Medicare Archives - ARC Benefit Solutions

Your Guide to Supplemental Health Insurance Products

March 18, 2022/in Employee Benefits, Individual/Family, Medicare/by ARC Benefit Solutions

Ancillary health insurance products cover what your typical health insurance plan might not, namely miscellaneous medical expenses. There are a number of ancillary products available on the market including accident, critical illness, dental, vision, and hospital indemnity. These supplemental plans are designed to help with the financial burden of expenses incurred from procedures or services that are not covered by your traditional medical plan. A basic dental cleaning, for example, will not be covered by your health insurance plan, but will be covered with a dental plan.

There are a number of supplemental products that you may consider when putting together your benefit package for the year, including:

Accident

The expenses from an accidental injury can quickly add up, and accident insurance is designed to help in those situations. The insurer will pay money directly to you to help with the costs of hospital stays, emergency treatment, medical exams, and so on.

Critical Illness

Critical illness products are designed to avoid the financial burden from extensive medical care and treatment that results from heart attack, stroke, organ transplants, coronary bypass, and cancer. The lump-sum of money provided can be used for non-medical-related costs, such as child care, transportation, etc.

Hospital Indemnity

Hospital indemnity products can help cover the cost expenses that may not be covered by your health insurance plan, like hospitalizations, intensive or critical care, and more. Your plan will make cash payments to you if you are admitted to the hospital for an injury or illness. Those funds can be used to pay for costs including health insurance deductibles, copays, coinsurance, cost-of-living expenses, and more.

Dental

Dental plans emphasize preventive care, saving you money in the long run from more major procedures that may result from not visiting the dentist on a regular basis.

Most dental plans provide coverage for routine exams, cleanings, and X-rays for limited to no out-of-pocket costs. Services that might entail a filling, bonding, veneer, extracting, crown, bridge, root canal, etc., on the other hand, are more comprehensive coverage options in which the insurance companies may only cover up to a certain annual limit.

Vision

Vision insurance is a great option to help reduce the cost of preventive eye care, glasses, and contacts. These plans tend to resemble discount plans more than health insurance. The insurance would usually pay a flat amount, while the subscriber would be responsible for the rest of the payment. Also, vision insurance usually only covers glasses or contact lenses during the same benefit period, not both.

If you are interested in adding any of these plans to your current package, contact your ARC client care advisor today. Our licensed sales agents are available to answer any questions and help you determine which products will be most beneficial for you and for your wallet.

Your Options for Submitting Your Monthly Premium Payments to Keep Your Account Updated

February 15, 2022/in Individual/Family, Medicare/by ARC Benefit Solutions

Paying your monthly health insurance premium on time is extremely important to maintain your coverage and ensure that your plan’s benefits and claims are paid in a timely manner. Health insurance companies, like other organizations, allow various methods of payment, including online, over the phone, or through the mail via check. Let’s take a look at some of the advantages and disadvantages of the payment options provided by insurance carriers:

Automatic deduction from a bank account or charge to a credit/debit card (autopay).

Pros	Cons
With automatic payments, you will never forget to pay your premium. These consistent payments will ensure the insurance company will pay claims properly and allow members to access benefits. Some insurance carriers may discount the premium if you choose autopay. Additionally, setting up autopay on a credit card every month may help with reward points on your credit card.	If you cancel a policy, sometimes the autopay may stay active for an extra month or two before it stops. Insurance companies are usually good about refunding these premiums, but you may have to call the company and contest the charges. Even with autopay, it’s still a good idea to keep an eye on your payment statements to ensure you aren’t over or underpaying.

Proactive online payment.

Pros

Cons

Making online payments each month gives you more control over your payment schedule. Based on your finances, you can make early or later payments prior to the due date.
You can make multiple months’ worth of payments at once. Some companies allow discounted premiums if you pay a full year’s premium all at once.
Once your payment is submitted, the payment information is in the company’s system, so processing can begin sooner and more efficiently than mailing a paper check.

You run the risk of missing premium payments if you don’t actively keep up with your account.
Most insurance companies have secure sites for submitting payments, but it is always a good idea to make sure.

Proactive payment over the phone.

Pros

Cons

Paying your premium through a representative allows you to document the interaction. You can keep track of the name of the representative, the time of the call, the phone number, and possibly even a confirmation number.
It is often easier to speak with a live representative rather navigating the insurance carrier’s online portal.
Rather than speaking with a representative, some companies provide an automated over-the-phone payment option.

Hold times are unpredictable.
With automated phone options, you will need to speak slowly and clearly enough to ensure the system understands you. This may be a challenge for some people.

Sending a paper check via postal mail.

Pros

Cons

This traditional method is beneficial for those who do not have computer access or who are hesitant to input their payment information online.
This is also an ideal option for those who want to bypass a phone call.
Members who write paper checks are able to make hard copies of those checks for tracking purposes.

Paper checks run the risk of getting lost in the mail.
Paper can also be easily torn and damaged.
It is possible that the insurance company may lose your paper check in the shuffle of the thousands of letters they receive.
An insurance company can choose not to process a paper check if it’s deemed illegible or if the wrong account number is mistakenly written on the check.
All of these errors can lead to your account being deemed “delinquent.”

Regardless of the pay method you choose, it’s always a good idea to keep track of your payments and question any unusual charges. If you need assistance setting up a payment routine that works well for you, please contact your ARC representative for help.

REMINDER: Employers Need to Report Part D Creditability to CMS By March 1

February 2, 2022/in Compliance, Employee Benefits, Medicare/by ARC Benefit Solutions

If your company health insurance plan renewed January 2022, CMS reporting of Part D creditability will be due March 1, 2022. Employers need to notify CMS within 60 days of their renewal of whether their plan(s) is creditable or not for Part D. Here is the information from CMS which includes a link to the notification which is done online. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage

Contact your ARC representative with any questions.

Here are the Medicare Enrollment Periods You Need to Know About

January 12, 2022/in Medicare, Open Enrollment/by ARC Benefit Solutions

When it comes to health insurance, most people don’t enjoy taking the time to sit down and unpack the intricate world of rules and regulations about when you can and cannot enroll in coverage. This becomes increasingly more complex once you hit the magic age of 65. When turning 65 and becoming eligible for Medicare, it is crucial to understand the time frames for enrollment because they can be a factor in your Medicare coverage options/decisions.

We will walk through most of the major Medicare enrollment situations and time periods that are available to you, not only when your initially eligible, but throughout the year as well.

Initial Enrollment Period

Your Initial Enrollment Period (IEP) starts three months before the month you turn 65, runs through the month of your birth month, and up to the three months following the month you turn 65. During this time, you can enroll in Medicare Part A and Part B (contact Social Security for enrollment). Once you have Part A and Part B, you are then eligible to enroll into a Medicare Advantage Prescription Drug Plan or a stand-alone prescription drug plan (usually coupled with a Medicare Supplement).

During your IEP, it is important to enroll or make a decision on your coverage to avoid penalties or delay in coverage. In the event you do not signup during this time frame, you may face late enrollment penalties if you do not have other credible coverage elsewhere (e.g., an employer based health plan).

Medicare Supplement Open Enrollment Period

While there are various Medicare Supplement plans available and every client’s budget and situation will be different, the enrollment time frame is the same. The Medicare Supplement enrollment period will start the month an individual turns 65 (assuming they have Medicare Part B in place) and continue for five months following. During this six-month window, your Medicare Supplement enrollment is considered guaranteed issue, which means that you do not have to complete a medical questionnaire to meet eligibility requirements. If you are not enrolled into a Medicare Supplement by the end of this six-month window, then there may be medical underwriting and questions to answer to determine eligibility.

General Enrollment Period

The General Enrollment Period only applies to people who meet both of the following two criteria: you did not signup when you were initially eligible and you are not eligible for for a Special Enrollment Period (which is discussed below). This enrollment period starts on January 1 and runs through March 31 every year. During this time, eligible individuals may enroll in Medicare Part A and Part B. The catch is that the plan year will not start until July 1 of that year. Along with a delayed start date, there may also be late enrollment penalties.

Annual Enrollment Period

The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year and is the time to make changes to your current coverage. Additionally, you can make these changes during AEP:

If you have only Medicare Part A and Part B, you can also pickup a Medicare Advantage plan or switch off a Medicare Advantage plan back to just Medicare Part A and Part B.
You can switch off a Medicare Advantage plan that has drug coverage to another Medicare Advantage plan that does not have drug coverage.
You can join or drop a Medicare prescription drug plan.
Beneficiaries can switch existing prescription drug coverage or Medicare Advantage plans to another plan of the same type.

Changes made during this time will take effect on January 1 of the following year. If no changes are needed or made, the insuring company will generally renew the plan automatically for January 1.

Medicare Advantage Open Enrollment

For those with a Medicare Advantage plan, from January 1 to March 31 every year, individuals can make a change to their current plan. This change can be to go to either another Medicare Advantage plan with or without prescription drug coverage or to Original Medicare. Any changes made will take effect the first of the following month in which they apply.

Special Enrollment Periods

Special enrollment periods come into play when an individual meets certain criteria or a particular event takes place. If you qualify for one of these special enrollment periods you can join, switch, or drop a Medicare Advantage or prescription plan. Below are some of the more common scenarios (see Medicare.gov for a full list)…

You move out of your plan’s service area.
You move back to the U.S. after living abroad.
You move into or out of a skilled nursing facility, psychiatric facility, rehab hospital or long-term care facility.
Your employment or your employer-provided plan ends.

Medicare can be confusing and we are here to be your translators. If you have questions about an existing plan or are looking to get started with Original Medicare, please give us a call today so our licensed agents can walk you through your options and let you know how the rules apply to you.

Resources

https://www.aetnamedicare.com/en/understanding-medicare/medicare-enrollment-periods-what-to-know.html

ARC’s Top Five Blog Posts of 2021

December 28, 2021/in ARC Updates, Employee Benefits, Individual/Family, Medicare/by ARC Benefit Solutions

2021 has wrapped up and we’re moving into 2022 with a goal of continually educating our clients so they can be empowered consumers. Here are some of our favorite blog posts from the past year that can help you this year…

Four Practical Ways to Make Your Healthy Habits Stick

We all know self care is important: exercising, eating healthy meals, meditation, etc. The internet is chock-full of information about why self care is important. However, the real head-scratcher is how to incorporate those self care habits into your daily life and make them stick. So what’s the recipe for making a habit stick? Here are our four tips…

Click here to read the post…

The Secrets to Designing an Effective Employee Benefits Program

Finding and retaining talented employees is a struggle for employers in today’s environment. A company’s employee benefits package is oftentimes a deciding factor for prospective employees looking for their perfect career and employer. Below are just a few of our most frequently asked questions along with considerations from our team…

Click here to read the post…

Getting the Most Out of Your Health Insurance

Health insurance, while necessary, can be expensive, so it is important to reap the benefits of your plan throughout the year. Aside from receiving financial help for your doctor and hospital visits, what other advantages to your health insurance plan should you think about?

Click here to read the post…

4 Healthy Ways to Manage Stress in Your Day-to-Day Life

Stress is a part of life and can’t always be avoided. It’s important to learn how to manage stress and find techniques that work for you to relax. Here are some techniques that you can use to build resilience and manage your stress in a healthy, adaptive way…

Click here to read the post…

How to Use a Health Savings Account and Why You Should Start One Today

Health Savings Accounts (HSA) have been around since 2003 to help individuals covered by high-deductible health plans (HDHP) save money for medical expenses. Though these accounts have been around for a long time, there are still many questions about them.

Click here to read the post…

Your Frequently Asked Questions About Deductibles Answered

December 28, 2021/in ARC Updates, Employee Benefits, Individual/Family, Medicare/by ARC Benefit Solutions

Understanding your health insurance benefits is important for being a well-informed consumer. One of many details of your plan that you should review is your deductible. Your deductible is the annual amount you must pay each year for specific non-copay health care services before your insurance begins to pay. For example, if you have a $2,000 deductible, you will pay $2,000 for health care services before your insurance kicks in. Generally, your deductible starts over every year in January, but you should check your specific plan to verify.

Deductibles can be confusing, so we have rounded up the most frequently asked questions we receive about health insurance deductibles:

What is the difference between a plan year deductible and an annual deductible?

An annual deductible runs by calendar year (January 1 through December 31) while a plan year deductible follows your plan’s renewal date. For example, if your renewal is in June, your plan year deductible would run June 1 through May 31 every year.

Will any of my deductible rollover to the new year?

Most plans no longer offer fourth-quarter carryover. However please check your certificate of coverage to see the guidelines from your plan.

What is the difference between an embedded deductible and an aggregate deductible?

For an embedded deductible, only one family member needs to meet their individual deductible. If their individual deductible is met, then the health insurance carrier will start to pay the coinsurance of the entire plan. For an aggregate deductible on coverage with more than one person, the entire family deductible must be met before the health insurance carrier begins to pay.

What happens once my deductible is met?

Once you have met your deductible, any in-network benefits would be paid by your health insurance carrier at the coinsurance level of the health plan for the remainder of the deductible year.

Do I have to pay my annual deductible upfront to the health provider?

Deductible charges are charged to patient as they are accrued. If you have a surgery, for example, your provider (i.e., the doctor or hospital) will contact the health insurance carrier and check to see how much deductible is remaining on your plan and may ask you to pay your portion of your deductible and coinsurance that are remaining at the time of the benefits check. Most providers will allow you to setup up a payment schedule if you cannot afford to pay the entire deductible at one time.

Your ARC representatives are available to walk you through your plan and what it means. Give us a call today to set up an appointment!

VIDEO: Do You Know These Important Health Insurance Terms?

December 2, 2020/in ARC Updates, Employee Benefits, Individual/Family, Medicare, Video/by ARC Benefit Solutions

ARC’s Vice President of Sales Operations Luke Boemker covers a few health insurance terms that you should know about.

Watch the video below!

End of the Year Health Insurance Checklist by ARC Benefit Solutions

FREE RESOURCE: Your New Year Health Insurance To-Do List

December 2, 2020/in ARC Updates, Employee Benefits, Individual/Family, Medicare/by ARC Benefit Solutions

It’s almost the new year, which means it’s time to review the details of your health plan for 2021 so you can maximize your savings. We have put together a quick checklist that you can use to review your current health insurance and any changes or items to be aware of for the upcoming year. As always, contact your ARC representative with any questions you may have about your health insurance plan!

Click here to download the checklist

It’s National Diabetes Month! Here are Some Resources You Can Use

November 16, 2020/in Health and Wellness, Medicare/by ARC Benefit Solutions

November is National Diabetes Month so we rounded up some resources from reputable sources for more information about preventing diabetes, managing diabetes during the COVID-19 pandemic, how to help your children and teens who have diabetes, and more.

American Diabetes Association Information on Diabetes and Coronavirus

“The ADA is doing all we can to protect our community during COVID-19.” Click here for more information.

National Institute of Diabetes and Digestive and Kidney Diseases Flyer

The NIDDK has provided a flyer with tips to help children and teens who have diabetes. Click here to download the flyer.

13 Ways to Prevent Type 2 Diabetes (Healthline)

“Although there are certain factors you can’t change —such as your genes, age or past behaviors—there are many actions you can take to reduce the risk of diabetes. Here are 13 ways to avoid getting diabetes.” Click here to read the full article.

Association of Diabetes Care and Education Specialists Educational Programs

“Diabetes care and education specialists are found in accredited programs across the country. They work with you to develop a plan to stay healthy, and give you the tools and ongoing support to make that plan a regular part of your life. Search for an accredited diabetes education program in your area.” Click here to find a program.

ARC Can Help You with Your Health Insurance

Did you know? Recently, the Centers for Medicare and Medicaid Services (CMS) announced that participating enhanced Part D prescription drug plans will provide Medicare beneficiaries access to a broad set of insulins at a maximum $35 copay for a month’s supply, from the beginning of the year through the Part D coverage gap.

We want to help you find a plan that works well for your budget and provides the resources that you need to manage your diabetes. Contact us today to find a plan.

How to determine whether to review or renew your health insurance coverage for the new plan year

To Review or to Renew, That is the Question

October 12, 2020/in Affordable Care Act, ARC Updates, Individual/Family, Medicare/by ARC Benefit Solutions

It’s that wonderful time of year when every other commercial advertises health insurance options for you to consider above all others, or your mailbox is giving way to the latest shipment of junk mail promising you $0 premiums, extra benefits at no cost to you with outstanding coverage that is all centered on your happiness. What to do, what to do?

There are some things to consider before taking the leap to enroll. Are you currently working with an agent that you trust to confirm that your doctors, hospitals, and medications are covered? A true insurance professional has your interests at heart, and will break down benefits and restrictions so you know what you are buying. Their professional reputation is on the line with every sale.

Medicare Eligible

When reviewing Medicare plans, there are a few things for you to consider. Has anything changed in the past year regarding your health, doctors, or medications? If so, you should reach out to your agent with the changes and discuss what you liked and disliked about your current coverage.

Your current health insurance carrier should be sending you what the new benefits will be for the upcoming year, and if there are any changes to the benefits, premiums, etc. You usually receive this well before your agent has access to them. It is best to reach out to them early in October to discuss.

If you currently have a Medicare Supplement, you do not need to shop for a new supplement plan, since those plans do not change from year to year. If you do decide to change carriers, you may have to go through underwriting and could be declined for the new plan, but still be able to keep your current plan.

On the other hand, if your medications change or you do not like your current plan, you do have the option to switch plans from October 15 through December 7 of each year with the new plan beginning on the first of the following year. I highly recommend that you email your agent with the changes in medications so they can provide you accurate quotes as soon as possible. If you like your plan and nothing really changes, you do not have to do anything; your plan will automatically renew.

Affordable Care Act/Individual Coverage

If you are not Medicare eligible, you do have the ability to look at individual coverage from November through December 15 of every year, with the effective date starting the first of the following year.

The same rules apply as far as changes in doctors, medications, and, in this case, income if you qualify for an Advanced Premium Tax Credit (APTC) to reduce your premium cost. If you do qualify for APTC, you should update your income every year, since benchmarks change from year to year, as well as the calculations of income, age, location, and smoker status. Obviously, you will be looking at the upcoming year for income, which, for the most part, will be a guess. You do have the ability to adjust your income during the course of the year if there have been significant changes. Otherwise, you will be required to reconcile your APTC every year with your taxes. If you make more, you may need to pay some of the APTC back to the government, but if you make less, you may receive a bigger refund check.

If you do not qualify for any assistance through the Affordable Care Act and you like your plan, you can just allow it to renew.

As always, your agent will be your go-to person regarding any changes for the upcoming year, and their services are at no cost to you. As an agent I recommend getting in touch with us as soon as possible, since the enrollment window is short and website systems do go down the closer you get to the end of the election period.

When speaking with your agent, be prepared with your doctor’s names, dates of birth, smoker or non-smoker, preferred hospitals, medications, and income (including the sources) since your agent is very busy trying to help all of their clients in this short election window.

We wish you all a wonderful election period, and will be happy to help you along the way—just give us a call.