Tag Archives: insurance

April 16, 2018

Long Term CARING – Introduction

By Paula L Wilson, RHU, REBC

This is an introductory blog for an ongoing discussion on Long Term Caring.   It is NOT a discussion you expect from an insurance agent specializing in these products.  The goal is to paint a picture of caring for the aged and point out short comings in the current system.  To understand the need to prepare everyone for the imminent onslaught of baby boomers that are about to enter this arena.  Education needs to start now.  Employers need to employ tactics to prepare for the business interruption and how they can help their employees. 

Note: I have always been and will continue to be supportive of Long Term Care Finance Planning.  However, financing and legal preparation are not the topic of this particular conversation.   Please feel free to reach out for a discussion on the several routes to attack this looming financial issue.  You may be able to shore up your liabilities by simply moving your existing life and annuities around.  Existing cash value policies can be used to fund new life policies that include Long Term Care benefits.

 

My parents did everything right.    I can’t imagine the additional stress and issues that we would have had to tackle had they not done the groundwork.   They set aside money to pay for their long term care needs.  They kept up the most comprehensive PPO healthcare options.  They even made sure all legal documents were in order so that we could make decisions and transactions on their behalf.  With all of the obvious boxes checked on the the road to long term care planning, future caregivers need so much more education and preparation for what may lie ahead.  Through our story, I would like to enlighten you on things that we have learned and suggest how we can prepare future generations on these overseen aspects.

Caregivers have a myriad of levels of responsibility.  From taking over the physical care of one or more individuals to overseeing and directing hired care workers and facilities.  Every day you need to take the time to review the situation, seek out new information, find new resources, weigh care options and make decisions.   In all of the conversations I have with people, I get the idea most people don’t understand the reality of the situation.  It’s not about the money, the time investment or the hard work.    It is personal, it is heart-wrenching, it is about your family…….it’s about caring.

Although we had been introduced to the issue years ago when we assumed the oversight of care of our grandparents, we never expected what we have and are continuing to experience today.  When we look back, the experience with our grandparents went as predicted and was on one end of the long term care spectrum.

When we became empty-nesters, we moved into a home with the proverbial “parents room” downstairs.   We had always promised to bring my parents home when and if they ever needed the help.  There was no way MY parents would go to a nursing home with strangers!  In almost every conversation on the topic, clients tell me they don’t need much LTC insurance because they are just going to take care of their parents at their home.  It’s the master and universal plan for most American families.   I don’t know the numbers, but it doesn’t always go down like that and it certainly didn’t go down that way for us!  Before you start making pronouncements and promises, here are a few reasons this plan may be problematic.

  • Your parents may not want to move in with you because “they can take care of themselves”.  When they need you, they will likely need medical oversight and/or professional nursing care.
  • The issue could come up under catastrophic/emergency conditions.  It may not be a planned event.  Many things in your life will be set aside until further notice.
  • If there is any issue with Alzheimers or Dementia, you aren’t offering someone a place to live, you are offering to be someone’s shadow 24/7.  Day and night, every second of every day.  If they are a fall risk due to physical limitations, there is NO wiggle room on this 24/7 shadowing.  You had better have back up even if you just want to run to the bathroom or walk outside to get the mail.  You will need to make sure your bed is right next to theirs because nighttime no longer means anything.
  • You may need to make adjustments to make your home ADA accessible or at least safe.
  • All hands on deck.  You can’t assign this to one spouse to handle.  It’s takes a team.

With the same mindset as most Americans, the following is how this journey launched for us.

My parents would not be told where they need to live or that they need any intruders in their home.  We took them on tours of wonderful Assisted Living Facilities and even tried in-home visiting caregivers.   As members of the Greatest Generation, they are tough, self sufficient and have withstood everything the world has thrown at them in the last 80 years.   We couldn’t force them to move to safety and we were less inclined to push it because they had mastered hiding their mental and physical decline.  My dad was quick to admit years prior that he could no longer take care of financial duties and immediately turned that over to us, but that was the end of their request for help.

It wasn’t lost on us that they were lacking in personal care, acting forgetful, ignoring illnesses and becoming increasingly fragile and physically unstable.  With this in mind, for years we had ramped up our oversight by making the countless 100 mile drives after work.  Even predicting something was going to happen, we had no idea how traumatic and overwhelming it was going to be for everyone.

Just hours after returning home from the Thanksgiving dinner we had taken to their home, we get a phone call from the ER in the middle of the night.  Both of my parents had fallen in the kitchen and had been brought to the hospital with a myriad of injuries.

My father was immediately hospitalized with a fractured pelvis where he would remain for months.  After a frantic search for my mom at the hospital, we found the unbelievable.  Due to preexisting conditions that precluded any surgical intervention and my mother’s insistence on getting home, the hospital didn’t see a need to admit her.  She was discharged into a taxi with a crushed shoulder that had been put in a cloth sling and was whisked off with no surgery, no painkillers, no notice to family.   She was off in the care of a random taxi driver that had set her in a chair in her home where we found her the next day.  She was scared, incapable of moving (or being moved), broken and bruised, partially blind, very confused, in excruciating pain, dependent on oxygen and in need of a multitude of cardiac and pulmonary drugs.

That was Day 1.   Thanksgiving 2014.

LESSON TO LEARN:  Be prepared to be available on the spur of the moment.  Have a plan for your family and business responsibilities.  Have all legal documents, insurance and personal health data available in various formats on hand.  Do it now.

 

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February 14, 2018

2018 ACA Update – Clearing up Common Misunderstandings

By Paula L Wilson, RHU, REBC

It’s seems like only yesterday that the Affordable Care Act (aka ACA, ObamaCare) was signed into law.   In fact, the law will celebrate it’s 8th anniversary on March 23, 2018…….and it was a big deal.   Yet, in all of this time and all of the front page conversations, so much is still not clear to so many.

Many misunderstandings are creating frustration for individuals, employees and employers.   Insurance and Benefit professionals spend countless hours providing service and guidance to those caught up in this ongoing learning curve.   I would like to take some time to highlight the most common, and often costly misunderstandings.

For Employers

The Employer Mandate to provide Affordable Coverage is in effect

Employers (and Controlled Groups) with 50 or more Full Time Equivalents must offer their eligible full-time employees health insurance that provides minimum essential coverage that is both affordable and provides minimum value.   Just this week, the IRS has released information to remind employers that they are going to be collecting penalties.   The Wall Street Journal (2-13-18) is reporting here that:

The financial impact on businesses could be significant. The nonpartisan Congressional Budget Office estimated in 2014 that companies would owe about $139 billion in penalties from fiscal 2016 to 2024.

“There are penalties of three, four, five million dollars,” said Alden Bianchi, an attorney at the firm Mintz Levin. “There is a smaller group of employers that really didn’t understand how the rules applied and didn’t offer coverage or sufficient coverage in 2015. … To a smaller company, a half-million is an existential threat.”

Employers need to offer coverage to at least 95% of their eligible full-time employees.  Penalties apply for non-compliance.  For additional information on affordability,  minimum value and penalties please contact Paula Wilson at paula@paulawilson.com.     (IRS Employer Mandate Penalties)

The Individual Mandate is still  in effect

Employers should remind their employees that the individual mandate is still in effect as well as the penalties for non-compliance through the end of calendar year 2018.  Employees declining coverage in 2018 should be warned.  Employers accepting employee declinations without proper counsel should provide time for employees to meet with your benefit advisor/agent.  We are always happy to provide this time to our clients.

Overwhelmed by 1095-C Tracking and Reporting on your Age Rated plan?

Employers subject to 1095 reporting in an age rating environment can often make their life easier with a bit of planning.    Employers offering more generous plans can often offer a Bronze level plan at no copay to the employees.   This would allow the 1095-C to be easily completed as the cost to the employee for a qualified plan would always be $0.  Because California considers groups from 1-100 to be small group, this reporting nightmare is a reality for employers with 51-100 employees.

Employers can make this reporting easier with thoughtful benefit planning and the advice of experienced benefit agents.

Plan Documents (WRAP) Documents

Employers must update and distribute a complete set of Plan Documents to all employees per ERISA.  These important Plan Documents will include but are not limited to Summary Plan Descriptions, Summaries of Benefits and Coverage as well as other documents needed based on your employee benefit package.   Simply offering an Employer Sponsored medical insurance plan constitutes an Employee Welfare Plan and you must comply with ERISA.  Be sure to ask your agent or administrator about these documents.

For Individuals and Employees

Preventive Care is covered at 100%. 

I am still shocked at the number of people who are not taking advantage of this benefit, if not for themselves….for their children.  As a society, we are living in a time when lifestyle related diseases can be caught and dealt with if you just know your numbers.  Make time to know your numbers.

Surprisingly, we spend a good part of our customer service hours explaining uncovered expenses that many thought were covered under this important benefits.   Blue Shield recently provided an excellent illustration to understand the coverage.  You can find that link here.

Even if you’re feeling fine, scheduling an appointment with your doctor for preventive care services is important. Through a preventive exam and routine health screenings, your doctor can determine your current health status and detect early warning signs of more serious, costly problems.

What’s covered in a preventive care visit

During your visit, your doctor will determine what tests or health screenings are right for you based on factors such as your age, gender, health status, and health and family history.  Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. Be sure your physician understands your expectations of the free visit and testing.   IF the physician orders tests that are not covered within the limitations of ACA YOU WILL BE responsible for the charges.

What’s not considered a preventive care visit

If you discuss new medical concerns or a current illness, the entire visit may be considered a medical treatment visit and would not be covered as preventive care.  Copayments, Deductibles and Coinsurance will apply. You will be required to pay the plan’s physician office copayment or coinsurance.

The complete definition and detail of what is covered under the Preventive Benefits can be found at  the Healthcare.gov website here.

If your employer offers you Affordable and Minimum Value Coverage you cannot go to the State or Federal Exchange and receive a subsidy.

Employers may charge the employee up to 9.69% of his pay as a contribution to the employee only coverage.   Employees often look to the State Exchanges for lower cost coverage when employers require employee contribution.

You will be asked to make repayment if you are receiving subsidies in error.   This often occurs when:

The Employee does not disclose the offer of the employer based coverage at the time of application to the Marketplace, or,

The Employee does not advise the Marketplace in which they are already enrolled of any change of income or employment status to justify continued eligibility.

It is important that employers utilize their benefits professional/agent at the time of open enrollment to review needs and address these issues with the employee.

 

Paula Wilson, RHU, REBC is a insurance agent specializing in benefits for employers in the Southern California area.

 

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April 27, 2012

Sometimes you just have to change the name to make it sell!

By Paula L Wilson, RHU, REBC

Changing names keeps this topic off the front page but it’s still lurking out there and EVERYONE will be impacted.

Originally, Obamacare(PPACA) called it the Federal Commission Coordinating Comparative Effectiveness Research (FCCCER).  ObamaCare opposition leaders called it the Death Panels.   Now it has been officially renamed the Patient-Centered Outcomes Research Institute (PCORI).  The new name certainly sounds better and the acronym is certainly better when trying to say it on national television.  Almost sounds like a private market think tank.  I’m getting warm and cozy feelings just saying it now.

The purpose of the “Institute” (cozy again) is to determine where medical dollars are best spent as the inevitable tightening of the belt looms on the horizon.  There research is supposed to provide insurers with information, not mandate levels of care.  However, there is a time coming when we just won’t do expensive life saving surgeries on 90 years olds or otherwise terminal patients.   Morbidly obese people aren’t going to get those knee replacements when they aren’t going to take care of them.   Does everyone need an nice electric wheel chair?   Maybe not.   They will get what Canadians get now, univeral and cheap walkers.  The Institute will be the panel determining your options in the future.

The purpose of today’s blog is to let you know who is paying for the “Institute”.  The insane will tell you that those nasty thieves at the insurance companies are going to pay fees!   The sane know that people pay all taxes, one way or the other.   In this case, the Institute will be funded by a trust fund that is financed in part by fees from health plan insurers and self funded plan sponsors.   Fees will be collected for plan years ending after September 30, 2012 and before October 1, 2019.   (Anyone want to start betting on the date they raid the trust fund and extend this temporary “fee”?)

The fees look like this:

From 10-1-2012 to 9-30-2013    – The fee is equal to $1 per average number of lives insured.

From 10-1-2013 to 9-30-2014   – The fee is equal to $2 per average number of lives insured.

From 10-1-2014 to 9-30-2019 –   The fee is equal to $2 per (adjusted for medical inflation) average number of lives insured.

I know it is just a couple of bucks, but they are YOUR bucks and my bucks.  Large employers who fully self fund their own benefits even have to pay the fee.   And by the way, it is a fee.   Taxes are paid to government entities.    This Institute was intentionally called a Nonprofit, NonGovernmental organization supported by a trust fund.   The fact that it is created and mandated by federal law and supported by forced contributions from the general public doesn’t mean it’s Governmental!  (Note: Medicare, Medicaid, SCHIP, VA and Indian Health are exempt)

You aren’t hearing about this anymore because they changed the name.  It’s all about what you call it.    FCCCER, Government Death Panels, Taxes have been replaced with cheery, non-instrusive, Patient-Centered, Non Profit, Fee based Institutes!   Oh joy!

Paula L. Wilson, RHU, REBC is an insurance agent and benefits consultant in Southern California.

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