ACA Compliance Deadline, Penalties for Noncompliance, and Transitional Relief for Smaller Employers

The Affordable Care Act is the law of the land – and employers have a lot of work to do to ensure they are in compliance with the employer mandate and other aspects of the sweeping health insurance reform law.

Can employers reimburse employees for health premiums purchased via an exchange or from an agent in lieu of setting up their own plan?

The Internal Revenue Service addresses these arrangements  – known as “employer payment plans,” in IRS Notice 2013-54. The IRS considers these plans to be group health plans, and when undertaken by an employer who is otherwise required to establish a group health plan and provide benefits to qualified employees, is not in compliance with the ACA.

According to the IRS, employers who do this in lieu of establishing a required ACA compliant health plan may be subject to an excise tax of up to $100 per day per employee. This could amount to a tax of up to $36,000 per employee per year, under Section 4980D of the Internal Revenue Code.

Is there any kind of relief for employers during the transitional period?

Yes. The IRS recently distributed Notice 2015-17 that allows a measure of relief for some employers from the above excise tax in four circumstances:

1.)   The plans are ’employer payment plans’ as defined in Notice 2013-54, provided the plan is not sponsored by an Applicable Large Employer (ALE) as defined in Paragraph (c)(2) of IRC 4980H (shared responsibility for employers regarding health coverage) and sections 54.4980H-1(a)(4) and -2 of the application.

2.)   The employer payment plan is an S corporation arrangement for shareholder employees who own 2 percent of the company or more.

3.)   The arrangements in question are to reimburse employees for Medicare premiums, or

4.)   The arrangements in question reimburse employees for TRICARE premiums within a health reimbursement arrangement (HRA).

Note also that the IRS allows for some temporary relief for small employers (those not designated as ALEs by IRC 4980H) for 2014 and up to July 1, 2015.  Generally, this relief will apply to employers with fewer than 50 full-time equivalents in the prior year.)

Special Arrangements for S Corporation Owner-Employees

According to the IRS (Notice 2015-17), S corporations are permitted to continue reporting health insurance reimbursement payments to 2 percent shareholders as described in IRS Notice 2008-1. Until the IRS issues further guidance, and at least through the end of 2015, the IRS will not assert IRC Section 4980D in enforcements against any such S corporation that fails to satisfy the ACA market reforms that involves a 2 percent shareholder-employee healthcare arrangement.

For More Information

For more information about how the ACA’s reforms apply to various types of group medical insurance plans, to include health reimbursement arrangements and arrangements wherein an employer provides reimbursement to employees for premium expenses paid for an individual or family insurance plan (as opposed to a group plan) see IRS Notice 2013-54.

For information about which employer plans will likely be found in non-compliance with the Affordable Care Act, see IRS Notice 2015-17. This notice also discusses transition relief arrangement specifics for smaller employers.

Please call or email us to discuss further.

Michael Braun

Franklin Benefits Group, LLC


Posted in Uncategorized | Tagged , , , , , , , , | Leave a comment

6 Most Common Mistakes Medicare Beneficiaries Make

It is important to find the right Medicare plan. Since there are hundreds of policies to consider when choosing and a large amount of information to learn with each one, most people just get frustrated and guess when they choose a policy. However, they typically wind up hurting themselves by paying too much for a plan that does not cover their needs. These are the six most common errors to avoid when completing Medicare enrollment.

1. Signing up too late or too early. The initial enrollment period for Medicare is when a person is 65 or nearing that age. Before turning 65, it is important to know what to do and when to enroll. Failing to do so will result in long-term penalties. If a person who is nearing the age of 65 is still working or that person’s spouse is still working and personal insurance complies with specific requirements, it makes sense for that individual to put off enrollment in Parts D, B and A.

2. Not knowing the difference between a Medicare Advantage plan and a Medicare supplement plan. People who are new to Medicare have an important choice to make when deciding whether to enroll in a Medicare Advantage plan or in original Medicare. Before enrolling, it is important to understand the benefits and advantages of each choice. Original Medicare involves a fee-for-service structure. Many people supplement their original Medicare plan with an Advantage plan to fill coverage gaps. In addition to this, beneficiaries typically choose a Part D plan to cover prescription medications. While Parts A and B in original Medicare cover some procedures and treatments, they usually lack coverage for others. This is where a supplemental plan is helpful. Advantage plans are considered Part C and are meant to replace Parts A and B but not to be supplemental plans. Medicare Part C plans also include prescription drug coverage.

3. Guessing when choosing plans. It takes a great deal of time to compare plans. However, it is essential to do some homework and to invest time researching. Avoid the common mistake of just picking an option out of frustration. Before picking a plan, review individual health insurance needs. Is there existing coverage from another source? Which hospitals and doctors are preferred? Are there any existing chronic conditions? What prescriptions are needed and where can they be obtained? Think about these factors to avoid picking a plan in haste.

4. Failing to apply for financial assistance. Millions of aging adults are eligible for one or more types of aid but do not realize this. The funds from financial assistance can be used to pay for prescriptions, coinsurance costs and health plan premiums. For those who have modest retirement income, it is best to check qualification criteria in advance. Discuss eligibility concerns and available options with an agent.

5. Not evaluating coverage each year. It is no longer a one-time choice for Medicare beneficiaries to pick health insurance. Changes are made to policies by insurance companies each year. If a certain doctor and medication are covered during one year, this does not mean they will be covered the next year. Experts say that beneficiaries could save themselves about $300 every year if they review Part D coverage annually. Research any coinsurance, cost and prescription drug changes. When determining if it is time to make plan changes, think about current health needs. Have they changed? Is the plan still meeting all individual needs? How many out-of-pocket expenses have there been in the past year? What were the expenses for?

6. Not seeking help. No person should have to go through this process alone and nobody has to. Get help from a trusted person who can assist in considering and picking options. When unsure about choices, use the Medicare QuickCheck feature to receive a customized report showing individual options. Use the report to discuss these options and which ones are best with an agent.

For a free consultation please contact us at

or 610-427-8122


Posted in Medicare | Tagged , , , , , | Leave a comment

What Taxpayers Need to Know about Reporting Health Coverage on Tax Forms

What Taxpayers Need to Know about Reporting Health Coverage on Tax Forms

While many people know there is a fee incurred by people who do not have health insurance, they do not understand how the Internal Revenue Service knows if they have insurance. When a person enrolls in an insurance policy, information is sent to the IRS by the insurer. Any coverage purchased must meet the minimum essential coverage requirements. If a policy does not meet these standards or if a person goes uninsured, the fee is assessed based on income and every month a person was uninsured or did not have sufficient coverage.

Tax Information
The 2014 tax year was the first year where people had to submit information about their health insurance coverage. This was reported on line 61 of IRS Form 1040. People who had coverage should check the box. For those who did not have coverage, the box should not be checked. For the 2015 tax year and beyond, look for the Form 1095-B from your insurance company. It will be sent out for all policyholders to help them file their tax returns.

What Is A 1095-B?
This form shows what type of coverage a person has, the period of coverage and the person or people who are covered. This includes the policyholder and any spouses or dependents. If there are any adult dependents under the plan, they will not receive their own Form 1095-B. It is not necessary to have the same health insurance plan for spouses and children. However, every person must have health insurance or qualify for an exemption.

Some examples of exemptions include losing a job where the employer provided insurance, moving out of state, incarceration and similar events. When in doubt, discuss these exemption rules with an agent. People who do not have insurance and do not qualify for an exemption will be fined on tax forms for the months they were uninsured based on their total household income. If a person has insurance from one provider for part of the year and insurance from another provider for the other part of the year, that individual should receive two separate Form 1095-B statements.

Expect to see these forms arrive in the mail every year around the time when W-2s, 1099s and other tax forms arrive in the mail. To learn more about exemptions and how to use a Form 1095-B to report insurance coverage, discuss concerns with your agent.

Michael Braun


Posted in Insurance | Tagged , , , , , , , | Leave a comment

Filing a Medicare Complaint

Filing a Medicare Complaint

If you believe you have not been treated fairly as a Medicare beneficiary, or if you have not received the benefits you believe you are entitled to, you may file a complaint with the Department of Medicare and Medicaid Services.

To complain about a specific doctor, nurse or other care provider

The best way to complain about a medical care provider is to contact your state medical board directly. This is the appropriate route for complaints about unprofessional or unethical care, incompetent practice, practicing without a license, etc.

To complain about a hospital or clinic

If you want to file a complaint about a hospital, clinic or other facility, contact your state health department. This is the appropriate avenue to take for facilities that are unsafe, have poor access for the handicapped, have air conditioning or heating issues that impact care, have poor food, poor housekeeping or unsanitary conditions.

To complain about quality of care

To complain about the quality of care you received at the hands of a Medicare provider, contact your Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO).

Examples of quality of care complaints include:

  • Drug errors
  • Unnecessary treatments
  • Unnecessary surgery
  • Premature discharges from hospitals
  • Not getting adequate treatment when your condition changes.
  • Poor or incomplete discharge instructions

To complain about your prescription drug plan

If you have a problem with your prescription drug plan and you want the Department of Medicare and Medicaid Services to address it, you mist file the complaint within 60 days of the event or events leading to your complaint.

To do so, contact the plan directly, either in writing or over the phone. Generally, you must be notified of the action or decision regarding your complaint within 30 days of the day your plan receives your complaint.

If your complaint arises because the plan has not made a fast coverage determination and you have not received the drug, the plan must respond with a decision within 24 hours of the time it receives your complaint.

Other plan complaints

For more general plan complaints about such things as customer service, access to specialists, problems with the processing of an appeal, or complaints about information you receive or don’t receive from your plan, you should consult the contact information on your plan membership card.

Complaints about durable medical equipment

To file a complaint about durable medical equipment (DME), contact your supplier first. Your supplier must acknowledge your complaint within 5 calendar days, and send you the result of their investigation within 14 calendar days, per Medicare rules.

If this is not sufficient, call 1-800-Medicare and request your complaint be forwarded to the Medicare Competitive Acquisition Ombudsman (CAO)

Complaints about kidney care

If you are receiving treatment for end-stage renal disease (ESRD) and you have a complaint about your facility, you can contact your ESRD network and file a complaint with them. You may do this if you cannot resolve your complaint at the facility level or if you wish to remain anonymous. This route may be appropriate for complaints about your dialysis or kidney transplant center.

You may file a complaint, for example, if your dialysis shift conflicts with your job and you cannot get your center to change your shift so you can work.

You may also contact your state survey agency if you believe you cannot resolve the situation with the clinic, or if you wish to remain anonymous.

You can find a directory of ESRD Network Organizations here.

Need Assistance?

You can contact your State Health Insurance Assistance Program (SHIP). Assistance is free.

You can contact us as well.

Mike Braun

Posted in Uncategorized | Tagged , , , , , , | Leave a comment

Special Enrollment Period for Individuals

The Centers for Medicare and Medicaid Services (CMS) announced a new Individual Health Insurance Marketplace Special Enrollment Opportunity beginning on March 15 through April 30. This Special Enrollment Opportunity is for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in a Federally Facilitated Marketplace (FFM) states.

Who is Eligible
Your clients who live in a FFM state are eligible for this Special Enrollment Opportunity if they:

  • Are not currently enrolled in health coverage through the FFM for 2015,
  • Attest that they paid the fee for not having health coverage in 2014, and
  • Attest that they first became aware of, or understood the implications of, the penalty or shared responsibility payment after Feb. 15, 2015, when Open Enrollment ended, in connection with preparing their 2014 taxes.

State-based Exchanges (SBE) have the flexibility to determine whether they will establish a similar special enrollment period. Check specific SBE websites for additional information.

What This Means
Your eligible clients will have the opportunity to purchase an On-Exchange Individual Health Plan from March 15 through April 30.

  • Enrollments made by the 15th of the month will have coverage effective on the 1st day of the following month.
  • Enrollments made after the 15th of the month will have coverage effective on the 1st day of the second month.

Please contact us at 610-427-8122 for a consultation.   If you would like to see a quote you can also go to

Free Quote Click Here

Posted in Uncategorized | Tagged , , , , , , | Leave a comment

When Urgent Care is a Better Option than the Emergency Room


When it comes to emergency care and emergency rooms in hospitals, what exactly is a true emergency? It is not uncommon to walk into an emergency room and see an overly-concerned parent bringing in a child with a small scrape, an uninsured person visiting the ER for an ear infection because lack of insurance prohibits doctor visits, and a person with severe chest pain. Of those three, the person with chest pain is experiencing a true emergency. That pain could be an indicator of an impending heart attack.

A real emergency is an event that could result in loss of a limb or loss of life. Chest pain and injuries due to serious accidents or gunshots are priorities in hospital emergency rooms. Loss of consciousness, abdominal pain that could indicate appendicitis and broken limbs are also examples. Many people in emergency room waiting areas complain about long waits, but they are also usually the ones who come in with issues such as a sprained ankle or back pain. Health experts emphasize that emergency rooms never have been and never will be based on the concept of first come, first served.

They also point out the topic of urgent care. This is several steps down from emergency care, and it includes issues that need to be addressed quickly. Cuts that may need stitches, possible infections, sprained ankles, dog bites and severe muscular pains are all examples of incidents that require prompt attention but are not considered threatening enough to send a person to the emergency room. Urgent care clinics are usually open past regular business hours. This means a person who has an issue such as a cold or sore throat that needs attention but not immediate attention could also be seen if it is not possible to come in during day hours to a physician’s office. At urgent care clinics, people are usually seen in the order the show up.

Health experts recommend urgent care clinics for issues that are not true emergencies, because people who need urgent but not emergency care will almost always be seen faster at an urgent care clinic. Emergency rooms are crowded, busy and very expensive. It is much more affordable to visit an urgent care clinic. Insurance companies assign higher copay amounts to emergency room visits than they do to urgent care visits. For example, an insurer who may charge a $20 copay for a regular doctor visit may also charge $100 for an emergency room visit. However, the copay for urgent care on that scale would likely be about $40 or $50.

People who visit emergency rooms for all health issues instead of obtaining insurance these days are only hurting themselves. Affordable plans can cost a person much less than even half of one emergency room visit for a sore throat today. Emergency room care includes high fees for the use of emergency services as well as lab fees, testing fees and many other increased charges. For those who have free medical care, it is important to take advantage of urgent care services when an issue must be addressed immediately. Always remember that if the issue may not result in loss of a limb or life, visit the urgent care clinic to avoid waiting and overcrowding the emergency room. It is also a courtesy to people who are suffering true emergencies and the staff who need to treat them. To learn more about what insurance covers or what affordable options are newly available, discuss concerns with an agent.

Posted in Uncategorized | Tagged , , , , , , , | Leave a comment

Buy Your Own Health Insurance – Get a Tax Break


The government wants you to have health insurance. So much so that it will actually penalize you if you go without health insurance – by as much as 2 percent of your household income in 2015, or $325 per person for the year ($162.50 per child under 18), up to $975 per family, whichever is higher.

But Uncle Sam has a carrot to go along with the stick – it actually encourages the ownership of health insurance by providing tax incentives to help make the decision to buy coverage easier.

Self-Employed Individuals

Self-employed individuals may be able to deduct the cost of their health insurance premiums for themselves and their families – up to the amount of earned income claimed for the year.

Health insurance premiums are considered an adjustment to income, and hence are “above the line” deductions. That’s good news, because it means you don’t have to itemize your expenses in order to take the deduction. You can take the tax benefit while still opting for the standard deduction. It’s also not subject to the 10 percent of adjusted gross income threshold that generally applies to medical expenses if claimed as miscellaneous itemized expenses on a Schedule A.

You do need to file using a Form 1040, however. You cannot use a Form EZ.

You must have paid the premiums yourself, however. If someone else can take a tax deduction for your premiums, then you cannot subtract your health insurance premiums from your income.

You can only claim this deduction if you are not eligible for an employer sponsored plan, and eligibility is determined month-by-month. So if you were laid off or left a job for six months out of the year and paid your own health insurance premiums (including COLA premiums) then you can deduct the cost of premiums paid those six months.

Lower-income Families

Lower-income Individuals and families can take advantage of a new premium tax credit to help them afford health insurance coverage purchased through an Affordable Insurance Exchange. You don’t have to have a high income to take advantage of this provision; the credit is refundable, so it still works for people with little or no income tax liability. The credit also can be paid in advance to a taxpayer’s insurance company to help cover the cost of premiums.

If you make over 400 percent of the federal poverty level, however, you will likely not qualify for this credit.

If Your Employer Pays Your Premiums

You are not taxed on premiums your employer pays on your behalf for group coverage. You cannot claim a deduction on any premiums your employer paid on your behalf – your employer is already claiming that deduction (However, if you are the owner/employee of your own corporation, you can have your corporation pay the health insurance premiums. This may help you if your corporate tax rate is higher than your personal income tax rate – but don’t forget to account for Social Security Taxes in this scenario!

Long Term Care Insurance

You may be able to deduct premiums paid for qualified long term care insurance, depending on your age. These premiums are also ‘above the line’ deduction, noted on Page 1 of your Form 1040, so you do not have to itemize your expenses in order to take advantage of the deduction. It is also not subject to a 10 percent of AGI threshold.

Your allowable deduction is based on your age (or your spouse’s age, if your spouse is the insured), and increases as you get older. For 2015, allowable deductions are as follows:

  • 40 or younger:                                                          $380
  • More than than 40 but not more than 50:                     $710
  • More than 50 but not more than 60:                          $1,430
  • More than 60 but not more than 70:                          $3,800
  • More than 70:                                                         $4,750
Posted in Uncategorized | Tagged , , , , | 1 Comment

Between Jobs? What To Do About Health Insurance

These days it happens more and more. You’ve been downsized, underemployed, divorced from someone with access to group health insurance, or your employer has simply decided to discontinue a workplace plan. What now?

Many times, the choice comes down to purchasing insurance in the private market via a broker, or to continue enrollment in the employer’s old plan via COBRA – a special program that entitles certain individuals to continue coverage under the employer’s old plan for up to 18 months.

COBRA doesn’t apply in every situation. If you were fired for cause or voluntarily left your employer for example, or if your employer did not have enough employees, you may not be eligible. To be covered under COBRA, an employer must have at least 20 employees, either full- or part- time, on 50 percent of its typical business days or more during the previous calendar year.

Also, there has to have been a ‘qualifying event’ to trigger COBRA eligibility. These include:


  • Terminations for reasons besides “gross misconduct.”
  • Reduction in hours worked

For dependents – that is, for spouses and children of workers in COBRA eligible plans, a qualifying event could involve a divorce or legal separation from the worker, the death of the worker, or the worker qualifying for Medicare and therefore losing eligibility for the workplace plan.

If you do lose access to your health care plan, and you are, indeed, covered under COBRA, how can you choose between continuing via COBRA or going out on the open market?


  • Compare COBRA premiums with broker-sold quotes. Because of the way insurance companies price large groups, COBRA may make sense for older workers. Younger workers, on the other hand, may be better off going through an insurance broker because they can frequently offer better pricing for younger ages.
  • Check open enrollment. By statute, you can only enroll in an ACA plan via the exchanges through March 31st.

In the Affordable Care Act Marketplace, you generally qualify for a special enrollment period of 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. If you don’t have a special enrollment period, you can’t buy insurance through the Marketplace until the next Open Enrollment period. Job-based plans generally allow special enrollment periods of 30 days.


  • Calculate your income. If it’s below 400 percent of the poverty level for a family of your size, you may be eligible for a subsidy under the Affordable Care Act – provided you go through the online exchanges to purchase a policy. As of 2014, the cutoff for subsidy eligibility for individuals was an annual income of $45,960. The cutoff for couples is $62,040, and the cutoff for a family of five is $110,280. Amounts in some areas like Alaska and Hawaii are higher because of the comparatively high costs of living in those states.


  • Examine provider networks. HMOs and PPOs tend to offer lower premiums than comparable indemnity plans, but restrict your options when it comes to providers, doctors, clinics and hospitals.


Many insurance policies available on the exchanges have severely restricted networks of authorized care providers. Keep that in mind as you shop for insurance coverage. If you are COBRA eligible, however, ask you HR department about some help paying COBRA premiums. Many times, severance packages also include some additional amounts to offset COBRA premiums for laid-off employees.


  • Consider how much you have already paid toward this years’ deductible. Have you already had medical expenses this year? If so, that could be a vote in favor of COBRA, since your expenditures would count against any deductibles for this year. If you switch to another plan you may well have to meet a whole new deductible before benefits kick in.


Many times, a knowledgeable agent is able to bring a great deal of value to the table. Because an agent has a wider variety of plans to choose from, and he or she knows your personal situation, an agent can reduce the amount of time spent searching for the ideal plan and refer you to the insurance policy that is best tailored to your individual circumstances.

Click here to get a quote.

You can also consider Short term medical insurance as well.


Mike Braun

Leading Times Insurance, LLC



Posted in Uncategorized | Tagged , , , , , , , , , , | Leave a comment

Insurance Agents vs. Payroll Providers – Who Do You Want to Call When Your Business is On The Line?

For many years, insurance agents and brokers have worked side-by-side with payroll service providers, cooperating and combining their separate skill sets for the benefit of their small business clients.

In recent years, as competition tightened across the board, we have seen an increasing movement on the part of payroll service providers to offer services and products and solutions that have traditionally fallen under the purview of the insurance agent.

Payroll service providers in many cases bring the advantages of economies of scale and a seamless integration with payroll software currently in place. After all, it’s their program!

And so we are seeing payroll providers call on business owners to offer things like workers compensation quotes, business and umbrella coverage, and other basic programs.

But insurance is much more than a matter of providing a quote. The most suitable plan for small business owners is rarely the cheapest. Insurance planning is a matter of using multiple insurance products and solutions in combination to protect the unique risk profile of the client – whether that client is a business, the business owner, or an employee and his or her family.

It’s a matter of core competencies. Payroll service providers are experts at efficiently moving dollars between accounts via sophisticated computer programs. But very few payroll providers understand your people like an experienced insurance agent.

By the time a typical insurance agent becomes a multi-line benefits broker with a sizeable small business clientele, he or she has generally done hundreds, if not thousands, of detailed fact finders not just with business owners, but with workers just like your employees and families just like those of your employees – at the individual level.

He or she has asked them what happens if the breadwinner dies tomorrow? What happens if the breadwinner or a stay at home spouse becomes disabled tomorrow? How will college be funded? How will the healthy spouse, or a surviving parent, continue to work and manage child care and home duties at the same time?

Asking these difficult questions at the individual family level, and sensitively designing insurance solutions for your workers families as well as for your own needs as a business owner or principal.

There is nothing in any payroll company’s list of core competencies that is a substitute for what insurance agents do best – protect people.

Another core competency is in the area of specialty lines – some of which few people outside of veteran property and casualty agents have even heard of.

Is your business in an antique building? Do you need specialized errors and omissions coverage?  Do you have unique concerns about wildfires, flooding and contents coverage? Directors and Officers liability? Do your employees ever drive their own cars on company business? If the answer to any of these three questions is “yes,” you may need some special underwriting attention from a veteran agent who has shepherded cases through underwriting and managed claims many times before, at multiple insurance carriers.

That’s when your relationship with your insurance provider matters the most – when the chips are down and everything is in crisis and when all seems lost. When you pick up the phone, do you want to call the agent who lives, eats and breathes insurance? Or do you want to talk to someone for whom insurance is merely a sideline to their payroll processing business.

The difference is clear – when the claim is on the line, you want an insurance professional handling it. Not a payroll vendor.

by Mike Braun, Leading Times Insurance, LLC 610-427-8122

Posted in Uncategorized | Tagged , , , , , , , , | 1 Comment

What to Know Before Enrolling in Medicare


Medicare is the government-sponsored health coverage for people who are 65 years of age or older or those who are under 65 but are disabled. People whose spouses have worked at least 10 years in the United States or people who have received SSDI benefits for two years may be eligible for both Part A and Part B coverage. There are four parts of Medicare.

Part A
This is also known as hospital coverage, and it compensates for inpatient hospital visits, some extended home health care and skilled nursing care.

Part B
This is the medical insurance part of Medicare, which covers doctor visits and most outpatient treatments. It also covers some home health care, physical therapy and medical equipment.

Part C
This is the Medicare Advantage Plan, and private insurers with Medicare contracts offer it. Part C coverage may be offered as POS, PPO, HMO or MSA plans. It may also be offered in a plan featuring fees for services. There are more benefits than found in original Medicare in Part C coverage, and there are low premiums or no premiums depending on circumstances and insurers. Copay amounts and out-of-pocket maximums vary.

Part D
This form of Medicare coverage applies to prescription drugs. It may be combined with Part C coverage or purchased as a standalone policy. The types of drugs covered and the percentages vary from one insurer to another, and the premiums also vary depending on several factors.

How To Enroll In Original Medicare
During the three months before a person turns 65, he or she can apply for Medicare. The best way to do this is to discuss the details with an agent. Every person’s circumstances vary, and agents can recommend options that will fit each person’s needs best. In addition to Advantage plans, there are also supplemental plans and retiree plans. After being approved for Medicare, coverage will begin on the first day of the following month. People who do not enroll in Part A, Part B and Part D when eligible may be subject to a penalty for late enrollment, which is added to the premium amount. It is important to note that Part C and Part D plans have regulated enrollment, so there are open enrollment periods. These usually occur during the fall each year. In most states, enrollment can occur during any time of the year for Part A and Part B. Failing to apply on time will result in medical questions being asked for these parts. However, Part C and Part D plan sponsors cannot ask medical questions aside from whether a person has been diagnosed with end-stage renal disease.

How Much Does Each Part Cover?
Coverage amounts are subject to change from one year to the next, so it is best to discuss the current copay amounts, coverage limits and out-of-pocket limits for each plan with an agent. Premiums will vary depending on circumstances and plan details. Some people may also be eligible for extra help. People who have low income may qualify for special plans that pay the Part B premiums or offer reduced fees for prescription drugs through Part D. To learn more about these options, discuss concerns with an agent.

Not all people may need full Medicare coverage. Those who have employer-sponsored health plans may not need coverage from multiple Medicare parts. In some situations, people who are working may be able to delay their Medicare enrollment. Individuals who receive Railroad benefits or Social Security will automatically receive their cards, but a person does not have to be receiving Social Security to sign up for Medicare.

If you would like more information on Medicare, please contact me at the information below.

Mike Braun

Leading Times Insurance, LLC

Posted in Uncategorized | Tagged , , , , , , , , , , , | 1 Comment