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Monday, February 27, 2017

ACA’s Replacement…A Sneak Peek

Until recently (late February, 2017), talk of “repealing/reforming/replacing” the Affordable Care Act (ACA), aka Obamacare, has been largely speculative.  We now have our first look at draft legislation that aims to replace major aspects of the ACA.  It is important to note that what is being considered is not a wholesale repeal of the ACA,LEARN MORE

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Monday, December 19, 2016

21st Century Cures Act Becomes Law!

On Tuesday, December 13th, 2016, the President signed into law the – “21st Century Cures Act” – which includes a provision that will be very good news to many stakeholders, in particular, employers that have fewer than 50 full time/full-time equivalent employees.  Now law, the Act addresses a variety of issues including expanded treatment for mentalLEARN MORE

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Monday, November 21, 2016

IRS Announces Delay to ACA Form Filing Deadline

Last Friday (11/18/2016) the IRS announced extended deadlines for the delivery of forms 1095-B & C to INDIVIDUALS.  IRS forms 1095-B and 1095-C must now be provided to affected individuals no later than March 2, 2017 (originally 1/31/2017). Please note this extension does NOT apply to the deadlines for filing forms 1095-C, along with 1094-C, 1094-B, andLEARN MORE

Wednesday, October 12, 2016

Medicare Part D Notices

Each year, Medicare Part D requires group health plan sponsors to disclose to individuals who are eligible for Medicare Part D AND to the Centers for Medicare and Medicaid Services (CMS) whether their health plan’s prescription drug coverage is creditable. Plan sponsors must provide the annual disclosure notice to Medicare-eligible individuals before Oct. 15, 2016—theLEARN MORE

Saturday, October 1, 2016

Medicare Part D Notice Requirement

Each year, Medicare Part D requires group health plan sponsors to disclose to individuals who are eligible for Medicare Part D to the Centers for Medicare and Medicaid Services (CMS) whether their health plan’s prescription drug coverage is creditable. Plan sponsors must provide the annual disclosure notice to Medicare-eligible individuals before Oct. 15, 2016,the start date of the annual enrollment period for Medicare Part D.

Thursday, March 3, 2016

2016 ACA Compliance Updates

By one count (The Galen Institute); there have been seventy (70) significant changes, delays, modifications, and partial repeals of the Affordable Care Act (ACA)/Obamacare to date. (For those keeping score at home, 43 have come from the White House; 24 from Congress; and 3 from the Supreme Court.) The challenges for stakeholders lie not only in developing sound, effective compliance strategies, but in keeping up with the various fits and starts of the law. In addition, various penalties, fees, taxes, limits, and safe harbors are indexed for inflation, and thus, subject to change on an annual basis. Listed below are some of the more relevant and timely announcements which impact ACA compliance in 2016 and beyond:

Wednesday, January 20, 2016

Short Term/Temporary Health Ins.- Buyer Beware!

Short Term Major Medical (STMM) coverage, sometimes referred to as Temporary Major Medical, can be an ideal solution to a specific, health insurance related challenge.  However, changes brought upon by the Affordable Care Act (ACA) have significantly altered the rules, restrictions, and considerations relative to the purchase and reliance upon STMM coverage.  Here is anLEARN MORE

Thursday, October 8, 2015

President Signs Important ACA Modification Bill!

Yesterday (October 7, 2015) the President signed the Protecting Affordable Coverage for Employees, or PACE Act, giving states the flexibility to define “small employer group”, for purposes of the Affordable Care Act (ACA).  The PACE Act also redefines the definition of small employer to 1 – 50 employees.  This is an extremely important tweak toLEARN MORE

Long Term Care’s Silver Tsunami

Recently I read an article in a trade publication that addressed the so called “silver tsunami”, related to long term care.  While the word “tsunami” certainly got my attention, some of the statistics mentioned in the piece had me downright concerned. As an employee benefits consultant/broker, health insurance is almost always at the top of the list in terms of importance and cost, followed by dental, life insurance, disability income, vision, and tax preferred spending accounts (e.g., health savings accounts, flexible spending accounts, health reimbursement arrangements).  However, with 10,000 Americans turning 65, each and every day, and the propensity to need some form of assisted care in the future as we age, LONG TERM CARE INSURANCE (LTCI) deserves a “seat at the table”.  Here are some important considerations relative to long term care, which includes facility care at various levels, and potentially care received in the comfort of one’s own home…

***UPDATE***
See updated figures for 2021, along with 25 year projected data – scan_sstevens_2022-05-18-11-40-41

Based on insurance company – Northwestern Mutual Life Insurance Company’s 2014 Long Term Care Study:
  • Currently 1 in 3 Americans provides or is expected to provide care for a loved one.
  • The largest share of caregivers is in their peak earning years of age (45-64).
  • 47% of working caregivers reduce or deplete personal savings to cover expenses related to care giving.
  • 80% of primary and 50% of secondary caregivers reduced retirement plan contributions to cover long term care related expenses.
  • 75% of Americans agree that as people live longer, the need for long term care is greater.
  • By the year 2020, it is estimated that 25% of the workforce will be 55 years of age or older.
And finally…
  • Someone turning 65 years of age today has a nearly 70% chance of needing some form of long term care services/support in their remaining lifetime.
There are a number of quality insurance companies offering long term care insurance protection in the form of both individual and group policies. And, there are a several factors to take into consideration when evaluating long term care insurance.  Some of these factors include:
  1. The maximum benefit period (usually expressed in a number of years, or in some cases, for life).
  2. The per day or per month benefit amount.
  3. The total amount of benefits available or the lifetime maximum benefit (generally determined by multiplying the per day benefit amount (no. 2.above) by 365, then multiplying this figure by the number of years associated with the maximum benefit period (no. 1. above).
  4. The length of time before benefits are payable (referred to as the benefit waiting period).
  5. Whether or not the policy provides coverage for care provided in and out of a nursing home, assisted living facility, and/or the person’s home.
  6. Whether or not the policy only provides benefits for licensed care givers.  Some policies provide benefits to care givers that are not necessarily licensed providers, but rather, friends, neighbors, and relatives.
  7. Inflation protection.
  8. Partial or full return of premium in the event benefits are never triggered.
  9. Whether or not the policy can continue with limited benefits if the policy owner decides to stop paying premiums (generally referred to as a non-forfeiture option).
  10. Whether the policy pays benefits based on an expense incurred, indemnity, or disability model.
  11. Whether the policy is considered qualified or non-qualified.  (Note: in order to be eligible for tax deductability of premiums, the policy must be qualified.).
And unlike other forms of insurance that have clearly defined benefit “triggers” (e.g., death, accident, fire, theft), LTCI benefits are usually triggered by a physician’s certification of either or both of the following:
  1. Inability to perform a specific number of “activities of daily living”, or ADL’s, which may include bathing, continence, dressing, eating, toileting, and transferring; or
  2. Cognitive impairment (e.g., dementia, Alzheimer’s disease).
Finally, the federal government encourages the purchase of LTCI by allowing tax deductability of a portion, and in certain instances, all of the premiums paid for coverage.  For example, in 2015, an individual between the ages of 60 – 70 can deduct up to $3,800 if such premiums and other allowable medical expenses exceed 10% of adjusted gross income (AGI).  Tax deductability of LTCI premiums paid for group/employer provided coverage depend on the structure of the organization (i.e., partnership, S corporation, C corporation).  And, like many other insurance benefits provided by employers, LTCI benefits received are tax free to covered employees and dependents!
 
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Wednesday, August 12, 2015

2016 Health Savings Account (HSA) Guidelines

Earlier this summer (2016) the IRS released its annual guidance affecting Health Savings Accounts (HSA), and associated qualified high deductible health plans (QHDHP).  Interestingly, for the first time since rules were relaxed to allow contribution amounts to be higher than a percentage of the deductible (remember those days?), the IRS chose to keep the maximumLEARN MORE