Category: Individual Insurance

IRS Adjusts HSA Amounts

November 18, 2024

In Rev. Proc. 2024-25, the IRS made changes for health savings accounts for 2025. The maximum annual HSA contribution is:

  • $4,300 for an eligible individual with self-only coverage.
  • $8,550 for family coverage.

HSAs are used in conjunction with a High Deductible Health Plan. The 2025 maximum annual out-of-pocket amount for HDHP self-only coverage is $8,300. For HDHP family coverage it’s $16,600.

For HSA-compatible HDHPs, the 2025 minimum deductible amounts are:

  • $1,650 for self-only coverage.
  • $3,300 for family coverage.

For the full details, see the IRS revenue procedure.

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
© 2024 Industry Newsletters

How to find a health insurance Agent or Broker Blog

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.

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:

  1. Does my current dentist participate in any dental insurance networks?
  2. 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?

  1. Is my dentist in the network?
  2. With a dental PPO plan, what is the out of network reimbursement schedule based on?
  3. What is the maximum the plan will pay out for the year?
  4. Does the plan have a deductible and what is subject to the deductible?
  5. Is preventive care covered at 100%?
  6. Is there a waiting period for any services?
  7. What are the exclusions of the plan?
  8. 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.

Little charges count, too. READ YOUR insurance company’s EXPLANATION OF BENEFITS details on your bills!

October 10, 2018

Today I personally “saved” myself a $35 charge.  Unfortunately, the “billing error that is sometimes generated” was a mistake that would not have been caught without calling the (largest) HMO and questioning, and staying on hold 4 minutes while “Kelsey” talked with billing to correct the error and remove it from my account.

Details:  At time of annual eye exam, I made my regular office visit copay.  The exam went as usual, with a clean bill of health and a new prescription for “reading glasses”  but a month later I got an additional copay for the same amount previously paid.  Inspecting the bill revealed this detail:   Procedure 92012, “eye exam” was credited what I had paid with nothing more owed. However, additional Procedure 92015 LENS EYEWEAR PRESCRIPTION ASSESSMENT” included a new charge for $35.

Guess what?  My doctor had no clue..her manager had no clue…and even after 40 years of servicing health insurance, I had no clue why there would be a charge for writing a prescription.   The HMO’s claims department representative, Kelsey, had no idea either but kept saying that extra billing was “sometimes generated”.  She would not say how many times people had called in; nor whether they would find and remove the mistake if someone did not call in..only that in my case, she would take it away as it was an error.

Moral of the story is two-fold.  The first moral is in the title.  READ your statements and REVIEW for errors.  Don’t pick up the phone and complain to the doctor, broker, or State insurance commissioner…unless you do not get satisfaction after picking up the phone and complaining to the actual insurance billing office.     The second moral is just a suggestion…publicize.  I’ve put the billing error out on my Nextdoor.com, social media accounts, and just wrote this blog for the business.  If everyone shines the bright light of publicity, maybe the insurer will figure out how or why “the system sometimes generates” a billing when it should not do so.  Hint:  someone told it to do this duplicitous billing, and someone is taking credit for a better-than-expected bottom line.  Fight it!   And don’t forget to get your eyes checked annually!

 

 

How Much Life Insurance Do I Need?

July 7, 2018

Consider why you need it at all. If, for example, you have young children and are providing protection against early death, figure out how much your family needs per year to survive and then cover at the very least five full years.

Good questionnaires which help you think about covering additional expenses (college, for example) are available to help you determine your life insurance needs.  Here is an example:

whentermmakessense

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