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Group Health Insurance Benefits

You want to offer your employees the best healthcare benefits, but you’re also dealing with rising premiums. It’s possible to reduce your cost, while still providing top-tier coverage.

Lower Your Healthcare Premiums

Whether your organization lacks an HR department or HR team, or simply needs a resource to make more informed decisions about benefits management, GMS can help. Working with GMS allows you to enter into a relationship that encompasses all of your administrative functions, allowing you to focus on core business.

Group Health Insurance Coverage

Traditional healthcare arrangements are no longer working; GMS can help change the approach to increase affordable options. At GMS we give small businesses the buying power of a large corporation. We offer financial security, flexible benefit options, and our unprecedented customer service sets GMS apart as an industry leader and the preferred provider of employee management services.

Which Types of Benefits Can I Offer My Employees Through a PEO?

Benefits plan sponsorship:

Health care coverage: medical, dental, and vision

Health care Flexible Spending Account

Life and personal accident insurance

Short-term and long-term disability insurance

A comprehensive 401(k) plan integrated with payroll (additional fee required)

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LIFE, HEALTH AND BENEFITS

When you are buying health insurance, you might need to think about more than you had initially imagined. If you have insurance coverage at your current place of employment, you may have less coverage than you think. When your employer insures you, they will usually give you only very specific coverages and a narrow amount of options.

If you have a employer purchased policy that covers your entire family, it can really be prohibitively expensive -- especially if your whole family does not frequently use or need the services being purchased.

If you are self employed, you might have no coverage at all, or you might have a very minimal policy that isn't really meeting your needs and is therefore just a waste of money every month. Fortunately you can purchase individual health insurance from an independent agent, allowing you to get the coverage you need.

Whether you are already covered by a health insurance policy or you need to purchase a brand new policy, it makes sense to stop and really evaluate your personal insurance needs. Do you need an extensive policy because you visit the doctor frequently and have considerable medical bills? Or do you visit the doctor so rarely you can't even remember your last visit and would be better off with emergency coverage only?

How much is the ideal amount you would pay per month for a health insurance policy? Are you really getting your money's worth from your current policy? Ask yourself all these questions and speak with us about the type of policy that is best for you.

Don't settle for too little coverage, overpriced coverage, or a policy that just doesn't fit your needs. The experts can offer live comparative quotes over the Internet, giving you the chance to compare and contrast health insurance policy offers from all the major providers!

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Medicare Open Enrollment for 2020: 10 Tips for Getting Great Coverage

Now is the time to assess your current coverage and shop around for perhaps a better deal or a plan more suitable to your current health needs. Here are 10 tips for getting the best coverage and care in the 2020 Medicare Open Enrollment Period:

1. Find Out How Your Existing Plan Has Changed

Not everyone knows this, but Medicare plans can — and do — change. So, the first step is to find out what is new with your existing coverage.

Pay particular attention to:

The list of drugs that the plan will cover in the next year

How much those drugs will cost

What the premium will be in 2020

What percentage that the plan will pay for different types of medical expenses

You will likely receive a notice from your insurer in the mail that will outline all of the changes. Keep an eye out for it. If you think you missed it, call your insurer and ask for the “annual notice of change.”

2. Find Out What Plans Your Preferred Doctors Will Be Accepting in 2020

You may want to call your doctors’ offices and ask to speak with the billing department. They should be able to tell you which plans they will be accepting in 2020. If they are dropping your existing plan, then you will want to see if any of the other plans are affordable for you.

3. Is Your Existing Plan Still a Good Match for Your Health Needs

Once you know what your existing Medicare Supplemental plan will cover in 2020, you should compare how well that matches your current and anticipated needs. Will your existing plan still cover the medications you take? Has your health changed and do you now have different needs?

4. Compare Your Existing Plan to Alternatives

Even if your existing plan works well for you, you should still shop around to see if there is a more cost-effective option.

You can instantly compare Medicare Supplemental Plans here.

Or, you can contact your State Health Insurance Assistance Program (SHIP). SHIP (sometimes called by another name) provides free counseling to any Medicare recipient to help people choose a Medicare plan.

The New Retirement Retirement Planner also enables you to estimate your lifetime medical costs for different coverage types, health conditions and premium levels.

5. Check Out Ratings on Plans

Once you have identified a plan or plans that may be a good fit for your particular health needs, you can look up how well those plans rate.

Medicare.gov lets you research plan quality and performance ratings.

U.S. News and World Report is also a reliable source. They have evaluated all insurance companies and the plans they offer in each state. See the Best Medicare Advantage Plans and the Best Medicare Part D Plans.

6. Special Note for Seniors in Rural Areas

In 2017 there were 147 different counties — mostly rural areas — that completely lacked any Medicare Advantage insurers.That number may go up or down in 2020. If there are not any Medicare Advantage plans, you could switch to a Medigap plan.

7. Cut Your Prescription Costs

Even with supplemental coverage, prescription copays can add up. To save money, discuss your concerns with your doctor. Ask if they will prescribe a less expensive alternative or a generic.

Whatever your doctor prescribes, shop around to fill your prescription. Filling the same prescription at Costco versus CVS could save a lot. Ordering a 90-day supply online may save you even more.

8. Use a Health Savings Account (HSA)

If you’re still working and are eligible to contribute to an HSA, take advantage of it. Your contributions are made pre-tax, the money in your account grows tax-free, and you can withdraw funds from the account at any time tax-free, as long as the money is used for qualified medical expenses.

9. Be Proactive to Stay Healthy

If you are in good health, you’ll spend less on retirement health care costs. Medicare offers a wide range of immunizations, preventive screenings and well-being programs for free.

10. Make Sure Out of Pocket Medical Costs Are Factored into Your Overall Retirement Financial Plan

Out of pocket medical costs are one of the three biggest expenditures for most retirees.

Studies have shown that the total out of pocket Medicare costs are higher than the total Social Security income for the average retiree. In other words, Social Security income does not even cover what most retirees will have to spend on their health.

So, it is important to make sure that your retirement finances are prepared for this major expense. The New Retirement Planner is an award-winning calculator that can help you prepare.This easy to use tool offers very detailed and sophisticated calculations and includes retirement health care costs.

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3 ways to use your health plan when you’re feeling well

Health insurance isn’t only for when you’re sick. You can use it to maintain your health. Understanding how your coverage works before you need care can also make things easier if you get sick.

Take advantage of free insurance benefits anytime

Get preventive services, like the flu shot or a depression screening, that are right for you.

Being proactive with preventive care can prevent illnesses, diseases, and other health problems, or detect illness at an early stage when treatment is likely to work best.

These services are free when delivered by a doctor or other provider in your plan’s network.

Even if you don’t need care right now, find a doctor you can trust

Taking the time to find a doctor you trust when you’re feeling well can save you stress when you get sick.

You usually pay less if you choose a doctor in your network. Visit your health plan’s website and check the provider directory to see who’s in your network.

Understand your costs before you need care

It’s important to learn which services in your plan aren’t subject to your health insurance deductible.

Some plans charge only a copayment for primary care visits before you meet your deductible; others offer discounts on drugs, including generic drugs.

Knowing your costs up front can prevent the stress of unexpected costs later on.

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Impact of Children Health Insurance Plans

A 2018 survey of the existing research noted that the availability of "CHIP coverage for children has led to improvements in access to health care and to improvements in health over both the short-run and the long-run."

In 2007, researchers from Brigham Young University and Arizona State found that children who drop out of CHIP cost states more money because they shift away from routine care to more frequent emergency care situations. The conclusion of the study is that an attempt to cut the costs of a state healthcare program could create a false savings because other government organizations pick up the tab for the children who lose insurance coverage and later need care.

In a 2007 analysis by the Congressional Budget Office, researchers determined that "for every 100 children who gain coverage as a result of chip health insurance pa, there is a corresponding reduction in private coverage of between 25 and 50 children." The CBO speculates this is because the state programs offer better benefits at lower cost to enrollees than the private alternatives. A briefing paper by libertarian think-tank Cato Institute estimated the "crowding out" of private insurers by the public program could be as much as 60%.

Reauthorization

SCHIP was created in 1997 as a ten-year program; to continue past federal fiscal year 2007, passage of a reauthorization bill was required. The first two reauthorization bills to pass through Congress would also expand the program's scope; President George W. Bush vetoed them as improper expansions. A two-year reauthorization bill was signed into law by the President in December 2007 that would merely extend current CHIP services without expanding any portion of the program.

With the 2008 Presidential and Congressional elections giving Democrats control of the Oval Office as well as expanded majorities in both houses of Congress, CHIP was reauthorized and expanded in the same bill through fiscal year 2013.

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4 Tips to Prepare for Medicare Open Enrollment

Enrolling in Medicare can be an intimidating and confusing process. With the 2018 enrollment season beginning on October 15, it’s time to begin thinking about the best ways to prepare for enrollment, whether you need to change a plan or start your first one. Here are some helpful tips leading up to enrollment.

Know what you want from your coverage

Since there are many options for coverage, it’s important to know what you’re looking for as a benefactor. For example, Plans A and B may not be enough for you if coverage for hospitalization, outpatient care or prescription-drug coverage is important. Dental and vision are not covered by original Medicare, so make sure the plan you sign up for covers those services.

Check medication and doctor’s affiliation

Two important factors for your health are good relationships with doctors and maintaining the medications you need when you need them. Make sure your medication is covered by the plan you are considering, and check the restrictions. Ask your doctor is the office still accepts your particular Medicare Advantage plan for 2018. If your doctor will be out of network, that could mean higher out-of-pocket costs for the coming year.

Look past premiums

Zero or low-premium plans may be tempting, but many times do not tell the full story of what you will be paying. Be sure to add up all possible costs including premiums, co pays, coinsurance and deductibles so you are clear about what your total spending could be for the year.

Check out the quality ratings of Medicare Advantage plans

Use consumer reviews and ratings of Medicare’s plans to learn from other’s troubles and successes. The Centers for Medicare and Medicare Services provide ratings on how well a Medicare Advantage plan worked for members who enrolled in it on a scale of one star (poor) to five (excellent). These ratings are based on members’ experiences, complaints and customer service.

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Fight Repeal and Replace (Graham-Cassidy-Heller)! Support CHIP (Children's Health Insurance Program)!

Never let your guard down!  An effort to Repeal and Replace [the Affordable Care Act] has reared its ugly head again, threatening to take away healthcare from millions by ending Medicaid expansion (the Healthy Michigan Plan); raising costs for everyone; eliminating protections for pre-existing conditions; cutting coverage for low income seniors, children and the disabled; and attacking women's health and family planning.  

The Congressional Budget Office (CBO) will not have time to fully score this bill before September 30th, 2017, and so there are not as many details about the costs and implications of this bill as there would be otherwise. However, the CBO has rated similar bills, and under those bills, 15 million people would lose Medicaid alone, and 32 million people might lose insurance.

The Graham-Cassidy-Heller bill also privileges rural states over urban/suburban states, and Michigan is a clear loser. Large cuts to funding begin in 2020 but accelerate over time. Under this bill, there would be huge premium increases for people with pre-existing conditions. Compare the bill to the ACA using the Kaiser Family Foundation comparisons web site.

But What About MIChild?

The Children's Health Insurance Program (CHIP), which provides coverage to children who do not qualify for Medicaid but whose families cannot otherwise afford health insurance, is also under attack.  In Michigan, CHIP is the MIChild program. CHIP funding is set to expire on September 30, 2017. Although there is, in principle, bipartisan agreement on extending the CHIP program, including MIChild, this agreement is being set aside while the Senate focuses on the Graham-Cassidy-Heller bill.

This piece from the Georgetown Center for Children and Families does a good job explaining the conflict between the two efforts. As Kelly Whitener writes, Without CHIP renewal, MIChild will end when the state's reserve runs out (likely, early spring of 2018). This puts the health of over 40,000 of Michigan's children at risk.

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Factors Affecting CHIP and Federal Financing

Like Medicaid, chip program is a federal-state matching program. For each dollar of state spending, the federal government makes a matching payment drawn from CHIP accounts. A state's share of program spending for Medicaid is equal to 100% minus the federal medical assistance percentage (FMAP).

The enhanced FMAP (E-FMAP) for CHIP means a state's share of expenditures is 30% lower than under the regular FMAP. One new exception is that the temporary Medicaid FMAP increases specified in the American Recovery and Reinvestment Act of 2009, are not considered in calculating the E-FMAP.

Compared with the Medicaid FMAP, which ranged from 50% to 75.84% in FY2009 prior to ARRA, the enhanced FMAP for CHIP ranges from 65% to 83.09%. All CHIP assistance for targeted low-income children, including coverage provided under Medicaid, is eligible for the enhanced FMAP. The Medicaid FMAP and the enhanced CHIP FMAP are subject to a ceiling of 83% and 85%, respectively, and a floor of 50% and 65%.

There is a limit on federal spending for CHIP administrative expenses, which include activities such as data collection and reporting, outreach and education, and other activities. For federal matching purposes, a 10% cap applies to state non-benefit expenses.

This cap is tied to the dollar amount that a state draws down from its annual allotment to cover benefits and these non-benefit costs under CHIP, as opposed to 10% of a state's total annual allotment. In other words, no more than 10% of the federal funds that a state draws down for CHIP benefit and non-benefit expenditures combined can be used for non-benefit costs including administrative expenses.

Under CHIPRA, federal CHIP bonus payments are available to states that (1) increase Medicaid (not CHIP) child enrollment by certain amounts, and (2) implement five out of eight specific outreach and enrollment activities. The source of funding for these payments would be an initial $3.225 billion appropriation in FY2009 as well as unspent national allotment and redistribution amounts.

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Tips for Medicare Enrollment

A few days after the end of the annual registration, beneficiaries may make expensive mistakes and rush to choose a plan without help and guidance. Experts say that beneficiaries of health insurance have many questions about how to find the best plan, including what is the best plan for everyone? Decisions made by the elderly in the last few days of annual enrollment each year will affect their financial situation and may affect their health throughout the next year. Therefore, make sure to make the right decision.

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How Much Does CHIP Coverage Cost?

It is important to know that CHIP is different from Medicaid and usually requires payment of premiums. Certain types of visits, such as regular doctor checkups and dental visits, are provided free of charge. However, you may need to copay to get certain medical services covered by your child's insurance. CHIP premiums vary from state to state, so it is necessary to contact your local agent to obtain more information about the exact cost you may have to pay. However, no matter where you are, the premium will not exceed 5% of your family's annual income.

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MEDICARE SAVINGS PROGRAMS: SAVE MONEY ON HEALTHCARE AND PRESCRIPTION COSTS

Saving money is always helpful, especially when it comes to senior health care. Health Markets shares information about 4 types of Medicare Savings Programs and how to qualify. Like health needs, insurance plans change frequently.And just like an annual doctor’s check-up evaluates overall health, a regular check-in with your older adult’s health insurance plans could save them money.

With Medicare program requirements changing annually, it’s possible that they could qualify to get more savings. Find out about 4 Medicare Savings Programs and how to know if your older adult qualifies.

There are 4 Medicare Savings Programs

There are four types of Medicare Savings Programs:

Qualified Medicare Beneficiary (QMB)

Specified Low-Income Medicare Beneficiary (SLMB)

Qualifying Individual (QI)

Qualified Disabled and Working Individuals (QDWI)

Each of these savings programs is based on monthly income limits on money in the beneficiary’s bank, stock, and bonds accounts.If your older adult is eligible for Medicare Part A and meets the income limits or has limited resources, they may qualify for these additional Medicare savings.

However, even if someone’s income is slightly higher than the published requirements, they may still qualify. So it could be worth the effort to apply to find out if they could get the extra savings.Under each program, your older adult’s state would provide help in paying their Medicare premiums.

Additional help with Part A and Part B deductibles, coinsurance, and copayments may also be available if they meet certain conditions.

An additional prescription drug savings program

In addition to those four Medicare Savings Programs, the Medicare Low-Income Subsidy (LIS), also known as Extra Help, provides help with Medicare Part D prescription drug costs for those with low incomes. People who qualify for the QMB program, SLMB, or QI program automatically qualify for the Extra Help program.

Saving money on prescription drugs can help people save thousands of dollars each year. In fact, in 2019, more than 350,000 individuals who applied for this assistance through the government were eligible for savings. And even though the 2020 enrollment period for Medicare has passed, there still may be an opportunity to save money and make changes to an existing plan.

For example, if they qualify for Extra Help, changes to existing plans can be made through a Special Enrollment Period (SEP).

Find out if your older adult qualifies

Because annual income limits change for each program, it is important to re-evaluate insurance plans each year. If your older adult meets the published income requirements, call their state’s Medicaid program or apply to find out if they qualify for a Medicare Savings Program.

There are various nuances with different Medicare plans and it can be confusing so you may want to work with a free Medicare counselor from a state program or a licensed health insurance agent who can help guide you through the process.

Health Markets also has an online quiz called Fit Score that helps Medicare beneficiaries find health insurance coverage and uncover possible savings with your current Medicare plan.FitScore includes a low-income subsidy (LIS) calculator that helps you determine if your older adult qualifies for Medicare’s Extra Help program.

In addition, you could answer a few quick questions about income and resources to uncover additional savings on prescription drug program premiums, deductibles, and coinsurance. Most people are happy with their medicare plan. Choose the right medicare plan for yourself. If you want to know about blue cross medicare advantage plan and its benefits then get in touch with the experts.

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State Children's Health Insurance Program (CHIP): A Brief Overview

The Balanced Budget Act of 1997 (BBA 97; P.L. 105-33) established the State Children's Health Insurance Program (CHIP) under a new Title XXI of the Social Security Act and provided annual appropriations for CHIP through FY2007. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA, H.R. 2, P.L. 111-3), which was signed into law on February 4, 2009, provided CHIP appropriations through FY2013 and made other changes.

In general, CHIP allows states to cover targeted low-income children with no health insurance in families with income above Medicaid eligibility levels. States may also extend CHIP coverage to pregnant women when certain conditions are met. The highest state-reported upper income eligibility limit for children in CHIP is 350% of the federal poverty level, in New Jersey.

Under CHIP, states may enroll targeted low-income children in a CHIP-financed expansion of Medicaid, create a new separate state CHIP program, or devise a combination of both approaches. States choosing the Medicaid option must provide all Medicaid mandatory benefits and all optional services covered under the state plan.

In addition, they must follow the nominal Medicaid cost-sharing rules or apply the new state plan option for premiums and service-related cost-sharing as allowed under the Deficit Reduction Act of 2005 (DRA). In general, separate state programs must follow certain coverage and benefit options outlined in CHIP law. While some cost-sharing provisions vary by family income, the total annual aggregate cost-sharing (including premiums, copayments, and other similar charges) for a family may not exceed 5% of total income in a year. Preventive services are exempt from cost-sharing.

All states, the District of Columbia, and the five territories have CHIP programs. The territories, the District of Columbia, and six states use Medicaid expansions; 18 states use separate state programs; and 26 states use a combination approach. At the national level, nearly 7.4 million children were enrolled in CHIP during FY2008. In addition, 12 states reported enrolling about 335,000 adults in CHIP through program waivers in FY2008.

Check the chip guidelines carefully before exploring the CHIP programs, this will help you to find best plans for your child.

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Compare Advantage Vs. Medicare Supplement

Medicare Advantage has a smaller, local network of providers. While Medicare Supplement network has over 800,000 providers nationwide. You must have Medicare Part B and pay $198 deductible for a Medicare Advantage plan. However, a Medicare Supplement plan pays the 20% co-insurance expense of Medicare Part B and the deductible of Part A ($1408 in 2020). Medicare Advantage has set co-payments. While Medicare Supplement covers your co-pays for hospital stays, skilled nursing facility care, hospice and home health care. Essentially, Medicare Supplement fills the holes in Medicare so you don’t have any surprise bills. That’s why it is also called Medigap. For example, when you go to the hospital, the Supplement plan pays your $1408 deductible. However, Medicare Advantage charges you around $300 per day each day for days 1-7. As a result, spending a week in the hospital with Medicare Advantage will cost you $2,100. Referrals and Underwriting Medicare Supplement plans have consistent benefits from year to year. On the other hand, Medicare Advantage plans may change their benefits. So you will have more homework to review upcoming Advantage plans. Medicare Supplement plan require no referrals. So you can quickly go to any doctor or hospital without a referral or prior authorization.

However, HMO Advantage plan requires you to get referrals. There is no medicare underwriting requirements for Supplement plan as long as you apply within your initial 6 month enrollment period (get more details on Medicare Supplement plan). Likewise, all health conditions are accepted except End-Stage Renal Disease (ESRD) before 2021. However, the ESRD restrictions will be removed in 2021. Premiums Medicare Advantage plans have lower monthly premiums. However, you will pay extra every time you use your benefits by paying fixed co-payments and co-insurance. Moreover, you will continue to pay for benefits until your reach your maximum out-of-pocket limit of about $7,000. On the other hand, Medicare Supplement plans have higher monthly premiums. However, the plan pays all copays and co-insurance costs for Medicare covered services. In other words, you total out-of-pocket equals your annual premium amount. Therefore, you get a predictable monthly expense.

Prescription Drugs Medicare Supplement require you to add Medicare Part D plan to cover prescription drugs. To avoid late enrollment penalty, you want to enroll in Medicare Part D during your initial open enrollment period.

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Children's Health Insurance Program (CHIP)

Every child deserves to grow up healthy and happy. To help them get there, kids need regular checkups and medical care.

If your child doesn’t have health insurance, there’s help. The Children’s Health Insurance Program (CHIP) offers low-cost or no-cost coverage for infants, children and teens. It’s designed to help children get the care they need as they develop.

Each state runs its own CHIP program, and Medicaid helps pay for it. Your state will have specific rules about who qualifies and what’s covered.

Does my child qualify for CHIP?

CHIP is for children who can’t get insurance elsewhere. Your child may qualify, even if you make too much to receive Medicaid.

Can I apply if I’m not the child’s parent?

Grandparents, aunts, uncles – anyone can apply as long as they have legal custody (Your state may use the term “legal guardian”). The good news is you can apply at any time. Note: If you apply once and your child isn’t accepted, don’t give up. Programs and rules may change, and your child could qualify later on.

What does CHIP cover?

CHIP offers coverage for a wide range of services, including:

Well-baby doctor visits

Shots

Hospital care

Prescriptions

Emergency care

Dental and vision care

What does CHIP cost?

For some plans, your cost is nothing. For others, you may need to pay a small amount each month and when your child gets care. But there’s a limit – no more than 5 percent of your annual income.

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How to Apply for CHIP ?

There are two main ways to apply for CHIP in your state. The first way is to use the health insurance marketplace to submit an application online or by phone. This method is the same as applying for any other type of insurance coverage through the marketplace.

Applications may be submitted over the phone. To complete the process online, you will need to take the following steps:

Log into your marketplace account or, if you are a new user, create an account.

Start an application by filling out the required information, including your name, income, family size, state of residency and other details.

Submit your completed form.

Learn what plans you qualify for based on your income and other information provided on your application.

Wait to receive information from your state’s agency about getting coverage, if anyone in your household is deemed eligible for CHIP.

The second method for getting CHIP coverage is to apply directly through your state Medicaid agency, which is in charge of administering CHIP in most cases. The application steps and methods may be different in each state, so it is necessary to follow the specific instructions provided by the agency in your state. Some states may accept applications online, by phone and in person, but methods will vary.

No matter which CHIP application method you choose, it is important to be aware that you can enroll at any time of the year. There is no specific enrollment window in which you must sign up for CHIP coverage. Therefore, you can apply for this type of insurance as soon as you become eligible.

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MEDICARE COVERAGE FOR COVID 19

Coronavirus testing will be incorporated as a fundamental first step in medicare coverage. CMS proclaimed that Medicare will provide full coverage for COVID-19 testing under Medicare Part B for those who have been or will be examined after February 4, 2020. People with Blue Cross Medicare Advantage will also be completely covered since all Advantage plans are expected to provide coverage for all care/services covered by Parts A and B. 

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What is Chip?

The Children’s insurance Program is a very important program administered by the U.S. Department of Health and Human Services. The chip program provides matching funds to states to provide families with children health insurance. The plan aims to cover uninsured children in families with moderate income but too high to receive Medicaid. The plan has been passed into law as part of the Balanced Budget Act of 1997.