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COVID-19 and Medicare

Employee Benefit Advisors recommends communicating the following to you employees. Odds are your company has either employees on Medicare, family members on Medicare, or both.

Copays for the Coronavirus test have been waived, but not the cost of the doctor visit needed to get the test or the treatment.

Telehealth – CMS announced that it will expand telehealth services for Medicare beneficiaries and cut back on HIPAA enforcement. Email and texts to docs will be possible! Read the CMS details here

Cost of testing – Medicare Part B (Medical Insurance) covers a test to see if you have coronavirus (officially called 2019-novel coronavirus or COVID-19). https://www.medicare.gov/coverage/coronavirus-test

3 Day Hospitalization Waived for Skilled Nursing Facilities – The waiver of the requirement for a 3-day prior hospitalization for coverage of a SNF stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (Blanket waiver for all impacted facilities). Click here to download the full CMS memo.

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

Coronavirus – do the 5

I’ve been seeing this advice on Google the past few days. I think it’s simple and easy for employees t grasp. Pass it on.

Help Stop Coronavirus

1. Hands – Wash them often
2. Elbow – Cough into it
3. Face – Don’t touch it
4. Feet – Stay more than 3ft apart
5. Feel sick? Stay home

 

 

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

Coronavirus – easy to understand info for employees

Symptoms people may experience:
1. runny nose (Not to be confused with allergies)
2. sore throat
3. cough (develop the habit of coughing into your sleeve or handkerchief – never your hand!)
4. fever
5. tightening of chest / difficulty breathing (severe cases)

What can you do?
• Emergency Room – very expensive
• Urgent Care – less expensive than ER but more cost-effective options exist
• Primary Care Physician – generally a low flat copy; at most the contracted rate between the physician and insurance company
Because COVID-19 is highly contagious to prevent contaminating health care service workers, it is not recommended you go directly to the              ER, UC or PCP.
Telemedicine – no cost! – If you need emergency care or any additional care the doctor will advise you.
(According to the Centers for Medicare & Medicaid Services (CMS), Essential Health Benefits (EHB) coverage generally includes coverage for the diagnosis and treatment of COVID-19.)

 

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

Should you get a second opinion?

If you find yourself asking questions like:

  • Do I have the right diagnosis?
  • Am I on the best treatment path and medications?
  • Is this surgery or procedure the best option for me?
  • How can I find the best local doctor for my medical needs or my surgery?

2nd.MD will get you help and answers.

Here are some quick stats:

  • 24% of consults lead to an alternate diagnosis
  • 82% of consults result in an improved treatment plan
  • 29% of surgery consultations result in surgery cancellation

2nd.MD provides support for any condition. Your support starts with a Care Team Nurse. Within days, 2nd.MD will collect your pertinent medical records and imaging and connect you via phone or video to a world-class specialist, uncovering all the possibilities and taking control of your health outcome through local and national in-network referrals.

Service is at no cost to if you are enrolled with a participating organization/employer as part of your benefits package. Many people have their service through their insurance carrier and don’t even know it! The benefit of 2nd.MD is also available to individuals. Contact them directly for pricing.

 

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

IRS Guidelines – Indexed for 2020

FICA
Social Security Tax is 6.2% on income up to $137,700
Medicare Tax unlimited 1.45% to Unlimited

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,400 / $2,800
Maximum Out-of-Pocket Limit (Individual/Family) $6,900 / $13,800

Health Savings Accounts
Individual / Family $3,550 /  $7,100
Catch-up Contribution $1,000

ACA Plan Limits
Out-of-Pocket Limits Individual / Family $8,150 / $16,300

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $2,750
Dependent Care Spending Account Maximum $5,000
The dependent care FSA maximum is set by statute and is not subject to inflation-related adjustments.

Mileage & Transportation
Standard Mileage Rates
57.5 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) $270
Mass Transit Passes (monthly) $270

Compensation
Compensation Limit $285,000
Highly Compensated Employee Salary Amount $130,000
Annual Compensation for Key Employee $185,000
Defined Benefit Plan Limit $230,000
Defined Contribution Plan Limit $57,000

Retirement Plans
401(k) $19,500
401(k) Catch-up $6,500
403(b) $19,500
457(b)(2) and 124(c)(1) $19,500
457(b) Catch-up $6,500

IRA Limit $6,000/$7,000 for age 50+
Simple IRA Limit $13,500/$3,000 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.

Proposed Transparency in Coverage Rule vs. American Hospital Association

A proposed rule would require plans and issuers to disclose cost-sharing estimates to participants, as well as post in-network provider-negotiated rates and historical out-of-network allowed amounts on their websites. The rule would apply to group health plans and insurers in the individual and group markets and sponsors of self-insured group health plans. They would not apply to grandfathered plans. The Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued the rule.

The American Hospital Association and other hospital groups have filed a lawsuit in the U.S. District Court in Washington that claims the Centers for Medicare and Medicaid Services rule violates the First Amendment by provoking compelled speech and goes beyond the intended meaning of “standard charges” transparency in the Affordable Care Act.

 

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

2020 EMPLOYEE BENEFITS UPDATE

As we head into a new year, there will be some noticeable changes in employee benefits that you and your clients should be made aware of. The following list encompasses a few of the items you may expect to change:

Required Reporting
Effective January 1, 2020, Medicare Secondary Payer reporting will now include prescription drug coverage. Right now, this is an optional procedure. It is handled by insurance carriers and third-party administrators. Employers should be aware that they may get requests for information from those carriers and third-party administrators. A more detailed explanation can be found here.

PCORI Fee Elimination
The PCORI fee will be eliminated for plan years ending before October 1, 2019. If an employer’s plan year ends between October 1, 2018 and December 31, 2018, then the last PCORI fee for that plan should have been paid by July of 2019. This would generally include plans that have plan years beginning November 1, December 1, or January 1. All other plans will make their last PCORI fee payment by the end of July 2020.

Out-of-Pocket Maximum Increase
In 2020, out-of-pocket maximums will increase to $8,150 for self-only coverage and $16,300 for family coverage. This represents an increase of about 3.20% from last year. HHS requires that the individual out-of-pocket maximum be embedded for each individual within the family OOPM. You can refer to the 2020 Benefit and Payment Parameters found here.

Health Insurance Tax
The Health Insurance Tax (HIT) which has been on a moratorium for 2019, will make a return in 2020 unless Congress acts on pending legislation to delay or repeal. This would result in increased premiums ranging from 2.7% to 4% according to actuarial experts.

Employer Mandate Affordability
The affordability percentage used in the safe harbors will be reduced to 9.78% in 2020. Employers should review their contribution levels to make sure they are within the new percentage requirement.

Individual Mandates in the States
Effective January 1, 2020, California and Vermont will have an individual mandate that will require employer reporting to be completed in 2021. New Jersey, which already has an individual mandate in place, will have to complete the employer reporting in 2020.

Self-Funded Plans
Employers that self-fund may have different benefits that cannot be subject to annual and lifetime limits. Self-insured employers should reevaluate which state plan they use as their benchmark for purposes of determining which benefits cannot be subject to annual and lifetime limits.

2020 Employer Mandate Penalties
As they do each year, the Department of Health and Human Services (HHS) calculates the health insurance premium growth rate. That rate is then used to adjust the amount of the ACA employer mandate penalties. Although not finalized, the 2020 employer mandate penalties could be $2,570 for the (a) penalty and $3,860 for the (b) penalty.

There is a lot of pending legislation that Congress could still take up before the recess. Issues pertaining to a Cadillac Tax repeal, transparency in prescription drug prices (H.R.3), redefining a full-time employee, surprise billing, and employer reporting can all be potentially addressed in the coming weeks.

 

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

Top 10 health conditions costing employers the most

Employee Benefit News recently published a list of the 10 health conditions that are costing employers the most. They are:

  1. High-Risk Pregnancy
  2. Smoking
  3. High Cholesterol
  4. Depression/Mental Illness
  5. Hypertension/High Blood Pressure
  6. Heart Disease
  7. Arthritis/back/musculoskeletal
  8. Obesity
  9. Cancer
  10. Diabetes

Employee Benefit Advisors would like to point out that a least half the list is related to one’s weight. It prompts reposting the meat of EBA’s November 19th, 2014 blog.

The following was posted by one of my fellow CEBS (Certified Employee Benefit Specialist) colleagues. Employee Benefit Advisors has seen, time after time with our own clients, that weight loss is the number one factor to controlling health care costs.

“One of the most effective ways to ensure quality healthcare services is to not need it in the first place… All those overweight, please raise your hand. All those currently being treated for a preventable healthcare issue raise your hand.

My husband is 68 years old and was on high blood pressure, diabetes and cholesterol meds–pretty typical at this age. Oh, yes, and frequently had terrible heart burn. Lost 38 pounds and just had his annual physical. Doc took him off all his prescription meds and he no longer ever has heart burn. Go figure… How’d he do it? Cut way back on consumption of carbs/sugar. That’s it. Pretty simple. Nothing else…not even exercise. Now that he feels so good he has started to exercise on a regular basis.”

 

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

Employer medical benefit costs projections for 2020

Employer-provided medical benefit costs are forecast to rise 6.5% in 2020, outpacing general inflation by 3.8%. The expected increase for medical plans is due to a combination of higher costs for specialty drugs, moderate price increases for care and flat or decreasing health utilization. (Medical costs in the U.S. will rise more slowly compared to other regions around the world.)

Prices, not utilization, are the leading cause for healthcare spending. High deductibles and other cost sharing are two reasons for the decrease in utilization.

The primary drivers of health care claims are musculoskeletal, cancer, cardiovascular, diabetes and high blood pressure. It’s important to note the growing risks from unhealthy personal habits, i.e. physical inactivity, obesity, bad nutrition, ageing and excessive alcohol and substance abuse. Many of those risk factors can lead to chronic conditions that are difficult to treat and can contribute to long-term increases in medical costs.

2020 Global Medical Trend Rates Report

 

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

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