Health Insurance Seminar by John Klimchak - Part 7
Usually gives you more access to doctors so better more doctors here on the plans.
Well, I'm gonna say it depends and the reason I say it depends because usually as you go up and take a look at health insurance you're right about access to care networks of doctors.
So primarily in New York there's really under the small group platform, there's really only two players, it's either Anthem Blue Cross Blue Shield or Oxford each of them have three networks of doctors.
Anthem has their connection network which is very very thin they have their access network which is a great network and then they have the EPO network which is a great network.
There's about a 97% overlap between our access network and their EPO PPO network the only difference is if you're out in Suffolk County is Stony Brook so if you're out in Suffolk County you gotta get the EPO PPO network because the blue access excludes Stony Brook.
For Oxford the three networks are the Metro which is thin out here in Nassau County. In the boroughs it's fine it's a decent network then you have the Liberty network which is a very good network then you have the freedom network and with Oxford between the Liberty and freedom network there's about a 93% overlap.
So when you're doing any of these comparisons especially in small group it makes sense to do with some of the physician match analysis get a list of the doctors either call them send them over to your broker say listen I want to see what networks they belong in based upon the networks and you can determine where they go.
But really when you're talking about the quality networks are important but as we as we go up the metallic tier structure as we go from bronze to platinum then the platinum plan is gonna be more expensive than a premium but when I'm using the plan it's gonna have significantly less out of pocket because why my health insurance premium is gonna be deductible to the corporation.
So if I can get a deductible and have a lower out of pocket when I use the plan isn't that the mission so under the platinum plan over here as an example I go to the doctor 20 dollar copay better than a 5,000 dollar deductible in the bronze the platinum plans.
When I go to the specialist no referrals I pay 40 dollars better than a 5,000 dollar deductible in the bronze if I'm hospitalized cost me 500 bucks better than 8,000 and look at the premium the premium of the small group these are filed rates July 1st filed rates is 16 46 27 so then the question becomes am I better off paying 1646 under small group or am I better off paying 11 hundred dollars getting a Medicare supplement plan and rolling a Medicare that's ultimately.
To be clear you're saying 1646 per month?
Yep.
And what is Medicare Part C?
Well that's the Manage Care.
The Manage care like the HMOs.
That's the Medicare Advantage plans. Exactly.
So wait, you did the example of we're talking about the lower job level of Medicare you know like your hundred and eighty five so just assume that we're owners and so like what would the cost be?
630.
But then if you add in like
For 11 hundred, at least eleven hundred a month.
What is that a little
It doesn't include dental or vision.
Correct.
If you add those in then whatever you
But keep the dental and vision under the group plan anyway, take it under the group you don't have to you can still enroll in it just because you're enrolling in that you're not enrolling in the medical does not mean you cannot enroll in the in the dental or vision. So you can keep the dental or vision group plan and just do the Medicare separately.
Then the question becomes okay you know is it gonna be any incentive for those employees that decide to enroll in Medicare especially if they're on if groups that have less than 20 rather than enrolling in our plan.
How do you get to a level so it's called 600 for doctor coverage part B and then another hundred dollars for Medicare drug coverage?
So let's say 630.
It's 630.
Plus another 85.
No, it's more drug plans like 300 a month.
Well cause that's how this works.
That's in addition, that's another 85 on 100, so it's gonna be 185.
For the low end employee or 185 for everybody
For the executive.
For the executive, just for drugs.
There's gonna be 85 dollar surcharge because it's based upon their income that gets added to the premium of the prescription plan so it's 85 plus 115 so full $200.
So we're up to 835.
And then you have to add the 326 for the Plan G.
What is G?
For the doctors to be able to go to any doctor you want.
So that's the Medicare supplement that's gonna wrap around Medicare.
So and then normally they take Medicare payments out of your Social Security payment?
If you elect to. It's your choice.
But if you Medicare you can start taking it at 65 but Social Security you can defer to it's called 70.
Correct.
So then you send them a check every month.
They bill you direct debit.
So does it make sense to go to Medicare versus that if you had first the exchange or like
It depends it's a matter of doing the math.
It's each one's different.
But so even if once you turn 65 which I'm not there yet thankfully but if once you turn 65 you still have to enroll even if you don't use it.
You have to enroll, three months prior to your 16th birthday.
Let's get back to what part we have to enroll in.
It's not the whole thing.
A is gonna come hospitals are gonna come automatically that's gonna be free.
But you have to enroll?
That's Part A
You have to enroll
Normally thats, it's an autobot normally happens automatically. Part B is where you definitely you know have to make again
Ph doctors
Normally 90 days they send notification they'll say you're enrolled or if you want to enroll then you just so B you have to enroll A normally comes automatically 'cause its free.
But you can enroll and not pay premiumsand you've met the obligation because if you're covered under an employer plan like my husband still works so he's enrolled but I don't pay premiums.
He's enrolled in A but not B, he doesn't have to enroll in Part B.
Cause he has health insurance through his employer.
His employer is more than 20 employees so he doesn't need to enroll in Part B so what'll happen is when her husband retires that's gonna create qualifying event you know qualifying events in health insurance married,terminate, divorce, all that kind of stuff right that's gonna create a qualifying event whereby he can enroll Medicare without any penalty 'cause if you don't have coverage and you don't enroll when you do enroll later you're gonna be subject to penalty.
For the rest of your life, you pay that every month.
How high is the penalty?
Pretty high.
Why do they do that?
Cause they want everybody to enroll.
Does Medicare offer vision and dental also or not?
No.
Vhat happened you gotta go to that point usually if you're still employed maybe the employer is providing it or maybe the Medicare supplement plan that you're going to will give you the options to enroll in a some type of dental or vision plan
The one last comment I want to leave you with it would be something new because again healthcare costs are through the roof, it's huge, so now what what you hear of now more and more are these ICHRA plans.
You ever hear of the term ICHRA?
No, what is this thing?
Individual Coverage Health Reimbursement Arrangement.
Basically what it does is this, it gets the employer out of the mix even if you're 50 or more of having to provide coverage. In New York and most states they have individual exchanges so basically what an ICHRA is doing you get you hire an outside third party administrator a TPA and the employees are gonna have the opportunity to enroll in the individual coverages that are that are available through the exchange in their county cause most of the plans are based on county.
Now rather than having the employee have to pay the full premium it's treated as a group plan whereby the employer is still gonna pay their contribution towards the cost of coverage and the employee will pay their amount on a payroll deduction basis but it gets the employee out of having to pay the full boat and then having being reimbursed so it's obtaining getting individual coverage under a under a group platform.
But it's county by county so like so for example if I'm living in Suffolk County and I want to go doctor in Nassau County I can't do it.
No, I'm just talking about the rates depends upon the plan but the rates are based upon county. The rates in NASA are gonna be significantly different than in Rochester just to right prove the so if I have a company I might have employees in both places but the employee will have access to the exchange in in which they live and me as the employer. I would say listen I don't want to deal with my broker. I don't want to deal with that we're gonna hire a third party administrator you can get any plan that's available through a individual exchange.
I don't care if it's a bronze, silver, gold platinum we're gonna contribute the 9% minimum required by law and you can get any plan you want and it'll be payroll deduction and we're off to the races.
So that's something new that you see more happening because employers don't want to be in the insurance business because it's tough right what happens with the insurance every year the premiums are going up Johnny my premiums are going up why is it going up close to care trending all that kind of good stuff.
Employees don't wanna hear that so in order to get out of that so listen maybe you go to make sure your contribution needs the required by the ACA and you're done.