The following videos are provided by and copyright of The Centers for Medicare and Medicaid Services (CMS) and are for informational purposes.
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Also known as Dental and Vision Savings Plans, this option offers reduced rates on dental and vision services through a membership program, rather than traditional insurance coverage. Members pay an annual fee and receive discounted rates from participating dentists and eyecare providers. These plans differ from insurance in that there are no claim forms, deductibles, or annual maximums. These plans are a form of savings program, not insurance, and can be used as a standalone option or to supplement an existing insurance plan.
Services include eye exams, eyeglasses, and contact lenses, dental cleanings, fillings, crowns and other dental services at a network of participating providers.
A Flexible Spending Account (FSA) is a cafeteria plan under Section 125 of the tax code and allows for benefits to be paid with pre-tax dollars which results in tax savings to both the employee and the employer. The average working employee in America spends thousands of dollars annually on certain types of medical benefits, daycare expenses and transportation services. By participating in an employer sponsored FSA, the employee funds the plan through regular pre-tax payroll deductions, which reduces his/her taxable income, and increases the percentage of pay they take home. Employees elect how much they want withdrawn from each pay period, which can be changed annually or upon a qualifying event such as marriage or divorce. The account allows them to pay for certain healthcare and other services with the account (pre-taxed dollars), in essence giving them a discount on these services. The administrator of the FSA account can issue a debit card that is tied to the FSA making it easy to use the account when needed.
Typically unused contributions at end of year are forfeited to the plan, however some employers may include provisions in their FSA plan design to allow either additional time to spend or a rollover of unused funds.
Contributions to a Flexible Spending Account (FSA) are exempt from federal income tax, Social Security tax (FICA), and in many cases, state income tax, as well as Medicare.
Many group health plans benefit by having a Health Savings Account (HSA) feature that combines a high deductible/lower premium health insurance plan (PPO) with a savings account. Both employer and employee can contribute, tax-free to the savings account, which can help fund the deductible and other qualified medical expenses. Then, the insurance will begin paying claims, once the deductible is satisfied.
Funds in an HSA roll over year to year and are portable, meaning they can be transferred or remain with the employee if they leave or change employers.
HSA contributions, whether made by the employer or through pre-tax payroll deductions, are exempt from federal income tax, Social Security tax, and Medicare tax.
A Health Reimbursement Account (HRA) combines high deductible/low premium health insurance with a tax-favored employer owned savings account. Employers solely contribute to the savings account, which can be used to reimburse employees for co-pays and other qualified expenses prior to the deductible being met.
If an employee does not use the contributions by the of the end of the year, the funds can be forfeited to the plan, or the employer can optionally choose to roll over unused funds.
Employer contributions and employee reimbursements through an HRA are not subject to federal income tax, Social Security tax, or Medicare tax, offering a triple tax advantage. This tax-free edge allows for more cost-effective healthcare spending and benefits both employers and employees.
A Premium-Only Plan is a win-win solution for both you and your employees. It allows allows employees to purchase their own individual insurance with pre-tax dollars, decreasing taxable income and increasing take-home pay. It also reduces the employer tax liability and generally reduces premiums.
Employees elect a set amount of pre-tax dollars to be deducted from each payroll. Then, the employee purchases an individual health insurance policy from a carrier of their choice. Accordingly, the employee is responsible responsible for paying the monthly premiums directly to the carrier. The employee is then reimbursed by the employer for the monthly premium with the pre-taxed dollars.
Premium Only Plans (POPs) typically offer exemptions from federal income tax, Social Security tax (FICA), and Medicare tax on the employee’s portion of health insurance premiums.
Employer-provided disability insurance is often a good starting point, but it may not be enough to cover all your expenses if you become disabled. It’s crucial to assess your individual needs and potentially supplement your employer’s coverage with a private disability insurance policy.
Short Term Disability
During the time you are unable to work due to a qualifying disability (illness or injury), STD generally allows for income payments to begin after about a two-week waiting period and will continue until you recover or max out the benefits–usually anywhere between one month to two years, depending on the policy.
Long Term Disability
During the time you are unable to work due to a qualifying disability (illness or injury), LTD generally allows for income payments to begin after about a 90-day waiting period. However, it could be much longer depending on the policy. The policy will pay the benefits far longer than STD–for a few years, up to age 65, or even for life.
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:
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.
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 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 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.
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.
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 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.
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.
Employees always appreciate dental & vision coverage as part of the benefits package. We offer both dental and vision as part of the employer sponsored package or on a voluntary basis.
Dental Plans
Studies have shown that regular dental exams help employees to stay healthier and more productive in the work place. Additionally, you can detect serious underlying conditions such as heart disease and diabetes, through regular dental exams. In fact, the National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with dental insurance have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.
Dental insurance offers a variety of diagnostic, preventative care and corrective services. This includes cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.
Vision Plans
Similar to dental policies, vision plans are inexpensive and save employees money on routine eye care. Examples of care include exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Additionally, monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts. In addition, regular eye exams help to detect early stages of diabetes, high blood pressure, and high cholesterol.
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.
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.
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.
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.
With today’s high cost of medical care, it is just no longer an option to go without healthcare insurance. One accident or illness can be financially devastating. You need to protect yourself and protect your family. In fact, according to a new study 66.5% of all personal bankruptcies that were filed were due to illnesses and accidents leaving individuals unable to work and strapped with medical bills. Whether you qualify for a subsidy or not, a comprehensive health plan can help you avoid financial ruin.
Additionally, Non-ACA alternatives such as Short Term Health Insurance, and/or Critical Care or Hospital Indemnity Plans will cost you about a third of what an unsubsidized major medical plan costs, and will protect your finances so you can focus on your health and getting better, should you have an accident or unexpected illness. Click here to learn more about our NON-ACA options.
Non-ACA options, however, have limitations and in some cases, do not cover certain and/or preexisting conditions.
You can avoid the hassle of trying to find a plan on your own by letting our agent, Tracey Pal Izzi help you find a plan that meets your exact requirements. She is an experienced, trained agent who will personally guide you past all the pitfalls. She is a true insurance professional who thoroughly researches the insurance options so that you don’t have to “buy a plan in order to find out what is in it”. Best of all, her service is completely free.
You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:
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.
Currently, most people are not required to purchase health insurance. The ACA “shared responsibility payment” and the individual mandate has been eliminated by the Trump Administration for 2019 and beyond. However, some states have established their own individual mandates, so you still may be subject to your specific state tax penalty, if any.
Following is a list of the states, as of 2019, that have mandated residents purchase qualifying health insurance (which is similar to the federal essential health benefits), or face a tax penalty when they file their income taxes.
Updated in 2023…
California – The penalty for not having coverage the entire year will be at least $850 per adult and $426 per dependent child under 18 in the household. The penalty can also be calculated based on percentage; you could also be charged 2.5% of the gross income that exceeds the filing threshold, whichever is greater.
Massachusetts – the tax penalty amount varies depending on your income, age and family size, but note the maximum penalty can be no more than half the price of the lowest premium plan available on the Massachusetts healthcare marketplace.
New Jersey – the tax penalty is $695 for adults and $347.50 for each child, with a maximum family penalty of 2.5% of annual income,. The penalty is capped at three times the adult penalty ($3,661), or the state average cost for a bronze-level plan, whichever is greater.
Rhode Island – the tax penalty is $695 for adults and $347.50 for each child, with a maximum family penalty of 2.5% of income, or three times the adult penalty ($2,100), whichever is greater. The maximum tax penalty is based on the average bronze health plan premiums cost.
Vermont – Vermont requires residents to have qualifying health insurance, but currently, there is no cash penalty for non compliance.
Washington, D.C. – the tax penalty is $700 for adults and $350 for each child, with a maximum family penalty of 2.5% of income, or three times the adult penalty ($2,100), whichever is greater. The maximum tax penalty is based on the average bronze health plan premiums cost.
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The public health insurance Marketplace (also referred to as an “Exchange”) is where you can purchase health insurance (also known as Obama Care) for you and your family. A plan from the marketplace is considered a comprehensive major medical plan and also contains the essential health benefits (see below) as established under the Affordable Care Act (ACA) law. When you purchase your health insurance through the marketplace, you are guaranteed issue regardless of any pre-existing condition and you may be eligible for a subsidy (premium tax credit) to help off-set high premiums. Our agents, Tracey Pal Izzi and Victoria Salinas can help you determine if you qualify for a subsidy.
The essential health benefits are as follows:
An HMO offers lower premiums and a significant savings on routine and preventative healthcare. However, this type of health plan requires you to appoint a primary care physician and to use doctors and facilities that are affiliated with the HMO. Thus, if you use healthcare service providers outside of the HMO, there is a good chance those charges won’t be covered by your policy. But, the great thing about an HMO is that the only charges you incur, outside of your premiums, are co-pays for doctor’s visits and other services such as procedures and prescriptions.
A PPO will save you money on services if you use the preferred providers within the network. Keep in mind that deductibles must be met on this plan before some services will be covered. The good thing about a PPO is they generally will allow a certain amount of services annually outside of the deductible with a small co-pay, and most often the PPO has a large network with quality care providers and excellent prescription drug coverage.
POS plans combine features of HMOs and PPOs. Most POS plans require members to choose a primary care physician from within the POS network, but allow them to use out-of-network specialists with a referral from a primary care physician. Co-payments will be higher for out-of-network services.
An HSA is a tax-advantaged bank account tied to certain high-deductible health plans. It allows you to use tax free dollars to pay for allowable health expenses, such as copays, prescription drug costs and more.
Most insurers include wellness benefits in their comprehensive coverage, designed to improve lives and keep members healthy. Your plan from the Marketplace will generally include services like preventative screenings, free or discounted gym memberships, diet advice, disease management, telehealth, and much more.
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.
A Gap plan provides benefits that supplement a comprehensive medical plan that you purchase from the marketplace. It works by paying a significant amount of the deductible on your 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, and provide a lump sum payment that is sent directly to you and can be used for anything you choose. For example, if you have a $2,500 to $10,000 deductible on your major medical plan, gap coverage could pay some or all of that deductible, depending on the level of benefits you select. Some of our carriers have plans that include critical illness and accident (disability) benefits, with the option to purchase additional hospital confinement coverage. Read more below on these benefits.
Critical Illness insurance is a special type of insurance coverage that pays cash directly to you to help reduce the personal financial impact of the cost of fighting common types of critical illnesses, such as cancer, heart attack, stroke and more. With the advancements in modern medical technology, Critical Illness insurance is an increasing popular supplemental health insurance policy that allows you to focus more on recovery and less on the financial burden of a critical illness event or diagnosis.
Accidents can happen anytime. Accident Insurance is very affordable and provides benefits in addition to your regular health insurance and/or disability insurance, in the case of an accidental injury. Accident Insurance can go a long way to protect you from financial hardship due to a great deal of medical, recovery and out-of-pocket expenses that follow accidental injuries.
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.
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.
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:
Individual dental plans are inexpensive and can contribute greatly in promoting overall good health. They can range from a PPO or HMO to Pre-Paid, Fee-for-Service, and Discount on a variety of diagnostic and preventative care services including cleanings, exams, x-rays, fillings, orthodontia for children, and emergency care while traveling.
A PPO Dental Plan will save you the most money if you use providers within the network, and a HMO requires you use providers and the network and appoint a primary dentist.
Individual vision plans are similar to individual dental policies, as they are inexpensive and save you money on routine eye care, such as exams, eyeglass frames and lenses, contacts, and even offer big discounts on procedures like LASIK. Plans often work similar to a PPO or HMO, having a small copay and saving you the most money if you use providers within a specified network.
An HMO offers lower premiums and a significant savings on routine and preventative healthcare. However, this type of health plan requires you to appoint a primary care physician and to use doctors and facilities that are affiliated with the HMO. Thus, if you use healthcare service providers outside of the HMO, there is a good chance those charges won’t be covered by your policy. But, the great thing about an HMO is that the only charges you incur, outside of your premiums, are co-pays for doctor’s visits and other services such as procedures and prescriptions.
A PPO will save you money on services if you use the preferred providers within the network. Keep in mind that deductibles must be met on this plan before some services will be covered. The good thing about a PPO is they generally will allow a certain amount of services annually outside of the deductible with a small co-pay, and most often the PPO has a large network with quality care providers and excellent prescription drug coverage.
An HSA is a tax-advantaged bank account tied to certain high-deductible health plans. It allows you to use tax free dollars to pay for allowable health expenses, such as copays, prescription drug costs and more.
Most insurers include wellness benefits in their comprehensive coverage, designed to improve lives and keep members healthy. Your plan will generally include services like preventative screenings, free or discounted gym memberships, diet advice, disease management, telehealth, and much more.
To ensure your employees continually have the coverage they need, we think ahead and outside the box when it comes to annual renewals.
Our proactive approach eliminates the fear of annual renewals by making sure you understand your costs for the new year and that those costs stay within your budget.
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.
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.
Once we secure the right benefit package for you, we follow through with comprehensive support for you and your employees. Our services include plan implementation, benefit Q&A, and ongoing communications designed to help your employees appreciate and utilize their benefits wisely.
More about online enrollment. Depending on your carrier and plan, employers and employees manage their benefit programs through a cutting edge online benefits portal that can be accessed 24/7, eliminating hours of paperwork for employers, helps with onboarding, enrollment, renewals, increases employee communications/engagement and more, Employees view side-by-side plan comparisons, make elections, access summaries, forms, providers, or download policies, handbooks, memos, ID cards and more.
Studies consistently show that benefit education is key to driving participation, productivity and increased job satisfaction.
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.
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.
Our consultation process is designed to find the best benefit strategy that will provide rich, desirable benefits for your employees, yet also meet financial objectives of the company. First, we take the time to understand you, your company’s goals and your employee’s unique benefit needs. Utilizing a holistic approach, we provide superior carrier options and advice on various trends, funding strategies and tax incentives that help lower costs for both you and your employees.
Offering health benefits is a significant cost for employers. We break it down for you providing options in easy-to-understand comparisons, so you can make informed, smart decisions about your benefit offering and associated costs.
As independent brokers, our insurance guidance is provided at no cost and you will never pay a higher premium by utilizing our services.
As independent brokers, our insurance guidance is provided at no cost and you will never pay a higher premium by utilizing our services.
Our platform offers plans through Aetna, Anthem, Blue Cross Blue Shield, Wellcare, CIGNA, Clear Spring, Clover Health, Devoted Health, Excellus, Fidelis, Geisinger, Highmark, Humana, Jefferson Health Plans, UnitedHealthcare™, and UPMC.*
Important Medicare Disclaimer
I/We do not offer every plan available in your area. Any information I/we provide is limited to the plans I/we do offer in your area. Please contact Medicare.gov or 1-800-Medicare to get information on all of your options. Custom Benefits USA LLC and Tracey Pal Izzi & Victoria Salinas are not part of the Federal Government Medicare System. The content in on this page has not been reviewed or approved by Medicare.
