BY JUDY TURE
The summer of 2015 is coming to an end
and now is the time when many employers,
individuals and Medicare beneficiaries are
anticipating the new 2016 health benefit
programs.
The Affordable Care Act (ACA)
has certainly impacted everyone in one way
or another. In about a month, the new plans
and premiums rates will be available for group
employer plans, individuals and seniors.
Let’s first talk about employer group health
plans. The year 2016 will be a very interesting
year as more of the ACA policies and laws take
effect. Reporting requirements continue to be
implemented and we encourage employers to
speak with their accountant, payroll service,
Insurance broker and financial planner.
These professionals all have access to certain
aspects specific to the employer and may offer
guidance and assistance with compliance.
There also may be situations where an
attorney specializing with employee benefit
administration is an option well worth the
money. Also the local healthcare providers have
information, podcasts and newsletters on their
websites designed to educate employers and
members every step of the way.
With group health plans in New York states the ‘”prior approval process” for the 2016 health plan
premiums and benefits is under way. Premiums
that the insurance carriers charge for small
group and individual plans whether increasing
or decreasing require approval from the state
Department of Financial Services. With double digit increases expected health care premiums
costs have our attention once again.
For those members of health plans that
are young and/or just plain healthy they find
it difficult to understand. One of the major
components of your health plan coverage is
your premium that is paid to the carrier. Then
as benefits are utilized there are additional
costs to the consumer such as copayments,
deductibles and coinsurance. The insurance
carrier is the messenger and they are not the
sole cause of these increases. With Prescription
premiums expected to increase 15 percent as
pharmaceutical companies increase drug costs
and the increased hospitalization utilization,
local carriers site these two factors as major
reasons for premium increases. Carriers are
working to keep their members on the right
drugs and be cost effective. Also keeping
members healthy is another cost effective step.
Individuals under the age of 65 purchasing
health plans directly from a local carrier will
be receiving the new plan premium rates and
benefits effective for January 2016. All plans
offered must include the ACA essential benefits
as required by law. There are many plans available
to fit all individuals’ level of healthcare needs
and financial budget. With the average annual
premium of approximately $5,000 for an
individual many individuals are finding it more
and more difficult to sustain these costs. Again
there is the premium and then the cost of the out of pocket expenses, copayments, deductible
and coinsurance.
Individuals age 65 and older will soon be
facing “open enrollment” for 2016 Medicare
plans. This enrollment begins Oct. 15 and runs
through Dec. 715. Only those with special events
such as a change of address, loss of employer
coverage, to name a few may qualify for “special
election period.” Working with a certified
agent of a carrier is the best way to access all
of your options and make a informed decision.
We anticipate 2016 will be challenging for this
demographic as fewer plans are available and
premiums and out of pocket expenses will
surely increase.
Understanding and receiving good
information is all part of making the best
decisions for your health plan coverage. Whether
you are an employer, individual or over the age
of 65, there are many resources ready to assist
you. Working with a insurance agent or broker
will make this process easier. Health Insurance
is a valuable asset no one should go without.
There are also many programs that you may
want to learn about, Health Reimbursement
Accounts (HRA), Flexible Spending Accounts
(FSA) and Health Savings Accounts (HSA).
Reach out to your local professionals for all of
the information and options available and enjoy
a healthy year.
Ture is owner of Employee Benefits Center in
Saratoga Springs.
Photo Courtesy Employee Benefits Center