so you don’t have to go without coverage.

IMPORTANT enrollment dates for individuals residing in Pennsylvania only.  For this year’s upcoming enrollment and beyond (2021), the state of Pennsylvania is leaving Healthcare.gov (the Federal Market) and switching to their own state-based exchange. The enrollment dates are slightly different for this exchange and run from November 1 to January 15th of each year.

Telemedicine – Health and Well Plans

This Health and Wellness Option is very affordable and gives you access to a variety of discounted health services that include prescriptions, counseling, as well as telehealth solutions. Our telehealth solutions are provided by DialCare, which is a modern, easy-to-use telemedicine solution for non-emergency illnesses and general care.  Members and their families have direct access to state-licensed and fully credentialed doctors, via phone or video consultations, to receive treatment (including prescriptions) and advice for common ailments, including colds, the flu, rashes and more. All for a $0 consult fee.

Short Term Health Plans

If you have missed the open enrollment period per the Affordable Care Act (ACA), and do not qualify for special enrollment, or are in between jobs, or maybe you need a more affordable alternative to the ACA, you can purchase Short Term Health Insurance any time of the year. Per the new health insurance regulations as set by the Trump Administration, there is no longer a tax penalty or individual mandate, so you do not have to worry about non compliance of the essential health benefits.

A short term health plan is a non-ACA option that is much less expensive than a comprehensive health plan, because it does not cover pre-existing conditions nor does it contain all of the essential benefits required by the ACA. The great thing about a short term policy is that it will help you avoid financial disaster in case of unexpected illnesses and accidents. And, per new federal guidelines, carriers allow for plans up to one year, and are renewable for up to three years in some states.

Hospital Indemnity Plan

Unlike a traditional major medical plan that reimburses you or pays directly to a provider for approved hospital stays and medical care, a Hospital Indemnity Plan is a limited benefit plans that pays a lump-sum payment directly to the insured. Also, unlike a comprehensive plan on the Marketplace, you can enroll in this non-ACA option any time of the year.

When paid directly to the insured, cash payments help with out-of-pocket expenses and covers you when you are off work due to a hospital stay. There are no plan maximums, however the coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected. Some plans include optional benefits, such as preventive wellness, diagnostic testing and physician office visits.

Vision Plans

Take care of your eyes with an individual vision plan that can be purchased anytime of the year. Monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts, and also helps to detect early stages of diabetes, high blood pressure, and high cholesterol. Individual vision plans are similar to individual dental policies, as they are inexpensive and save you money on several services:

• Eye Exams
• Eyeglass Frames
• Contact Lenses
• Discounts on LASIK
• And more

Ongoing Service

Managing your benefit programs can be time consuming and tedious.  We, along with our carrier partners and vendors, assist with the ongoing maintenance of your programs by taking care of as much as we can.

• New hires and terminations
• Assist with any carrier billing
• Assist with claims issues
• And more.

Our approach to benefit management ensures your benefit objectives are met and your program(s) continue to run smooth, while allowing you time to focus on other important matters.