Getting Started with Medicare and Medicare & You
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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Licensed States: IN, IL, KY, MI, & OH
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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The Professionals at Miller & Associates Insurance Solutions will assist you in complying with the requirements of the Affordable Care Act in many ways. We are continually monitoring and updating ourselves on the ever change law and have designed our services to keep our clients compliant and informed.
-Design benefit coverage to meet the requirements of the ACA
-Assist with tracking hours
-Ensure eligible employees are offered coverage
-Assist with the reporting process and necessary tax forms
-Handle employee notices
Individuals and Small Businesses may be eligible for a tax credit under ACA healthcare reform laws. The credit is applied as a discount on your monthly insurance premium. To see if you are eligible for a tax credit, use the Subsidy Calculator provided by the Health Insurance Marketplace. Or, if you are a business, use the Small Business Tax Credit Calculator provided by the Health Insurance Marketplace. In any case, both businesses and individuals must purchase benefits through the Health Insurance Marketplace to secure their tax credit.
Employers who have more than 50 full-time equivalent employees must offer those employees benefits that pay for 60% of the minimum essential benefits. If you are in non-compliance, you will incur a penalty of $2,140 per year multiplied by the number of full-time employees, and excludes the first 30 employees. Additionally, the penalty is increased each year by the growth in insurance premiums. However, note you may also incur a penalty when at least one of your employees receives a premium tax credit in the Health Insurance Marketplace (Exchange).
-Insurance companies can not increase rates or deny coverage because of a pre-existing condition.
-Your dependents can remain on you policy until they turn 26 years old.
-Insurance companies can not consider gender when setting rates.
-Employer renewals must be based on the same rates as new business.
-The waiting period for employer benefits should not exceed 90 days.
Your employer paid benefits must comply with the “Essential Benefits” of ACA. Specifically, to be in full compliance with the law, your insurance policy must cover at least 60% of the costs of the following essential benefits. If you purchase an individual policy from the marketplace, it’s likely that your policy will also contain these benefits.
-Ambulatory patient services
-Emergency services
-Hospitalization
-Maternity and newborn care
-Prescription Drugs
-Mental health and Substance Abuse disorder services
-Rehabilitative and habilitative services and devices
-Pediatric services, including oral and vision care
-Preventive and wellness services, and chronic disease management
A Long Term Care Plan augments your health insurance or Medicare and pays for services associated with performing tasks required for daily living such as dressing, bathing, eating, getting in/out of bed, toileting, walking or other basic activities. These services fall under skilled care or personal care and are the types of services that regular health insurance, Medicare or Disability generally does not cover.
As stated, long-term care is usually not medical care and most often does not require a doctor or a nurse. In addition, the need for LTC is not always age related. In fact, statistics tell us that more than half of all individuals age 65 & over will need LTC at some point. Even so, it is important to note that roughly 40% of those receiving LTC today are between the ages of 18 and 64.
Why LTC Insurance?
Regular health insurance, Medicare or Medicaid typically will not pay for Long-Term Care services. The cost of LTC can quickly add up and burden those closest to you, both financially and emotionally. Purchasing a LTC plan can help you avoid those difficult situations, as well as give you the power you need to maintain control of your care, choosing the facilities that best suit your needs. Thus, instead of allowing welfare or the government to make your LTC decisions for you, you are in charge. Additionally, you should be aware that Disability Income Insurance is not designed to cover LTC expenses, but simply replaces part or all of your income during your working years should you become disabled. You need specific coverage to pay for long-term care needs.
Here are examples of what LTC policies may cover:
-Institutional Care: Nursing home, assisted living services, residential care facility, hospice care, adult foster home, respite care and more.
-Home Care: Home health care, adult day care, personal care, homemaker services, hospice care, respite care and more.
If you are purchasing regular health insurance on or off the Exchange (Marketplace), you must do so during the annual open enrollment period. Failure to do so may result in your having no coverage for the following year and having to wait until the next year’s open enrollment to sign up for coverage. However, you may enroll in a health insurance plan outside of the annual open enrollment dates if you have a qualifying event.
You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:
-change in legal marital status
-a change in the number of dependents
-a change in place of residence and the current carrier is not available
-significant cost or coverage change
-a change in coverage of a spouse or dependent
-a COBRA qualifying event
-legal judgements, decrees and orders
-entitlement to Medicare or Medicaid
Note you can purchase Cost Sharing Plans, Short-Term Health or Travel Health Insurance anytime of the year
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 employers self-fund their own group health plan, they will benefit from a significant savings in the overall cost of their benefit programs. For example, savings may be in premiums, increased cash flow and certain tax advantages. Additionally, employers have more control over the benefits that the plan offers. Typically, self-funding was not available to small employers in the past. However, today self-insured group health plans are considered to be good options for both small and large employers.
A self-funded group health plan requires the employer to become the insurer. Most often, employers will partner with a PPO to provide services for the plan. Then, a third party administrator (a TPA) is engaged to handle claims and processing. Self-insured employers run the risk of large catastrophic claims. As a result, they need to purchase stop-loss insurance to protect themselves in such an event. Even with the additional expense of stop-loss insurance, employers save a significant amount of money on premiums and other advantages.
Shared Funding Plans allow small employers to take advantages of all the cost saving and benefit design features of a self-insured plan. Typically, these plans have been designed for larger groups. However, in today’s market, any small or large group could benefit greatly by the cost saving opportunities of a shared funding plan.
An employer will select any of the fully insured plans that the carrier offers. Then rates will be determined by the group’s claim history. Next, stop-loss insurance is added to protect against catastrophic claims. Since the carrier will handle the administration of the plan, there is no need to hire a separate vendor to handle claims and processing.
The premiums for shared funding plans are generally much lower than fully insured plans. That is because the employer shares some of the risk. Additionally, an employer may save even more by implementing wellness programs into the benefit programs. Our thorough plan analysis will help you determine if shared-funding is right for your company.
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.
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.
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.
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.
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.
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.
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.
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.
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.
An HMO group health plan requires group members to obtain their health care services from doctors and hospitals affiliated with the HMO. Thus, members are required to designate a primary care physician within the HMO. Then, the primary care physician treats and directs health care decisions. In addition, the primary care physician coordinates referrals to specialties within the HMO network. Accordingly, HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (or “premium”). However, most HMOs charge a small co-payment depending upon the type of service provided.
If you belong to a PPO group health plan, you will save the most money on healthcare if you use providers within the PPO network. Thus, if providers outside of the network are used, it is possible that those services may be covered only partially or not at all. Also, deductibles must be met on this plan before some services will be covered. PPOs require a co-pay for physician visits and some other healthcare services. However, the great thing about a PPO is it’s rich network of quality doctors and healthcare facilities, and the ability to utilize healthcare services outside of your deductible. For example, doctors visits.
An HSA combines a high deductible, lower premium group health insurance plan (PPO) with a savings account. Accordingly, both employer and employee can contribute, tax-free, to the savings account. Then, the account is used to help fund the deductible and other qualified medical expenses. Once the deductible is met, the insurance starts paying.
An HRA combines high deductible, low premium health insurance plan with a tax favored savings account. Consequently, this plan requires that the employer contribute to the savings account. Then, the account can be used to fund co-pays and other qualified expenses submitted by the employee, prior to the deductible being met.
Single, Dual or Triple Option Plans offer eligible employees a choice between several different types of plans as described above.
Through our thorough analysis and plan design process, we can help you determine which traditional health plan is right for your company.
A Flexible Spending Account is a cafeteria plan under Section 125 of the tax code. It is a tax-favored savings account and is funded solely by the employee through regular pre-tax payroll deductions. The funds from the account can be withdrawn tax-free to pay for eligible medical, dental, vision, prescription and dependent daycare expenses. Additionally, 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. For example, the average working employee in America spends more than $1,000 annually on these types of benefits. By participating in a FSA, an employee always has cash to pay for these expenses, and as an added benefit, their taxable income is reduced which also increases the percentage of pay they take home.
An Health Reimbursement Account pairs a high deductible, low premium health insurance plan with a tax-favored savings account to cover the high deductible. The plan requires that the employer contribute to the savings account. The account can be used to reimburse employees for co-pays and other qualified expenses submitted by the employee, prior to the deductible being met.
High Net-Worth Life insurance or High Net-Worth Disability Insurance is for people who have a high net worth, or who are high income earners. This type of life insurance helps you save for future goals, pays off your debts should you pass away, and may allow you to leave a large legacy behind to your family or favorite charity.
High limit disability insurance allows executives to maintain their standard of living in the event that an injury or illness leaves them unable to work.
These types of policies have a high dollar benefit payout, usually more than a million dollar death benefit, and the disability benefit may go as high as $50K a month. They come with a higher premium, so the carrier may qualify you before approving your policy.
Critical Illness insurance is considered a type of supplemental health insurance that provides benefits in addition to your regular health insurance and/or disability insurance.
This special type of insurance coverage 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.
Costs are based on your age and selected benefit amount. There is typically a 30 to 90 day waiting period.
Statistics show that our chances of becoming disabled are greater than dying between the ages of 25 & 45. During the time you are unable to work due to a qualifying disability, the replacement of your regular income through a monthly benefit provided by disability insurance helps to maintain your pre-disability lifestyle.
Employers often provide standard short-term disability (STD) and long-term disability (LTD) insurance to meet federal guidelines. Individual disability income insurance can be customized to meet your needs and considers your occupation, age, income and other factors in determining your cost and monthly benefit payment amount.
Who needs coverage?
Individuals who do not have disability through their employer can purchase an individual disability policy. Additionally, self-employed individuals who desire disability coverage can also purchase an individual policy. Even those who already have disability insurance through their employer, may wish to consider a “wrap around” disability policy to supplement their employer provided coverage.
What type of coverage is available?
A standard Short Term Disability (STD) policy allows for income payments to begin after a two-week waiting period. Payments will continue to the insured until he/she recovers or maxes out the benefits. Thus, total benefits for a STD could last for anywhere from one month to two years, depending on the policy.
A Long Term Disability (LTD) policy allows for income payments to begin after a ninety-day waiting period, although it could be much longer depending on the policy. Once payments begin, they will continue far longer than STD. Thus, the total benefits for a LTD could last for a few years, up to age 65, or even for life.
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 a 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.
In the event of a covered accident, Accidental Injury insurance pays benefits directly to you or anyone you assign. How you use the money is up to you. Cover deductibles and copays for primary care visits and physical therapy, emergency treatment, hospital stays, medical exams, transportation and lodging needs, along with other expenses that regular health insurance doesn’t cover when you have an accident. Some policies can even pay benefits in as little as one day, based on time of claim submission.
A well-conceived benefit program that includes key-person insurance will protect you, your family and your business, as well as help you attract and retain key people. Additionally, because typical group insurance only covers a fraction of a key executive’s high income, you’ll also be able to adequately protect key people and their families from loss as well.
Key Person Life Insurance protects your business if one of the main partners passes away unexpectedly, and helps to minimize financial loss. Your business is typically responsible for the premiums, as it is also the beneficiary. The value of your business (as established through financial records) will help to determine the benefit level and premium amounts.
A Business Overhead Disability policy prevents businesses from going under from regular overhead expenses while the business owner is unable to work and run the business due to disability. These types of policies will typically pay for things like employee salaries, rent and utilities, among other expenses.
Buy-Sell Agreements protect a business after the death of a key employee. Also, known as Continuation Agreements, they are tied to and funded by life insurance policies. The agreement sets out the details of the transfer of business interest by the key-person (or his/her estate) upon a certain triggering event–usually death, disability and retirement. The surviving or continuing business owner or partner can rest assured knowing that they will be able to purchase the key-person share without interference from other survivors of the key person and his/her estate.
National surveys have shown that Short Term Disability and Long Term Disability remain of high importance for most employees. 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.
Here’s How Disability Plans Typically Work
Short Term Disability
During the time an employee is unable to work due to a qualifying disability (illness or injury), STD will begin. It generally allows for income payments to the employee to begin after about a two-week waiting period. It will continue to pay the employee until he/she recovers or maxes out the benefits. This is 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, although it could be much longer depending on the policy, but will continue to pay the employee far longer than STD–for a few years, up to age 65, or even for life.
We offer Dental and Vision Plans through many of our major insurance carriers. These plans are offered on a stand-alone (voluntary or employer-sponsored) basis or incorporated into the group health plan offering. Whether as voluntary or paid benefit, employees appreciate both dental & vision coverage as part of their Employee Benefits Package.
Dental Plans
Regular dental exams help employees stay healthier and more productive in the work place. Simple routine visits to the dentist, which are usually covered 100% by insurers, help to detect serious underlying conditions. The National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with Dental Insurance plans have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.
Dental Plans offer a variety of diagnostic, preventative care and corrective services. These include 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 money on routine exams. They provide eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Monitoring your eye health with regular exams also 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.
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.
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.
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.
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.
Along with Health Insurance, Life Insurance is considered to be a key part of the benefit package for employees. Besides being a valuable tool in attracting top talent, employees are happier and more productive feeling secure that their loved ones will be taken care of in the event of illness or an untimely death.
Whether an employer paid or voluntary benefit, a good life insurance policy provides for an employee’s final expenses, taxes, mortgage and even their children’s education as well as offering additional added benefits. We can help employers protect their employees and their employees’ families with a variety of different life insurance products.
Permanent Life Insurance
Life insurance that builds cash value and the savings can be tax deferred and/or borrowed against, if needed. These policies are known as Permanent Life Insurance.
Term Policy
Life insurance that 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. Some policies may also make payments upon terminal or critical illness.
Medicare open enrollment begins each year on October 15th and runs through December 7th.
To sign up for Medicare Parts A, B, or Medicare Advantage, or for Prescription Drug coverage), 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 your Medicare coverage, you must act during the annual open enrollment period.
Note that Medicare Supplement Plans can be purchased any time of the year, but you will be able to skip the underwriting process if you sign up during the annual open enrollment period.
Also 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 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.
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Employees have access to preventative medicine such as flu shots, mammograms, colonoscopy, heart and cancer screenings and more.
Employees have access to programs such as smoking cessation, substance abuse help, financial wellness seminars and more.
Onsite or offsite nutritional classes, access to other nutritional resources such as diet apps, blogs and other subscriptions. Members may also qualify for special assistance with diabetes management and more.
Your employees can consult with a licensed physican, via phone or video for litle or no copay. Physicians can consult on health matters, diagnose medical conditions, and prescribe medications. Employees also have access to a nurse hotline 24/7 for general medical advice.
Biometric screenings onsite or at provider offices, aimed at creating awareness, improving health and reducing claims of your most at risk employees.
Onsite, offsite or virtual physical fitness classes or special group events, such as 5K runs. Discounts to gym memberships. Access to additional resources such as fitness trackers, blogs, subscriptions and more.
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. In other words, both employees and employers can potentially save thousands annually in taxes and premiums combined.
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. Then, the employee is then reimbursed by the employer for the monthly premium with the pre-taxed dollars. After a thorough plan analysis, we can help you determine if a POP program would benefit you and your employees.
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We help retirees and other eligible employees tackle the challenges of ever increasing premiums and health care costs by purchasing a quality Medicare Supplement. While there are many options, the best coverage is a plan that leaves you with the least expenses, and has the lowest 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.
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Individual dental plans are inexpensive and can contribute greatly in promoting overall good health. Studies have shown that regular dental exams can optimize oral health to prevent cavities and bad breath. In addition, they help to detect serious medical conditions such as heart disease and diabetes. Some studies have even shown that people who have dental insurance suffer less from depression.
Dental plans 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.
Take care of your eyes with an individual vision plan that can be purchased separately or combined with your major medical insurance. 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. Additionally, 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.
Call 866-820-1739 or fill out the form below to request a FREE assessment of our supplemental insurance plans.