Blog 2018-04-22T03:00:08+00:00

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ObamaCare Employer Mandate may be halted, ACA on the chopping block again

By | July 18th, 2018|Categories: Uncategorized|

Currently employers with over 50 employees are mandated to provide Group Health Insurance coverage for their full timer workers.  If they don’t, the #ACA penalties can be very stiff, to the tune of $2000 to $3000 an employee per year.  #Employers not in compliance have been getting IRS 226-J letters, advising them of their misdeeds and what they owe to the #IRS.

Big scary #226J letters from the IRS are nothing to mess with

Whether you agree with the #EmployerMandate of the ACA or not, ObamaCare is the law of the land, currently.  The IRS 226J letters that have been going out are freaking out employers all over the country.  The letter is generated by the IRS when an employer is out of compliance with the ACA’s Employer Mandate, with their Employee Benefits offering to their employees.  Many times the employer simply filled out the yearly form incorrectly, and is easily fixed.  The employers that have ignored the Employer Mandate or are out of compliance, have a problem.  If the Employer Mandate is halted or taken away, these employers will have dodged a bullet.

The GOP is sponsoring a bill to halt and maybe do away with the Employer Mandate

The bill sponsored by GOP Reps. Devin Nunes (Calif.) and Mike Kelly (R-Pa.) would suspend penalties for the employer mandate for 2015 through 2019 and delay implementation of the tax on high-cost employer-sponsored health plans for another year, pushing it back to 2022.  This would be a big blow to all of the ACA supporters that had hoped that #ObamaCare would solve the nations healthcare issues, or at least address them.  I’m all in favor of helping businesses, which is the life blood of the nation, but if you get rid of the ACA, you had better have something in place to replace it….and not something that would bring us to our knees in cost.  Many people are screaming for #SinglePayer.  To them I say…is it better care, and what is the cost.  Usually when that question is posed, all you hear is crickets.

 

Steve Brauer-Principal, Brauer Insurance Services, www.brauerinsurance.com  (877) 421-4325

Employee Benefits and Group Health Insurance will be looking different in 2019 with Trump

By | July 18th, 2018|Categories: Uncategorized|

The Employee Benefits and Group Health industry will be making some major changes soon.  President Trump is bringing back Short Term Health Plans and Association Plans, to help ease the skyrocketing cost of Group Health Insurance for employers.  There is a down side to this.  Short Term plans, many times, can be very light on benefits and even deny people coverage for their pre-existing conditions.  That might actually be good news for a lot of us.  The lower rates means that some people can now afford coverage that they could not afford under the #ACA.

ACA plans have certain mandated benefits embedded in every plan

Some people may not NEED all of the coverage and may not WANT to pay for all of that coverage.  These Short Term Plans may be a viable alternative.  I used to be able to get a 20 year old a health plan for about $80 a month.  Yes, it was thin on coverage, more of a catastrophic plan….but it was something to cover major issues.  NOW, you cannot find a plan for under $225, why?  All of the “essential benefits” in EVERY plan, no matter what age you are.  No wonder 20 somethings are waiving off these plans.  Even if they do have to pay a “tax”, its much cheaper than the monthly premium of a base health insurance plan.

Employee Benefits are even more important now, for employers

With the economy booming, employers are fighting for every employee they can find.  #EmployeeBenefits and #GroupHealth are one of the first things that potential employees ask about.  They are becoming much more savvy than years ago.  Employers with crappy Group Health Plans, or ones that don’t offer any Group Benefits, are missing the boat.  Yes, they are crazy expensive, and yes, they are confusing.  That is why every employer needs a Benefits Advisor that specializes in Group Health Insurance and Employee Benefits.  Speaking to a “generalist” is a waste of time, and is not in your best interest.

Do your due diligence and stalk some of these “specialists”

What makes a broker a specialist?  Why are they calling themselves that?  Stalk them a bit….online of course, and find out a bit about them.  Have they been in business for 10+ years, or did they just change careers?  What’s their background….can they be trusted.  Maybe yes, maybe no.  I’ve met a lot of brokers that should not be selling insurance, for many reasons.  Message here….do your homework!!

 

Steve Brauer-Principal, Brauer Insurance Services, www.brauerinsurance.com,  (877) 421-4325

Employee Benefits and Health Insurance fraud sting netted about 600 arrests, 2 BILLION in loss

By | July 12th, 2018|Categories: Uncategorized|

A giant sting operation ended with 601 people indicted on multiple charges including fraud, false billings, opioid  and dangerous narcotic distribution.  Of the people arrested…..165 were doctors, nurses and other licensed medical “professionals”.  This occurred across 58 Federal Districts in the US.  I’m sure this is just the tip of the iceberg.  These were just the people they could PROVE committed fraud.  After working as an Undercover Narcotics Agent for several years, I have first hand knowledge of the nonsense that goes on in the Employee Benefits and Insurance world, specifically the Medicare and Medicaid (MediCal in CA).

Fraud is only ONE of the reasons that Group Health Insurance is so expensive

Fraud is not the only reason that our rates are crazy expensive.  Have you been following the news about the Big Pharma?  When you charge someone a ton of money for a single pill, when it costs you very little…its not fraud, but just unscrupulous business practices, and another reason rates keep going up.  The pharmaceutical industry has an explanation for this.  They claim that just to be able to make a drug, pay all of the cost associated with the formation of the drug, the Research and Development, failed attempts during the development, anticipated lawsuits, and a host of other things…they claim they HAVE to charge high prices, just to pay all of this and make a profit.  I can buy into part of that argument.  I think most of us want companies to make a profit.  Its when they are making a KILLING, that people have a problem.

Medicare Fraud Strike Force

There is actually a team that investigates fraud and other shenanigans that go on with medical billing, specifically Medicare Fraud Billing.  The task force has charged almost 4000 people who collectively, have falsely billed and bilked the Medicare system, to the tune of about $14 BILLION.  That’s enough to make anyone sick to hear that.

 

Steve Brauer-Principal, Brauer Insurance Services,  www.brauerinsurance.com,  (877) 421-4325

High Deductible Group Health Plans. Don’t frown…they can be a good thing, if you Supplement or “Underfund” them.

By | July 5th, 2018|Categories: Uncategorized|

The reaction from employers to High Deductible Employee Benefit plans is usually a scowl or unhappy face.  Their employees are used to having a cadillac plan or something that has a super low deductible.  Anything less than that is looked as a “take away”.  The real story is that in most cases, you can enhance a #HighDeductible #Employer plan with other products, and make them as rich, or richer, than what the employees have now.  The key to all of it is the education, both to the employer and the employees.  It takes a minute to explain how it works and the strategy behind it.  Some employers are not going to want it…which is fine.  I’m just suggesting that #employers check it out.

Many times your High Deductible Group Benefits Plan can be even richer in benefits than a traditional PPO

Besides the ridiculous savings every month to enroll into a High Deductible Health Insurance Plan, there are ways that you can structure the plan, to make it as good or better than a traditional plan.  #Aflac and #ColonialLife have great products that can help underfund the gaps in the cheaper High Deductible Group Health Plans.  These products pay you money when certain things happen to you.  You can structure the “payout” to cover most, if not all, of the cost of the services under the #HDHP.

ColonialLife, Aflac aka: #VoluntaryBenefits, Ancillary, Supplemental Benefits are gaining steam

Most times the monthly savings, moving to a cheaper, High Deductible Health Plan, more than pays for the Voluntary Benefits that an employee can use.  These #VoluntaryBenefits will pay for things like, Hospital Stays, Accidents on and off the job, Disability, ER visits, X-Rays, broken teeth, and a whole host of other issues.  Life Insurance can be done on a guarantee issue basis, depending on the number of enrolling employees.  Cancer and Critical Illness plans can cover employees, and pay out thousands of dollars each incident.  These plans are super cheap too…we’re not talking about a ton of money each month for the premium.  For my employees at our agency, I have the Accident and Hospital Bridge Plan.  My daughter has used it twice now for having babies, and I’ve used it multiple times on the Accident Plan.

In these times, strategy is the name of the game.  There is no magic bullet to reduce #EmployeeBenefit costs, but having a plan and keeping an open mind is critical.

Steve Brauer, Principal, Brauer Insurance Services, (877) 421-4325,  www.brauerinsurance.com

Employee Benefit, Group Health Insurance brokers are not all alike, size does not matter

By | June 28th, 2018|Categories: Uncategorized|

When you evaluate either your current Employee Benefits broker, or considering hiring one, there are a few things to consider.  The “size” comment was an attempt at a joke, but seriously, size may very well make all the difference in the world, and not in the way you think.  Smaller agencies are usually more responsive and have the owner’s best interests in mind.  Nothing is 100%, but think of it like this; are you working with one of the Owners, Principals, Partners of the company, or simply an account manager.  #EmployeeBenefits are a big deal.  They are expensive, confusing, and carry great liability for businesses, if not administered properly.

Here are some things to ask, and if you get a befuddled answer or a blank stare, there’s a problem

There’s lots of insurance brokers out there that have no business advising Group Health clients on Employee Benefits.  Any moron can throw plans around and enroll people.  That takes no skill at all.  The value that Group Health Brokers give is their expertise and knowledge of the Health Insurance industry.  Ask your broker, or potential broker, what makes them different, and what is their “strategy”.  Also…ask them what type of insurance they do.  If they begin to list all kinds of insurance, run screaming.  When I started in 2003, I didn’t know *%#&  about insurance.  I quickly realized that unless I specialized in one product, I would never be an expert at anything.  I picked #EmployeeBenefits and #GroupHealth Insurance for businesses.  That was before it imploded in 2010 with the ACA.  Being an expert in #ObamaCare and the #ACA has been a blessing, and my clients benefit from it.

Employee Benefits, Group Benefits is a niche product…do yourself a favor and find an expert

If you have a broker that specializes in Group Benefits, that’s a start.  Are they helping you with ERISA compliance and administering your Federal Cobra?  OK..now we’re talking.  You have no idea how many employer groups I’ve spoken to, who have no idea of any of these terms.  Well…if you have not had a DOL audit before, you’re lucky.  If you’re not compliant and you DO have an audit at some point, you better be dialed into these concepts.  They are not very forgiving.

Call us for ANY questions you have…with NO expectation of us doing business.  Call myself or my daughter Bonnie.  (877) 421-4325. www.brauerinsurance.com    Steve Brauer

AHPs, Association Health Plans, how they’re different, costs, coverage. Group Benefits that may work for some

By | June 27th, 2018|Categories: Uncategorized|

#AHPs are one of the latest twists in the ever changing Group Health Insurance landscape for #employers.  AHPs will be coming as soon as September and the offerings are not set in stone.  The Association Health Plans can have various ways of setting prices on industries, ages, even gender.  One of the selling points to AHPs are that they can be offered by insurance companies out of CA, increasing competition between the carriers.  Some of the embedded #GroupBenefits will be carried over from the #ACA into the AHPs.

Association Health Plan membership is changed drastically with Trump’s ruling

With previous AHPs, the member groups had to share a common industry or some other economic nexus.  The new ruling allows AHP members to be connected by business, professional interests, or even simply geography.  The new AHPs can even be formed with the sole intent of providing insurance to their members.  Members can be small businesses, larger businesses or even individuals.  AHPs will still be required to allow members to cover their kids until age 26, and they can’t discriminate against individuals with pre-existing conditions.  These folks may have higher premiums, but coverage will not be denied.

Differences with the new AHPs

The new AHPs don’t HAVE to include the 10 essential health benefits that the ACA was built on, but my suspicion is that most of them will have most of these benefits.  AHPs that cover #employees with at least 15 employees, must offer maternity coverage.  That means “offer”….not necessarily be mandated to have embedded in the plans, like now.  The new plans will have the yearly maximums that ACA plans have currently.  That is a good thing, although having plans with much higher yearly maximums, in earlier years, were WAY less expensive.  An interesting option if it was allowed to be offered now.

Companies with over 50 employees and the #EmployerMandate

Applicable Large Employers, or #ALEs, will still be required to offer health insurance that meets the minimum standards set by the ACA, back in 2010, or face harsh penalties.  Currently, ALE employers cannot allow employees to pay more than 9.5% of their gross wages for the single employee monthly premium, to stay compliant.  Many employers are being audited by the IRS now, for non compliance in the 2015 tax year.  They are getting big scary letters with penalties and assessments from the IRS.  Nothing you want to mess with.

Overall, the onset of the new AHPs may be a good thing.  Too hard to tell just yet.  Either way, Group Benefit Brokers are needed even more, to translate all of this nonsense, so business people can spend their time running their business.  What may happen is that insurance brokers that are not specialists, may be squeezed out of the market, for lack of #ACA understanding.

Steve Brauer, Brauer Insurance Services LLC.  Call us to get the scoop on the ACA…with NO expectation of doing business.  www.brauerinsurance.com  (877) 421-4325

Trump institutes new Health Insurance options for Small Business owners, lower prices

By | June 21st, 2018|Categories: Uncategorized|

Yesterday, President Trump finalized the regulations allowing #SmallBusiness to have more options for their Group Health offerings to #employees.  Association Health Plans, or #AHP, are now less restrictive because of Trump legislation.  AHPs allow certain employers to band together to obtain Group Health Insurance through an “association” affiliation.  The employer must be in the same industry to be able to join the AHP, but the potential benefits could be much lower pricing.

Potential benefits to joining an AHP

When an employer joins an AHP and purchases Health Insurance through them, there could be a monthly savings on premium.  The idea is that pooling resources and large group purchasing has more power than our traditional #EmployeeBenefits pricing structure in place now.  The Group Health benefits could be tailored to fit the industry and what the AHP wants to offer to their members.  Something else that you don’t hear much about it that the rating structure can be different than what is currently available now.  When a larger group obtains #GroupHealth from insurance carriers, employee pricing is not based on age.  A single employee price is X, employee plus spouse is Y….etc.  Currently groups under 100 employees pricing is age rated, meaning someone 20 is fairly cheap (nothing is cheap anymore) and someone 60 is stupid expensive.  If you have an older group of employees, this may be a viable solution for cost savings….younger groups, maybe not.

Drawbacks to AHPs and the coverage options

With AHPs, because of the way they’re structured, they can offer #EmployeeBenefit plans that do not include the #ACA mandated essential coverage services like maternity, pediatric dental, even hospitalization.  Some see this as a good thing.  Why would someone 55 years old want to pay for maternity coverage or pediatric dental at their age.  I get more angry calls from people that are seeing double digit increases, complaining about having to “subsidize” others for coverage they don’t need or want.  They have a point.  If someone has kids, let THEM pay for the increase

Employee Benefits and Group Health Insurance may not make sense for some employers

By | June 17th, 2018|Categories: Uncategorized|

Depending on what type of company you run and who you are trying to attract and retain as employees, will determine if you, as an #employer, should be offering #GroupBenefits and Group Health Insurance for your people.  Employee Benefits are usually the second most costly line item for employers, right underneath wages.  Depending on your industry, you may not need to offer Employee Benefits

Employees have to see Employee Benefits as a value, or don’t waste your money

I speak to employers constantly that wrestle with the idea of having to spend tons of money each month on Group Benefits,   In some cases, I recommend against it.  My first question to them is “why are you looking into Employee Benefits?”  Their answers are usually all over the map.  If the employer does not see this as a value for their people, our conversation is usually pretty short.  Without having the right mindset for an Employee Benefits offering, it usually goes horribly wrong.  What I’ve learned is that unless you’re going into this for the right reasons, no one likes the outcome.

Unless both the employER and the EmployEES see value in Group Insurance, we’ve got a problem

Here is a typical scenario: the business owner, begrudgingly puts together an Group Health Insurance plan for the company.  The owner does not see value in the offering and selects the absolute cheapest plan available….and then wants to contribute almost nothing towards the employee’s monthly premium.  The message that the employee hears: they don’t care about me, and they only want to spend the bare minimum and expect me to foot the rest of the bill.  Which translated means: I’m not valued.  So the employer spends lots of money every month, for a Employee Benefits plan that the employees don’t like, and also sends a negative message to the employees who are expected to pay for the bulk of the coverage.

Having employees involved in the Employee Benefits process sends a positive message

In every Group Health Plan I’ve helped put together, when an employer has the employees become part of the process, it always turns out more positive.  Both the business owner and employees can discuss what’s available, what each can afford, and sends a much more positive message.  The outcome is ALWAYS more productive, everyone feels better, and in some cases, they determine, together, that the offering of Group Benefits is not a good fit.  That is totally OK.

Steve Brauer is the Principal for Brauer Insurance Services in the Bay Area.  He is a recognized expert in the translation of ObamaCare and the #ACA.  He and his daughter, own and operate an Independent Employee Benefits agency.  www.brauerinsurance.com   (877) 421-4325

Medicare at 55? What would that look like, who would pay for it? Tens of millions more on Federal System

By | June 8th, 2018|Categories: Uncategorized|

Late in 2017 there was proposed legislation in the Senate to allow people between the ages of 55 and 64 to “buy into” the Medicare program.  This would allow people to access the #Medicare hospital, medical services and prescription drug benefits.  On the surface it sounds interesting, until someone asks how we are going to pay for having tens of millions more on the Federal books.  However you want to phrase it, Socialized medicine, Universal Health Care, it all sounds great, until you break down the numbers.

If you think Health Insurance is expensive now, wait until its free!

No easy answers here.  I always laugh when someone from another country tells me that the healthcare system is so great in their country, “why can’t the US figure it out”, they ask me.  My answer to that….you get what you pay for!  When you break down the cost of all of these great healthcare systems that people crow about in other countries and try to apply it to the US, it ends up being WAY more expensive than the system we have now.  This issue has been examined from all angles and there is no easy way to solve it, and too many problems to point to just one issue to solve.  One thing is certain.  Until we can reign in the COST of #HealthCare, the cost of the insurance will continue to go up.

Feinstein vs. De Leon for Senate and their views on HealthCare

Well…both of them are liberal, De Leon is seen as an ultra liberal and believes a #SinglePayer or Medicare for all, is the only way to solve the health care issues in America.  Feinstein is a bit more tempered.  She supports #ObamaCare and supports a Medicare-based public insurance option for individuals and employers.  She believes this would increase competition and choice in the #employer marketplace and drive down costs.

One thing is certain….if this was an easy problem, we would have solved it a long time ago.

Steve Brauer is the Principal of Brauer Insurance Services, an Independent Insurance Agency that specializes in Employer Based Health Insurance plans.  As a ACA expert and speaker, Steve is one of the go-to people in the Bay Area insurance industry.  www.brauerinsurance.com  (877) 421-4325

Employers finding a way around the ACA, looking at the 2018 Farm Bill for relief

By | June 5th, 2018|Categories: Uncategorized|

OK, maybe we can’t scrap the #ACA altogether, and I’m not sure we should, frankly, but there is a piece of legislation inside the #FarmBill2018 that may provide some relief to the Agriculture Industry.  Inside the Farm Bill is the potential for up to $65 Million in loans for AHPs or Association Health Plans.  An AHP is basically a co-op of employers that share an industry or profession that can band together and purchase Group Health Insurance.  By doing this the AHP may be able to structure plans that don’t meet the current ACA standards.

AHPs can be set up cheaper, less comprehensive Health Insurance Plans, that don’t have certain “essential” services

Under the current proposal, the #AHP would be able to offer plans without things like Maternity, Prescription Drugs, even Hospitalization, some of the biggest cost drivers of the Employee Benefits industry.  By doing this, the AHP would most likely be much less expensive and attractive to employers trying to save money.  The Trump Administration will be finalizing new rules with these AHP plans, so we should be seeing something fairly soon.

Limited Medical Plans or Short Term plans are also being proposed to curb pricing, but not without skeptics

The Trump Administration is proposing Limited Medical Plans and Short Term plans for consumers that don’t want to pay for things like maternity or other benefits they don’t need.  These plans are not Guarantee Issue and people can be rejected, if they have a considerable medical condition.  Critics also say that by allowing these plans to flourish, we would be driving out healthier people from the ACA, who can qualify for these plans.  That would leave a skewed risk pool for the ACA type plans, and pricing would skyrocket.  All of this has yet to be proven, but makes sense.  Opponents also say that people would put themselves in a position to take on way too much risk with a Limited Plan and it could create financial hardship.

No easy answers here, but one thing is certain….we cannot handle the double digit price increases each year, year after year.

Steve Brauer is the Principal of Brauer Insurance Services, an Independent Employee Benefits Agency in the Bay Area, serving employer groups of typically under 100 employees.  www.brauerinsurance.com   (877) 421-4325

What are the main cost drivers behind Health Insurance…who’s making the money??

By | June 1st, 2018|Categories: Uncategorized|

A recent study done by AHIP, America’s Health Insurance Plans, shows that about 50% of the monthly premium costs associated with each of the Health Insurance plans in America, go to Doctors and Prescription Drugs.  22% goes to doctors and physicians, another 23% goes to Prescription Drug costs.  Recently the spotlight by President Trump has been the huge increases in pharmaceutical costs.  Trump is trying to control spending at the insurer and pharmacy benefit manager level.  Recently pharmaceutical companies are being blamed for “blocking” the availability of Generic Drugs

There is a real problem with allowing generics to be distributed….follow the money

The FDA listed more than 50 drug companies that are actively blocking the generic companies to develop cheaper alternatives.  One case in point is the drug Revlimid, a cancer fighting drug.  The manufacturer of Revlimid, Celgene Corp, being blamed for what the FDA called “shenanigans”.  This one drug, is very lucrative for Celgene, and accounts for about 63% of their revenue.  Just to give you an idea of the amount of revenue.  Many of these Brand Name Drugs, can be hundreds of millions of dollars for the manufacturer…almost as much as the health care system itself.  Folks, something is wrong with this system.  What a sham!!

Some of these companies basically have a monopoly on certain drugs

Remember Martin Shkreli, the CEO of the BioTech company Retrophin that jacked up the AIDS drug from $15 a pill to almost $800 and then laughed about it.  Well…he’s on his way to prison, for something else, but he is the poster child for “Big Pharma” and what everyone hates.  According to multiple sources, Shkreli is even more hated than the dentist that killed Cecil the Lion.  This is an extreme example, but you get the picture.  We have to figure out a way for Drug Companies to make money, and people have access to the medications they need.  This goes way deeper than I have time to write about, but this is not an easy fix.  But then, neither is our whole Health Insurance industry we have.

Steve Brauer is the Principal at Brauer Insurance Services, www.brauerinsurance.com   (877) 421-4325

HSAs, Medicare, and employees over 65 still working, can they contribute, draw, what does it all mean

By | May 30th, 2018|Categories: Uncategorized|

I get this question from more and more these days, about #Medicare.  What happens if I have an employee that is over 65, is eligible for Medicare and wants to continue with their HSA.  Lets break this down a couple of ways.  First off, someone can continue to participate in the company’s health plan over 65…even if they have Medicare.  There area a couple of situations to think about.  Since Part A (hospital services) are free to people over 65, many will enroll, even if they are still working, and on the company’s Health Insurance plan.  Most of them will delay the enrollment into Medicare Part B (Physician Services), until they leave employment, and that’s perfectly fine.  This is the typical scenario for people working over 65…except when you have an #HSA or #HDHP (High Deductible Health Plan)

If you have an #HSA plan at work and you enroll into Medicare

When an #employee is enrolled into an HSA compatible Health Insurance plan at work, the #employER can contribute to the HSA savings account, the employEE can contribute, or both.  If the employee is enrolled into ANY part of Medicare, either Part A, Part B, or both, they are not allowed to contribute to the HSA savings account anymore.  The employee is free to use the already banked funds for the allowed services, but they have to stop contributing when they enroll into any parts of #Medicare.  I know its confusing….welcome to the dysfunctional world of #HealthInsurance.

Who pays claims when an employee is enrolled in Medicare and the #GroupHealth plan at work

If the company has 20 or more employees and the employee is enrolled into both Medicare and the employer plan, the company plan is the Primary Payer of claims.  Conversely, if the company has under 20 employees, Medicare is the Primary Payer.

Every situation is different, so having a strategy BEFORE you end up in this situation is the key.  #EmployeeBenefits is an absolute specialty product, and deserves to be recognized as such.  Find an Independent Brokerage that can give you guidance, its well worth it!

Steve Brauer is the Principal at Brauer Insurance Services in San Jose, an Employee Benefits specialist.  He and his daughter are Independent Brokers serving employers all over the state of CA.  www.brauerinsurance.com   (877) 421-4325

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