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What to Look for With 2020 Group Health Plans

Despite pushes for change in Congress, it looks like the ACA is still at the top of the list for people. With solid medical benefits and cheaper premiums, this controversial program will keep people covered, but with only the basic essentials. More and more, employer health seems to be the way to go if you want both comprehensive coverage while still maintaining a budget.

group health plan money with calculator — *Calculating your savings is easier when you know what to look for.*

The healthcare system seems to bring out a new update every month. It can get confusing to anyone that’s just started. Let’s take a look at what you can expect.

Besides the standard HRA improvements, there are more interesting changes to be aware of for the future. Here’s a couple we’ve found:

Accountable Care Organizations

These networks were created to foster cooperation in the healthcare system. Through building a “team” of sorts, hospitals, doctors, and specialists can provide a smooth transition through the system for the patients.

This is great news to watch for as an employer. Check with your group health plan to see if there’s a network near you to highlight for your employees. The easier you can make it for them to get well again, the better.

Virtual Care

Programs like Teledoc are growing in popularity. It’s no wonder considering their ease of use. Why go to a doctor’s office and deal with their wait times, prices, and discomfort when you can just pick up your phone for the same services? See if the plans you offer your employees include these services.

Of course, this won’t cover every case. However, rising at-home services could lead to improvements in our medical system. If you have something simple like the flu, and just need prescription medication to get well, then virtual care is a great fit. Think of how this can alleviate crowded doctor’s offices. In addition, the spread of germs would decrease as ill people can stay in the comfort of their own homes.

A 6% Premium Rise

Estimated premium increases are about 6% across the board. While some larger companies are implementing cost management adjustments (These tactics reduce their projected cost.), it still will only reduce the overall budget increase to 5%.

rising group health plan charges on tablet — *Unfortunately, there’s no good news overall with health charges. Rates just seem to rise.*

Statistically, the smaller to midsize businesses pay a bit more than their larger counterparts for the same benefits because they simply don’t have the clout to bargain prices down. These businesses do have the option of turning to consumer-directed health plans (CDHPs) to help out.

CDHPs are high-deductible health plans that are linked to either an HSA or an HRA. However, it’s projected that employers will reduce the number of employees covered by these CDHPs because employees have stated they’d rather have a choice for their benefits, meaning they’ll turn to other alternatives like a preferred provider organization (PPO).

With so many changes coming, it can be hard to see where your best choices lie in purchasing a new Group Health plan. While you can see the reasoning for it, the ultimate decision for your business needs to be a tailored fit. That way, you get the best coverage options for your workforce while still meeting your budget.

If you want to get the best coverage for your company, EZ.Insure offers solutions. Your personalized agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

HSAs: What They Are, and Why You Should Be Using Them.

Do you know about Health Savings Accounts (HSAs)? According to surveys, about half of Americans have no idea what they are, or what to use them for. This situation isn’t good considering how present medical expenses have a crippling effect on the average person. If your employees are hospitalized from a serious injury, the resulting bill can equal the cost of a family sedan. Help them understand what these are, so they’ll opt into your group health plan.

HSAs are a great solution for these high payments, but not if people don’t know how to use them.

What is an HSA?

blue piggy bank for a health savings account — *Saving money is good just in case something happens, but what if you had an account that was ALSO tax-advantaged?*

HSAs were created to help pay for medical expenses that your health insurance plan doesn’t cover. These savings accounts are only compatible with high deductible health plans that are specifically tagged “HSA-eligible.”HSAs are tax-advantaged, giving you more of a reason to use them. On this note, if you make a withdrawal from the account to pay for a qualified expense, then the amount will not be taxed.

If their deductible is $1500, and your medical expense is $4500, then you will be expected to pay the $1500 deductible, and your insurance company will take care of the rest. For some, $1500 is still a lot of money. With an HSA in place, you can cover that as well.

Either you, or your employee, or both, will put money into the account. While HSAs can be opened by yourself, starting one with an employer will help it grow faster with you both making contributions. These are saved up to pay for things like dental work or prescription drugs to make you feel better.

How Do You Start One?

Before starting an account, your employees have to meet the requirements. This is easier if you have a high-deductible health plan (HDHP). With the HDHP, they often are bundled with an HSA, or at least give you the option.

Besides the basic stuff, you won’t qualify if you:

Have other health coverage
Are considered a dependent
Are enrolled in Medicare

How Do You Use It?

Let’s say an employee started their HSA, saved money with it, but now an urgent medical need arises.

We’ll say this urgent need is the medicine to help their recovery. Thankfully, the IRS approves this for HSA spending. Make sure to double-check though. No one wants to pay a 20% surprise tax when you file your taxes later.

stack of coins for HSAs — *If you open up an HSA with your employer, they can help put money in the account too. That’s twice the contributions!*

That being said, they have options with spending your HSA. They can either get a debit card for it from your bank or insurance company, or you can ask for a reimbursement.

No matter which place they go to, they will have experts to help explain everything. After they use these accounts to save money, they can withdraw from it to pay for qualified medical expenses. In the long run, these expenses will cost less because the HSAs are tax-advantaged.

HSAs seem fairly easy, but most people have no idea how to use them. Many insurance providers will not give HSAs the time of day, just throwing them in like a less useful option. As savings accounts go, they are specific to medical expenses, and those are restricted even more by the IRS.

We can only assume that their extreme restrictions and mystery are a cause for people not using HSAs properly, if at all. Don’t miss out on the opportunity to help your employees pay for hefty medical expenses without going bankrupt. Do some research and ask your insurance company or bank about these benefits.

If you are stuck, don’t know where to start, or have issues, don’t worry. EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

New Probe on Group Health Insurance

Governor Charlie Baker of Massachusetts ordered a new probe into the health insurance market. Under executive order 589, the new Merged Market Advisory Council will gather and verify information about insurance rates, producing a helpful report for lawmakers to adjust insurance legislation.

The report is due on April 30, 2020.

council meeting for group health probe — *The first step in any decision is to research, and that’s just what’s happening now.*

The Council

The newly formed council consists of 13 members, 10 of them experts in the health insurance industry. This report’s entire purpose is to give an overview of the merged market based on analysis to “ensure the long-term stability of coverage for individuals and small employers in the merged market and the affordability of insured health benefit plan products offered therein.” (No. 589 Merged Market Advisory Council)

To help balance the report and keep it truthful, the council members will operate by considering:

The general stability of the merged market risk pool
Trends correlating with the risk pool and their impacts on premiums
What drives health care costs to increase
Policies that threaten market stability
Strategies to help keep market costs down

Why It Was Formed

Baker supported his own recommendation for a fact-finding committee by arguing for the complex nature that the market presents. No two people have the same view of it, and it gets even murkier as you talk to both providers and the people purchasing the premiums.

group health probe meeting between two industry professionals — *With better information, we can see some better changes for health insurance in the future.*

Essentially, Massachusetts’ hospitals, physician groups, and insurers will report their spending on primary care and behavioral health to the state agency. The projected spending increase in these areas is 30% over the next three years, an unreal amount considering the state’s cap on spending is 3.1% annually.

Hospitals are already in a losing situation here, with those two healthcare options losing money for them, especially behavioral health. They just don’t provide the same insurance reimbursement as the more sensational options like cancer.

The bill will also touch on drug prices. After review, state representatives can place regulations on predatory prescription drug practices like:

Gag rules, preventing patients from hearing about cheaper drug options
Drugmakers who charge more annually than the 2% inflation can keep up with
Any drug that costs someone $50,000 or more

The Results

If lawmakers are to better understand ways to improve insurance legislation (specifically to help with rapidly increasing healthcare costs), the first step is to compile accurate information for how the market is affected.

The creation of this council instills hope in Massachusetts’ citizens. Informed decisions are how our government should operate. With such a convoluted case like insurance, an advisory council will provide verified facts to create a better healthcare system, with more satisfied individuals.

With all the constant insurance changes occurring, there might be some confusion as to what the rates will be, and if it is affordable. If it is too much, we can help. EZ.Insure will compare plans within your region and assess which fits your needs and budget. You will be connected with your own highly trained agent that will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

Employer Health VS Individual Plans: Which Should You Use

When you start a new job, you might be offered group health insurance. Employer health insurance is usually cheaper than an individual plan, which is why an attractive benefits plan is such a big deal.

However, the plans they offer could potentially cover less than what you need. In some circumstances, you can (and should) buy health insurance on your own. When making this choice, you have a lot to keep in mind, like what are their differences, and which one is better for you?

Individual Health Insurance Plan

When you look into individual or family health plans, you have the option to compare companies and their plans, then choose which one best fulfills your needs. With private insurance, you have more control over your options. These plans can be bought through the Marketplace, or directly from the insurance company via online, an agent, or broker.

The biggest advantage of an individual plan is its flexibility. This flexibility extends to your career too. You won’t have any formal insurance ties with your employer. That way if you leave or change jobs, you won’t have to worry about losing coverage.

The flexibility also goes with medical networks. You can choose a plan that includes your current doctors and hospitals. After you review your network, make sure you know when to renew or change your plan during the annual Open Enrollment period.

group of papers and folders for employer health — *Healthcare can take a lot of research to find the right plans. Lucky for you, EZ.Insure can do most of that for you!*

Employer Health Plan (Group Plan)

The biggest pro for employer health is how much they take off your hands. A company will do its own research, comparing the best plans in their area for employees. After purchasing a plan, the employer shares the premium cost with you. What this means is that they can get a better deal for group insurance and then help you pay for it.

As mentioned, this coverage will only be available to you when you stay with the company, so the moment you leave or are let go, the coverage ends. Also note that if their plan doesn’t include your usual doctor, you will have to choose between changing networks, or keeping your individual plan.

Other advantages of a group plan are as follows:

The company has done the research and picked the plan options already. Group health plans are guaranteed-issue, which means there is no medical underwriting.
Contributions toward your premium from your employer are not subject to federal taxes, and your contributions can be made pre-tax. This will lower your taxable income.

What It Comes Down To

Deciding whether to seek out your own individual family plan or go with an employer’s can be confusing. Your employer may not offer plan options that suit your needs. There are differences within the price, benefit options, and flexibility, not to mention the overall increase in insurance rates.

Over the years, employer insurance has seen premiums increase by about 3% for individuals and 5% for family plans, while individual health plans have increased by about 4%.

document with glasses for employer health — *Still confused about a policy type? After you gather your info, give us a call and let us help you find the best coverage.*

The average annual premium for an employer-sponsored plan is $1,242 for an individual. Compare that to the individual market, which has an average individual premium of more than $5,000 annually. This can be great (and saves you money), but there is a possibility you can find a plan for cheaper on your own.

Individual plans would be the way to go if you want to shop for the plan that exactly matches your needs. That way, you are in control of the costs and the coverage that you get. You will not have to worry about losing your plan if you lose your job or change jobs.

Group plans would be the way to go if you want to save money and are happy with the plan they offer. Their plans are also guarantee-issue, which is great if you have a pre-existing condition. If you seek an individual plan with a pre-existing condition, you can be denied, or it will be expensive. Some employers do offer incentives that lower premiums, such as quitting smoking or getting a gym membership.

All in all, the choice needs to be yours. What it comes down to in the end is what your needs are and the costs. While your boss could offer a plan that you think is too expensive, your individual plan may be even more costly.

Don’t stress out and overthink if you should opt for your employer’s plan or buy your own. If you want to seek what health insurance options are out there, EZ.Insure has your back. We will provide you with a trained agent within your region who can compare all available plans and their costs. This should make the process easier when it comes down to making a decision to go with your employers plan or not. For free quotes, enter your zip code in the bar above, or contact an advisor by calling 888-350-1890, or emailing [email protected]. Life is stressful enough, let us take some of the load off of you.

Can Small Business Owners Afford Group Health?

Studies answer this question with a tentative “for now.”

Group health is the best option for the majority of Americans, with over 100 million covered. People list insurance coverage as a top priority when choosing an employer. However, the question on most researchers’ minds is how long will this be a reality? With healthcare costs increasing yearly, this coverage type is the only option for most Americans.

The Kaiser Family Foundation’s survey conducted over the past decade found increasingly worrisome data.

For Example

To make things simple, we’ll say in 2019, an average worker makes $1000 in one month. (This is excluding the half of Americans not making the average income, and thus not even qualifying for this breakdown.) Counting for inflation, the $1000 average is an adequate amount for this fictional example.

employees in their store working on how to afford group health — *When you’re working hard to keep your business afloat, it can be difficult to offer insurance to your employees. Thankfully, you have help.*

However, the premiums for a family are 50% more expensive than the average worker’s income. Meaning, in this example, a premium would cost $2000 per month. Factoring in a spouse, and the employer’s contribution, this should keep things down well enough for affordability, right?

Wrong.

Even with employer help, the 50% higher premium would bring the total up to $500 per month. That’s half or more of each monthly paycheck. On top of this, deductibles soar over 150%. So, in essence, if you make the fictional $12,000/year, you’re expected to contribute to $6,000 in premiums that year, and then meet a $2500 deductible on top of before insurance companies will offer you any assistance for medical expenses.

At $500 a month, you’ll be struggling to pay your rent, let alone medical bills. It paints a somber picture if you’re an average American.

What Can We Do?

This is easier for larger corporate employers who can afford to take more of the premium burden for their employees, creating a subset of people who are happy with their insurance. For these people, they have lucked out joining a business that can ease this healthcare burden.

However, for the rest, including small businesses, the struggle is much more apparent. Without the help of a larger group, it is difficult for legislation to help extend coverage. While the focus is on extending coverage, perhaps it would be more helpful to talk about lowering premium costs instead or extending other programs like HRAs. With lower costs for everyone, it would bring a greater impact. Both covered employees would be able to afford higher plans, and non-covered ones could actually purchase coverage.

computers to help afford group health for small business owner — *Start with EZ.Insure! Our agents can help find the best plan to keep everyone covered–and your bottom line met!*

There needs to be a balance, and it looks like the best option for that is to set legislation to lower insurance premiums. For now, Americans’ best choice for health insurance is Group with their employers, making it more important than ever to choose a solid policy.

For the best policy choice, EZ.Insure can help. Our agents are highly trained within your region on all group health insurance plans. When you use EZ.Insure, you will be provided with your own personal agent. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. There is no hassle involved, and no obligation to buy, and no headaches. Just easy, fast, and free quotes.

Group Health Plans Accused of Medicare Fraud

If you live in the Seattle area, you might have seen that Group Health Cooperative (GHC) is under investigation. The nonprofit health insurance company allegedly took advantage of Medicare’s system, stealing millions of dollars to recover from earlier financial losses.

A former employee noticed the company was embellishing patient stories to claim more funds. This extended to even billing Medicare for conditions that were not real.

This all started in 2012 but has remained under lock and key in court until this year. While several employees came forward, the investigation is still in the “ongoing” phase.

Situations like these aren’t isolated.

Almost 20 major cases under Kaiser Health News saw companies skimming off the top of government funds. Medicare Advantage is the easiest tool to do so. All the companies have to do is lie about their patient’s cases, and the money pours in.

face of an insurance building with people walking alongside of it — *Make sure to double-check your information when you give it to your insurance company.*

How It Happened

One employee, Teresa Ross, worked at GHC and noticed the company’s management making some bad choices. Because of these, Group Health saw a drop in operating income by $60 million.

To recover from this, the insurer allegedly took advantage of Medicare’s billing formula. Under Medicare, they give a patient a “risk score.” The higher the risk score, the sicker the patient, and higher-risk patients receive more funds.

GHC hired another company, DxID, to assist with medical charts. With their help, GHC gained $12 million in new claims, and DxID received $1.5 million that year for their assistance.

Ross, with a doctor’s help, reviewed cases GHC oversaw. In the medical coding, she found errors that directly contradicted each other. One case stated the patient had a great disposition, but on further searching, this patient was also billed with having major depression. Clinical depression easily raises a patient’s risk score under Medicare, and this is only one of $35 million in new claims that GHC inflated.

Overestimating these scores, the company received enough funds from Medicare to climb out of their financial hole, but at the cost of government funds allocated to help a sick country–and directly from taxpayers’ pockets. The estimated gross damages climbed up into billions of dollars in just the past few years.

What Happens Next

The Justice Department is investigating this whistleblower case. Like other insurance cases, these last for years in order to provide the most accurate evidence to support such allegations. If Ross succeeds in her case, she will share in reparations the company must make for their actions.

meeting room to discuss medicare fraud — *Investigations take a while for a reason. People just like to make sure justice will be served without any doubt.*

However, the company’s official stance is: “We believe the doing policies being challenged here were lawful and proper and all parties paid appropriately.” GHC’s defense is that Ross found an “honest mistake” and made a bigger conflict out of it than was necessary.

Two conflicting defenses for one stance? For now, we wait for the Justice Department.

Don’t worry about big insurance problems; EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

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