Benefits by Design Insurance Services Blog Archives - Page 3 of 4

Employee Wellness vs. Employee Well-Being

December 10, 2022

As a way of encouraging engagement and productivity in the workplace, a lot of employers will offer wellness benefits to their employees. In March 2021, analytics and advisory company Gallup reported that approximately 85% of large employers give their employees the opportunity to enroll in wellness programs.

Additionally, the Society for Human Resource Management, or SHRM, published an Employee Benefits Survey in 2022 that revealed the importance of offering wellness benefits to your employees.

Here are percentages that reflect how many employers decided that wellness benefits are either very or extremely important:

In 2019, 36%.
In 2020 and 2021, collectively, 62%.
In 2022, 46%.

While employers continue to prioritize the wellness of their employees, another term that is commonly tossed around at the same time is employee well-being. As mentioned previously, while wellness and well-being are similar terms, the concepts of each are identifiably different.

What is wellness?

According to Gallup, the concept of “wellness describes a healthy lifestyle beyond acute illness.” It pertains to the physical health of individuals; it means they can reach their goals without having to endure pain or discomfort in the process. Even though the definition of wellness will vary based on your stage in life, the term mainly refers to preferable health-related states, such as eating well, working out regularly and getting enough sleep.

The concept of health can refer to the physical, mental or emotional state of any given individual. That said, the general consensus is that wellness is a term that is concerned with the physical body.

Because of this, workplace wellness programs often place a primary focus on assessing health, preventing disease, changing lifestyles in a positive manner, losing weight and managing physical health overall.

By providing employees with the option to enroll in wellness programs if they so desire, employers can work toward reducing engagement in unhealthy or detrimental behaviors that ultimately result in chronic and costly health conditions. Such health conditions could adversely impact the productivity of employees as well as the overall bottom line of business operations.

What is well-being?

According to Gallup, the idea of “well-being encompasses the broader holistic dimensions of a well-lived life.”

Per Gallup’s well-regarded research, the following aspects of well-being contribute to a beneficial and excellent life:

Career-wise: You enjoy what you do on a professional level every day.
Socially: You have connections with people, and your friendships are meaningful.
Financially: You are capable of managing your own money well.
Physically: You are physically capable of exerting energy and accomplishing tasks that require you to move your body.
Community-wise: You are not only comfortable in your neighborhood but you also enjoy where you currently live.

The Centers for Disease Control and Prevention, or the CDC, has stated that not a single definition for well-being is the be-all and end-all way of defining the term. Even so, research has shown that the well-being of an individual is connected to the following aspects:

Social life.
Economic status.
Physical state.
Emotional frame of mind.
Psychological mindset.
Developmental abilities and activity levels.
Outlook on work and extracurricular activities.
Life satisfaction.

In the words of the CDC, the general consensus is that “well-being includes the presence of positive emotions and moods (e.g., contentment, happiness), the absence of negative emotions (e.g., depression, anxiety), satisfaction with life, fulfillment and positive functioning.”

Studies have shown that ever since the COVID-19 pandemic erupted and altered everyone’s lives as they once knew them, more and more employers have begun prioritizing the well-being of their employees by extending the opportunities that their mental health options include.

The bottom line

Wellness is a vital element of an individual’s well-being, but even so, it is merely a small percentage of well-being as a whole. While wellness focuses specifically on physical health, well-being is more concerned with the totality of an individual, meaning it applies not only to an individual’s body but also to his or her mind.

By knowing the difference between wellness and well-being, you can make far more informed decisions in regard to your workforce’s wellness and well-being benefits alike.

If you would like some guidance on Employee Benefits, call Pam Morton at EVCO Insurance Services at 760-696-3573 or pam@evcoinsuranceservices.com. Pam offers a complimentary review of your current benefit offerings.

15 Anti Inflammatory Foods and Why You Should Eat Them

November 30, 2022

What if there was a way to reduce your risks of getting cancer or diabetes by almost 25 percent? Actually, there is! According to many studies and one conducted by Harvard, certain foods can reduce inflammation that leads to those diseases.

Even more than obesity, inflammation is a major cause of diseases like cancer, rheumatoid arthritis and heart disease. If you can reduce inflammation with a change in diet by adding these 15 anti-inflammatory foods, why wouldn’t you? It’s easier than you think!

The Good News: Anti-Inflammatory Foods Can Protect You from Cancer and Diabetes

Swelling is good when you have an acute injury. It is your body’s way of protecting your tissues and keeping your blood from spilling out. However, when you are not in mortal danger, inflammation itself can become the danger.

The good news is that you don’t need a prescription to combat inflammation. In fact, by simply incorporating more anti-inflammatory foods into your diet, you can do more than reduce inflammation. That reduction also decreases your risks of developing diseases like cancer, heart disease and type II diabetes.

The Bad News: Some of Your Favorite Foods Cause Inflammation

The bad news is, the foods that you love the most are probably not on the list of 15 anti-inflammatory foods. In fact, a lot of your favorites are actually causing inflammation in your body. Do you like hamburgers, fries, bread, steak, margarine, pasta and soda? All of those foods cause inflammation.

Add to that list sausage, cupcakes and fried foods in general. No wonder Americans have a heart disease and obesity problem. Over time, prolonged inflammation increases your chances of developing arthritis, diabetes, Alzheimer’s disease, heart disease and cancer. Not to mention these foods also contribute to obesity.

Even people who are not overweight but suffer from sustained inflammation suffer the same results, leading researchers to conclude that inflammation is more of a factor than obesity as a cause of disease.

Eat a Mediterranean Diet and You’ve Got It!

Don’t lose hope, though – everything in moderation. You can have a burger and fries from time to time. You can have all of those things, just much less of them. Instead, you need to incorporate these 15 anti-inflammatory foods into your diet:

Almonds
Blueberries
Cherries
Collard Greens
Kale
Mackerel
Olive oi
Oranges
Salmon
Sardines
Spinach
Strawberries
Tomatoes
Tuna
Walnuts

Face it, the idea of eating mackerel and salmon four or five times a week is not appealing. Subbing these things in to replace burgers and fries may seem crazy but there is an easy and delicious way to do it.

The Greeks actually figured this out centuries ago. Eating a Mediterranean diet ensures that you are getting all of these 15 anti-inflammatory foods. Individually they may not sound very appetizing, but Mediterranean cuisine blends these ingredients together beautifully.

Don’t know anything about Mediterranean cuisine? We’ve got you covered. Here are dozens of mouth-watering Mediterranean dishes from Betty Crocker that will have you craving these foods tonight.

How to find a health insurance Agent or Broker Blog

November 22, 2022

How to find a health insurance agent or broker

1) Find a specialist in your State. Never go with a Benefits Provider located “nationally” only. California, NY, Hawaii…all are way too complicated in their requirements (ever-changing) to ignore the specialists who are in-State in favor of one located elsewhere.

2) Payroll companies are not Health Insurance and Employee Benefits specialists. My personal recommendation is FIRST to avoid the payroll companies who try to talk about how easy it is to put their benefits together with the payroll withholding. Most payroll companies allow you to work with a broker.

3) Where to find a Health Insurance Agent, Broker

Google is actually a good place to find a health insurance broker or Employee Benefits broker. Search locally and look for someone who specializes in the type of health insurance products you are looking for. It is best to find a broker who can offer you all available products in your area vs. an agent who just represents one company.

In California, I recommend going to two different spots to find names in your area of competent, vetted, and professional benefits brokers. One option is to go to the National Association of Health Underwriters (NAHU.org). and top left menu, “Find An Agent” (put in zip code plus 25 miles). Look at what the agents listed sell and choose a couple who sell small group benefits plans.

NO ONE can give you a better price: rates are set by law in each state and/or through the ACA. You are looking for someone who can offer ways to give you good choices with a reasonable price structure. (You can set your maximum monthly rate per employee; you can choose a level of plan you will cover at, say, 75% and let employees go up or down; you can work with volunteer benefits as well as employer-sponsored benefits, etc.)

4) In California you can contact Pam Morton with Benefits by Design Insurance Services at admin@benefitsbydesignca.com to get an online insurance quote. She has offices in both Northern Ca and Southern Ca. She is one of many good group benefits brokers in CA with more than 30 years of experience as a health insurance corporate sales and leadership professional and 5 years as an Independent Benefits broker. Phone numbers for her agency are 415-524-8959 and 760-696-3573. Their website is www.benefitsbydesignca.com to buy insurance online.

Benefits by Design specializes in Employee Benefits and Medical health insurance, is an authorized agent for Covered California and has a corporate back ground in selling Medicare Products, including Medicare supplements, Medicare Part D prescription Drug plans, Medicare Advantage plans and she can simplify the process for people who are becoming eligible for Medicare for the first time.

Basic Information For People Just Getting Medicare – Medicare Supplement – Medicare Advantage – Medicare Part D Prescription Drug Coverage

October 18, 2022

If you are eligible for Medicare or will be in the next year, this is for you!

Medicare Advantage

If you have a Medicare Advantage plan (such as Kaiser Senior Advantage or another Medicare Advantage plan available in your County), open enrollment will start on October 15 and end on December 7th.

Medicare Supplement

If you have a Medicare Supplement plan, you can change plans during the month of your birthday for an effective date of the first of the next month. This is called the birthday rule.

Why would you want to change your Medicare Supplement plan?

If you get a big increase from your current Medicare Supplement plan company because you are another year older (the price usually increases each year, according to your age). Medicare Supplement plans are standardized, and you can switch from one company to another without having to answer questions about your health during your birthday month. You can switch to the same plan or downgrade your plan (such as from a plan F to a plan G) using the birthday rule. We do not recommend switching Medicare Supplement plans unless you have a reason to do that.

Medicare Part D prescription drug plans

Open enrollment for Medicare Part D prescription drug plan open enrollment is also from October 15th to December 7th each year. Part D prescription drug plans are not standardized. We have seen huge fluctuations in cost, benefits, and formulary (the covered drug list) from some companies.

If you get your annual notice of change mailing on your Part D drug plan and the cost has not gone up very much and you are not notified that the medications you need are changing (sometimes the formulary gets updated depending on the pharmacy committee of that plan’s recommendations for the most clinically effective drugs to treat specific conditions or other instances such as when medications change to be able in a generic drug), then you can keep the Medicare Part D drug plan for another year.

If you have any questions about this information or you need any Medicare quotes, please contact us at Benefits by Design. admin@benefitsbydesignca.com 760-696-3573 760-696-3573

Employee Benefits: hands writing at a meeting at a white office table

Are You Starting To Plan For Your Employee Benefits In 2025?

October 18, 2022

If you need new ideas, this post is for you. I’ll be sharing more about Budget, Benefits, & Value

We know we need to address all of the aspects of employee well-being. That would include physical, mental, emotional, financial and purpose. It has to be balanced with your budget and your employee’s ability to pay their share if applicable.

Budget

Most employers have a budget for employee benefits. We usually tell our employers to budget for a 12% renewal cost and 1% for each month for renewal increases. For January 2021, we didn’t see many that were that high. And it is too early to predict trends for mid-year 2022 or 2023.

Benefits

At Benefits by Design, we know one size does not fit all. Healthcare is human-centric. What works for a super-healthy employee does not necessarily work for an employee with health issues. We will help you put together an offering that will work for all of your employee population.

Offering a choice of Benefits

Whether you are a large employer or a small one, there are lots of options available for employee benefits. Offering a choice doesn’t mean it will be more expensive. At Benefits by Design, we work with all of the Health Insurance Companies in California. We offer Creative Benefits. There are ways to establish a budget and allow employees to buy up if they want more as a payroll deduction.

What we are seeing is that most employers are offering Kaiser and then at least one additional medical insurance company.

For employers under 100 employees, California Choice or Covered CA small business plans are popular because they provide multiple carrier options at different price points.

California Choice is a small group exchange and I have seen as many as 5 different health insurance companies offered, depending on where the employee lives.

Covered CA small businesses can work well for employers with low-wage-earning employees because if employee-only coverage is offered, the employee can enroll their dependents on Covered CA and get a subsidy if they qualify.

H.S.A, H.R,A and F.S.A

Many employers are saving cost on their benefits using High Deductible Health plans with Health Savings Accounts (H.S.A), Health Reimbursement Accounts (HRA)to lower an employee’s overall out-of-pocket costs and Flexible Spending Accounts (FSA) to allow employees to pay for uncovered benefits expenses with pre-tax dollars.

Specialty benefits

Some specialty benefits can be voluntary, which means the employer pays the monthly bill, but the employee pays for them through payroll deduction. If payroll is reduced because the employee is getting benefits instead of salary, that reduces employer taxes and employee costs. You can set up a Section 125 plan, Premium Only Plan, that allows employees to pay their portion with pre-tax dollars.

Depending on how competitive employee benefits are in your industry, employees may expect to have dental, vision, employee assistance programs, disability, and life insurance to be employer paid. At Benefits by Design, we have a lot of ideas we can propose to help meet your needs in this category.

Some of the other things that can be part of the package are Pet insurance, student loan pay-off benefits, adoption assistance, fitness class passes, and commuter benefits.

Value for the organization and your employees

If you are not sure what will interest your employees and motivate them the most, consider doing a focus group or an employee survey.

At Benefits by Design, we can offer the best health insurance benefits in California. Contact us for more information.

Pam Morton
Benefits by Design Insurance Services
415-524-8959 Larkspur, CA office
760-696-3573 Carlsbad, CA office
PamM@benefitsbydesignca.com
www.benefitsbydesignca.com
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What You Need To Know About Medicare

October 18, 2022

Medicare may seem confusing, but if you take it step by step, it all becomes clear. Start with Medicare Part A. This helps cover inpatient care in hospitals, skilled nursing facility care, hospice care and home health care.

Next, you have Part B, which covers services from doctors and other health care providers, as well as:

Outpatient care.
Home health care.
Durable medical equipment such as wheelchairs, walkers and hospital beds.
Preventive services — screenings, shots or vaccines and yearly wellness visits.

Part B will cover most routine medical expenses as well as emergency room and urgent care services.

Medicare Advantage plans are Part C. Medicare Advantage is a Medicare-approved plan from a private company that bundles Parts A, B and typically D, which helps cover the cost of prescription drugs.

With Medicare Advantage, you’ll need to use doctors who are in the plan’s network. Medicare Advantage plans may have lower out-of-pocket costs than Original Medicare does. In addition, they may offer some extra benefits, such as vision, hearing and dental services.

You join a Medicare drug plan in addition to Original Medicare or you get it by joining a Medicare Advantage plan with drug coverage. Medicare drug coverage is run by private insurance companies that follow rules set by Medicare.

If you stick with Original Medicare, this just includes Part A and Part B. You can use any doctor or hospital that takes Medicare anywhere in the U.S.

What should you do?

You only need to sign up for Part A and Part B once. Each year, you can choose how you want to get your health care coverage and whether you want to add or switch drug coverage. You don’t have to make the same choice as your spouse — Medicare plans aren’t offered for couples or families.

There’s also Medicare Supplement Insurance that’s called Medigap, a policy to help lower your share of costs for services you get. Medigap policies are run by private companies to fill the holes in regular Medicare coverage — copayments, deductibles and health care coverage — when you travel outside the country.

If you are receiving medical coverage through your job, you’re not required to enroll in Part B, but you may have to pay a late enrollment fee — in the form of a higher premium — when you finally do sign up for Part B. Late enrollment rules can be complex, but the government explains them in more detail online.

How does Medicare Advantage work?

You join through Medicare-approved private companies. Some Medicare Advantage plans will ask you to get referrals to see a specialist and others offer additional benefits to treat specific conditions.

With Medicare Advantage, you pay a premium for the plan in addition to the monthly Part B premium. Plans may have a $0 premium or may help pay all or part of your Part B premium. You can’t buy or use separate supplemental coverage like Medigap with Medicare Advantage.

If you or your spouse has worked and paid Medicare taxes for at least 10 years, Part A of Medicare is free. Part A and Part B each have annual deductibles you must reach before Medicare starts paying. Part C and Part D have monthly premiums that vary based on the plan you choose.

Basically, Medicare is a way for people to have health care coverage as they get older and leave the workforce. The program is funded primarily by three sources: general revenues, payroll taxes and beneficiary premiums.

Of course, this is just a summary, and there will be additional provisions and exceptions. What’s right for you? It depends on your particular financial and family situation. Work with a financial professional to find the options best suited for you.

For more information, please visit our website at www.benefitsbydesignca.com

Contact us at Benefits by Design Insurance Services at 760-696-3573 for Medicare quotes. We offer all health insurance companies in California. Let us help you to simplify the Getting Ready for Medicare process for you.

Price Transparency Rules for Health Care Plans

October 18, 2022

According to the Peterson-KFF Health System Tracker, health care costs have increased at a steep rate over the course of the past five decades. In 1970, people were spending approximately $353 per person, and as of 2020, that number had climbed to a whopping $12,531 per person.

Accounting for inflation, $353 in 1970 is equivalent to about $1,875 in 2020. This information was pulled from data collected as part of the National Health Expenditure Projections.

Now, while the monetary adjustment decreases the discrepancy ever so slightly, the difference between $1,875 and $12,531 is still astonishing. With that in mind the amount of money people have spent on health care-related costs has risen by about $10,656 per person on average.

Additionally, the Centers for Medicare & Medicaid Services stated that the costs of health care are expected to continue to grow by 5.1% every year from 2021 to 2030. Furthermore, not only are these numbers rather jarring, but the rising costs of health care tend to be incredibly stressful for consumers, employers and employees alike, even if they have insurance.

Along with that, many employees do not fully understand the details of their health care costs or what their insurance will provide in terms of coverage. Thankfully, in an effort to offer far greater clarity in terms of the costs of health care plans, the federal government has enacted new price transparency rules that health care plans must adhere to and reflect.

These requirements are part of the 2021 Consolidated Appropriations Act, which includes the No Surprises Act as well as the Transparency in Coverage Final Rule. Together, the Department of Health and Human Services, the Department of Labor and the Department of the Treasury released the preexisting Transparency in Coverage Rule back in October 2020, whereas the CAA was signed into law in December 2020. The No Surprises Act is the most recent addition to this set of disclosure-related regulations regarding health care and insurance plans.

General requirements

The CAA’s No Surprises Act addresses surprise medical billing for specific health care services. The No Surprises Act also requires health insurers and group health plans alike to provide their consumers with specific information and tools that will help them better understand their health care options.
The Transparency in Coverage Final Rule requires that health insurers and group health plans accurately disclose specific information regarding health care pricing plans to consumers in an up-front manner, with the long-term goal of greater transparency overall.

Some of these transparency requirements will take effect in 2022, while others will be phased into effect over the course of a three-year period.

What this means for employers

As a result of the implementation of new transparency laws pertaining to health care plans, employers will be required to supply participants of said health care plans with certain information. In greater detail, here’s what the new transparency requirements mean for employers:

Employers can anticipate having to provide employees with an advanced explanation of benefits and accurate estimates of the out-of-pocket costs that employees can expect to face when receiving in-network medical services. The point of this is to provide participants with a better understanding of what certain services will cost them prior to them agreeing to receive medical care.
Additionally, employers will need to provide online and accessible price comparison tools with the goal of providing participants with the opportunity to compare the costs of medical care between various medical providers. Furthermore, the online tool, as provided by the employers, must depict the rates for in-network providers as well as the price points of the out-of-pocket costs for said providers. Information of this nature must display prices for “500 shoppable services,” including but not limited to doctor appointments, screenings for cancer and MRI scans.
Last but not least, another facet of change that employers can expect to be required to uphold is a website that publicly and accessibly displays information as it pertains to the prices of health care plans. For instance, the costs of both in-network and out-of-network services as well as prescription drugs are examples of information that employers will need to supply to participants. As a result of this publicized data, employees will be able to compare the costs of their employer’s health care plans with the plans being offered to other employees by their respective employers. Another benefit of this call for publicity is that job seekers can compare the costs of various health care costs between potential employers.

Work closely with your insurer and benefits team

If the newest transparency rules are applicable to your employers’ group health plans, the insurer or the third-party administrator of said group health plan is typically responsible for handling your disclosure-related obligations. However, as the plan sponsor, it’s important to remember that, at the end of the day, you are ultimately fully responsible for ensuring that you are in compliance with transparency requirements.

For more information, please visit our website at www.benefitsbydesignca.com

Contact us at Benefits by Design Insurance Services at 760-696-3573 for Instant quotes. We offer all health insurance companies in California.

The Inflation Reduction Act: What Does It Contain?

October 18, 2022

On August 12, Congress passed the Inflation Reduction Act, over 700 pages of economic changes. What does the act do? And just as important, what does it not do?

To start with the name, the act’s proponents say the new law will fight inflation with deficit reductions — which makes most people ask, “Does it raise my taxes?” The good news is that for the vast number of people, the answer is no. Taxes are changing, but not for average individuals. The two major tax provisions are for corporations:

15% minimum tax on corporations with over $1 billion in revenue.
1% excise tax on corporate share buybacks.

A statement released by the Senate Democratic leaders said, “There are no new taxes on families making $400,000 or less and no new taxes on small businesses.”

On the plus side

Indeed, according to an analysis by USA Today, there are some definite benefits for individuals, including:

An Affordable Care Act subsidy extension through 2025.
Permission for Medicare to negotiate drug prices.
A cap on Medicare recipients’ drug expenditures at $2,000 per year.

The AARP has posted an article that describes the changes in more detail.

Climate change offerings

The new act also provides:

Tax credits for buying a new or used electric vehicle, extended until December 2032.
Tax credits on electric commercial vehicles over a certain size.

According to USA Today, the net result could be a benefit for small businesses, as they avoid the tax hike the giant corporations now face. Also, the climate-change benefits likely will encourage homeowners to upgrade to energy-efficient systems, and this work is typically done by small companies.

Fighting the rumors

A key provision in the act is substantially increased funding for the IRS, which the bill’s opponents say will be used to investigate all taxpayers to squeeze every last dime to fill federal coffers. However, the administration has denied this is the case. Treasury Secretary Janet L. Yellen sent a letter to IRS Commissioner Charles P. Rettig with the following paragraph:

“Specifically, I direct that any additional resources — including any new personnel or auditors that are hired — shall not be used to increase the share of small business or households below the $400,000 threshold that are audited relative to historical levels. This means that, contrary to the misinformation from opponents of this legislation, small business or households earning $400,000 per year or less will not see an increase in the chances that they are audited.”

Indeed, some conservative activists have said that the IRS will be spending substantial sums to create a de facto army of gun-wielding agents. Although a relatively small number of agents, only in the IRS’s criminal investigation division, are armed, the new influx of cash isn’t expected to change that.

For the future

This is just a broad summary of the act’s many complex provisions. There are exceptions and exceptions to the exceptions. As with any large act, lawyers and accountants will be poring over the details and implications in the coming weeks and months. More guidance likely will follow. Meanwhile, if you have any questions about how this act may affect you or your business, be sure to contact a qualified professional.

For more information, please visit our website at www.benefitsbydesignca.com

Contact us at Benefits by Design Insurance Services at 760-696-3573 for Instant Insurance quotes. We offer all health insurance companies in California.

Why Does a Medicare Supplement from One Company Cost More Than Another?

October 1, 2022

Why Does a Medicare Supplement from One Company Cost More Than Another?

Medicare Supplement insurance companies set their own monthly premiums and then they are approved by their state Department of Insurance, so the cost of a Medigap plan will differ from one company to another.

Medicare Supplement premiums may vary significantly from one insurance carrier to another, even if their plans provide the same benefits. There are a standard set of Medicare Supplements that are regulated by Medicare. Any insurance carrier can change its rate structure from one year to another. That is why it is so important to stay up on what different insurance companies are charging for their Medigap policies so that you can change to another insurance carrier, if necessary.

When can you change Medicare Supplement insurance plans?

In California, we have the Birthday Rule, called the California Medicare Supplemental Insurance law. A person who has a Medigap policy can switch to a different insurance plan or provider within the 30 or 60 days following their birthday each year. They can purchase a Medigap policy without medical screening or a new waiting period if the new policy has the same or lesser benefits as the old policy. That means you have an opportunity each year to shop your current plan for a better premium.

What factors affect how much Medicare Supplement insurance costs?

Most insurance companies use one of the following three types of pricing structures:

Community Rated – With this pricing structure, everyone who buys a specific standardized plan (such as Medicare Supplement Plan F) pays the same premium, regardless of age or health status.
Issue-Age Rated – With this pricing scheme, your premium is based on the age you were when your plan was issued to you. This generally favors younger enrollees, because your premium won’t increase based on your age, for as long as you are enrolled.
Attained-Age Rated – These plans offer a graduated premium structure that typically increases over time. Premiums may be low for younger enrollees, but they may be the most expensive for older enrollees.

Other factors that determine your premium cost

When You Enroll – The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. Generally, you will have the most choices available and the lowest costs if you join a Medicare Supplement plan when you are first eligible.
Your Gender – Some insurance companies offer lower rates for women because statistically women typically live longer and will pay more for their coverage over their lifetime.
Where You Live – Insurance companies consider average wealth in any area and charge what they believe residents can afford to pay.
Your Age – If you purchase a Medicare Supplement when you are first eligible, usually at the age of 65, you’ll pay less than if you had waited until you were 75.
Households Discounts – Some insurance companies entice couples to take out a Medicare Supplement plan with the same insurance provider by offering a discount.
How You Pay the Insurance Company – Some insurance companies will charge more for quarterly, semi-annual, or annual payments. Others may offer a discount if you pay electronically, rather than by check or credit card.
Inflation – Due to inflation and rising healthcare costs, you will typically see your Medicare Supplement premiums increase every year.
Whether You Use Tobacco – Your Medigap premium will be more expensive if you use tobacco.

When can you sign up for a Medicare Supplement plan?

The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. During that time, you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you’re 65 and enrolled in Medicare Part B (Medical Insurance)

Medicare Supplement insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge for your Medigap policy. But during your open enrollment period, an insurance company cannot do any of the following, even if you have a disability or health problem:

Refuse to sell you any Medigap policy it offers
Charge you a higher premium than they charge others who are 65 and older
Delay the start of your coverage

Still, have questions about Medicare Supplement costs and plans? We provide Medicare quotes.

Call us at Benefits by Design Insurance Services at 760-696-3573 or 760-696-3573 or email admin@benefitsbydesignca.com.

We can run a quote for you so that you can find out what is the most cost-effective plan to meet your Medicare Supplement needs.

Pros and Cons of Purchasing Individual Dental Insurance

September 9, 2021

When is it cost effective to buy Individual dental insurance?

People ask me all the time what dental insurance I recommend. My answer is, it depends. There are pros and cons of purchasing individual dental insurance.

To get a good value out of your individual dental insurance, consider these 2 things:

Does my current dentist participate in any dental insurance networks?
If they don’t, will they accept any PPO dental insurance?

Most dentists don’t participate in dental insurance networks because they have to accept reduced fees for their services. When a dentist participates in a dental network, they have to agree to not charge the member more than the reimbursement fee schedule of the dental insurance company. That is an advantage for you as a member because you can get more coverage for your dental work for less.

Dental HMO

In some cases, such as with a dental HMO network, the fee schedule is greatly reduced from what the dentist would normally charge. Reasons why a dental office would participate could be 1) The dentist or the dental office is new and trying to build a client base 2) The dental office wants to build volume for their practice and offering reduced fees will bring in more clients 3) The dental office is well established and they have found that over time serving everyone, regardless of their profit is good business.

If your dentist participates in a dental HMO provider network, you can get the most out of your dental insurance at the lowest cost. If you are willing to change dentists or you need to pick a new dentist anyway, a dental HMO plan would have the most value from both a benefits and a cost perspective.

Here are the pros and cons of Dental HMO:

Pros Cons

Costs less Not very many dental offices to choose from

Better coverage Dentist office may try to upsell other procedures to make up for less profit

Dental PPO

If your dentist only takes PPO dental plans, go to their website or call them to find out if they participate in any dental networks and ask if they are DHMO or dental PPO (DPPO) networks and which ones. Let us know the names of the dental networks and we’ll include those in your quote.

If your dentist participates in a dental PPO network, you will get the most value out of the plan because the dentist can only charge you the maximum allowed amount and your out of pocket maximum for the year will go a lot farther.

Here are the pros and cons of Dental PPO:

Pros Cons

Go to any dentist Pay more out of pocket for an out of network dentist

Preventive care usually covered at 100% Watch out for balance billing I the dentist is not in

Higher max out of pocket covered the dental PPO network

What if your dentist doesn’t participate in any dental networks but they will bill any dental PPO plan? Then you will want to pick a dental plan that offers the most reimbursement for your dental claims. Some dental companies use their own dental claims data to determine the maximum they will pay (using their participating dentists fees which are reduced) and others will base their reimbursement on Usual and Customary. Usual and Customary is the best reimbursement schedule for you because it is usually based on an industry average of what dentist charge in your area. If they pay at the 80th or 90th percentile, then it means that your claims will be paid at 80% or 90% of what most dentists charge.

Now that you have taken the time to figure out if your dentist participates in any DHMO or DPPO networks, here are some guiding questions?

What are the most important things to look for in the dental plan you are considering?

Is my dentist in the network?
With a dental PPO plan, what is the out of network reimbursement schedule based on?
What is the maximum the plan will pay out for the year?
Does the plan have a deductible and what is subject to the deductible?
Is preventive care covered at 100%?
Is there a waiting period for any services?
What are the exclusions of the plan?
Does the plan cover major services such as crowns and root canals?

Tip: If you need to have any dental work done that will cost more than $100, ask your dentist’s office for a predetermination of benefits. A predetermination of benefits will be an itemized cost your dentist office will get from your dental insurance company to find out what your final cost will be after the insurance pays their part.

For more information on dental insurance or to get a quote for dental insurance, please contact Benefits by Design Insurance Services at 760-696-3573 or admin@benefitsbydesignca.com.

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Category: Blog