Insurance FAQs

At CDA Inc., we understand that insurance is complicated and we are here to help! Please feel free to call at (770) 449-7369 with any questions. Also, for your convenience, we have provided the most frequently asked questions on group, individual and medical benefits below.

 

Group

As an employer, what am I required to provide my employees?

• Most insurers require companies to pay a minimum of 50% of the employee premium cost, and the ACA offers tax credits for small businesses that do so. If offering multiple medical plan options, employers have the right to cover 50% of the lowest cost plan and have employees “buy up” to the richer plan(s). Additionally, under the ACA, “Applicable Large Employers” or “ALEs” (those with 50 or more full-time equivalent employees) must offer minimum essential coverage to substantially all of their employees and dependent children and must limit the employee’s cost for the least expensive plan to a specified percentage of household income.
• Companies that employ fewer than 50 full-time equivalent employees are not required to provide medical coverage. ALEs, however, are required by the ACA’s employer mandate to provide medical benefits and will face penalties for not offering that coverage to all benefits eligible employees. The employer mandate will remain in place for 2019 and, potentially, beyond.

How do I keep my benefits package affordable?

• By educating staff about applying best usage practices and discussing cost containment strategies that can be implemented in all groups, we can produce positive impact for both the employees and the employer. In utilizing supplemental and alternative insurance options, employees can often move to less expensive medical plans. Ask us about how we guide employees to make better healthcare decisions.

What are the compliance requirements that impact me?

• Every employer currently offering employee benefits is required by law to adhere to a myriad of requirements under ERISA and other federal and state laws. Businesses that do not meet these regulatory standards can incur civil and criminal penalties that may be levied against either the business or the at-fault individual.  We have staff that can help address what is required and how best to meet the mandates.

What lines of coverage are the most important / impactful for my company and employees?

• Medical coverage will make the largest impact on your employees’ daily lives, but there are other significant concerns that many people should be strongly considering. Over 1 in 4 younger generation workers are expected to experience a disability in their lifetime that will require them to miss work for an extended period (presumably without pay).  By offering Short-Term and Long-Term Disability insurance in your benefits package, you are not only protecting your employees’ income, but also helping them maintain a sense of normalcy when unexpected life-altering issues occur.  Disability coverage also may relieve much of a company’s liability regarding Workers’ Compensation and injuries that have a tendency to carry over from the weekend and spontaneously manifest on Monday morning at work.

Medicare

I’m still working and am on my employer medical plan…when do I need to sign up for Medicare A/B?

• For employees of firms that employ less than 20 employees, Medicare parts A & B are required as the private insurance carrier can consider Medicare coverage primary and only be responsible for charges that exceed that coverage. For employees of firms that employ 20 or more employees, there is a chance that enrollment in Medicare will be unnecessary, and may even be discouraged.  The employer group plan for these larger plans will be the primary carrier so enrolling in Medicare will be redundant.  If employees in this category elect to enroll in Medicare they should NOT enroll in Medicare part B as there are a series of other complications which could come up later.

If I retire before age 65 am I eligible for Medicare?

• Unless an individual qualifies for Medicare as the result of a disability, end stage renal disease or ALS, enrollment begins at age 65.

How much of a window do I have before penalties apply and what are those penalties?

• If individuals do not enroll within the enrollment window around their 65^th birthdays or have credible coverage through an employer of 20 or more employees, late penalties will apply.

Will I be fine with just Medicare or do I need other coverage (Medicare Supplement/Medicare Advantage)?

• It is always in an individual’s best interest to compare the benefits of a Medicare supplement plan to a Medicare Advantage plan. Considering options of continuing any coverage available through employment that extends beyond age 65 or available through the VA is also critical.  We at CDA, Inc. offer an educational consult which can help compare the various options available to individuals as they become eligible for Medicare and beyond.

Will I be subject to medical underwriting?

• If enrollment is done on a timely basis there will be no medical underwriting for the Medicare supplement. Enrollment for Medicare parts A and B, never includes medical questions.

Which is preferred – home health care or nursing home care?

• Discussions about style and cost of care, once we can no longer fully care for ourselves, are critical as we age. As part of the PCQL group, CDA, Inc. provides seminars and consults that address the various considerations of this type of care.  The levels of home care and facility care that are available are constantly changing as are their costs, and decisions about these are very individualized.

How can I use Medicare while traveling inside the continental US?

• A Medicare beneficiary can access care from any provider in the United States. Those providers who accept Medicare assignment will be reimbursed directly by Medicare. An individual will need to pay those providers who do not accept Medicare assignment directly and be reimbursed by Medicare for the amount of compensation a provider who did accept Medicare reimbursement would have been paid.  Any balance of the bill will be the beneficiary’s responsibility.

What should I know about Medicare while traveling internationally?

• Please remember that Medicare does NOT provide coverage when a Medicare beneficiary is travelling outside the U.S., its territories or U.S. waters. Certain Medicare supplement policies and Medicare Advantage plans help address this gap, but not all do.

Individual

Am I required to have medical coverage?

• Although it is not illegal to go without insurance, the IRS will impose tax penalties on individuals for not having Affordable Care Act (ACA, otherwise coined “Obamacare”) compliant insurance unless coverage is in force under a Christian Healthcare program.

Is the tax penalty still in place? I thought it was repealed…

• For the remainder of 2018, the tax penalty is still in place for those individuals who are considered non-compliant. The Trump administration passed a massive tax bill that included legislative measures to remove the individual tax mandate starting in 2019.

Is health insurance tax deductible?

• Medical insurance premiums are only tax deductible if you are self-employed, a business owner or have a separate Health Savings Account (HSA). With some exceptions, if you are self-employed or a business owner, your premiums and those for your dependents can be deducted on your taxes.  If you have a separate HSA and have a plan considered to be a High Deductible Health Plan (HDHP), the money that you contribute into the Health Savings Account, to the federally mandated limit, is tax deductible.

What are my options for individual insurance?

• A large number of insurance carriers have left the individual market, and those who have remained offer primarily HMO products. In Georgia there are 4 major carriers still offering coverage for 2018 – Alliant, Ambetter, BCBS, and Kaiser.  These carriers only offer coverage in certain areas of the state and there are only a couple of overlapping coverage areas.  There are a number of alternate coverage options / packages that are offered from various insurance companies and CDA, Inc. can consult with you to help determine if any are appropriate for your circumstances.

Can I set up a Health Savings Account?

• You can enroll in a HSA at any time, so long as you are not enrolled in Medicare, and are otherwise eligible. You can only contribute to your HSA while enrolled on a High Deductible Health Plan (HSA eligible plan).

Do I need dental or vision insurance? How do I determine if I need coverage?

• If you find that the services you need are limited to routine and preventive care, dental and vision insurance may not be necessary. Insurance can provide financial help if you require more than regular maintenance, but keep in mind that dental products have mandatory waiting periods for those who have gone without dental coverage for over 63 days.

How early is too early to consider Long Term Care coverage / how late is too late?

• For most people, the time to begin the conversation is much earlier than they might think, normally while in their 40s or early 50s. While addressing concerns about the cost of care with their own parents, many of our clients are recognizing the DOs and DON’Ts of this major transition firsthand and are creating better outcomes through guided strategic planning.  The longer this conversation is postponed, the more difficult the underwriting process can be and the more limited financial options can become.