Medicare Archives - ARC Benefit Solutions

What You Need to Know About the Cost of Medicare Supplements

September 14, 2023/in Medicare/by ARC Benefit Solutions

If you didn’t already know, Medicare can be confusing, especially when it comes to Medicare Supplements and how they are priced.

Medicare Supplement insurance, also known as Medigap, is additional insurance you can purchase through a private health insurance company to help pay for any out-of-pocket costs without network restrictions (as long as your doctor or hospital accepts Medicare) that Original Medicare does not cover. You must have Original Medicare (Part A and Part B) to purchase a Medicare Supplement.

There are 10 different types of Medicare Supplement plans offered in most states (the different types of plans are designated using letters A-D, F, G, and K-N). Price is the only difference between plans with the same letter that are sold by different insurance companies. But how do carriers determine these prices?

Each insurance company conducts an annual review of their book of business to determine any rate changes based on the health of the risk pool, as well as changes in age, smoking status, and type of plan. Medicare Supplements are rated by the insurance company using three different metrics: attained age, issue age, or community rated. Here’s what those metrics mean…

Attained age: Essentially, this type of rating increases your monthly premium as you age. For example, if you are currently 65, once you “attain” (turn) age 66, your premium may increase.
Issue age: With issue age, your premium is based on your age when you bought the policy and does not increase as you get older. Premiums may still increase because of inflation or other economic factors, but will not change because of your age.
Community rating: With community rating, everyone, regardless of age, is given the same rate up to a benchmark age. Some insurance companies may offer discounts for every year you are younger than the benchmark age.

Health insurance companies may also consider smoking versus non-smoking rates and household discount rates between about 3.5 and 13 percent, which apply when two people in a household (who do not need to be the same age) enroll into the same plan. (Please note: Some states, like Florida, may not offer household discounts.)

Some insurance companies offer “Medicare Supplement Select” plans at lower rates, which may limit your network options when it comes to doctors and hospitals covered under your plan. Medicare Select policies are not required to pay any benefits if you do not use a network hospital for non-emergency services and Medicare will still pay its share of the cost.

As with most things Medicare-related, finding a plan that suits your budget can be difficult. At ARC Benefit Solutions, our licensed health insurance agents can help walk you through your options to ensure you have the coverage you need at a price that works with your budget. If you’re interested in a consultation with one of our client advisors, contact us today for a no-obligation quote!

Resources

Costs of Medigap Policies (Medicare.gov)

Learn How Medigap Works (Medicare.gov)

Here is What You Need to Know About 2024 Open Enrollment and Annual Enrollment

August 16, 2023/in ARC Updates, Individual/Family, Medicare, Open Enrollment/by ARC Benefit Solutions

Oops, you blinked and it’s already August, which means the 2024 Open Enrollment and Annual Enrollment Periods are looming. If you don’t already know, Open Enrollment and Annual Enrollment is a window of time during the year where you can sign up for health insurance, adjust your current plan, or cancel your plan.

With Open Enrollment on the horizon, now is a good time to review your current health insurance plan and make any changes needed. Here are some reminders and tips to help make your enrollment season smooth and constructive:

Know Your Dates (Trust Us, They’re Important)

Open Enrollment Period (individual and family health insurance): November 1 to December 15, 2023

Please note: December 15 is the last day to enroll in or change plans for coverage starting January 1, 2024. For plans that do not start January 1, Open Enrollment ends on January 15.

Annual Enrollment Period (Medicare): October 15 to December 7, 2023

If you miss the Open Enrollment window, you may need to wait until the next Open Enrollment Period to make changes, or there are additional opportunities throughout the year to update your plan called Special Enrollment Periods (SEPs). However, an SEP is only triggered by particular qualifying life events, including marriage, divorce, loss of coverage, changes in household, a child’s birth or adoption, etc. Generally, you are given 60 days prior to the event and/or 60 days from the day of the event to enroll into a new plan and that new plan will start the first of the following month in which you apply. Contact your ARC client advisor if you think you may qualify for an SEP.

Take Inventory of Your Current Situation

At this time, it’s important to review any changes from throughout the year, including your household income, medications, doctors, facilities, etc., and communicate those changes with your client advisor because they may affect the efficacy of your plan for your current situation or your qualifications for subsidies. If you are currently on a plan with subsidies, a change in household income could significantly impact your monthly premium for 2024. Using current information ensures you aren’t receiving too much or too little in federal assistance with your Marketplace plan.

“What if I’m happy with my current plan and don’t need to make any changes?” Great! Depending upon the plan you are on, your renewal may be automatic. You may receive the Annual Notice of Change from your health insurance carrier that details the plan premium and coverage for the 2024 plan year.

What You Can Expect from ARC Benefit Solutions

If you’re looking for health insurance coverage (for yourself, your family, your employees, etc.) and you don’t know where to start, give us a call! Our licensed health insurance agents are armed with the knowledge needed to find you a plan that works for budget and your situation. Our goal is to help simplify the process for you.

For our current clients…

As we do each year, we will be sending out annual renewal letters in mid-September with instructions on filling out your annual renewal form, either digitally or by using the paper form we include with your letter. We will include a QR code in the letter if you prefer to fill out the form digitally.

If you are interested in reviewing your coverage or shopping for a new plan, be sure to submit your annual renewal form and schedule an appointment with your client advisor by September 30, 2023. As you can probably imagine, Open Enrollment is our busiest time of the year, so appointment times fill up fast!

As always, ARC’s client advisors are available to help you sort through your options and walk you through your health insurance plan so you can take full advantage of your benefits. Contact us today with any questions or if you’d like to get set up with a health insurance plan.

Patient Protections from Surprise Medical Bills in the “No Surprises Act”

May 30, 2023/in Employee Benefits, Individual/Family, Legislation, Medicare/by ARC Benefit Solutions

There’s nothing worse than receiving an unexpected medical bill. It’s the worst kind of surprise.

You might have received an unexpected “balance bill” for medical services from a provider that, usually unknown to you, is out of network. A balance bill provides the difference between the provider’s billed charges and the amount collected from the plan and from the patient in the form of cost sharing (such as a copayment or deductible amount). Surprise medical bills often arise when an individual does not have the opportunity to select an in-network provider, such as in a medical emergency. For nonemergency care, an individual might choose an in-network facility or an in-network provider, but not know that a provider involved in their care (e.g., an anesthesiologist or radiologist) is an out-of-network provider.

The “No Surprises Act” (NSA) was enacted on December 27, 2020, as part of the Consolidated Appropriations Act of 2021 (CAA) to increase health care transparency and protect consumers from surprise medical bills. Effective for plan years beginning on or after January 1, 2022, the NSA provides federal protections against surprise medical billing by limiting out-of-network cost sharing and prohibiting “balance billing” in many of the circumstances in which surprise medical bills arise most frequently.

The NSA’s protections for surprise medical billing apply to group health plans and health insurance issuers offering group or individual health insurance coverage. The Departments of Labor, Health and Human Services, and the Treasury (Departments) have issued guidance detailing how health plans and issuers determine provider payment amounts for services subject to the NSA’s balance billing protections. If the parties cannot agree on a payment amount, they can use the NSA’s federal independent dispute resolution (IDR) process to resolve the dispute.

The NSA’s surprise medical billing protections apply to the following services:

Emergency services received in a hospital’s emergency department or an independent freestanding emergency department
Nonemergency services provided by an out-of-network provider at an in-network facility
Air ambulance services provided by an out-of-network provider

In addition, the NSA provides the following protections for covered services:

Limits cost sharing for out-of-network services to in-network levels
Requires the cost sharing to count toward any in-network deductibles and out-of-pocket maximums
Prohibits balance billing in most situations

However, these protections don’t apply in all situations. For example, these new billing protections generally don’t apply to services covered by vision- or dental-only plans. However, if the health plan includes dental or vision benefits, these protections could apply to dental or vision services covered by the health plan. The balance billing protections also do not generally apply to ground ambulance services.

Some health insurance coverage programs already have protections against high medical bills and surprise medical billing if covered through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE. The new rules don’t apply to these programs.

If you are faced with a surprise high-dollar medical bill, your ARC representative is available to help. We can advocate on your behalf and ensure you are receiving the lowest costs for your services possible. Contact us today to learn more.

Resources

Interim final rules from July 13, 2021, prohibiting balance billing for items and services subject to the NSA’s protections

Interim final rules from Oct. 7, 2021, implementing the federal IDR process

Final rules from Aug. 26, 2022, addressing certain issues related to the federal IDR process and payment disclosures

Model notice for surprise medical billing

No Surprises: Understand your rights against surprise medical bills (PDF)

https://www.cms.gov/nosurprises/consumers/new-protections-for-you

What is the Difference Between Skilled Nursing Facilities and Nursing Homes?

February 15, 2023/in Medicare/by ARC Benefit Solutions

Though they may seem similar, skilled nursing facilities and nursing homes differ in the care they provide to patients.

A skilled nursing facility is an in-patient rehabilitation and treatment center where patients may go for physical, occupational, or speech therapy after an injury or illness after a hospital stay. Typically, patients may stay at the facility for one to two weeks, sometimes longer.

Nursing homes, on the other hand, are more focused on helping someone with activities of daily living (ADLs) such as bathing, dressing, and eating, also known as “custodial care”. Nursing homes and assisted living facilities provide assistance with ADLs, but differ in the level of care provided. Those in nursing homes may require 24 hour medical supervision, while those in assisted living are mostly independent but may require assistance with ADLs.

So what can patients expect Medicare to cover when it comes to these services?

What Does Medicare Cover?

For Medicare beneficiaries, Medicare provides 100 percent coverage for skilled nursing services for the first 20 days in a facility, and then all but $200 per day from days 21 to 100. Beyond 100 days, the beneficiary is responsible for all charges.

To qualify to for skilled nursing services, Medicare beneficiaries must:

Be hospitalized with the status of “inpatient” for at least three days; if one is hospitalized with the status of “under observation” for three days, this does not qualify the beneficiary for skilled nursing care
Enter a Medicare-approved skilled nursing facility within 30 days after leaving the hospital

Medicare does not, however, cover assistance with ADLs, and therefore will not cover nursing home or assisted living stays, as these could be covered under long-term care insurance. Long-term care insurance is less expensive and easier to obtain before 70 years old as this requires a form of medical underwriting. Medicare, will, however, provide medical care for nursing home and assisted living residents.

If you have questions about skilled nursing facilities or nursing homes and what your plan does or does not cover, reach out to ARC representative today. We are happy to walk through your plan with you or review your options so that you are covered when it comes to needing these facilities.

Resources

Independent Research | HCG Secure

Difference Between Assisted Living and Nursing Home | Compare the Difference Between Similar Terms

Assisted Living Long-Term Care Insurance | A Place for Mom

What’s the difference between a skilled nursing facility and a nursing home? | UnitedHealthcare (uhc.com)

Compliance Corner: Considerations for Employees or Dependents Becoming Eligible for Medicare

January 5, 2023/in Compliance, Employee Benefits, Medicare/by ARC Benefit Solutions

As employees of companies near age 65, they become eligible for Medicare, which has a lot of implications for their health coverage. This article contains answers to frequently asked questions to help you and your employees make the best decision and stay compliant.

Can I require my employee or their spouse take Medicare instead of our group plan?

No. This is considered discrimination based on age. Employees who reach age 65 and who are still working (also referred to as “Active”) have the option to choose between Medicare products and/or supplements versus their employer’s plan at each open enrollment.

In addition, for groups with less than 20 employees, insurance companies or health plans may require the employee elect Part B with their Part A coverage. Their plans usually pay second to Medicare regardless of whether the employee has purchased Part B. This can leave employees with potential unexpected expenses if they have not enrolled in both Medicare Parts.

Why would my employee or their dependent opt to stay on my plan when they could have Medicare, Medicare Supplements, or even Medicare Advantage plans?

There are many reasons why a member may stay on their group health plan. The two most common reasons are:

They have a spouse and/or dependents who still need coverage.
If the employer pays most of the cost of coverage, it may be less expensive for them to stay on the employer’s coverage. This is particularly true for plans where the employer picks up 100 percent of the cost. Unfortunately, for a group under 20 employees, this could backfire if the employee doesn’t understand they need to also purchase Part B if required by their insurance plan.

What are common issues for employees or their spouses who reach age 65 and are automatically enrolled in Medicare Part A?

There are several issues that can come up if employees don’t have a good understanding of the Medicare Secondary Payer rules. These rules impact which insurer pays first–– Medicare or the employer plan. This is dependent on the size of the employer. For more detail, click here for a guide from Medicare.gov regarding the payment rules.
Members over age 65 must ensure their prescription drug coverage continues to be creditable for Part D (notices we ask you to distribute each October). If the plan is not creditable, the member will have to pay a higher price later for Part D coverage. We recently helped a long-time employee of a customer retiring at age 80 to find all their Part D notices for the past 15 years so that they could prove they have been covered by creditable coverage.
If you offer an HSA-qualified plan and the employee is making contributions, they’ll want to review the rules and perhaps consult their tax advisor. Once you turn 65, qualified U.S. citizens are automatically enrolled in Part A, which prevents HSA contributions to be made by both the employer and the employee. In addition, there is a six-month look-back period for which the individual may not make contributions. This may also impact spousal contributions to their HSA even if the spouse is under age 65.
If your plan is a MEWA (Multiple Employer Welfare Arrangement), additional paperwork will be needed to submit to CMS/Medicare and the insurer to get claims paid correctly. Without the proper forms, the employer plan will pay primary and typically the employer is charged a higher premium for those employees.

This can be very difficult for employers to explain to employees. We’ve prepared a document that can be shared with employees to guide them in learning what works best for themselves and their families. Click here to access.

How do I know if my plan pays secondary or primary to Medicare?

Like the 20-employee rule used for COBRA, the count includes all full-time and part-time employees from the prior calendar year.

Will it save money on my premiums if individuals aged 65 or older leave the employer’s plan?

Not necessarily. In some cases, healthy individuals can help the overall risk of your group regardless of their age. This primarily helps groups that are medically underwritten (e.g., grandmothered status, level-funded, or in a multiple-employer plan). Plans with age-banded rates such as ACA plans, are going to reduce premiums for the employer.

If there are alternative “Medicare Rates,” those are typically shown on the renewal or proposal. They are only offered if the member provides proof to the insurer that they are enrolled in Medicare A and B. Generally, ACA plans do not have a reduced premium for employees with Medicare.

Can I pay for the employee’s Medicare product or supplement?

The law considers any incentives or disincentives to be discriminatory when used to encourage Medicare aged employees, spouses and/or dependents to opt for Medicare instead of the employer’s medical plan.

If the incentive was offered to all employees who opt for other coverage, regardless of their age, this would be permitted. This is called “Cash In Lieu of Benefits.” Payments under these terms are reported as taxable income to the employee but they must be consistent regardless of the age of the employee or any dependents. The employer can choose to only offer the incentive for their employees and not spouses or children.

Can I set up a Health Reimbursement Arrangement (HRA) to pay for Medicare premiums?

There are no permissible HRAs for the reimbursement of Medicare premiums for active employees if the employer offers a group plan. They are permitted for retirees.

An option exists if the employer disbands their group coverage. The employer can offer either an Individual Coverage HRA (ICHRA) or Qualified Small Employer HRA (QSEHRA). These types of HRAs are the only vehicles available for reimbursing premiums for all eligible employees. The downside is that the employer can no longer offer a group medical plan and all employees would need to secure individual coverage. ARC Benefit Solutions has assisted clients with establishing ICHRAs to replace traditional group coverage. If you’re interested in exploring this for your group, please contact your ARC representative.

The Inflation Reduction Act and What it Means for America’s Medicare Population

November 16, 2022/in ARC Updates, Legislation, Medicare/by ARC Benefit Solutions

Between 1946 and 1964, there were 76 million births in the United States. Of those 76 million babies, we have 65.2 million surviving seniors today. As of today, this population of “Baby Boomers” are two-thirds the way into Medicare. The promise of good health care in their golden year is a constant challenge for law makers to make good on. It’s a massive undertaking delivering good health outcomes and medical cost relief for these boomers.

This year, Washington has taken some steps to bring the care that Medicare promised these Americans during their working lives. The passing of the Inflation Reduction Act of 2022 is the latest in spending bills that at least partially targets help for these citizens. So how does the inflation reduction benefit us? When can we expect from the relief and how does it improve health outcomes?

First of all, The Inflation Reduction Act of 2022, sponsored by Senators Chuck Schumer (NY) and Joe Manchin (WV), was originally part of the “Build Back Better” bill. After the bill failed to pass in Congress, the two senators met to negotiate the Inflation Reduction Act with some Medicare fixes, as well as spending for energy, climate change, tax provisions, and the expansion of the Internal Revenue Service.

Here are some of the health care highlights of the legislation:

$2,000 limit out-of-pocket cost for prescription drugs for all Americans on Medicare
Caps the cost of insulin at $35
Zero cost for most vaccinations
Continued expansion of the Affordable Care Act’s (ACA) subsidies for three more years
Direct drug price negotiations with drug manufacturers

Sounds pretty good right? However, the devil is in the details.

Some help is coming right away or at least very soon. If you’re a diabetic, you won’t have to choose between paying the mortgage or buying your insulin. This is some overdue relief and that program starts next year. Also, beginning in January, most vaccines will be free through Medicare. Furthermore, for people who buy their health insurance through the ACA Marketplace, the bill extends through 2025 the expanded federal premium subsidy. For those 50 to 64 years of age, these subsidies provide an average savings of over $950 annually, and all consumers will continue to pay no more than 8.5 percent of their income for ACA health insurance premiums.

Now for the goodies that we must wait on:

The $2,000 cap on drug costs is great, but Medicare beneficiaries will have to wait until 2025 to see the benefit.
The new law authorizes the Health and Human Services secretary to begin negotiating the prices of 10 high-cost prescription drugs in 2023. Unfortunately, the negotiated prices will not go into effect until 2026 for Part D medications and in 2028 for drugs covered under Medicare Part B.
More drugs will be negotiated on behalf of Medicare in subsequent years and by 2029 a total of 60 drugs will be subject to negotiated prices.

According to the Congressional Budget Office, Medicare will save hundreds of billions of dollars over 10 years as a result of the new law with the majority of the savings resulting from drug cost negotiations. And good news: The savings involves no cuts to Medicare.

If you are a Medicare eligible or beneficiary, we want to help you learn about the rules of Medicare and how they apply to you. Contact your Client Care Advisor today to learn more.

September is Healthy Aging Month! Follow These Three Tips to Help You Maintain Your Health and Function

September 13, 2022/in Health and Wellness, Medicare/by ARC Benefit Solutions

Journalist Betty Friedan said, “Aging is not ‘lost youth,’ but a new stage of opportunity and strength.” From taking care of your body with regular screenings to getting moving, there are many ways you can positively influence your health. Here are three habits you can add to your life to age healthily.

1) Regular health screenings.

Regular preventative screenings can help your doctor determine a baseline for your health and can help them preemptively identify symptoms of illness. It’s also important to consistently consult with your doctor about the medicines you’re currently taking to ensure they are right for you and your situation.

Did you know? Blood pressure screenings, colonoscopies, bone density scans, mammograms, and hearing tests are just a few of the many screenings that may be covered by your health insurance. Contact ARC Benefit Solutions today to find out more.

2) Challenge your mind.

Maintain your cognitive health by continually challenging your mind. According to the National Institute on Aging, changes in the brain as a person gets older, such as reduction of neuron communication and reduced blood flow, can affect mental function, even in healthy older people. Learning a new language, reading, and taking dance lessons are just a few of the ways you can improve brain health. Connecting with your family, friends, and community are also great ways to reduce your risk of cognitive impairment.

3) Stay active.

Among numerous other benefits, regular exercise can improve your health, your balance, and your mobility, and can reduce the impact of illness and chronic disease. Finding an activity that you enjoy doing on a consistent basis is a good start for maintaining a fitness routine. According to Go4Life, an exercise and physical activity campaign from the National Institute on Aging at NIH, exercise falls into four different categories: endurance, strength, balance, and flexibility. Mixing these different workouts has been proven to improve your overall health. Walking, Tai Chi, yoga, and water aerobics are just a few of the many fitness options for older adults.

Did you know? Many Medicare plans include access to the SilverSneakers® program, which is specifically designed for adults 65 and older. Contact your ARC Client Care Advisor for more information!

Consult your healthcare provider before taking on a new exercise plan, especially if you have a pre-existing condition.

Resources

How the Aging Brain Affects Thinking (National Institute on Aging) Ten Tips for Healthy Aging (Dartmouth-Hitchcock)

Healthy Aging (U.S. Department of Health and Human Services)

Health Highlights: September, Healthy Aging Month (WebMD)

5 Healthy Aging Tips for Women (U.S. Food and Drug Administration)

4 Types of Exercise (Go4Life, National Institute on Aging at NIH)

Senior Exercise and Fitness Tips (HelpGuide)

Medicare Supplement vs. Medicare Advantage: Which Plan is Best for You?

June 17, 2022/in Medicare/by ARC Benefit Solutions

I have worked with Medicare-eligible clients since 2015. A majority of people I have helped have actually enrolled in a Medicare Supplement with a separate stand-alone Part D drug plan. However, in past 18 months, there has been a trend of more and more Medicare Advantage plans.

To make an informed decision about your Medicare coverage, it is imperative to understand the differences between the two options: Medicare Supplement plans and Medicare Advantage plans.

Medicare Supplement Plans

All Medicare Supplement plans are standardized with 10 different plan designs and the varying monthly premiums, depending on how comprehensive the plan design is. For example, Plan F and Plan G are the most comprehensive of all Medicare Supplement plans so, the coverage is the same for all those plan types. However, in a given area, insurance company A might charge $150 for their plan G premiums, while insurance company B might only change $135 for the same plan G coverage. Not all plans are commercially available in all areas; the insurance company decides which plans they will offer in a given area or state.

To avoid overpaying for the supplement, it’s a good idea to speak with you agent, who can provide quotes from multiple insurance companies. You may already realize Medicare Supplement plans charge a monthly premium cost for the coverage. This premium cost will increase slightly each year as you age. For example, with a Plan G, in exchange for the monthly premium cost, the plan will pay all Medicare-eligible expenses after you meet an annual one-time $233 Part B deductible.

When considering a Medicare Supplement plan, also remember that:

You can go to any doctor or healthcare facility anywhere in the US as long as the provider or facility accepts Original Medicare.
Medicare Supplements require medical underwriting expect when first turning age 65, or first enrolling in Medicare part B after being in group health coverage. In those instances, the applicant has one-time right to a guaranteed issue policy without underwriting.

In summary, Medicare Supplement plans…

Have a monthly cost that increases with age.
Do not require members to use a network.
Pays all Medicare approved cost after a $233 annual Part B deductible so anyone who enrolls has a very predictable cost for their medical coverage for the year.
Do not include Part D prescription drug coverage, so anyone applying for a supplement will want to purchase a stand-alone Part D plan.

Medicare Advantage Plans

In comparison, Medicare Advantage offers an assortment of different plans including PFFS, HMO, PPO, or POS options. Availability of these plan types may be limited to specific geographic areas. Medicare Advantage plans can be available with or without Part D drug coverage, and anyone who enrolls in Medicare Advantage with Part D coverage will have medical and drug coverage all together in one plan; this is commonly referred to as MAPD or is sometimes referred to as an all-in-one plan or Medicare Part C.

The most commonly available Medicare Advantage plan types are the HMO and PPO. Generally, Medicare Advantage HMO and PPO plans are available with a $0 monthly premium, or if the plan does have a premium it is usually much less than the monthly cost of a Medicare Supplement plan. Anyone who selects an Advantage plan for their Medicare coverage will typically pay lower monthly cost than for a supplement.

When the member of a Medicare Advantage plan obtains medical treatment, they will be required to pay a pre-determined flat dollar co-pay amount or a coinsurance percentage for all services. These amounts are due to the provider at the time of service. To limit catastrophic medical costs, Advantage plans provide an annual max out-of-pocket amount that limits the members annual medical cost to a fixed dollar amount. Conditionally, the Advantage plan counts the members out-of-pocket medical cost toward the out-of-pocket limit. Some plans require the member to use network providers in order to count medical cost toward the out of pocket limit.

Except for a medical emergency, Medicare Advantage HMO plan members are required to obtain all of their health coverage from a network of providers. In the case of medical emergency, the member can go to the nearest hospital and the treatment will be considered as in-network according to policy terms and conditions. Medicare Advantage PPO plan members have an option to use a network provider and pay lower cost or they can go to any non-network provider of choice and pay more for services and have a higher out-of-pocket limit.

All Medicare Advantage plans are reviewed and approved by Medicare before they are offered commercially. In addition to medical and drug coverage, Medicare Advantage plans may offer various additional benefits and services such as routine dental and vision coverage, quarterly allowance for over-the-counter items, such as vitamins or medical supplies, home-delivered meals post hospital discharge, no-cost fitness club memberships, assisted devices for emergency, 24/7 nurse hot line, telemedicine, and more.

In summary, compared to the Supplement option, Medicare Advantage offers lower monthly premium cost for a good number of zero dollar premium or low monthly premium HMO or PPO plans. Medicare Advantage is a pay for services as you go option while each member has a built-in protection against high medical cost with the max out of pocket limit. Many of additional benefits and services available with Medicare Advantage are not included or available with the Medicare Supplement plans.

In summary, Medicare Advantage plans…

Offer lower or zero-dollar monthly premium cost for HMO or PPO plans
Are a pay-for-services-as-you-go option while each member has a built-in protection against high medical cost with the max out-of-pocket limit.
Offer many additional benefits and services that are not included or available with the Medicare Supplement plans.

The Medicare maze can be confusing and it can be difficult to find the right plan for you and your situation. Contact your ARC licensed health insurance representative today and we will help you find options that work well for your health and your budget.

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.