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Here’s why the CBO report on AHCA is wrong – BIG TIME!

Opponents of the American Health Care Act say 24 million more Americans will lose coverage. However, that number is based on faulty assumptions. The CBO report uses the ACA’s March 16 baseline projections for comparison. Projections that have already proven inaccurate. This leads to three flawed assumptions.

1) Premiums will not be more expensive than under the baseline.
This is false. American’s saw significant premium increases in 2017 and if Obamacare is left intact future increases will undoubtedly occur.

2) Insures will not drop out of the system.
This is false. Carriers have already announced they are pulling out altogether.

3) The number of people under Obamacare will not decrease.
This is false. Under Obamacare the marketplace was expected to rise to 18 million by 2023 and then level off. However exchange enrollment actually dropped by about half a million between 2016 and 2017 — to 12.2 million. That suggests that the number of insureds has already begun to contract. Premium increases and insurance companies dropping out of the market have and will continue to force people to drop their insurance, impacting the original assumption even further.

Garbage in, garbage out.

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Rx Refills made easy!

Don’t like lengthy waits to refill your prescriptions? Prefer to have refills delivered to your door? Prefer someone else troubleshoot insurance & renew refills for you? Let me introduce you to Phil.

Phil is a service that manages your ongoing prescriptions. Phil partners with top-rated, locally-owned pharmacies that are licensed by the Pharmacy Board. These pharmacies will deliver your medications to you on time and answer any questions over the phone. Using the Phil app, you are able to refill on your own terms by scheduling when your medications arrive, ordering vacation refills etc.

Welcome to Phil – Smarter Prescription Refills: same copay, free delivery and a real time saver.

 

Phil takes 3 easy steps.
Step 1 – Sign Up and add your existing prescriptions to Phil.
Step 2 – Phil does the rest, they contact your old pharmacy and do the paperwork.
Step 3 – Receive your meds. Partner pharmacies deliver meds to your doorstep every month.

All partner pharmacies are rated 4-5 stars on Yelp®

Delivery is free. Phil will guarantee your copay will be the same as what you pay at your current pharmacy. Some rare exceptions may apply; in those cases, you’ll be contacted for approval. If you don’t have insurance, Phil partner pharmacies will quote you the lowest price they can obtain for you.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Social Security – Where’s the AARP?

Do you know when you retire you may be paying taxes on your Social Security income? And yes, you already paid taxes on that income. It’s double taxation. (Our friends in Boston that had a bit of a tea party would love this one.)

Not everyone pays though. Only high income earners. – When you retire will you be a high income earner? – Don’t think so? I suggest you take another look. The government says “This usually happens only if you have other substantial income (such as wages, self-employment, interest, dividends and other taxable income that must be reported on your tax return) in addition to your benefits.”

And, they try to soften the blow by saying “No one pays federal income tax on more than 85 percent of his or her Social Security benefits based on Internal Revenue Service (IRS) rules.”

Who pays? You do, if you

  • file a federal tax return as an “individual” and your combined income* is
    • between $25,000 and $34,000, you may have to pay income tax on up to 50 percent of your benefits.
    • more than $34,000, up to 85 percent of your benefits may be taxable.
  • file a joint return, and you and your spouse have a combined income* that is
    • between $32,000 and $44,000, you may have to pay income tax on up to 50 percent of your benefits
    • more than $44,000, up to 85 percent of your benefits may be taxable.
  • are married and file a separate tax return, you probably will pay taxes on your benefits.

Note: Your adjusted gross income + nontaxable interest + ½ of your Social Security benefits = your “combined income”

And the income levels mentioned above are not adjusted for inflation.

Clients and followers of Employee Benefit Advisors know that despite being well versed in investing and retirement planning we do not dabble in retirement benefits. Our practice is strictly Health & Welfare. We decided to blog bout this issue because every time this topic comes up people are stunned.

Do you want to change this law? Write the AARP. How did they let this get through and why are they not addressing this issue?

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Men are the problem!

Men don’t go to the doctor unless their arm or leg is falling off or they are dying. Consequently they are a major reason for the large preventable claims your company is incurring. So men, get a reality check, and become a smart patient.

Human Resource Directors, read the following then think about this recommendation. “Employees that have their annual wellness exam should pay less for their employer provided health insurance.” (This recommendation is good for women as well, you don’t want to discriminate. And you can implement this staying HIPAA compliant.)

Guys, you may feel fine, but the numbers don’t lie: More men than women are likely to be diagnosed with diabetes and kidney disease. And according to the Centers for Disease Control and Prevention (CDC) 12.1% of US men have circulatory diseases like coronary heart disease, heart attack and stroke. Your body may be suffering from silent conditions that have little or no symptoms, such as hypertension or colon cancer. About 3.5 million people are diagnosed with skin cancer every year, and men are more likely than women to die from melanoma, the deadliest form of skin cancer.

You should talk to your doctor about your risk of prostate cancer – especially if you’re over 50, African American, or if prostate cancer runs in your family. If you’re a baby boomer, you should get tested for hepatitis C (HCV). More than 75% of adults infected with HCV, often a symptomless disease, were born between 1945-1965. Left untreated, HCV can cause life-threatening diseases such as liver damage, liver cancer and cirrhosis.

So no more excuses. The old “ignore-it-and-it-will-go-away” approach doesn’t work. It’s time to get informed and become a smart patient. Make that doctor’s appointment now.

Statistical information came from sharecare, www.shaecare.com, a great resource for men and women’s health.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Health Care Reform – Where do we stand?

By now everyone knows the initial attempt to replace Obamacare with a more workable solution has failed. I’m sure another attempt will resurface later. Let’s focus on what we know and how President Trump’s executive order, signed in January, impacted Obamacare.

President Trump’s executive order is still in effect. – The primary focus of the executive order was for Federal agencies to minimize the economic burden of the Affordable Care Act (ACA), pending repeal of the law. However, until further guidance or legislation, all ACA requirements remain in effect, including penalties for noncompliance.

The executive order specifically calls upon agencies to exercise authority and discretion to:

  • exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications;
  • provide greater flexibility to States and cooperate with them in implementing healthcare programs; and
  • encourage the development of a free and open market in interstate commerce for the offering of healthcare services and health insurance, with the goal of achieving and preserving maximum options for patients and consumers.

Although the penalties for noncompliance remain in effect it does give the appearance that there is an out. However, I don’t recommend you be the one to test it.

BMI – Good News for those trending on the Porky Side!

BMI, body mass index, measures the weight to height ratio. Good news for those trending on the high side, according to the report in the Journal of the American Medical Association (JAMA), the optimum ratio is on the upper side of the index.

Currently, doctors define the normal range for BMI is between 18.5 and 24.9. A BMI of 25-29.9 is considered overweight, while 30 or higher is obese. In the 1970s, the optimal BMI for the lowest risk of death was 23.7. By 1991-94, the optimal BMI had risen to 24.6, in 2003-2013, it reached 27.

Although the findings suggest the need to reevaluate the categories presently used to define overweight, which are based on data pre 1990s data, don’t start packing on those pounds. Health experts still maintain the risks of being overweight include diabetes, high blood pressure, high cholesterol, and cardiovascular disease – among other things.

Want to know your BMI? – BMI is calculated by weight in kilograms divided by height in meters squared.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Predictive Modeling – GRx

Many health insurance companies are looking at prescription usage to underwrite and rate group health insurance. It’s called predictive modeling.

GRx uses complete and current prescription histories. Details include drug name, dosage, fill date, pharmacy and physician information. This Healthcare Intelligence allows carriers to make risk assessment decisions with confidence and more accurately develop premiums. New group rates are quickly and more accurately developed. GRx turns group census data into a risk score. Health plans use the GRx risk score to more accurately predict the group’s future claim costs.

It’s good for the health insurance carrier and the group. Both get a more accurate quote potentially avoiding large rate fluctuations.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

IRS Guidelines – Indexed for 2017

FICA
Social Security Tax is 6.2% on income up to $127,200 up from $ 118,500.
Medicare Tax unlimited 1.45% to Unlimited

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,300 / $2,600
Maximum Out-of-Pocket Limit (Individual/Family) $6,550 / $13,100

Health Savings Accounts
Individual / Family $3,400 / $6,750
Catch-up Contribution $1,000

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $2,600
Dependent Care Spending Account Maximum $5,000

Mileage & Transportation
Standard Mileage Rate
53.5 cents per mile for business miles driven
17 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations
Parking (monthly) $255
Mass Transit Passes (monthly) $255

Compensation
Compensation Limit $270,000
Highly Compensated Employee Salary Amount $120,000
Annual Compensation for Key Employee $175,000
Defined Benefit Plan Limit $215,000
Defined Contribution Plan Limit $54,000

Retirement Plans
401(k) $18,000
401(k) Catch-up $6,000
403(b) $18,000
457(b)(2) and 124(c)(1) $18,000
457(b) Catch-up $6,000
IRA Limit $5,500/$6,500 for age 50+
Simple IRA Limit $12,500/$3,00 Catch-Up

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Health Insurance As It Should Be (Part 2 of 2): Preventative, Wellness & Biometrics, Genetics & DNA

Under the ACA preventative care was free. At least there was no charge to the insured at the time they received the exam, the cost was built into the premiums. The argument was that an advanced diagnosis would save long term medical costs because illnesses would be caught at an early stage.

If we use that same argument to create “health Insurance as it should be” there are three key strategies that would prove to be very effective.  Here they are and here’s how to use them. (1) Preventative – Individuals have a responsibility to be examined at least periodically (every two years, yearly as we get older – I’ll let the AMA set the standard) and get their immunizations. Those that do receive a lower insurance premium. (2) Wellness / Biometrics – Smokers should be charged more (no need to argue why, everyone should be aware of the added health risks and costs). Lower premiums or premium rebates for those actively managing and meeting standards for blood pressure, BMI, cholesterol and blood sugar level. All are key indicators of health. It makes sense to provide a premium discount to the individual going to the gym or utilizing some other method to improve their health. Those that don’t should pay more. After all, they are costing everyone else more. (3) Genetics & DNA – Technology is a great tool. Let’s use it to help predetermine the medical conditions which we’re predisposed. Not to punish people with higher costs, but to be proactive. A lifestyle change at an early age could help prevent certain illnesses. Information can be kept confidential with case managers and not shared or used with underwriting. – i.e. If you knew you had a family history of cancer, breast or colon, you could be proactive and monitor the signs. Same principle for other genetic diseases.

Let’s use all the available resources to lower health care costs and create a proactive system, health insurance as it should be.

What ideas do you have?

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Health Insurance As It Should Be (Part 1 of 2): Taxes and Regulations

Much speculations evolves around what changes the Trump administration will bring to health care. Although I don’t know why. The basics have been laid out by the Republicans for months. There is some fine tuning that needs to be done, but the core is in place. In addition to the principles that have been laid out, here are a few well thought out suggestions.  (For a closer look at what’s been proposed go to my July 13th and 27th blogs, Repealing Obamacare – Individual Tax Credit & The Employer Tax Exclusion.)

What part of the current healthcare reform plan would I keep? Once Obamacare is repealed, it must be repealed, my primary complaint is the ACA was implemented as a regulatory law not a health advocacy tool, I’d reintroduce three things. (1) No one should be denied coverage due to preexisting conditions. However, no one should be allowed to burden the system who carries no insurance, goes to the doctor, learns they need medical care and now applies for insurance. They should be required to apply for insurance, bear a heavy portion of the medical expenses for a year or two (contracted rate), and have the carrier assign a case manager. (2) Keep adult children on the plan until age 26, unless they are employed full-time. Then it’s time to put their big boy & girl pants on and be a responsible adult. (3) The Summary of Benefits & Coverage and Glossary of Health Coverage & Medical Terms make it easier to understand coverages. However changes need to be made.

Whatever happens I hope we’ll see both the introduction of individual tax credits and the continuation of the employer tax exclusion, rightfully so. Both are integral to health care. Why individuals have not been able to deduct health insurance premiums is a mystery. The need to continue the employer tax exclusion is important because the vast majority of Americans receive coverage through their employer. Suddenly thrusting 170 million people into the individual market would be chaotic. Also, the employer resources can be provide health advocacy for the employees (independently contracted, through HR or the broker).

Here are some simple solutions that will make health insurance easier and better.

  • Paying for Preexisting Conditions – Every transaction, buying aspirin, medical procedures, hospital stays – anything medical related – should be charged a ‘PreX’ fee of 1 penny. The money would go towards funding preexisting conditions, nothing else. If it raises more than is needed, then cut it back to either ½ penny or only on certain purchases or procedures. (Need to have the bean counters look at this recommendation.)
  • All medical expenses (premium included) should be pretax. Do I really have to explain why this is good/fair? If health care is as important as everyone says, and it is, let’s make it as inexpensive and accessible as possible to all. Eliminate all the complex tax regulations around health insurance, especially the need to have 7.5% of income before receiving the current deduction. (Note: It’s a deduction not a tax credit.)
  • Everyone should be eligible for HSA accounts and eliminate FSA accounts. Why have the use-it-or-lose-it rule? Makes no sense, except the federal government is overly concerned about the tax revenue. Although medical expenses would be pretax, based on my recommendation above, the HSA account would continue pretax deductions with tax free expenditures for medical care. HSA accounts would incentivize people to finance future medical expenses. What should be the allowable limit for HSA contributions? It’s open for discussion, but a dollar amount equal to the plans out-of-pocket maximum would make sense.
  • Any able body, able mind,  receiving a government subsidy for health care (Medicaid) should be required to do some form of work, be it ever so menial. Health insurance is expensive, everyone can do their part.
  • Major changes to medical liability and malpractice need to be made. I’ll let others suggest specific tort reform recommendations. But we need to get the attorneys to give up their strong hold on the medical market. It’ll help lower costs.

Finally, before you suggest eliminating insurance companies, I hope you’ll think about the import role they play in lowering health care costs. Health insurance companies, just like many items you buy, negotiate rates, buy in bulk, and monitor expenditures. Need proof? Look at your EOB (Explanation of Benefits). Compare the original billed amount to the allowed amount (after discounts).

I’m not saying they are perfect or that changes can’t be made. I’m just saying they play an important role and we need to recognize it. Insurance companies are much better than a bloated government agency with little or no accountability. We tried that with the VA health care and Obamacare. – No thank you!

What ideas do you have?

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

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