Sackett Insurance Services - Blog

When Can You Change Your Medicare Plan? Understanding Special Enrollment Periods

Thu, 23 Apr 2026 16:45:01 GMT

When Can You Change Your Medicare Plan After Enrollment

Medicare beneficiaries aren't necessarily locked into their plan until fall — and many don't realize it. The Annual Enrollment Period, Medicare Advantage Open Enrollment Period, and Special Enrollment Periods each offer distinct windows to review and change coverage, depending on your situation. Understanding which period applies to you can prevent costly gaps, missed deadlines, and plans that no longer fit your needs.

Key Takeaways:

The Annual Enrollment Period (Oct 15–Dec 7) is the primary window to switch Medicare plans, with changes taking effect January 1
Medicare Advantage enrollees get an additional opportunity from January 1–March 31 to make one coverage change or return to Original Medicare
A Medicare Special Enrollment Period is triggered by qualifying life events — like moving or losing employer coverage — and is not tied to the standard calendar windows
The 8-month rule is critical for people retiring or leaving jobs: it governs how long you have to enroll in Part B after employer coverage ends without incurring a late penalty
Because SEP eligibility depends on specific circumstances, reviewing your situation with a licensed broker helps ensure you don't miss a window you didn't know was available

Many people believe that once they enroll in Medicare, they’re stuck with their plan until the next fall. That’s one of the most common misunderstandings about Medicare coverage. In reality, there are several times throughout the year when you may be able to change your Medicare plan after enrollment.

The key is understanding how each Medicare enrollment period works and how it applies to your situation. Once you know the difference between the Annual Enrollment Period (AEP), the Medicare Advantage Open Enrollment Period (MA-OEP), and a Medicare Special Enrollment Period, you can make confident decisions about your coverage instead of guessing or waiting longer than necessary.

Annual Enrollment Period (October 15 – December 7)

The Annual Enrollment Period runs every year from October 15 through December 7. This is the most widely known opportunity to change a Medicare plan after enrollment. During this window, you can switch from Original Medicare to a Medicare Advantage plan, move from one Medicare Advantage plan to another, or enroll in, drop, or change a Part D prescription drug plan. Any changes you make take effect on January 1 of the following year.

AEP is your annual opportunity to review your coverage for the coming year. Plans can change premiums, provider networks, drug formularies, and supplemental benefits like dental or vision coverage. Even if your health has stayed the same, your prescriptions, preferred doctors, or budget may have changed.

Reviewing your options each fall helps ensure your plan still supports both your healthcare needs and your financial goals and helps you avoid common Medicare open enrollment mistakes .

Medicare Advantage Open Enrollment Period (January 1 – March 31)

If you’re already enrolled in a Medicare Advantage plan, you have another opportunity from January 1 through March 31. This period is called the Medicare Advantage Open Enrollment Period, and it allows you to make one coverage change.

During this time, you can switch to a different Medicare Advantage plan or return to Original Medicare. If you return to Original Medicare, you may also enroll in a standalone Part D drug plan to maintain prescription coverage. This is also the time many people review whether they need to review their Medigap (Medicare Supplement) coverage to help manage out-of-pocket costs.

How a Medicare Special Enrollment Period Works

A Medicare Special Enrollment Period gives you the ability to make changes outside of the standard enrollment windows if you experience certain life events. Unlike AEP and MA-OEP, a Special Enrollment Period is not tied to specific calendar dates. Instead, it’s triggered by changes in your personal circumstances.

Common qualifying events include moving to a new address, especially if you relocate outside your current plan’s service area. Losing employer-sponsored health coverage can also make you eligible. In fact, what many people call the “ 8-month rule for Medicare ” refers to the time you have to enroll in Part B after your employer coverage ends without facing a late penalty. Understanding how this rule works is critical if you are retiring or leaving a job. In many cases, you have a limited timeframe, often 60 days from the qualifying event, to make changes, although the exact window depends on the type of Special Enrollment Period.

Flexibility Exists After Medicare Enrollment

When you first select a Medicare plan , you’re making a decision based on your health needs, prescriptions, doctors, and budget at that time. But those factors can change. A new diagnosis, a specialist referral, rising drug costs, or even a move to a different ZIP code can all affect whether your current coverage still works for you.

Because Medicare rules are highly specific, it’s not always clear whether your situation qualifies you to make a change. Some Special Enrollment Periods are triggered by life events you may not realize count. Reviewing your circumstances with a licensed professional can help determine whether you’re eligible to adjust your coverage and avoid missing an important deadline.

When You Can Change Your Medicare Plan Depends on Understanding the Rules

Instead of spending hours trying to sort through Medicare enrollment rules, qualifying events, and documentation requirements on your own, let Sackett & Associates Insurance Services help. Our team is ready to review your situation, determine whether you qualify for a Medicare Special Enrollment Period, and guide you through your next steps.

How Small Employers Can Budget for Mid-Year Health Insurance Rate Increases

Fri, 10 Apr 2026 18:00:05 GMT

How Small Employers Can Budget for Health Insurance Rate Increases

Rising health insurance premiums are a reality for small employers — but they don't have to catch you off guard. By building rate-increase scenarios into your budget early, revisiting your contribution structure, and working with an independent broker who can compare options across carriers, you can manage cost increases without leaving your employees with worse coverage.

Key Takeaways:

Model multiple renewal scenarios (5%, 8%, higher) before your renewal date so you're never reacting in a panic
Switching from percentage-based to defined-dollar contributions gives employers more predictable costs year over year
Plan design — deductibles, premium splits, plan tier options — directly affects how well you absorb ongoing cost increases
Level-funded and partially self-funded plans are worth exploring for businesses where fully insured premiums have become difficult to manage
An independent broker can compare competing carriers and funding models on your behalf, giving you more options than a single-carrier renewal

If you run a small or mid-sized business, you already know how quickly health coverage costs can shift. One renewal notice or mid-year adjustment can bring unexpected group health insurance cost increases, putting pressure on your operating budget.

Recent employer health benefit surveys show health plan expenses rising at the fastest pace in more than a decade. Many employers are facing projected increases of 6% to 7% or more. Higher hospital prices, specialty drug costs, and increased use of medical services are driving much of this growth. That’s why strong small business health insurance budgeting is no longer optional.

How Can Small Employers Plan Ahead for Group Health Insurance Cost Increases?

The best defense against rising health benefits costs for employers is preparation. Instead of assuming your renewal will stay close to last year’s rate, build room in your budget for potential group health insurance cost increases.

Start by running several projections. What would a 5% increase look like? How would 8% affect payroll and cash flow? Modeling different scenarios gives you flexibility and reduces stress when renewal season arrives. Working with a broker who understands carrier trends can also give you more accurate expectations before numbers are finalized.

How Does Your Small Business Health Insurance Contribution Strategy Affect Costs?

Your contribution strategy directly affects how you absorb increases to your group health insurance. If you currently pay a set percentage of premiums, your costs automatically rise when premiums rise. That structure can make long-term budgeting unpredictable.

Some employers move to a defined dollar contribution instead of a percentage. This creates more stability year over year and helps make overall healthcare costs more predictable. If changes are needed, clear and honest communication with employees helps maintain trust while protecting your company’s financial health.

Can Small Businesses Reduce Health Insurance Costs Without Cutting Coverage Quality?

Smart decisions about group health insurance for small business owners often come down to how you structure contributions and design your plan. The way you split premium costs, set deductibles, and choose plan options directly affects how well you manage ongoing healthcare expenses. When these elements are reviewed carefully, they help control costs while still protecting the quality of coverage your employees rely on.

Should Small Businesses Consider Alternative Health Insurance Funding Models?

If rising group health insurance costs are making fully insured plans harder to manage, it may be time to look at other funding options. Exploring alternatives can give you more flexibility and help you choose the right group health plan for your employees based on your company’s size, cash flow, and long-term goals.

Level-funded plans are one option many small and mid-sized employers consider. These plans offer predictable monthly payments but may return money if claims are lower than expected. Some businesses also explore partially self-funded plans, which provide greater visibility into claims data and more control over spending patterns. When reviewed carefully with an experienced broker, these models can support stronger cost management and help stabilize expenses over time.

Why Does Working With the Right Health Insurance Broker Matter?

A knowledgeable, independent broker can make a meaningful difference when dealing with small business health insurance cost increases. When your advisor isn’t tied to a single carrier, you gain access to multiple insurance companies, plan structures, and contribution strategies.

For example, you might work with an independent broker to compare competing carriers, evaluate different funding models, and adjust contribution levels before renewal. Instead of simply accepting the first renewal offer, you can review several structured options designed to improve long-term stability and manage rising costs more strategically.

Small Employers Can Take Control of Group Health Insurance Cost Increases

Managing group health insurance cost increases takes planning, clear contribution strategies, and guidance from an experienced advisor who understands the market. Sackett & Associates Insurance Services works with small and mid-sized employers to compare insurance carriers, evaluate funding models, and design benefits plans that support long-term stability. As an independent agency, we focus on solutions that fit your workforce and your budget, not just a single carrier’s offer.

Contact Sackett & Associates today to review your options and implement group health insurance solutions that support your employees and strengthen your financial outlook.

How To Get Health Insurance for Your Employees as a Small Business in Santa Rosa

Thu, 26 Feb 2026 08:00:11 GMT

How Small Businesses in Santa Rosa Can Offer Health Insurance

Providing health insurance as a small business in Santa Rosa is more accessible and manageable than many employers expect. By understanding group health insurance basics, working with a knowledgeable local broker, and using benefits management software, businesses can offer valuable coverage while controlling costs and staying compliant.

Key Takeaways:

Group health insurance offers a more affordable option than individual plans and is a great choice for small businesses.
Work with a local broker to help you navigate options and ensure compliance with California’s regulations.
Use benefits management software to streamline your employee health insurance administration and control costs effectively.

Understanding group health insurance options, working with a local broker, and using benefits management software can help you make smart, cost-effective decisions for your employees' health coverage.

As a small business owner in Santa Rosa, offering health insurance to your employees is a big step in supporting their health and attracting great talent. If you're new to this or reconsidering your options, this guide to group health insurance will help you understand the basics and how to choose the right health plan for your employees.

What Is Group Health Insurance?

Group health insurance is when a business provides health coverage to its employees under one plan. This option is often cheaper than individual health insurance. You’ll choose the plan, but the risk is shared between you and your employees.

There are two main types of group health insurance:

Fully insured plans: The insurance company takes on the risk of paying healthcare costs.
Self-funded plans: The business takes on the risk and directly pays for claims.

Most small businesses choose fully insured plans because they are easier to manage. Understanding these options is key to navigating the cost of health benefits .

Contribution and Eligibility Rules

You’ll need to pay a part of your employees' health premiums. Generally, you must pay at least 50% of their premiums, but this can vary depending on the plan. Offering coverage to employees' spouses and children is optional.

Employees typically need to be full-time to be eligible for coverage. Some plans also require a waiting period for new employees before they can join. These eligibility rules are important factors to consider when you’re planning your small business health insurance offerings.

How Your Business Size Affects Health Insurance Options

The size of your business plays a role in the health insurance options available to you. In California, if you have fewer than 50 employees, you’re not required by law to offer health insurance, but you can still buy a plan through the Small Business Health Options Program (SHOP).

If you have 50 or more employees, you must provide health insurance under the Affordable Care Act (ACA). Understanding the available plans is essential when deciding how to choose the right health plan for your team.

How Can You Control Health Insurance Costs?

Health insurance premiums can be expensive, but there are ways to manage costs:

Offer tiered plans: These plans let employees choose from different coverage levels, which can help save money.
Encourage wellness programs: Helping employees stay healthy can reduce healthcare costs in the long run.
Shop around: Compare plans from different providers to get the best deal.

You may also qualify for tax credits, like the Small Business Health Care Tax Credit, if your business meets certain criteria.

Minimum Participation and Other Requirements for Group Health Plans

Most health insurance plans require a certain number of employees to enroll for the plan to work. Insurance providers often need at least 70-75% of eligible employees to sign up. This helps ensure the plan is financially stable.

It’s important to communicate with your employees and encourage them to enroll so you meet the minimum participation requirements. A clear guide to group health insurance options will help make this process smoother for your business.

Why Should You Work With a Local Broker To Choose a Health Plan?

Working with a local broker who understands California’s insurance rules can make the process easier. A broker can help you:

Find the best health insurance plan for your business.
Understand the rules and regulations.
Guide you through the enrollment process.
Help with managing the plan each year.

Working with a local Santa Rosa broker ensures that you’re making informed decisions about your small business health insurance.

Benefits Management Software

As your business grows, managing employee health insurance can get more complex. Working with brokers who use benefits management software can help make this easier. They track enrollment, ensure everyone is covered, and help you stay compliant with the law.

A local broker can also help you better understand your health benefits costs, allowing you to make smarter decisions. Some of their software solutions provide data analytics, helping you track health claims and trends over time, which can be valuable when planning future benefit strategies.

What Additional Health Benefits Should You Consider?

While health insurance is one of the most important benefits you can offer, consider other options that can enhance your employees' overall well-being.

Dental and Vision Plans

Many businesses offer dental and vision insurance as optional add-ons to their health plan.

Mental Health Support

Mental health services are increasingly important to employees. Look for plans that provide access to counseling or therapy.

Employee Assistance Programs (EAPs)

These programs offer additional support for employees dealing with personal issues that may affect their work performance.

Next Steps for Offering Health Insurance to Your Employees

Providing health insurance can be a great benefit for your employees and can help your business stand out. By understanding your options and working with a local broker, you can find the right plan for your business.

If you're ready to explore group health insurance or want to learn more about benefits management software with expert brokers at Sackett Insurance, contact us today to discuss your options.

What Employers Should Know About Group Health Plan Trends and Costs in 2026

Wed, 11 Feb 2026 19:30:00 GMT

How Small Businesses Can Cut Health Insurance Costs 2026

Rising costs and changing trends in group health insurance impact small and midsize businesses. It’s important to stay informed about new options and strategies that can help you manage these costs while offering valuable benefits to your employees.

Key Takeaways:

Health insurance costs for employers will continue to increase, making it important to explore alternative plan options like tiered networks and HSAs.
Mental health services and wellness programs are becoming a bigger part of employee benefits, which can help reduce long-term health costs.
Offering telehealth services is a great way to improve employee access to care and reduce the need for in-person visits, saving both time and money.

Managing a company’s budget requires taking a clear look at the costs of healthcare. Current small business health insurance trends in 2026 show that mental health and wellness are now top priorities for many workers. By staying informed about these changes, you can make better decisions for your business. This allows you to offer competitive benefits that support your employees without overspending.

Rising Costs of Employer-Sponsored Health Plans

The cost of providing group health insurance continues to rise. In 2026, employers face higher prices for health plans. This is partly due to rising medical costs and more people needing healthcare.

For small business owners , these rising costs can be tough to manage. One way to handle the increase is by exploring cost-saving options, such as tiered networks or Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs). These options help reduce costs for employers and give employees more control over their healthcare.

It’s also important for employers to anticipate these cost increases early. Proactively reviewing your health plan options and considering alternatives to traditional coverage can help businesses avoid surprise cost hikes and adjust their budgets accordingly.

New Group Health Insurance Plan Designs

Group health insurance plans are getting more flexible. Employers are offering plans that better fit the needs of different employees. These plans may include more options for coverage, mental health services, and telehealth visits.

Preventive care is also becoming more important. By offering coverage for things like screenings and early intervention, businesses can help employees stay healthier and avoid long-term health issues. This also helps keep costs down over time.

Another important consideration for employers is offering a range of plan tiers that allow employees to choose the coverage that fits their needs. With more personalized options, employees can feel more confident in their health plan choice.

Mental Health and Wellness Benefits

Mental health is a big focus for employers. The pandemic has shown just how important it is to take care of employees’ mental health. Many health plans now offer more coverage for therapy and mental health support.

Employers are also introducing wellness programs to keep employees healthy. These programs can include things like stress management, fitness challenges, and virtual mental health resources. Supporting mental health can reduce burnout and improve employee productivity.

Some employers are even providing access to mental health apps or offering wellness coaching. These resources can be just as important as traditional healthcare services in promoting a well-rounded health plan.

The Role of Telehealth in Health Plans

Telehealth has become a popular option for both employers and employees. With telehealth, employees can see a doctor or therapist from home, making it easier to get care without taking time off work.

Expect telehealth to expand throughout 2026. Employers may offer more telehealth services, like virtual doctor visits, mental health support, and even remote physical therapy. This helps employees get care when they need it and saves employers money by reducing in-person visits.

For employees who live in rural areas or have limited access to healthcare, telehealth offers an important lifeline. It provides them with timely medical attention and reduces the need to travel for appointments, which can be especially helpful for those with busy schedules.

How To Manage Group Health Insurance Costs

With the cost of health benefits for employers rising, it’s important to have a strategy in place. Here are some ways you can manage these costs while still offering good benefits to your employees:

1. Evaluate Tiered Networks

Tiered networks offer different levels of care at different prices. By encouraging employees to use in-network providers, employers can reduce healthcare costs.

2. Offer Wellness Incentives

Wellness incentives, such as discounts for employees who take part in health programs, can help lower costs. Programs that encourage employees to stay healthy can also prevent expensive health issues down the road.

3. Use HSAs and HRAs

HSAs and HRAs are smart ways to help employees save money on medical expenses. They also give employers a way to control costs while offering employees more flexibility in how they use their benefits.

4. Benefits Management Software

Using benefits management software can make it easier to track and manage your health plan. It helps reduce administrative costs and makes it easier for employees to access their benefits.

5. Consider Self-Funding

For larger businesses, self-funding health plans can be a good option. This allows employers to take on more risk in exchange for potentially lower overall costs. Self-funded plans also provide greater flexibility in plan design and coverage options.

Preparing for Changes in 2026

Group health insurance will continue to be more flexible and focus on mental health, wellness, and telehealth in 2026. Employers should start thinking about how to adjust their health plans to keep up with these trends. By exploring different plan designs, offering wellness programs, and using HSAs or HRAs, businesses can manage costs and offer better benefits to their employees.

For more information on creating the right health plan for your business, contact Sacket Insurance .

2026 Medicare Open Enrollment Trends in Sonoma County

Mon, 26 Jan 2026 14:46:54 GMT

Summary and Key Takeaways: TL;DR

The 2026 Medicare Open Enrollment season in Sonoma County revealed distinct trends that diverge from national patterns. While Medicare Advantage gained popularity across the U.S., local beneficiaries overwhelmingly favored Medicare Supplement plans. This shift was driven by a strong demand for provider access, fewer network limitations, and more predictable costs.

87% of local enrollees chose Medicare Supplement plans over Advantage.
Prescription drug coverage changes triggered most plan reviews.
Plan exits and provider network shifts forced many to reconsider options.
Access to doctors and hospitals outweighed the appeal of added benefits.
Local data emphasized the growing need for annual Medicare plan reviews.

What Local Enrollment Data Reveals About Medicare Choices in Northern California

Medicare Open Enrollment is often discussed through national headlines and statewide enrollment totals. Those numbers are useful, but they rarely explain what Medicare beneficiaries experience at the local level. Sonoma County offers a clear example of why local data matters.

During the 2026 Medicare Open Enrollment period, Sackett & Associates Insurance Services conducted hundreds of one-on-one Medicare plan reviews with residents across Sonoma County. These reviews provide a grounded view of how people actually make Medicare decisions when faced with plan exits, prescription changes, and shifting provider networks.

To document these trends, Sackett & Associates published the 2026 Northern California Medicare Open Enrollment Annual Report. This blog highlights the key findings and explains what they mean for Medicare beneficiaries in Sonoma County.

The official press release can see seen on at EIN Newswire

Why Sonoma County Medicare Trends Look Different

Most Medicare research focuses on enrollment growth. It tracks how many people enroll in Medicare Advantage or how fast certain plans expand. That approach misses a critical factor: local healthcare structure.

Sonoma County is not dominated by a single integrated health system. Many residents rely on independent doctors, local specialists, and multiple hospital networks. When plans change networks or exit service areas, the impact is immediate and personal.

Because of this structure, Medicare choices in Sonoma County are often driven by access and continuity rather than by premiums or extra benefits.

Medicare Advantage vs Medicare Supplement in 2026

Nationally, Medicare Advantage enrollment now represents more than half of all Medicare beneficiaries. California follows that pattern in many counties, especially urban areas with managed care systems.

Sonoma County did not follow that trend in 2026.

Based on direct enrollment outcomes reviewed during Open Enrollment, the majority of clients selected Medicare Supplement plans rather than Medicare Advantage. Roughly 87 percent enrolled in Medicare Supplement coverage, while only 13 percent chose Medicare Advantage plans.

This difference is not accidental. It reflects repeated concerns raised during Medicare consultations.

People wanted:

Broad access to doctors
Fewer network restrictions
More predictable out-of-pocket costs

Medicare Supplement plans aligned better with those priorities in this region.

Prescription Drug Changes Drove Most Plan Decisions

Prescription drug coverage was the most common reason Medicare beneficiaries reviewed or changed plans during the 2026 enrollment season.

In many cases, premiums remained stable. Drug coverage did not.

People encountered new medications, tier changes, and pharmacy network disruptions that significantly altered their expected costs. Even small formulary changes forced plan comparisons because the financial impact could be substantial.

One notable development during 2026 was a commonly selected Part D plan dropping to a zero-dollar monthly premium. That shift reduced resistance to switching drug plans and encouraged more active review.

This pattern reinforces a key takeaway. Prescription coverage now plays a larger role in Medicare decisions than premiums alone.

Plan Exits Created Forced Enrollment Activity

Another defining feature of the 2026 Open Enrollment period was plan exits.

Many Medicare beneficiaries did not review their coverage because they wanted to. They reviewed it because they had to.

Plans left service areas. Provider groups exited networks. Hospital access changed. These disruptions forced action, even for people who were satisfied with their prior coverage.

Plan exits are becoming more common as carriers adjust risk and refine geographic footprints. For beneficiaries, this means Medicare coverage can change even when health needs do not.

Provider and Hospital Access Remained Central

Across hundreds of Medicare reviews, provider access was one of the most consistent concerns raised.

People asked practical questions.

Will my doctor still accept this plan?
Is my hospital still in network?
Will I need referrals to see specialists?

These concerns mattered more than extra benefits or promotional features. They also help explain why Medicare Supplement plans remained dominant in Sonoma County during 2026.

Access drove confidence. Restrictions created hesitation.

Sonoma County Compared to State and National Trends

When viewed alongside state and national data, Sonoma County stands apart.

At the national level, Medicare Advantage continues to grow. At the local level, Medicare Supplement coverage remained the preferred option for many beneficiaries who value stability and provider choice.

This gap highlights an important lesson. Medicare is not one market. It behaves differently depending on local healthcare structure, provider availability, and carrier behavior.

Local data provides clarity that broad averages cannot.

What the 2026 Data Means for Medicare Beneficiaries

The 2026 Open Enrollment period reinforced one clear message. Medicare is no longer static.

Plans change year to year.
Drug coverage shifts.
Networks contract.

Beneficiaries who reviewed their coverage annually were better positioned to adapt. Those who did not were more likely to encounter surprises.

Annual review is becoming a practical necessity, not a precaution.

About the 2026 Northern California Medicare Open Enrollment Report

This blog highlights key findings from the full 2026 Northern California Medicare Open Enrollment Annual Report.

The complete report includes:

Detailed enrollment mix data
Comparisons to state and national trends
Analysis of plan change drivers
Market stability indicators observed during 2026

The report is based on real enrollment decisions from direct client consultations, not surveys or projections.

Download the Full 2026 Medicare Report

This post covers the highlights.
The full report provides the depth.

If you want a clearer understanding of how Medicare actually functioned in Sonoma County during the 2026 Open Enrollment period, the full report delivers that insight.

Download the 2026 Northern California Medicare Open Enrollment Annual Report

What To Do If You Missed the Medicare Advantage Open Enrollment Period

Mon, 12 Jan 2026 08:00:14 GMT

Summary and Key Takeaways: TL;DR

Missing a Medicare enrollment deadline, whether it’s your Initial Enrollment Period or the annual Open Enrollment, can lead to confusion, gaps in coverage, and potential penalties. Fortunately, there are still options available to adjust your coverage or prepare for the next window. Understanding your eligibility for Special Enrollment Periods and knowing what steps to take next can help you stay protected and avoid costly mistakes.

Initial Enrollment Missed: If you miss your IEP, you may have to wait until the General Enrollment Period and risk penalties or coverage delays.
Open Enrollment Options: Medicare Advantage enrollees can still switch or revert to Original Medicare between January 1 and March 31.
Special Enrollment Periods (SEPs): Life changes like moving or losing employer coverage may qualify you for a SEP to change plans without penalty.
Managing Coverage Gaps: Explore short-term coverage, COBRA, or a spouse’s plan to stay insured while you wait.
Broker Support Matters: A Medicare broker can help clarify rules, avoid penalties, and match you with the right plan for your health needs.

Missed Medicare Enrollment? Here’s What to Do Next

Missing a Medicare enrollment deadline can feel overwhelming, especially when you’re unsure what your next steps should be. Whether you overlooked your Initial Enrollment Period or didn’t make changes during the fall Open Enrollment window, there are still opportunities to secure or adjust your coverage.

When You Miss the Initial or Standard Medicare Enrollment

If you don’t sign up for Medicare when you’re first eligible, or you miss the annual chance to adjust your plan, your next steps depend on the specific period you overlooked.

Missing Your Initial Enrollment Period

Your Initial Enrollment Period (IEP) surrounds your 65th birthday and lasts seven months. Missing it typically pushes you to the General Enrollment Period (GEP), which runs January 1 through March 31 each year. Coverage doesn’t start until July 1, and late-enrollment penalties can apply for both Part A and Part B unless you qualify for a Special Enrollment Period.

You may also face gaps in coverage during the waiting period, which is why many people look for temporary solutions or double-check whether their former employer coverage qualifies them for the 8 month rule for Medicare, a rule that lets you delay Part B without penalties if you had creditable employer insurance.

Missing Medicare’s Annual Open Enrollment

If you were hoping to switch plans but missed the October 15–December 7 window, you still have options. First, the Medicare Advantage Open Enrollment Period (January 1–March 31) allows people already enrolled in Medicare Advantage to switch plans or return to Original Medicare. You may also qualify for a Special Enrollment Period (SEP), which we’ll cover below.

Special Enrollment Periods for Qualifying Life Circumstances

Special Enrollment Periods (SEPs) exist for people whose coverage needs to change due to specific life circumstances. These are often the best option for correcting Medicare open enrollment mistakes without waiting for the next annual window.

Common Reasons You May Qualify for an SEP

You may be eligible if:

● You move out of your plan’s service area

● You lose employer or union coverage

● You gain or lose Medicaid

● Your plan shuts down or no longer contracts with Medicare

Depending on the situation, you generally get two months to make updates. During an SEP, you can join a Medicare Advantage plan, switch plans, enroll in drug coverage, or adjust coverage while avoiding penalties that might apply during the GEP.

What Coverage Looks Like When You Miss Enrollment

If you miss your IEP and must enroll during the GEP, you may experience a gap in coverage until July 1. This can leave people exposed to high medical bills, especially if they rely on regular doctor visits or prescription medications.

People waiting for their coverage to begin often consider:

● Short-term health coverage

● COBRA or retiree benefits

● Relying temporarily on a spouse’s employer plan

If you are already enrolled in Medicare but missed the fall enrollment window to make changes, you’ll simply remain on your current plan until your next opportunity to switch. During this time, review benefits carefully to avoid surprises at the pharmacy or doctor’s office.

This is also a good moment to evaluate whether updating Medigap coverage or reassessing supplemental needs makes sense once eligible to change.

What To Do While Waiting for Your Next Enrollment Window

Even if you’re outside the main enrollment windows, you still have meaningful choices. To make the most informed decisions, consider the following steps.

Review Your Current Needs

Health needs can shift from year to year. New prescriptions, recent diagnoses, or more frequent doctor visits may require different coverage. Reviewing these details helps you narrow down options when selecting a Medicare plan .

Compare Plan Types

You may need to assess:

● Medicare Advantage plans

● Medigap plans

● Standalone Part D drug plans

Look at cost structures, provider networks, out-of-pocket limits, and any extra benefits that matter to you. Even if you can’t change today, understanding your options prepares you for your next eligible enrollment window.

Watch for the Next Enrollment Period

Mark your calendar. Set reminders. Missing one deadline is common, but missing future chances can lead to larger penalties or long-term coverage gaps.

Why Working With a Medicare Broker Makes a Difference

Medicare rules are layered, and even small misunderstandings can lead to expensive missteps. This is where a knowledgeable broker becomes invaluable.

A seasoned broker can help you:

● Confirm whether you qualify for an SEP

● Understand how the 8-month rule for Medicare applies to your situation

● Evaluate whether updating Medigap coverage is timely or advisable

● Compare multiple carriers and plans side-by-side

● Estimate long-term costs based on medication lists and health history

● Avoid repeating Medicare open enrollment mistakes

● Clarify deadlines so you always have the information you need about open enrollment

More importantly, brokers act as your year-round resource—not just at renewal time. They can explain coverage gaps, help you choose between Advantage and Medigap, and ensure you aren’t overpaying for benefits you don’t use.

Staying Confident and Covered With Sackett Insurance

Missing an enrollment deadline is frustrating, but it doesn’t mean you’re stuck. Whether you qualify for a Special Enrollment Period, need to wait for the next open window, or simply need clarification on rules like the 8 month rule for Medicare, the key is to take action quickly and understand your available pathways.

Don't risk making costly mistakes with your Medicare coverage. Work with a trusted broker at Sackett Insurance to secure the right plan, avoid delays, and navigate plan changes with ease. Contact us today for expert guidance and ensure your decisions meet your long-term health needs.

Preparing for 2026 ACA Subsidy Changes After Expiration of Temporary Tax Credits

Thu, 08 Jan 2026 19:45:02 GMT

Summary and Key Takeaways: TL;DR

In 2026, Californians who receive ACA health insurance subsidies through Covered California may face higher premiums due to the expiration of temporary federal tax credits. These changes will most impact middle-income households who previously qualified for expanded financial help under the Inflation Reduction Act. Understanding how your income aligns with the returning subsidy rules and reevaluating your coverage options can help you stay prepared.

Subsidy Rollback in 2026 : Temporary ACA tax credits end after 2025, restoring pre-pandemic eligibility limits and reducing aid for many.
Middle-Income Households Most Affected : Those earning just above 400% of the Federal Poverty Level may see the steepest premium increases.
Premiums Rising Across the Board : Health insurers project 10–25% increases, compounding the effect of subsidy losses.
Plan Ahead With Income Estimates : Early income planning and coverage review can help avoid surprises during open enrollment.
Explore Alternatives With a Broker : Licensed brokers can help you compare on- and off-exchange plans that align with the new financial landscape

ACA Subsidy Expiration: How Californians Can Prepare for 2026

Many Californians who rely on Covered California for affordable health insurance will face meaningful changes in 2026. With temporary federal aid ending, households that have benefited from expanded ACA subsidies may see higher monthly costs, especially those earning slightly above the returning eligibility limits.

This guide breaks down how expiring tax credits may drive premium changes , which income ranges could feel the biggest impact, and what steps you can take now to protect your budget.

Why ACA Tax Credits Will Shift in 2026

During the pandemic, the Inflation Reduction Act expanded financial help for marketplace consumers. For the first time, many middle-income Californians received subsidies even if they earned above the usual cutoff. This temporary boost lowered premiums for thousands of people, particularly families and self-employed individuals who often shoulder high health coverage costs.

However, these enhancements only applied through 2025. When the law sunsets, Covered California returns to the original structure: subsidies generally phase out above 400% of the Federal Poverty Level, or about $124,800 for a family of four based on current guidelines. As a result, many households that recently qualified for assistance will no longer meet the threshold starting in 2026.

These earlier subsidy expansions helped stabilize marketplace enrollment trends , so their expiration will likely influence how consumers shop next year.

What Health Insurance Premium Increases May Look Like

Although every household will experience the change differently, the biggest increases are expected among people whose incomes sit just above the returning eligibility cap. Temporary financial help pushed their premiums lower than ever before, so losing those credits creates a sharper jump. These are the households most likely to see larger premium increases:

Single adults earning roughly $60,000–$90,000
Couples earning around $100,000–$150,000
Families of four earning about $130,000–$170,000

Many households in these ranges received moderate or even significant subsidies under the temporary rules but will no longer qualify when the original ACA structure returns. A family that currently pays about $1,000 per month could see premiums rise to $1,500 or more once the credits expire.

This situation is heightened by projected statewide rate increases. Insurers expect premium adjustments of roughly 10–25% depending on the carrier and region. That means households may face two cost pressures at the same time: the loss of enhanced subsidies and higher base premiums.

Why Premiums Are Rising Beyond Subsidy Changes

Even without the tax credit adjustments, health insurance costs in California are trending upward. Carriers are responding to rising medical expenses, prescription drug pricing, and higher care utilization. These system-wide pressures affect plans on and off the marketplace.

For consumers, this means that premium increases are likely no matter what—though the amount varies by plan, metal tier, and county. Combined with the subsidy sunset, 2026 could mark one of the most significant year-to-year cost shifts since Covered California launched.

How To Prepare for the 2026 Marketplace

Planning ahead will help you manage costs more effectively and avoid last-minute surprises. These three actions can make the biggest difference.

1. Estimate Your 2026 Income Now

Your projected income determines your eligibility for financial help, so review your expected earnings early. Consider any changes such as raises, commission shifts, job transitions, retirement planning, or additions to household size. Since subsidies revert to stricter limits, updating your income accurately becomes even more important.

2. Reevaluate Your Coverage and Compare Plans

Start exploring plan options well before open enrollment. A plan that worked under expanded subsidies may no longer be the best fit once pricing adjusts. Look closely at your care usage, prescription needs, provider preferences, and metal tier. You may find opportunities to save by adjusting networks or cost-sharing levels.

A few tips for picking a plan include:

Reviewing whether your preferred doctors remain in-network
Checking how each plan handles your medications
Comparing deductibles and copays to see how they match your typical care patterns

These small details can significantly affect your 2026 costs.

3. Talk With a Broker About Alternative Coverage

A knowledgeable broker can help you compare on-exchange and off-exchange options, determine whether you still qualify for subsidies, and identify plans that offer better value under the new pricing structure. If you lose eligibility for ACA tax credits entirely, off-exchange plans may sometimes provide competitive alternatives.

This conversation can also help you think through whether pairing a lower-premium plan with savings strategies like HSAs or flexible networks makes sense for your situation.

Two Checkpoints To Stay Ahead of 2026 ACA Subsidy Changes

Before the 2026 changes arrive, it helps to focus on two key checkpoints:

Confirm your income relative to the returning subsidy rules. Knowing whether you’ll clear or fall above the 400% FPL line gives you a realistic picture of what to expect.
Reassess your care needs. Coverage should match your current health, not last year’s routine. If your medical usage has changed, a different metal tier or carrier could better support your budget.

Position Yourself for a Smoother 2026 With Help From Sackett Insurance

As expanded ACA tax credits expire, many Californians will face noticeable premium increases. The combination of returning eligibility limits and insurer rate adjustments makes 2026 an important year to reassess your coverage.

If you're feeling overwhelmed by your options, Sackett Insurance is here to help. Our expert brokers will assist you in comparing plans, understanding how the changes may impact your budget, and exploring both on- and off-exchange options. Reach out today for personalized guidance to make the best choice for your coverage needs.

Missed Medicare’s Fall Deadline? Here’s What You Can Still Do

Tue, 23 Dec 2025 02:00:06 GMT

Missed Medicare Enrollment? Here’s What You Can Do Next

If you missed the Medicare open enrollment or Annual Election Period (AEP), don’t panic. While the window from October 15 through December 7 is the main opportunity to adjust your coverage for the next year, there are still ways to make changes.

What AEP Covers

During the Annual Election Period, Medicare beneficiaries can:

Switch from Original Medicare (Parts A and B) to a Medicare Advantage (Part C) plan.
Move from a Medicare Advantage plan back to Original Medicare.
Change or join a Part D prescription drug plan.
Switch from one Medicare Advantage or Part D plan to another.

If no action is taken by December 7, your coverage automatically renews for the next year. That means you’ll stay in the same plan you had, including the same premiums, deductibles, and provider networks, even if those costs or networks change.

If you realize after December 7 that your plan isn’t a good fit, the good news is that Medicare gives you another chance early in the year, but only if you’re enrolled in Medicare Advantage.

Medicare Advantage Open Enrollment

From January 1 through March 31, the Medicare Advantage Open Enrollment Period allows individuals already enrolled in a Medicare Advantage (MA) plan to make certain changes, such as:

Switch to another Medicare Advantage plan that better matches your healthcare needs, preferred doctors, or prescription coverage.
Drop your MA plan and return to Original Medicare. If you make this change, you can also join a stand-alone Part D prescription drug plan.

You can make only one change during this period. Once you select a new Medicare plan , the new coverage will start the first day of the month after your request is received. For example, if you switch to a new plan on February 10, your new coverage begins March 1.

When Special Enrollment Periods (SEPs) Apply

A Special Enrollment Period (SEP) allows you to make changes to your Medicare coverage outside the regular enrollment windows. These are some common situations that trigger an SEP.

1. You Move to a New Location

If you relocate outside your plan’s service area, or even within the same area but where new plan options exist, you can change to a new Medicare Advantage or Part D plan.

You typically have two months from the date you move to make a new selection.

2. You Lose Other Health Coverage

Losing employer or union coverage, Medicaid eligibility, or other “creditable” coverage gives you an SEP to find a new Medicare plan.

The timing depends on when your other coverage ends, but it usually lasts for two months after the loss.

3. Your Plan Changes Its Contract With Medicare

If your current Medicare Advantage or Part D plan leaves Medicare or stops operating in your area, you’ll have an SEP to switch to a new plan.

This period usually begins two months before your coverage ends and continues one month after it ends.

4. You Qualify for Another Type of Coverage

Joining a program such as TRICARE, the Veterans Health Administration (VA), or a PACE plan (Program of All-Inclusive Care for the Elderly) opens a special window to make changes.

5. Exceptional Circumstances

Events beyond your control, like being affected by a natural disaster, serious illness, incarceration, or an administrative error by Medicare or your health plan, may qualify for an SEP.

Disaster-Related Extensions and Caregiver Considerations

If you or your caregiver lives in or moves from a FEMA-declared disaster area, you may be eligible for additional time to adjust your coverage. These SEPs are not automatic. You must contact Medicare and explain your situation.

Timelines and What To Expect After You Make a Change

Once you make a change during the Medicare Advantage OEP or an SEP, your new plan typically starts on the first day of the following month. For example, if you enroll in a new plan in March, your coverage begins on April 1. You’ll receive a new membership card and plan materials once your enrollment is processed.

It’s important to keep using your current plan until the effective date of your new one to avoid coverage gaps. If you’re switching back to Original Medicare, consider adding Medigap (Medicare Supplement Insurance) to help cover out-of-pocket costs.

If You Don’t Qualify for a Special Enrollment Period

If none of the Special Enrollment Period (SEP) circumstances apply to you and you’re not eligible to make changes right now, you won’t be able to switch or update your Marketplace health plan until the next Open Enrollment Period. Your current coverage will stay in place automatically, so your healthcare access continues without interruption.

Get Ready for Future Enrollment With a Guided Medicare Review

Even if you’re not eligible for changes right now, reviewing your plan annually can help you prepare for future enrollment periods. Coverage details, drug formularies, and provider networks often shift from year to year, sometimes subtly, sometimes significantly.

By sitting down with a licensed Medicare specialist, you can compare current plans to identify potential savings or improved coverage, learn whether you qualify for any ongoing assistance programs, and get personalized guidance if your health needs or financial situation change midyear.

Your healthcare needs deserve the right coverage and the right timing. Reach out to Sackett & Associates to set up your personalized review and make sure your Medicare works as well for you as it can.

Congress Ends Shutdown Without Renewing ACA Subsidies

Mon, 15 Dec 2025 22:30:02 GMT

ACA Tax Credits Set to Expire: What Californians Face

When lawmakers reached an agreement in November 2025 to end the federal government shutdown, they restored funding for key health programs through January 2026. One major issue was not included in the deal: an extension of the enhanced Affordable Care Act premium tax credits.

These expanded credits remain scheduled to expire at the end of 2025. Without action from Congress, roughly 1.7 million Californians enrolled through Covered California will see higher premiums in 2026. Covered California and national analysts expect sharp price increases once the enhanced assistance ends, raising the risk that many residents could lose coverage or switch to less protective plans.

Why ACA Tax Credits Matter

Premium tax credits lower monthly coverage costs based on income and household size. Before 2021, eligibility ended at 400 percent of the federal poverty level.

The American Rescue Plan changed that rule by increasing the size of the credits and allowing higher-income households to qualify. The Inflation Reduction Act extended those improvements through 2025.

These changes capped what families pay for benchmark plans and removed the steep subsidy cutoff that affected many middle-income earners.

For Californians, the effect has been significant. Research from KFF shows that the enhanced credits lowered monthly premiums by hundreds of dollars for many households. If the enhanced credits expire, premiums could rise as much as 97 percent for some Californians, with an estimated 400,000 individuals at risk of losing coverage.

The Impact on Insurance Premiums if Congress Doesn’t Act

Unless Congress renews the enhanced credits, they will expire at the start of 2026. Covered California projects substantial premium increases across income levels if that happens.

Households slightly above the 400 percent federal poverty level would lose all assistance, since their eligibility came from the temporary expansions.

A drop in enrollment could follow. If healthier members leave due to higher prices, insurers may face a smaller, higher-risk pool. That shift could lead to additional rate increases, reversing progress made in lowering the uninsured rate and stabilizing premiums.

Steps Covered California Enrollees Can Take

While the enhanced credits remain in place for 2025, consumers can start planning now in case Congress does not renew them.

Review income and household size

Estimate your 2026 income early. Even small changes can affect subsidy eligibility. Covered California lets you update income details at any time.

Estimate future premiums

Tools from KFF and Covered California can help you see what coverage may cost without the enhanced credits.

Speak with a certified broker or navigator

Licensed brokers can compare plans, explain premium changes, and help identify lower-cost options if support decreases. Early guidance helps avoid surprises during open enrollment.

Understanding your likely subsidy situation now will give you more control when selecting coverage for 2026.

Broader Policy Context

The funding bill President Trump signed in November extended several health programs, including Medicare telehealth flexibility and support for community health centers. The decision did not include an extension of the enhanced ACA subsidies.

Senate leaders scheduled votes on extending the tax credits, but the proposals did not pass. The House has not committed to a vote. A group of House Democrats is pursuing a discharge petition, which would require a small number of Republican members to succeed.

If Congress does not act before January, consumers will face the old subsidy rules as open enrollment approaches. That timing could lead to confusion and make it harder for families to estimate their 2026 health insurance costs.

How Enhanced ACA Subsidies Improved Access

The enhanced credits under the American Rescue Plan and the Inflation Reduction Act improved affordability in several ways:

They capped premiums as a share of income
They expanded eligibility beyond 400 percent of the federal poverty level
They helped Covered California reach record enrollment levels
They supported the lowest uninsured rate in state history

These improvements contributed to a more stable and accessible marketplace. Losing them would have the greatest impact on working families who rely on predictable premium costs.

Potential Impacts of Expiring Enhanced Premium Tax Credits in 2026

A family of four earning around 90,000 dollars could see premiums rise by several hundred dollars per month without the enhanced credits. Some may move to plans with higher deductibles, while others may drop coverage.

Rising uninsured rates could increase uncompensated care costs for hospitals and clinics. California’s progress toward broader coverage may slow or reverse.

Covered California plans to increase outreach and education, but state programs cannot fully replace federal support.

How Californians Can Prepare for Possible Changes to ACA Subsidies

As Congress continues to debate the future of the enhanced credits, Californians may face uncertainty about 2026 health insurance costs. Reviewing income, comparing options, and planning ahead can help you stay protected.

At Sackett & Associates, our independent brokers are ready to help you understand your choices and find coverage that meets your needs. If you want to see how potential changes could affect your plan or need help preparing for next year, contact us for personal guidance.

Medicare Open Enrollment Tips for California Seniors - 2025 Edition

Thu, 20 Nov 2025 22:15:02 GMT

Medicare 2025: Tips for California Seniors

Now that Medicare Open Enrollment has started, it’s the perfect time for California residents aged 65 and older to review their healthcare coverage. The decisions you make now can impact your access to healthcare services and your monthly costs for the upcoming year.

What California Seniors Need To Know for Medicare Open Enrollment

To help guide you through the process, here are some essential tips for making the most of Medicare Open Enrollment.

1. Review Your Current Medicare Coverage

Before making any changes, assess your existing Medicare plan. Medicare is divided into several parts:

Part A covers inpatient care, such as hospital stays and skilled nursing.
Part B covers outpatient services, including doctor visits and preventive care.
Part C (Medicare Advantage) combines Parts A and B and often includes additional benefits like prescription drug coverage, dental, and vision.
Part D covers prescription drugs.

Ensure your current plan still meets your healthcare needs and budget. If you're satisfied with your current coverage, you may choose to keep it; however, it's essential to verify that there are no significant changes in premiums, coverage, or provider networks for 2025.

2. Understand Prescription Drug Coverage Options

In California, seniors have the option to choose from 12 different Medicare Part D prescription drug plans. Each plan varies in terms of the medications covered, monthly premiums, and out-of-pocket costs. Review the formulary of each plan to ensure that your prescriptions are covered at an affordable cost.

Additionally, California seniors with low income may qualify for Extra Help, a program that assists with Part D premiums and out-of-pocket costs. You can apply for this through the Social Security Administration.

In 2025, Medicare will eliminate the "donut hole" coverage gap for prescription drugs, reducing out-of-pocket expenses. Additionally, there will be a cap on how much beneficiaries pay for prescription medications annually. Be sure to consider these changes when selecting a Part D plan.

3. Check If Your Doctors Are In-Network

If you're considering a Medicare Advantage plan, verify that your current healthcare providers are within the plan's network. Plans like Kaiser Permanente have a closed network, meaning you'll need to use their doctors and facilities. Other plans may offer broader networks but could have higher out-of-pocket costs for out-of-network care.

4. Compare Local Medicare Advantage Plans

California offers Medicare Advantage (Part C) plans in many regions, including:

Kaiser Permanente Senior Advantage: Known for comprehensive coverage and a large network of providers, available in many parts of California but primarily concentrated in Northern and Southern California.
Alignment Health: Offers PPO plans with flexibility in choosing healthcare providers, available in select counties across California.
Aetna Medicare: Provides various plan options with additional benefits, available in many regions of California.

Additionally, be sure to review specific regions and coverage options through the marketplace enrollment process or local brokers, as plan offerings can change year to year.

5. Consider Additional Benefits

Many Medicare Advantage plans offer extra benefits, such as:

Dental and Vision Coverage: Routine dental and eye exams, glasses, and hearing aids.
Fitness Programs: Access to gym memberships or wellness programs.
Transportation Services: Rides to medical appointments.

For California residents, Medi-Cal (California’s Medicaid program) can help cover additional costs for seniors, including dental, vision, and even long-term care. If you qualify for both Medicare and Medi-Cal, you are considered "dual eligible" and may have coverage for services that Medicare doesn't pay for, like long-term care and certain medications.

6. Seek Assistance From Medicare Brokers in California

A Medicare broker like Sackett & Associates Insurance Services can be a valuable resource when choosing the right plan. These professionals are experts in the various Medicare options available in California and can help you identify which plans best suit your healthcare needs and budget.

They assist you in comparing different plans, which makes it easier for you to evaluate the premiums, coverage details, and benefits of each option. With their personalized support, you’ll have a better understanding of how each plan works, helping you make an informed decision.

7. Be Aware of Key Enrollment Dates

One of the most important aspects of Medicare Open Enrollment is ensuring you don’t miss the deadlines. For 2025, the Open Enrollment period runs from October 15 to December 7. During this window, you can:

Switch from Original Medicare to a Medicare Advantage plan.
Change from one Medicare Advantage plan to another.
Join, switch, or drop a Part D prescription drug plan.

Any changes made during this period will take effect on January 1, 2026. Missing the Open Enrollment window means you'll have to wait until the next year to make adjustments, unless you qualify for a Special Enrollment Period. Set a reminder and review your options early to ensure you don't miss out on any important Medicare changes .

8. Know Your Enrollment Eligibility Periods

In addition to Open Enrollment, there are other important enrollment periods in the Medicare system:

Initial Enrollment Period: If you're turning 65, you can sign up for Medicare during a 7-month window—three months before your 65th birthday, the month of your birthday, and three months after.
Medicare Advantage OEP: If you're already enrolled in a Medicare Advantage plan, you can make changes to your coverage between January 1 and March 31 each year.
Medigap OEP: If you’re planning to add a Medigap policy, you have a six-month window after turning 65 to apply for Medigap coverage without underwriting.

Understanding these periods ensures you don't miss out on important opportunities to enroll or make changes to your coverage.

Helping California Seniors Find the Right Medicare Plan

At Sackett & Associates Insurance Services, our knowledgeable insurance brokers are here to simplify the Medicare Open Enrollment process and guide seniors in Sonoma County every step of the way. Whether you’re new to Medicare or reviewing your current plan, we’re dedicated to finding the solution that best fits your unique circumstances. Open Enrollment ends soon, so contact our knowledgeable Medicare insurance brokers today.

Medicare Open Enrollment 2025 Checklist: What To Do Before December 7

Mon, 10 Nov 2025 18:30:01 GMT

Your 2025 Medicare Checklist: What to Do by Dec. 7

Medicare Open Enrollment runs from October 15 to December 7, 2025. If you're already enrolled in Medicare, the Open Enrollment period is the time to review and make changes to your current coverage. For those who are turning 65 soon or have recently become eligible, this is also when you can sign up for Medicare if you haven’t already. Medicare changes made during this period take effect on January 1, 2026.

Step-by-Step Medicare Open Enrollment 2025 Checklist

Use this Medicare checklist to ensure you're fully prepared for the 2025 Open Enrollment.

1. Review Your Annual Notice of Change

Each fall, your Medicare plan sends an Annual Notice of Change (ANOC) detailing any modifications to your coverage, including changes in premiums, deductibles, co-pays, and the drug formulary. Read this document carefully to understand how these changes may impact your healthcare costs and access. Failing to review the ANOC can lead to unexpected expenses or disruptions in care.

2. Check for Other Changes in Medicare Benefits

Medicare can update its rules, benefits, and cost-sharing structures each year. Look for announcements regarding changes to preventive services, coverage for hearing, vision, and dental care, as well as any modifications to out-of-pocket spending limits. Staying updated ensures you can make informed decisions based on new benefits or restrictions.

3. Assess Your Prescription Drug Coverage

Even if you're satisfied with your current plan, verify that your medications are still covered and that your plan remains the most cost-effective option. Medicare Part D plans can change their formularies annually, and a plan that was suitable last year may no longer be the best choice.

4. Confirm Your Providers Are in Network

If you're enrolled in a Medicare Advantage plan, check that your preferred doctors, hospitals, and pharmacies are included in the plan's network for 2026. Network changes can affect your out-of-pocket costs and access to care.

5. Compare Medicare Advantage and Part D Plans

Even if you're content with your current plan, it's wise to compare it with other available options during Medicare Open Enrollment . Plans can change their benefits, costs, and coverage areas annually. By comparing plans, you might find one that better suits your needs or offers savings.

6. Make Sure You Have the Correct Coverage Type

Medicare offers different coverage types: Original Medicare (Parts A and B), Medicare Advantage (Part C), and Medicare Prescription Drug Plans (Part D). Verify if your current coverage is still the right fit for your needs. If you are enrolled in Original Medicare but require additional coverage, such as dental or vision, consider switching to a Medicare Advantage plan or adding supplemental coverage ( Medigap ).

7. Review Your Plan’s Star Rating

Medicare evaluates Medicare Advantage and Part D plans on a 5-star scale, based on quality and performance. A higher rating generally indicates a better-quality plan. Check the star rating of your current plan, as well as other available plans, to ensure you are receiving high-quality care and service.

8. Consult a Medicare Insurance Broker

Medicare options can be overwhelming at times. Consulting a licensed Medicare broker like Sackett & Associates can offer personalized help in choosing the best plan for your needs. They can explain plan details, compare different options, and ensure you make the best choice.

9. Review Your Healthcare Needs

Think ahead about what you may need in the coming year. For example, if you're planning surgery or starting a new treatment, review the coverage options available to ensure you won’t face unexpected out-of-pocket costs.

10. Be Aware of the Late Enrollment Penalty

If you miss the December 7 deadline and need to make changes after that, you may be subject to late enrollment penalties. It's important to act before December 7 to avoid additional costs in your premiums, especially for Medicare Part D or if you delayed enrolling in Part B. If you miss the deadline and don't qualify for a Special Enrollment Period, you may have to wait until the next Medicare Open Enrollment period.

11. Keep Track of Any Special Enrollment Periods

In certain situations, such as moving to a new location, losing employer coverage, or having a qualifying life event (like a change in marital status), you may be eligible for a Special Enrollment Period. If you believe you qualify for an SEP, contact Medicare directly to learn more and see if you can make changes to your coverage outside of the regular open enrollment period.

Partner With a Trusted Medicare Insurance Broker During Open Enrollment

Choosing the right Medicare plan can be confusing, but Sackett & Associates is here to assist you throughout the process. As an unbiased insurance broker, we offer expert advice tailored to your unique healthcare needs. Our team can help you understand your options, review your Annual Notice of Change, compare Medicare Advantage plans, and ensure your prescription drug coverage is up-to-date.

We specialize in helping local seniors in Sonoma County select the best Medicare coverage for the upcoming year. Our brokers will guide you through every step, answer all your questions, and make sure you meet the December 7 deadline without stress.

Don’t go through Open Enrollment alone. Contact the trusted Medicare insurance brokers at Sackett & Associates Insurance Services today for personalized support.

Covered California 2026: What You Need to Know About Premium Changes & Financial Help Before Open Enrollment

Mon, 20 Oct 2025 16:30:01 GMT

Covered California 2026: Premium Increases & Subsidy Updates

Planning for health insurance can feel overwhelming, especially when the rules, costs, and assistance programs seem to change each year. For many Californians, the decisions made during open enrollment affect not only monthly budgets but also access to doctors, prescriptions, and other essential care. As 2026 approaches, understanding how Covered California works and what may influence your premiums will be key to making confident choices.

Upcoming Changes to Premiums Under Covered California

Premiums are expected to climb in 2026 for several reasons. Rising prescription drug costs, higher medical expenses, and shifts in the insurance risk pool all contribute to the increase. On average, enrollees will see their monthly costs grow by 10.3%.

For most Californians, these changes will not go unnoticed. While Covered California’s average increase remains lower than national projections, the gap between healthcare expenses and what families can reasonably afford is widening. If left unaddressed, these rising costs could impact care decisions, financial stability, and long-term planning for many households.

The Impact of Federal Subsidy Changes

One of the biggest uncertainties for 2026 is the status of the Enhanced Premium Tax Credits, introduced in 2021 to lower premiums for millions of Americans. Unless Congress takes action, these expanded subsidies will expire, leaving many Californians to shoulder more of the cost themselves.

Without the enhanced credits, an enrollee’s monthly payment could rise sharply, in some cases by more than 60 percent. For Covered California, that means the affordability safety net many families have relied on could shrink overnight. The state plans to provide limited financial help, but it will not fully cover the shortfall left by the loss of federal aid.

For consumers, this shift highlights the need to review personal finances and insurance options ahead of open enrollment . Even small changes in household income or eligibility could affect whether you qualify for assistance.

Actions For Individuals to Take

If you are shopping for individual coverage in 2026, it helps to approach the process with a checklist in hand.

Review Income: Subsidies are tied directly to income. Double-check your expected 2026 earnings and update your information to avoid surprises when calculating financial help for health insurance in California.
Consider Needs: Think about your healthcare usage. Do you require ongoing prescriptions, dental care, or specialized equipment like glucose monitors? Understanding your needs ensures your plan provides appropriate coverage.
Compare Plans: Do not automatically stick with your current plan. Review what is available, compare networks and drug formularies, and weigh the cost of premiums against deductibles and out-of-pocket limits.

Taking these steps now can make the difference between paying for coverage that does not meet your needs and securing a plan that fits both your health and your budget.

Actions for Families to Take

Families face additional challenges in selecting the right coverage, since multiple people’s needs must be considered.

Consider Household Income: Look at the combined income of all working household members. This number determines eligibility for subsidies and can shift your overall costs significantly.
Update Household Info: Make sure your Covered California profile reflects current information such as dependents, marital status, or new employment. Outdated details can affect both eligibility and premium assistance.
Compare Plans Together: Family coverage often involves trade-offs. A plan that looks cost-effective for one adult might not adequately cover a child’s medical or dental needs. Reviewing options as a household helps balance everyone’s requirements .

Ultimately, protecting your family’s health and financial security means taking time to evaluate coverage thoroughly.

How an Insurance Broker Can Help

Sorting through health insurance options is not always straightforward. With premiums rising and subsidy rules in flux, it is easy to feel overwhelmed. An insurance broker can provide clarity by helping you evaluate multiple plans, explain the financial implications of each option, and guide you toward coverage that works for your situation.

Preparing Now for 2026

The health insurance landscape is shifting, and Covered California 2026 premiums reflect broader pressures across the healthcare system. With the potential expiration of enhanced federal aid, many households will feel the financial impact more acutely.

Choosing the right health insurance plan doesn’t need to be stressful. Let Sackett Insurance guide you through the options and simplify the process. Our team is here to help you compare plans, understand your eligibility for financial assistance, and find coverage that fits your needs. Contact us today to get started before open enrollment begins.

5 Medicare Open Enrollment Mistakes That Could Cost You — And How to Avoid Them

Thu, 16 Oct 2025 18:45:00 GMT

Top 5 Medicare Open Enrollment Mistakes to Avoid

Each year, Medicare gives you a window of time to review your coverage and make changes. This period, called the Annual Enrollment Period (AEP), runs from October 15 through December 7. During this time, you can switch Medicare Advantage plans, join a new prescription drug plan, or return to Original Medicare.

What Are the Top Mistakes to Avoid During Open Enrollment?

To make the most of Medicare’s Annual Enrollment Period, it helps to be aware of the common missteps people make. Knowing which mistakes to avoid gives you a better chance of choosing coverage that truly matches your health and financial needs. With careful planning, you can enter the new year confident that your Medicare plan is working for you.

1. Not Reading the Annual Notice of Change

Each fall, your plan will send you a document called the Annual Notice of Change, often referred to as the ANOC. It lists updates to your plan’s costs, benefits, and covered medications for the next year. Skipping over this letter may not seem like a big deal, but it can lead to unpleasant surprises such as higher copays or changes in drug coverage once January arrives.

Taking time to review your ANOC gives you the chance to compare your current plan with others available in your area. If your plan no longer fits your budget or your health needs, you will know it is time to make a switch before the enrollment window closes.

2. Assuming Your Prescription Needs Will Stay Consistent

Your health can change from year to year, and so can your prescription needs. Even if you do not currently take many medications, that does not mean you will not need them in the future. Prescription drug lists, also called formularies, shift annually. A medication covered this year may not be covered next year, or it may come with higher out-of-pocket costs.

Reviewing your prescriptions against your plan’s formulary helps you prepare for possible expenses. This is especially important as you age, since medical needs are more likely to evolve over time.

3. Ignoring Provider Network Changes

Another easy mistake is overlooking changes to your provider network. Medicare Advantage plans in particular rely on networks of doctors, specialists, and hospitals. If your doctor or preferred hospital leaves the network, you may face much higher costs or lose access to them altogether.

In California, where provider networks can vary widely between counties, checking this detail is essential. Before open enrollment ends, confirm that your doctors, specialists, and facilities are still included in your plan’s network so you are not caught off guard later.

4. Letting Deadlines Pass

The Annual Enrollment Period may last nearly two months, but waiting until the last week or the last day can backfire. With so many options to review, decisions made at the last minute are often rushed, and missed deadlines mean you are stuck with your current coverage for another year.

To avoid stress, mark your calendar early and give yourself time to compare plans. In California, just like elsewhere, if you miss the December 7 deadline, your next opportunity will not come until the following year unless you qualify for a Special Enrollment Period due to certain life events.

5. Misunderstanding Medigap Rules

Medigap , also called Medicare Supplement Insurance, helps cover costs that Original Medicare does not, including copayments, coinsurance, and deductibles. The rules around Medigap can be confusing. Unlike Medicare Advantage or Part D, Medigap does not follow the same open enrollment timelines.

In California, beneficiaries benefit from what is known as the birthday rule. This allows you to switch to another Medigap plan of equal or lesser benefits within 60 days of your birthday without medical underwriting. Missing this window, or misunderstanding the rules, could mean fewer options and higher costs..

Let an Insurance Broker Help You Be Successful During Open Enrollment.

Sorting through Medicare option s is not always simple. From understanding plan changes to meeting strict deadlines, it is easy to feel overwhelmed. An insurance broker can guide you through plan comparisons, explain how changes affect your coverage and budget, and make sure you stay on top of enrollment deadlines.

Instead of spending hours agonizing over these rules, let us help. Our team at Sackett Insurance is ready to be your health insurance broker. For more information, do not hesitate to contact us so we can help you get the coverage and support you deserve.

What Is Employer Group Health Insurance? A Complete Guide for Businesses

Mon, 22 Sep 2025 17:00:03 GMT

How Group Health Insurance Helps Small Business Teams Thrive

If you run a small business, you’ve probably wondered whether offering health benefits is worth it. You know it could help you attract great employees and keep your team happy, but figuring out where to start may feel overwhelming. Employer group health insurance is one of the most common and effective ways to provide health coverage for your employees.

What Is Employer Group Health Insurance?

Employer group health insurance is a type of health coverage offered by a business to its employees as part of their benefits package. Instead of each employee buying their own individual plan, everyone in the company is pooled into one plan, which often makes coverage more affordable and comprehensive.

Imagine you run a local bakery with six employees. Instead of everyone trying to shop for their own health insurance, you decide to provide a group plan. Your team can now access lower-cost health coverage through your business, while you gain the reputation of being a thoughtful, supportive employer.

How Does Employer Group Health Insurance Work?

It’s completely normal to feel confused about how group health insurance actually works. Luckily, the basics are straightforward once you break them down.

Eligibility Requirements

To qualify for employer group health benefits , a business generally needs to meet a few key standards. Most insurers require at least two employees, with one being a full-time worker who is not related to the owner. The company must also be legally recognized as a business entity. In addition, a minimum percentage of eligible employees must agree to enroll in the plan for it to take effect. Employers are usually expected to contribute toward the monthly premiums, helping make coverage more affordable for their team.

Typical Coverage Options

Employer group health insurance typically covers the essentials employees rely on, including visits to in-network doctors, prescription medications, and treatments such as physical therapy.

Preventive care and hospital services are also standard features of most plans. Depending on the options you select, you may be able to offer additional benefits such as dental and vision coverage. You may also be able to add a Health Savings Account (HSA) that allows employees to set aside pre-tax dollars for medical expenses.

Costs for Employees and Employees

Group plans are typically more affordable than individual policies because costs are spread across a larger group. Employers help shoulder the expense by paying part of the premiums, while employees cover the rest.

The good news? As a small business owner, you may qualify for tax breaks when you offer health benefits. That helps offset your costs while still making coverage more accessible for your team.

Insurance Brokers

Choosing the right plan can feel like navigating a maze. This is where insurance brokers step in. A broker acts as your advisor, comparing plans, negotiating rates, and ensuring your coverage meets both your budget and your employees’ needs.

Instead of spending hours researching, you can lean on a broker’s expertise to guide you through the process and manage the ongoing relationship with the insurer.

What Are the Advantages for Small Businesses That Offer Health Benefits?

When you offer health benefits, you’re not just supporting your employees; you’re also strengthening your business. Both employers and employees gain from participating in group health insurance.

Gains for Employers

When you sponsor a group health plan, you:

Attract and retain talent: Health benefits make your job offers more competitive.
Enjoy tax breaks: Premium contributions are often tax-deductible.
Boost performance: Healthy employees are more productive, and by reducing financial stress, you free them to focus on their work.

By helping your team stay healthy and financially secure, you strengthen your business from the inside out.

Perks for Employees

For your staff, the benefits are just as significant:

Lower premiums: Group rates are usually cheaper than individual coverage.
Comprehensive care: Plans often include a wide range of services and preventive care.
Easy enrollment: Instead of shopping for coverage on their own, employees can sign up directly through your business.

These advantages make group plans especially appealing for workers considering their long-term health and financial well-being.

Let Sackett Insurance Help You Get Started Offering Employer Group Health Insurance

Getting started with employer group health insurance doesn’t have to be stressful. By working with an experienced broker like Sackett Insurance, you can find the right plan for your business without the headache. We’ll help you compare options, understand your responsibilities, and choose coverage that fits both your budget and your employees’ needs.

Reach out today ! Let us make offering small business health benefits simple, so you can get back to running your business with confidence.

What Is Employer Group Health Insurance? A Complete Guide for Businesses

What Is Employer Group Health Insurance?

How Does Employer Group Health Insurance Work?

It’s completely normal to feel confused about how group health insurance actually works. Luckily, the basics are straightforward once you break them down.

Eligibility Requirements

To qualify for employer group health benefits, a business generally needs to meet a few key standards. Most insurers require at least two employees, with one being a full-time worker who is not related to the owner. The company must also be legally recognized as a business entity. In addition, a minimum percentage of eligible employees must agree to enroll in the plan for it to take effect. Employers are usually expected to contribute toward the monthly premiums, helping make coverage more affordable for their team.

Typical Coverage Options

Employer group health insurance typically covers the essentials employees rely on, including visits to in-network doctors, prescription medications, and treatments such as physical therapy.

Costs for Employees and Employees

The good news? As a small business owner, you may qualify for tax breaks when you offer health benefits. That helps offset your costs while still making coverage more accessible for your team.

Insurance Brokers

Instead of spending hours researching, you can lean on a broker’s expertise to guide you through the process and manage the ongoing relationship with the insurer.

What Are the Advantages for Small Businesses That Offer Health Benefits?

When you offer health benefits, you’re not just supporting your employees; you’re also strengthening your business. Both employers and employees gain from participating in group health insurance.

Gains for Employers

When you sponsor a group health plan, you:

Attract and retain talent: Health benefits make your job offers more competitive.
Enjoy tax breaks: Premium contributions are often tax-deductible.
Boost performance: Healthy employees are more productive, and by reducing financial stress, you free them to focus on their work.

By helping your team stay healthy and financially secure, you strengthen your business from the inside out.

Perks for Employees

For your staff, the benefits are just as significant:

Lower premiums: Group rates are usually cheaper than individual coverage.
Comprehensive care: Plans often include a wide range of services and preventive care.
Easy enrollment: Instead of shopping for coverage on their own, employees can sign up directly through your business.

These advantages make group plans especially appealing for workers considering their long-term health and financial well-being.

Let Sackett Insurance Help You Get Started Offering Employer Group Health Insurance

Reach out today ! Let us make offering small business health benefits simple, so you can get back to running your business with confidence.

How Small Business Owners Can Choose the Right Health Insurance Broker

Thu, 18 Sep 2025 16:30:03 GMT

Choosing the Best Health Insurance Broker for Your Small Business

As a small business owner, you work hard to keep your company moving forward. You want what’s best for your employees and for the long-term success of your business. One of the most powerful ways to achieve that is by offering health coverage. Not only does it show your team that you value their well-being, but it also strengthens your business as a whole.

Still, let’s be honest, navigating the world of health insurance isn’t easy. Between confusing regulations, dozens of plan options, and cost considerations, it’s enough to overwhelm anyone. That’s why many business owners turn to health insurance brokers for guidance. With the right partner, you can make the process far less stressful and ensure your employees get the coverage they deserve.

To help, we’ve put together some essential health insurance broker tips for small businesses.

Benefits of Health Coverage for a Small Business

When you provide health coverage, you do more than check off a box. You also give your business a competitive advantage. Here are a few of the biggest benefits:

Employee Retention: Offering health coverage helps you attract strong candidates and keep your best people from jumping ship.
Tax Credits: Depending on your business size and structure, you may qualify for tax credits that offset the cost of coverage.
Improved Productivity: Healthy employees are more engaged, more focused, and less likely to miss work.

When you weigh the benefits against the costs, offering health insurance simply makes sense.

How a Health Insurance Broker Can Help a Small Business

You already juggle marketing, finances, operations, and customer service, so trying to add “health plan expert” to that list is not realistic, and it certainly is not the best use of your time. A health insurance broker steps in to take that weight off your shoulders by helping you understand the full range of plan options, pointing out cost-saving opportunities without sacrificing benefits, and ensuring you stay compliant with regulations that often trip up small businesses.

Health Insurance Broker Tips for Small Businesses

Working with a broker is easier and more effective when you know how to approach the process. Here are three health insurance broker tips that will help you get the most from your partnership.

1. Know What to Look For

Not all brokers are created equal. You want someone who is qualified and experienced in handling small business health coverage, someone whose communication style matches your own so you feel comfortable asking questions and getting clear answers, and someone with a reputation and track record that reflect your company’s values.

It is also important to understand how brokers charge for their services. Some are paid on commission through insurance carriers, while others may charge fees directly. Be upfront about your budget and make sure their pricing structure works for your business.

2. Ask the Right Questions

A broker’s experience and connections matter. The best way to find out if they’re a good fit is to ask questions such as:

How long have you been working in health insurance, and do you have experience with businesses in my industry?
What kinds of health insurance plans do you provide, and which insurance companies do you work with?
Are there any extra fees for your services or for adding specialty coverage?
If issues come up with claims or coverage, how will you support us in resolving them?

You should also ask questions that are specific to your industry. For example, if your business has seasonal employees or a unique benefits need, make sure the broker has strategies to handle those challenges.

3. Compare Multiple Plans

Don’t settle for the first option presented. Ask your broker to compare plans by looking closely at employee needs, such as whether your team values lower premiums, lower deductibles, or wider provider networks. Consider the overall costs, including both employer contributions and employee expenses, to make sure the plan fits your budget.

You should also pay attention to network size so employees have access to a broad range of doctors and facilities. Taking all of these factors into account helps you strike the right balance between affordability and meaningful coverage.

Let Sackett Insurance Help You Find the Right Health Coverage Options for Your Small Business

If you’ve been searching for a health insurance broker who understands the unique needs of small businesses, Sackett Insurance is here to help. Our team combines expertise with compassion to guide you through the process, helping you find the right plans, supporting your employees, and making health coverage a true benefit rather than a burden.

Your employees are your greatest asset, and protecting their health protects your company’s future. Contact Sackett Insurance today to learn more about how we can help your business thrive.

How to Build a Competitive Employee Benefits Package

mira@sackettinsurance.net (Sackett Insurance Services) — Mon, 11 Aug 2025 20:30:06 GMT

2025 Guide to Creating Benefits That Attract Top Talent

In 2025, competitive employee benefits aren’t just nice to have—they’re essential. Today’s job seekers are evaluating more than just salary. They want to know how a company will support their health, work-life balance, and long-term financial security.

If you're wondering how to create an employee benefits package in 2025 that attracts top talent and retains your best people, you're in the right place.

What Makes Employee Benefits Competitive in 2025?

The standard health-dental-vision package is no longer enough. Employees expect flexibility, personalization, and value that goes beyond coverage. A competitive benefits package in 2025 includes options that match employees’ diverse lifestyles and life stages, plus the tools to understand and use them.

Employers also face rising expectations for communication, compliance, and tech-enabled support. Balancing cost, ease of administration, and employee satisfaction requires a more intentional strategy than ever before.

Flexibility and Choice

Modern employees want to feel like they have control over their benefits. That means offering multiple coverage levels and optional add-ons for dental, vision, or supplemental life insurance. Employers can also provide pre-tax savings tools like Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs).

Holistic Health and Wellbeing

A competitive benefits package supports the whole person—not just their physical health. That includes everything from mental health resources to lifestyle benefits for joining a gym or signing up for additional education.

Communication and Education

Even the best benefits package is ineffective if employees don’t understand it. A 2025-ready benefits package includes year-round communication, personalized tools and dashboards to explore benefits, and helpful resources such as email campaigns, explainer videos, and virtual info sessions.

Employees who feel confident navigating their benefits are more likely to use them, increasing ROI for the employer and satisfaction for the employee.

Regulatory Compliance and Cost Control

Between ACA reporting, state-specific mandates, and evolving transparency regulations, compliance is non-negotiable. Employers need a strategy that balances innovation with legal requirements. A trusted benefits advisor or broker can help small businesses avoid penalties while maintaining flexibility.

Tech-Enabled Administration

In 2025, your benefits need to be just as digital as your hiring and payroll systems. That means providing self-service portals where employees can enroll and manage benefits , and even mobile-friendly access to ID cards, plan info, and support.

How to Create an Employee Benefits Package That Works

Step 1 – Understand Your Workforce

Your employees won’t all want the same things. Conducting anonymous surveys or pulse polls can help identify what matters most. Consider demographic factors like age, family status, and job type. For example, younger employees might prioritize student loan assistance, while older workers may care more about long-term disability or retirement options.

Ask questions like:

What benefits do you currently use?
What benefits do you wish we offered?
What are your biggest stressors outside of work?

Understanding your team is the first step to creating a plan they’ll actually value.

Step 2 – Set Your Budget and Goals

Knowing how much you can spend is key—but so is knowing what you want to achieve. Are you trying to improve retention, attract skilled professionals in a tight labor market, or support employees through life changes? Clarifying your goals allows you to prioritize where your benefits budget will have the most impact.

Step 3 – Partner With a Trusted Broker

A broker like Sackett Insurance can help you compare plans, build a custom benefits strategy, and stay compliant. We’ll walk you through:

Plan design and carrier selection
Employee communication strategies
Technology integrations and admin tools

You don’t need to become a benefits expert—we’re here to support you every step of the way.

Why It Pays to Review Employee Benefits Annually

A competitive package is not a one-and-done deal. Plan limits, laws, and employee needs change every year. Annual reviews help you adjust offerings to meet evolving expectations, maintain compliance with the latest regulations, and ultimately build trust with employees who feel heard and valued.

Reviewing benefits annually ensures you continue to meet your goals—and your team’s needs.

Build Benefits That Work for Everyone

A strong employee benefits package can be a powerful differentiator in a crowded job market. Whether you’re building from scratch or refining what you already offer, the right strategy can boost retention, morale, and overall business success.

Contact Sackett Insurance Services to build a competitive employee benefits package that aligns with your budget, values, and goals. Let’s make 2025 the year your team feels fully supported

Group vs. Individual Health Insurance: Which is Right for You?

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 01 Aug 2025 20:15:00 GMT

Choosing the Right Health Insurance Plan in 2025

Finding the right health insurance plan for your life situation is one of the most important financial and personal decisions you can make. Whether you're self-employed, managing a growing business, or simply exploring your coverage options, understanding the difference between group and individual health insurance can help you find a plan that fits your lifestyle, health needs, and budget.

Pros and Cons of Group vs. Individual Health Insurance in 2025

When evaluating health insurance options, most people find themselves choosing between group and individual plans. Each comes with its own set of advantages and drawbacks that can significantly impact your finances, flexibility, and access to care.

The following sections break down the pros and cons of each type of health insurance to help you determine which one aligns best with your specific needs and circumstances.

Group Health Insurance Pros

Group health insurance is a popular option for many employees and their families, often included as part of a benefits package at work. It provides a variety of advantages that make it an appealing choice for those looking for affordable and comprehensive coverage.

Lower Monthly Premiums : One of the biggest advantages is cost-sharing. Employers typically cover a significant portion of the monthly premium, reducing out-of-pocket costs for employees.
Comprehensive Coverage Options : Group plans often offer a broad network of providers and may include extra benefits such as dental, vision, mental health support, wellness programs, and even gym memberships.
Simplified Enrollment: Since the employer manages the plan options and enrollment, the process is usually straightforward. There's also no need to shop around or navigate insurance marketplaces.

Group Health Insurance Cons

While group health insurance has its advantages, there are also certain drawbacks to consider before making your decision.

Limited Customization: Employers choose the plan (or a small selection of plans) based on the needs of the overall workforce. You may not be able to personalize your plan to suit specific health conditions or preferences.
Provider Network Restrictions: Group plans can limit your access to certain doctors or specialists. Depending on where you live, your choices may be narrower than expected.
Coverage Loss Upon Leaving a Job: If you change or lose your job, your coverage usually ends, leaving you to either pay out of pocket or seek new insurance immediately.

Group health insurance can be an affordable and convenient solution if your employer offers it. However, if flexibility and long-term stability are priorities, you may want to evaluate other options.

Individual Health Insurance Pros

Individual health insurance is designed for people who don’t receive coverage through an employer or who need a plan that best fits their unique needs. Individual plans offer several advantages:

Flexibility and Control: You choose the provider, plan type, and coverage level. This is particularly helpful if you have specific medical needs or want more control over your care.
Portability: Individual plans follow you regardless of employment status. This is ideal for independent contractors, those in career transitions, or retirees under 65.
Subsidy Opportunities: If you purchase coverage through the federal or state health insurance marketplace, you may qualify for subsidies that reduce your monthly premium and other costs.

Individual Health Insurance Cons

Despite its flexibility, individual health insurance also has some disadvantages. Here are some factors to consider before opting for an individual plan:

Higher Costs: Without an employer helping cover premiums, your monthly payments can be substantially higher. Deductibles and coinsurance may also be less favorable compared to group plans.
Fewer Plan Options in Some Areas: In regions with limited insurance providers, your choices for individual coverage may be restricted, especially if you want a broad provider network.
Preexisting Condition Concerns: While plans compliant with the Affordable Care Act (ACA) cover preexisting conditions, non-ACA-compliant plans may include exclusions or increased premiums.

If flexibility and portability are important to you, an individual health plan can be a strong choice. Just be sure to assess the total cost and available options in your area before committing.

Group vs. Individual Health Insurance: Which Costs More?

Cost is often a deciding factor when choosing between group and individual health insurance. Group plans are generally more affordable because the risk is shared among many employees, and employers contribute to premium costs. The larger the group, the lower the average cost per person.

In contrast, individual plans lack this built-in cost-sharing structure. However, marketplace subsidies can make individual coverage surprisingly affordable, especially for those with lower or moderate incomes.

For small business owners, offering group insurance may feel costly upfront, but it can also serve as a strong recruitment and retention tool. Alternatively, some small businesses opt for Health Reimbursement Arrangements, allowing employees to purchase their own plans and get reimbursed for premiums, giving flexibility to both employer and employee.

Which Health Insurance Plan Is Right for You?

There’s no one-size-fits-all answer when it comes to health insurance. By weighing the flexibility, costs, and benefits of each type, you can make an informed decision that supports your health and financial well-being.

Sackett Insurance offers both group and individual health insurance options, with guidance from a team that genuinely cares about your well-being. Contact us today to explore which health insurance plan is the better choice for your unique situation.

What to Expect from Medicare Changes Under H.R. 1: Important Updates for 2026

mira@sackettinsurance.net (Sackett Insurance Services) — Thu, 17 Jul 2025 20:41:46 GMT

Medicare in 2026: Key Changes from Trump's "Big Beautiful Bill"

As we approach 2026, significant updates to Medicare are expected, following the passage of recent legislation known as H.R. 1, often referred to as the “Big Beautiful Bill.” While no immediate action is required, it’s crucial to stay informed about these changes and how they may impact your health coverage in the coming years.

Medicare Funding Reductions Starting in 2026

One of the most notable changes expected to affect Medicare beneficiaries is a potential reduction in Medicare funding, beginning in 2026. The bill’s structure includes automatic federal budget rules that could lead to a 4% cut in Medicare funding. While this does not affect eligibility for Medicare, there are several potential consequences to be aware of.

The funding cuts could lead to:

Reduced access to providers : Some healthcare providers may choose not to accept Medicare due to the lowered reimbursement rates, which could affect options for care.
Increased out-of-pocket costs : While the exact impact is still uncertain, the cuts could lead to higher out-of-pocket expenses over time. This may include increased co-pays, plan premiums, or other costs that could impact a beneficiary's healthcare budget.
Limitations on certain services : Some services previously covered by Medicare may be reduced or restricted due to these funding reductions, affecting overall access to healthcare.

Changes for Dual Eligible Beneficiaries (Medicare and Medicaid)

For those who are “dual eligible” (covered by both Medicare and Medicaid), additional changes may be implemented. The proposed cuts and restructuring under H.R. 1 could alter how Medicaid assists with certain benefits, including:

Medicare premium assistance : Medicaid helps some beneficiaries with the cost of their Medicare premiums. Changes to Medicaid may affect this assistance, which could result in higher out-of-pocket costs for those relying on this support.
Long-term care coverage : Medicaid often provides coverage for long-term care services, including nursing homes and home healthcare. Proposed changes to Medicaid could reduce access to these services.
Dental, vision, and transportation services : Many dual-eligible beneficiaries rely on Medicaid for additional services like dental care, vision services, and transportation for medical visits. These services may be affected by upcoming changes, but specific details are still being reviewed at the state level.

It’s essential to stay informed about these changes, especially if you rely on Medicaid for supplementary coverage alongside Medicare. Sackett Insurance will continue to monitor these developments and keep you updated if these changes apply to you.

Drug Coverage Improvements Are Staying

While there are several changes on the horizon, some recent improvements to drug coverage will remain intact. These include:

A $2,000 annual cap on prescription drug costs : Starting in 2025, Medicare will implement a $2,000 cap on annual prescription drug expenses for beneficiaries, providing relief from high medication costs.
$35 insulin co-pay cap : For Medicare beneficiaries, insulin co-pays will be capped at $35 per month, significantly lowering the cost of this essential medication.
Free vaccines : Medicare beneficiaries will continue to receive certain vaccines at no cost, helping to ensure that beneficiaries stay protected against preventable diseases without the added financial burden.

These improvements are critical for Medicare beneficiaries, and it’s reassuring that they are not being affected by the budget reductions outlined in H.R. 1.

What You Can Do Now

While no immediate action is required, there are steps you can take to stay prepared for the upcoming changes:

Keep all notices from Medicare : It’s essential to stay on top of any communication from Medicare or your current plan provider. These notices will contain important updates about your coverage and any changes that might occur.
Notify us of any changes in your health or financial situation : If you experience any significant changes, such as a change in income or health needs, let us know. This could impact your eligibility for certain benefits or coverage options.
Reach out with any questions : Sackett Insurance is here to help you navigate these changes. Don’t hesitate to reach out if you have any questions or concerns.

Looking Ahead

2026 will bring a mix of changes to Medicare, including potential budget reductions, changes for dual-eligible beneficiaries, and the continuation of positive improvements like drug cost caps. As your Medicare advisor, Sackett Insurance will be closely monitoring these changes and will assist you during Open Enrollment in 2025 to ensure you have the right coverage for your needs.

Staying informed is key to making confident decisions about your healthcare, and we’ll continue to update you as more details about these changes become available.

Health Insurance Deductions: Enhancing Your 2025 Tax Strategy

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 16 Jul 2025 19:30:00 GMT

Tax Savings with Health Insurance: What to Know in 2025

Health insurance isn’t just protection for your family’s health—it can also play a key role in improving your financial wellness. With updates to deduction thresholds and contribution limits in 2025, health insurance tax benefits are more accessible than ever.

If you're looking to reduce your taxable income and build a smarter tax strategy, this guide breaks down how to use your health coverage to unlock tax savings.

What Health Insurance Tax Benefits Look Like in 2025

For the 2025 tax year, the IRS allows you to deduct unreimbursed medical and dental expenses that exceed 7.5% of your adjusted gross income (AGI). If your AGI is $60,000, for example, you can only deduct expenses beyond $4,500. This includes eligible out-of-pocket costs such as premiums, doctor visits, and prescriptions—but only if you itemize your deductions.

The key is understanding how these deductions interact with your income level, health insurance choices , and employment status.

Who Qualifies for Health Insurance Tax Benefits in 2025?

Not everyone can deduct their health insurance premiums in the same way. Your ability to claim these tax benefits depends on how you're insured and how you file your taxes. Let's take a look at how it breaks down:

Self-Employed Individuals

If you’re self-employed, you may be able to deduct 100% of your health insurance premiums from your taxable income using Form 7206. This includes coverage for your spouse and dependents, and the deduction applies whether or not you itemize. It’s one of the most direct ways to reduce your AGI while staying protected.

Employees Who Itemize

If you're covered through an employer plan and pay for part of your premiums or other qualifying expenses out-of-pocket, you might still benefit. But here, you'll need to itemize deductions on Schedule A and surpass that 7.5% AGI threshold.

Eligible expenses include:

Health, dental, and vision insurance premiums paid after tax
Prescription medications
Co-pays and deductibles
Therapy, mental health counseling, and chiropractic care

Tax Savings With Health Insurance Tools

Beyond the standard deductions, there are specialized tax-advantaged tools that can significantly boost your savings. These accounts are designed to help you plan ahead and pay for healthcare expenses more efficiently.

Health Savings Accounts (HSAs)

If you’re enrolled in a high-deductible health plan (HDHP), you may qualify for an HSA, which offers a triple tax advantage:

Pre-tax contributions reduce your taxable income
Tax-free growth on your investments
Tax-free withdrawals for qualified medical expenses

For 2025, the contribution limits are:

$3,900 for individuals
$7,800 for families

HSA funds never expire, making them a strategic savings vehicle for long-term medical planning.

Flexible Spending Accounts (FSAs)

If your employer offers an FSA, you can contribute up to $3,300 in 2025. These pre-tax dollars can be used for eligible medical expenses, ranging from co-pays to contact lenses. The caveat? Most FSAs are "use-it-or-lose-it," so planning is key.

Lesser-Known Health Insurance Tax Breaks That Add Up

Tax savings with health insurance don’t end with premiums and FSAs. Here are a few deductions that often get overlooked:

Long-term care insurance premiums (subject to age-based IRS limits)
Medical travel mileage (IRS allows a per-mile deduction for travel to and from appointments)
Prescribed dietary needs, such as gluten-free foods for celiac patients
Home modifications like ramps or stair lifts, if medically necessary
Marketplace plan premiums paid after tax credit application

Each of these can count toward your 7.5% AGI threshold, provided they’re unreimbursed.

How to Build a Smart Tax Strategy Using Health Insurance

Your tax return isn’t the only place to benefit from your health insurance. With a few proactive steps, you can maximize your deductions and reduce your liability:

Group elective procedures into one tax year when possible
Track dependent expenses if you're covering medical costs for children or elderly parents
Pre-pay known medical bills before December 31 if you're close to the 7.5% AGI mark
Use digital tools (spreadsheets or apps) to track receipts, mileage, and insurance statements

When in doubt, consulting with a tax advisor or benefits professional can help you identify which strategies apply best to your situation.

When to Talk to a Professional

Not sure whether to itemize? Confused by the HSA vs FSA rules? That's where a licensed tax preparer or health insurance advisor can help. Some scenarios where professional help is especially valuable include:

Managing multiple tax-advantaged accounts (like HSAs and FSAs)
Changing jobs or switching from employer to marketplace coverage
Supporting aging parents or dependents with medical costs
Making decisions about when to schedule large expenses like surgeries or braces

Your advisor can walk you through how your insurance plan pairs with tax deductions—and make sure you’re not leaving money on the table.

Maximize Your Health Insurance Tax Benefits in 2025

Getting more value out of your health insurance starts with knowing your options. Whether you're self-employed, managing a growing family, or just want to reduce your tax bill, 2025 offers multiple ways to make your health expenses work for you.

At Sackett Insurance Services, we specialize in helping individuals and families throughout Sonoma County get the most out of their coverage. Get a quote today to see how your plan aligns with your tax goals—and make your 2025 return one that works harder for your wallet.

How To Build Standout Employee Benefits for Your Startup

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 27 Jun 2025 19:15:00 GMT

Smart Employee Benefits Strategies for Startups

Offering a well-designed benefits plan is essential for any growing company. A strong benefits package tailored for startups can help attract top talent and improve employee retention, even when budgets are tight. Understanding the best approach to developing employee benefits for a small business ensures you create perks that truly meet your team’s needs. With the right strategy, your employee benefits can evolve as your company grows.

Understanding Your Team’s Benefit Priorities

Before creating your benefits plan, find out what your employees value most, whether it’s flexible schedules, work-life balance, or healthcare coverage. Simple surveys or casual conversations often reveal more than assumptions.

Focus on key benefits, such as health insurance and paid time off, which tend to have the greatest impact. By tailoring your startup's employee benefits package to your team’s demographics, you ensure it makes a meaningful difference.

Starting With Essential Benefits

Certain benefits form the backbone of any strong employee offering. Group health insurance , dental and vision coverage, and retirement plans provide important security. Paid time off, sick leave, and family leave, such as parental or caregiving leave, also support work-life balance and employee well-being. Prioritizing these core benefits helps startups demonstrate they value their people beyond productivity.

Keep in mind legal requirements when establishing these core offerings. Complying with state regulations is a crucial aspect of establishing employee benefits that are sustainable for small businesses.

Adding Perks For Employees

Once you have the essential benefits covered, consider affordable perks that boost employee satisfaction. Remote work options, flexible hours, stipends for professional development, or wellness reimbursements can all help employees balance their personal lives while staying productive.

Offering a diverse range of perks can enhance employee engagement and satisfaction. Some examples include:

Tuition Reimbursement: Offering tuition reimbursement is a powerful way to show your team that you're invested in their growth. This benefit encourages employees to further their education and enhance their skills, which can also help your company.
Stock Options: Stock options give employees a sense of ownership and a personal stake in the company’s success. As your business grows, employees with stock options are more likely to stay engaged. This is a particularly attractive incentive for startups or growing companies.
Childcare: Balancing work and family life can be challenging, especially for parents. Offering childcare benefits can significantly alleviate this burden and help employees maintain a better work-life balance.
Mental Health Support: Mental health support is more important than ever in today’s high-pressure work environments. Offering mental health benefits, such as counseling services or mental health days, demonstrates that you value your employees’ well-being.

These thoughtful employee benefits create a positive and supportive work environment that can foster long-term employee satisfaction and retention.

Setting a Clear Benefits Budget

Your benefits plan should grow as your business grows, but starting with a clear budget is important. Determine how much of your payroll you can reasonably allocate, then work with providers to find the best value. Being transparent about your offerings builds trust, which is especially helpful when figuring out how to establish benefits for a small business in its early stages.

Research what similar startups provide to stay competitive without overspending. When funds are limited, focus on a few high-impact benefits instead of trying to cover everything.

Communicating and Revisiting Your Benefits Plan

Benefits are only valuable if employees understand and use them. Conduct onboarding sessions, create easy-to-follow guides, and regularly check in so your team knows what’s available. Clear communication makes a big difference.

As your company evolves, so do your employees’ needs. Review your startup’s employee benefits package annually, gather feedback, and analyze usage data to make informed adjustments that reflect your team’s priorities.

Consider using HR software tools to track benefit usage and automate updates. These can help you manage costs and highlight which perks deliver the most value.

Aligning Benefits With Your Company Culture

Your benefits should reflect your company’s values and mission. If innovation drives you, a learning stipend might be a great fit. Benefits aligned with your culture help strengthen identity and boost employee engagement.

You don’t have to match the offerings of large tech companies. Instead, provide meaningful support that fits your startup’s goals and team. Involving employees in designing benefits increases appreciation and usage, deepening the connection between culture and perks.

Using Benefits to Build a Foundation for Long-Term Success

Creating the right employee benefits package for your startup early on lays the groundwork for future success.

Investing time in learning how to create employee benefits for a small business from the start prepares your company for growth. A happy, supported workforce is more productive, loyal, and ready to help your startup thrive. If you’d like help developing a plan, contact Sackett Insurance to learn more.

How Medicaid Cuts Could Undermine Health Care in 2025

mira@sackettinsurance.net (Sackett Insurance Services) — Tue, 10 Jun 2025 13:15:00 GMT

How Medicaid Cuts in 2025 Threaten Patient Care

This year, proposed federal reductions to Medicaid funding have been sparking concern across the healthcare industry. The impact of Medicaid cuts in 2025 goes far beyond budget numbers, affecting millions of patients, providers, and communities. While policymakers debate potential savings, understanding how these changes affect patient care is a necessary part of assessing the impact of this decision, as they could leave millions without coverage, destabilize hospitals, and exacerbate health disparities, particularly in rural and underserved areas.

Making Millions at Risk of Losing Coverage

The House-passed "One Big Beautiful Bill Act" includes over $700 billion in Medicaid reductions over the next decade. According to the Congressional Budget Office, these cuts could result in 8.6 million people losing health insurance by 2034. Proposed measures such as work requirements, shortened enrollment periods, and increased eligibility checks could disproportionately affect low-income families, seniors, and people with disabilities.

Notably, many of those impacted are already working or caring for family members, and may lose coverage due to bureaucratic hurdles rather than ineligibility. For some, exploring other health insurance options, such as Medicare plans, can provide a safety net.

These policy changes could also result in higher administrative costs for states responsible for enforcing eligibility rules. State Medicaid offices, which are often already understaffed, may struggle to keep up with the added oversight requirements. This could result in delayed care or wrongful terminations of coverage, creating additional stress and instability for patients.

Putting Strain on Hospitals and Health Systems

Hospitals, particularly those in safety-net and rural areas, rely heavily on Medicaid reimbursements. The proposed cuts would increase the number of uninsured Americans, reduce access to care, and place profound financial pressure on providers. When people lose Medicaid coverage, they often turn to emergency departments for care, leading to higher uncompensated care costs and further straining hospital resources.

Research suggests that discontinuing Medicaid expansion could significantly reduce hospital revenue from Medicaid patients and lead to a substantial increase in uncompensated care expenses. This financial strain could force hospitals to cut services, reduce staff, or even close, particularly in rural areas where alternative care options are limited. This highlights how Medicaid cuts affect patient care by limiting the availability and quality of essential services.

Teaching hospitals and academic medical centers may be particularly vulnerable, as they often provide highly specialized care to Medicaid patients. A loss in funding could threaten research, residency programs, and innovation in patient care, resulting in ripple effects across the entire healthcare ecosystem.

Impacting the Coverage of Vulnerable Populations Disproportionately

Medicaid is a lifeline for many, supporting individuals with substance use disorders and helping to cover a significant portion of births in the United States. Cuts to the program could disrupt access to essential services for individuals struggling with addiction, pregnant women, and children.

For example, in East Texas, a region with high unemployment, many families depend on Medicaid. Proposed cuts could result in the loss of coverage for over 10 million Americans, placing additional strain on already overburdened rural healthcare systems.

Elderly individuals who rely on Medicaid for long-term care services, including nursing home support, could also be severely impacted. Without this funding, many families would be forced to take on caregiving roles, find personal insurance , or face high out-of-pocket expenses. The result could be a growing caregiver crisis in the U.S., especially among working families.

Causing Economic Ripple Effects From Medicaid Cuts

Beyond health care, Medicaid cuts could have broader economic implications. Hospitals facing financial strain may reduce staffing or close, resulting in job losses and a decline in economic activity within their communities.

Additionally, shifting costs to states could force them to raise taxes or cut other services to maintain Medicaid programs. This could disproportionately affect states with limited budgets, thereby exacerbating regional disparities in healthcare access and quality.

In rural and economically distressed areas, hospital closures can be devastating. Hospitals are often among the largest employers in small towns, and their closure can impact not just health outcomes, but also real estate values, school funding, and local businesses. Medicaid’s reach is not just clinical—it plays a foundational role in supporting community infrastructure. This underscores the broader impact of Medicaid cuts in 2025 on both health and economic stability.

What You Can Do To Mitigate the Impact of Medicaid Cuts

The proposed Medicaid cuts have far-reaching implications for health care access, hospital stability, and community well-being. Understanding how Medicaid cuts affect patient care is key to advocating for policies that protect Medicaid and the millions who rely on it. As the Senate considers this legislation, it's important to stay informed and engaged. Reach out to your senators to express concerns and support measures that preserve access to care.

You can also support local health coalitions, community health organizations, and nonprofits that work to expand access to care. Every effort helps ensure vulnerable populations are not left behind as policy debates unfold.

If you’re concerned about how these changes may affect your health coverage, Sackett & Associates Insurance Services has licensed brokers who can offer expert advice. Contact us today to explore your options for health insurance and get guidance tailored to

The Future of Health Insurance: Key Changes to Watch in 2025

mira@sackettinsurance.net (Sackett Insurance Services) — Thu, 29 May 2025 20:45:00 GMT

Health Insurance Trends to Watch in 2025

The health insurance industry is moving through major changes in 2025. Technology is evolving quickly, consumer expectations are shifting, and new regulations are reshaping how coverage works. If you are an individual exploring better options or an employer managing benefits, keeping up with these trends can help you make smarter, more cost-effective choices. Knowing where the industry is heading gives you an edge when choosing plans, negotiating costs, and offering real value to your employees or family.

Navigating the Surge in Premiums and Cost-Sharing

Health insurance premiums have climbed steadily over the past several years. In 2024, the average annual premium for employer-sponsored family health insurance reached $25,572, a 24% jump since 2019. Along with higher premiums, many are dealing with larger deductibles and more out-of-pocket costs, adding financial pressure to both businesses and families.

Small business owners are feeling it especially hard. Around 68% said rising premiums were their top concern in 2025 . Many are rethinking their benefit strategies, looking for options that are sustainable and flexible. For individuals, higher costs often lead to weighing whether lower monthly premiums are worth higher deductibles or exploring alternatives like healthcare sharing plans or high-deductible health plans paired with HSAs.

Embracing Flexible, Employee-Centered Benefits

Today’s workforce spans several generations, each with different health needs. More employers are moving away from one-size-fits-all health plans. Instead, they are offering benefits that employees can personalize based on their circumstances. Some companies are even setting up health benefit accounts that allow workers to allocate funds toward healthcare, fitness memberships, mental health services, or wellness programs.

This shift improves employee satisfaction and helps companies retain top talent. When employees feel supported, they are often more engaged and motivated at work. Flexibility in benefits shows employees that their well-being matters.

The Growing Role of Digital Tools and AI in Health Insurance

Technology is changing how health insurance companies operate. Digital tools and artificial intelligence are making processes faster and more efficient. AI could help the U.S. healthcare system save up to $150 billion annually by 2026.

Insurance providers are using these tools to speed up claims processing, detect fraud, and create a better customer experience. Many companies now offer apps where members can view claims, check benefits, or connect with care providers. For consumers, health insurance could become simpler and more transparent, encouraging proactive care through better access to important information.

Mental Health Takes Center Stage

Mental health is finally receiving the attention it deserves in health benefits. More employers are adding mental health services to their insurance plans because they recognize the link between mental well-being and workplace performance.

In 2025, 41% of small business owners said providing mental health support was a top priority. Offering counseling services, digital therapy apps, or mental health days off has become more common. Supporting mental health not only improves overall wellness but also strengthens teams. Mental health resources are now seen as an essential part of a modern benefits package .

Staying on Top of Regulatory Changes

Healthcare policies and regulations continue to shift in 2025. Around 83% of small businesses voiced concerns about how political changes could impact health insurance costs and options. Employers are watching closely to see how upcoming legislation could affect tax credits, plan requirements, and affordability.

It is important for both employers and individuals to stay informed. Adjusting your benefits plan early can help you avoid surprises and maintain strong coverage. Partnering with consultants or using tools that track policy changes can make a real difference.

How You Can Stay Ahead

The health insurance world in 2025 is moving fast, with innovation and challenges at every turn. Whether you are managing a team or choosing a plan for yourself, understanding these trends can help you make smarter decisions.

By offering flexible benefits, using new technology wisely, supporting mental health, and keeping an eye on policy updates, you can create a strategy that works. Being proactive gives you the best chance of finding coverage that fits your needs today and prepares you for tomorrow. Treating health insurance planning as an ongoing conversation, rather than a once-a-year task, makes all the difference.

Looking for ways to keep your health insurance strategy strong in 2025? Contact us to explore our latest resources and tools to help you find the right fit for your goals and your team.

Navigating Healthcare Policy in 2025: What You Need to Know

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 16 May 2025 14:45:00 GMT

Navigating 2025 Healthcare Policy Changes

Healthcare policy in 2025 is changing because of new government leadership, shifts in the economy, and industry demands. Hospitals, insurance companies, and providers are keeping a close eye on new rules that can affect how they deliver care and how patients get services. Knowing about these updates helps healthcare workers, companies, and patients make better choices.

Medicare and Medicaid: Changes to Watch

Medicare and Medicaid are two big government programs that many people rely on. Hospitals are speaking up to protect special payments for facilities that treat a lot of seniors and people in rural areas. They are also trying to stop funding cuts that could hurt hospitals that serve low-income patients.

Extra help for buying insurance through the Affordable Care Act is set to end later this year. Without new laws, many families and employers could see their health insurance bills go up. Some could lose their coverage altogether. Lawmakers are trying to find ways to keep healthcare affordable without putting too much pressure on the federal budget. Discussions include adjusting payment formulas and expanding eligibility for subsidies.

Drug Prices and Pharmacy Benefit Managers (PBMs)

High drug prices are still a big problem. Medicare recently got the power to negotiate lower prices on some medicines to help seniors save money. But drug companies are fighting back, saying these changes could slow down new drug research.

Pharmacy Benefit Managers, known as PBMs, are also in the spotlight. These companies help decide which medicines are covered by insurance and how much people pay. Some lawmakers say PBMs are not clear about how they set prices. They want new rules that make it easier for patients to see where their money is going. Proposals include making PBMs report more information about rebates and discounts.

Telehealth and New Technology in Healthcare

During the COVID-19 pandemic, many people started using telehealth, which lets patients meet with doctors online. Now, leaders want to make some of these changes permanent. They are working on rules that would allow doctors to treat patients across state lines and get paid the same for telehealth visits as for in-person ones. This could make it easier for patients in rural areas to get care.

Other digital tools, like apps that track your health from home and programs that use artificial intelligence to help diagnose problems, are becoming more popular. Government agencies are updating their rules to make sure these tools are safe and effective. There is also a push to improve cybersecurity protections to keep patient information private.

Healthcare Workers: Solving the Shortage

Healthcare workers are stretched thin. There are not enough nurses, doctors, and support staff to meet the growing demand for care. Workers are feeling stressed and overworked, which makes it harder to keep them in their jobs.

Policymakers are offering ideas like helping with student loans, giving more chances for training, and improving working conditions. These efforts are aimed at keeping skilled workers in the field and bringing new people into healthcare careers. More funding for nursing programs and technical schools is being discussed.

Fighting for Fair Healthcare for Everyone

In 2025, making healthcare more fair is a big goal. People in low-income areas, rural communities, and communities of color often have a harder time getting the care they need. Leaders are backing programs that work on closing these gaps.

Plans include funding for clinics in neighborhoods that need them, improving transportation to healthcare facilities, and supporting services that deal with non-medical needs like housing, food, and education. Some programs are also focusing on hiring healthcare workers from the same communities they serve to build trust and improve outcomes.

Staying on Top of Healthcare Policy Changes

Healthcare rules and laws will keep changing in 2025. Providers, insurance companies, and patients need to stay updated to make smart decisions about care and coverage. Working together across healthcare can lead to better services for everyone.

If you work in healthcare, or if you care about how healthcare works, think about joining professional groups, signing up for news updates, or speaking out when important laws are being discussed. Staying informed and involved is one way to help improve healthcare for yourself and your community.

Healthcare plays a major role in everyone’s life. Staying informed about new policies and changes helps providers offer better care and helps patients get the services they need. If you have questions about how healthcare policy can affect your coverage or your options, contact us . Our team is ready to help you navigate your choices and stay prepared for the future.

Medicaid Cuts: How They Could Change Healthcare for Millions

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 23 Apr 2025 04:15:01 GMT

How Medicaid Cuts Could Impact Millions in the U.S.

Medicaid, or Medi-Cal in California, helps millions of Americans get healthcare, including low-income families, seniors, and people with disabilities. But new plans to cut federal funding could change who qualifies, what services are covered, and whether some healthcare providers can keep accepting Medicaid patients. These cuts could make it harder for many people to get the medical care they need.

Who Uses Medicaid?

Medicaid is the largest public health insurance program in the U.S., helping over 80 million people. It covers doctor visits, prescriptions, mental health care, and hospital stays for those who can’t afford private insurance . In California, Medi-Cal helps about 15 million people, or one-third of the state’s population. Many people depend on Medicaid as their only way to get healthcare. If funding is reduced, states might have to limit who can qualify, cut benefits, or lower payments to doctors and hospitals, making it harder to get care.

What Happens if Medicaid Funding is Cut?

If Medicaid loses funding, fewer people may qualify for coverage , and some could lose their insurance altogether. This means they may have to skip doctor visits or important treatments. Some services like dental care, home health aides, or mental health support could be removed, making it harder for people to stay healthy. Hospitals and clinics, especially in rural or low-income areas, might struggle to stay open because they rely on Medicaid payments. If these cuts happen, some medical centers might close, making it harder for people to find care close to home. Losing Medicaid could also mean higher medical bills for families, forcing some to use emergency rooms instead of regular doctor visits, which increases healthcare costs for everyone.

How States Might Respond

If the federal government cuts Medicaid funding, states will have to find ways to make up for the loss. Some may try to move money from other areas of their budgets, but others may have no choice but to reduce coverage or benefits. California leaders have strongly opposed Medicaid cuts, but even states with strong healthcare systems will struggle to replace lost federal dollars. Many people are already losing Medicaid coverage now that pandemic-era expansions have ended, and additional funding cuts could cause even more people to lose insurance. Some states might try to increase taxes to cover the shortfall, while others could limit services.

The Bigger Economic Impact

Medicaid cuts wouldn’t just affect people who use it; they could also hurt the economy. Many hospitals and clinics depend on Medicaid payments, and if funding is reduced, they might have to lay off workers or close entirely. This could lead to job losses in the healthcare industry. When people lose Medicaid, they often wait until they are very sick to seek care, which increases overall healthcare costs. Medicaid is especially important during recessions, when more people rely on it due to job loss. Cutting Medicaid during tough economic times could put even more strain on families and state budgets, causing problems that reach far beyond healthcare.

What Can You Do?

With so many people relying on Medicaid, it’s important to take action. Staying informed about policy changes and understanding how they might affect you and your community can help you prepare. Contacting lawmakers to express concerns, supporting healthcare advocacy groups, and educating others about how Medicaid cuts could impact families and seniors can make a difference. Raising awareness and staying engaged in the conversation can help shape the future of this important program.

Medicaid has helped millions of people get the care they need, and its future depends on decisions being made now. By staying involved and informed, individuals and communities can help influence these important healthcare policies

Congress Needs to Act Now to Protect Medicare and Keep Telehealth Available

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 11 Apr 2025 20:00:00 GMT

Why Congress Must Act to Save Medicare Telehealth

Millions of Americans rely on Medicare for healthcare, but policy changes could make it harder to get care. Telehealth has made seeing a doctor easier, especially for seniors and those with mobility issues. However, if Congress doesn’t act soon, many telehealth options could disappear, forcing patients to travel long distances for care or skip visits altogether. Lawmakers need to act now to protect Medicare funding and ensure telehealth remains available.

Why Medicare Cuts Are a Problem

Doctors and hospitals are receiving lower payments for treating Medicare patients, making it harder for them to stay open. Many doctors have already reduced the number of Medicare patients they accept, limiting care options. Fewer providers accepting Medicare means longer wait times, farther travel for appointments, and higher out-of-pocket costs. This is especially concerning for seniors on fixed incomes who depend on Medicare. Without action, these problems will only get worse, making healthcare less accessible for those who need it most.

The effects of these cuts go beyond just Medicare patients. When providers receive lower reimbursements, they often have to make difficult financial decisions, such as reducing staff, limiting services, or even closing their practices. This creates a ripple effect, putting additional strain on emergency rooms and urgent care centers, which may be overwhelmed by patients who can no longer access regular care. Over time, these changes could lead to a decline in overall healthcare quality and accessibility, especially in rural and underserved communities.

Telehealth: A Vital Service That Needs to Stay

During the COVID-19 pandemic, telehealth allowed millions to see doctors from home. It saved time, reduced travel, and connected patients in rural areas with specialists. It also benefited those with disabilities, chronic illnesses, or transportation challenges. Telehealth has improved long-term health by helping doctors catch problems early.

However, many telehealth options will expire unless Congress extends them. If lawmakers don’t act, millions may lose virtual doctor visits, forcing them back to in-person care that may not be convenient or possible. This will be especially difficult for older adults, people in remote areas, and those needing frequent specialist care. Keeping telehealth available ensures better access to medical care without unnecessary obstacles.

Congress Needs to Take Action

To fix these issues, Congress is considering bills to keep Medicare payment rates fair and extend telehealth services. Some lawmakers even want to make telehealth permanent, so patients don’t have to worry about losing access in the future. These bills aim to create long-term stability for both patients and healthcare providers, ensuring that access to medical care is not disrupted by policy changes. Additionally, a permanent telehealth policy would allow healthcare providers to invest in better virtual care technology, improving the quality and efficiency of remote healthcare services.

Doctors, hospitals, and patient advocates are urging Congress to act quickly. If nothing is done, patients will struggle to get care, and many healthcare providers may close their doors. The healthcare system is already under strain, and further cuts or restrictions could make things worse. Delayed care leads to worsening health conditions, more emergency room visits, and higher costs for everyone. By acting now, Congress can ensure Medicare patients continue receiving the care they need.

How You Can Help

If you or someone you love relies on Medicare or telehealth, speak up. Contact your representatives and explain why protecting Medicare and keeping telehealth available is important. Personal stories about how these services have helped can make a strong impact. Many healthcare organizations offer ways to get involved, such as petitions, letter-writing campaigns, and phone call initiatives.

Staying informed about these issues helps you understand how policy changes may affect your healthcare. Follow updates from advocacy groups and healthcare organizations that are working to protect Medicare and telehealth. The more people who reach out, the more likely Congress will act. Your voice can help shape policies that impact millions of people.

Take Action to Protect Your Healthcare

Medicare and telehealth services are critical for millions of Americans. Without them, patients could lose access to care, and doctors may struggle to serve their communities. Protecting Medicare funding and making telehealth permanent will create a more effective healthcare system. Now is the time to act—contact lawmakers, support advocacy efforts, and spread the word about why protecting Medicare and telehealth matters. Your voice can help ensure healthcare remains accessible to those who need it most.

Are health insurance brokers the key to fixing U.S. healthcare?

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 26 Mar 2025 16:15:00 GMT

Can Health Insurance Brokers Fix Healthcare?

Let's be honest, dealing with health insurance in the U.S. can be confusing, expensive, and stressful for individuals and businesses. With so many options and not enough clear answers, it can feel impossible to find the right plan. While lawmakers argue about healthcare reform, one group is already stepping up to help: health insurance brokers. Could they be the missing piece to making healthcare coverage easier and more affordable?

What do health insurance brokers do?

Health insurance brokers work as middlemen between insurance companies and people looking for coverage. They help individuals, businesses, and even healthcare providers find the best insurance plans to meet their needs. Their job has become even more important as healthcare costs continue to rise and employer-sponsored insurance gets more complicated.

Unlike insurance agents who sell plans from just one company, brokers can compare options from multiple providers. This gives them the flexibility to find the best deal for their clients. But brokers don’t just help pick plans, they also explain benefits, answer questions, and assist with cost-saving strategies.

How brokers make choosing insurance easier

Trying to pick a health insurance plan can be overwhelming. There are so many details, like deductibles, copays, and provider networks, that it’s easy to get lost. Brokers help by:

Understanding needs: They ask about medical history, budget, and coverage priorities to find the best match.
Comparing different plans: They break down options across different insurance companies to find the best coverage at the best price.
Explaining benefits: They make sense of complex terms so people know exactly what they’re signing up for.
Helping with claims: If there’s a problem with an insurance claim, brokers can step in and assist in resolving it.

By offering this kind of support, brokers make it much easier to navigate the complicated world of health insurance.

Helping people save money and get better coverage

One of the biggest reasons to use a broker? They can help lower costs. Healthcare prices keep going up, and businesses struggle to offer good benefits without breaking the bank. Brokers help by negotiating better deals, finding cost-saving options, and recommending alternative plans like self-funded programs or health reimbursement arrangements (HRAs).

Why small businesses benefit the most

Small businesses often don’t have the time or expertise to figure out the best health insurance options for their employees. That’s where brokers come in. They help companies find affordable group plans , make sure they follow health insurance laws like the Affordable Care Act (ACA), and educate employees on how to use their benefits effectively. Many small businesses that work with brokers can offer better health plans for their employees at lower costs compared to those that try to do it alone.

Making healthcare fairer for everyone

Not everyone in the U.S. has the same access to quality healthcare. Low-income families, people in rural areas, and minority groups often struggle to find affordable insurance. Brokers can help close this gap by connecting people with government programs like Medicaid or finding them affordable plans on the ACA marketplace.

How brokers help individuals

For people without job-based health insurance, brokers make the process easier by guiding them through the ACA marketplace and helping them find subsidies to lower costs. They can also suggest extra coverage for things like dental and vision care or help eligible individuals sign up for Medicare and Medicaid. Their goal is to make health insurance as simple and accessible as possible for everyone.

Challenges and concerns with brokers

Even though brokers offer a lot of benefits, there are some concerns to keep in mind. Some people worry that brokers might be biased if they get paid by insurance companies. Others point out that not all insurance companies work with brokers, so they might not always offer every possible plan. Plus, with healthcare laws constantly changing, brokers have to work hard to stay up to date.

To make sure they’re getting the best advice, people should look for brokers who are transparent about their recommendations and who prioritize their clients' needs over commissions.

What’s next for health insurance brokers?

As healthcare keeps changing, brokers will likely play an even bigger role in helping people and businesses figure out their insurance options. Technology is also making their jobs easier, with new tools that allow them to compare plans and provide more personalized recommendations faster than ever.

With healthcare costs rising and insurance getting more complicated, brokers offer a much-needed service. Whether you're an individual trying to find the right plan or a business looking for affordable benefits for employees , working with a broker might be the smartest move you can make.

Ready to find the right health insurance?

Health insurance doesn’t have to be confusing. If you’re feeling overwhelmed by all the options, a licensed health insurance broker can help. They’ll compare plans, find savings, and make sure you get the coverage that’s right for you. Take the first step toward better healthcare by reaching out to a broker today.

Health insurance in 2025: What’s changing and how it affects you

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 07 Mar 2025 18:00:03 GMT

Health Insurance Trends 2025: Changes and Impact

The health insurance industry is changing fast, driven by new technology, policy updates, and shifting consumer needs. As 2025 approaches, insurers are adapting to stay competitive and provide better service. From AI-powered customer support to expanded telehealth options, here’s what to expect in the coming year.

AI and automation in health insurance

Artificial intelligence (AI) is transforming health insurance by making processes more efficient and improving customer experiences. Insurers are using AI-driven chatbots and virtual assistants to provide 24/7 support, helping policyholders with claims, coverage questions, and other inquiries in real time.

Predictive analytics powered by AI is also allowing insurers to assess risk more accurately, leading to more personalized policy pricing and faster underwriting. Automation is cutting down processing times for claims and approvals, making the experience smoother for customers.

How AI is making an impact:

● Faster claims processing and approvals

● Better fraud detection through data analysis

● Enhanced customer service with AI chatbots

● Personalized policy recommendations based on health data

The shift to value-based care

Traditional fee-for-service models are giving way to value-based care, which prioritizes patient outcomes over the number of procedures performed. This approach encourages healthcare providers and insurers to focus on preventive care, chronic disease management, and overall wellness.

Insurers are offering plans that reward policyholders for engaging in healthier behaviors, like completing wellness checkups, exercising regularly, and following medication plans. These changes help improve health outcomes while managing costs more effectively.

Growing role of telehealth

Telehealth has seen tremendous growth in recent years, and it’s only going to become more important. With more consumers expecting the convenience of virtual healthcare, insurers are expanding their coverage for telemedicine, mental health counseling, and remote patient monitoring. Medicare has also increased its support for telehealth, allowing more beneficiaries to access virtual doctor visits and remote monitoring services.

What’s changing in telehealth:

● Higher reimbursement rates for virtual visits

● More coverage for remote health monitoring devices

● AI-powered preliminary diagnoses through telemedicine

● Expanded mental health teletherapy options

This expansion allows patients to access medical care without unnecessary travel, reducing overall healthcare costs while improving convenience.

Personalized insurance through big data

Big data is reshaping how insurance policies are designed and priced. Insurers are analyzing vast amounts of health information to create plans that better match individual needs .

Wearable devices like fitness trackers and smartwatches provide real-time health data that insurers can use to offer incentives for healthy habits. By using this information, insurers can offer more accurate pricing and encourage policyholders to take an active role in maintaining their health.

Adapting to new regulations

Health insurance regulations are constantly evolving, with new policies focusing on transparency, affordability, and accessibility. Governments worldwide are rolling out changes that require insurers to improve pricing clarity, offer more affordable plans, and enhance data security for policyholders.

Insurers are also expanding mental health and substance abuse coverage, ensuring policyholders have better access to these essential services. Keeping up with these changes is key for insurers to stay compliant and meet the expectations of consumers.

Expanding mental health coverage

Mental health is receiving more attention than ever, and insurance providers are adjusting their plans to reflect that. More individuals and employers are looking for policies that include therapy, counseling, and psychiatric care as part of their benefits.

To meet this demand, insurers are increasing reimbursements for mental health services, making care more accessible. They’re also offering digital mental health platforms, making it easier for policyholders to connect with professionals. Workplace wellness programs are being expanded to include mental health support, ensuring employees have the resources they need.

What these changes mean for you

With so many advancements happening in health insurance, it’s important to stay informed and understand how these trends could impact your coverage. Whether it’s AI-powered support, telehealth options, or personalized plans, the industry is moving toward a more accessible and efficient system.

If you’re considering a new insurance plan or looking to update your existing coverage, now is a great time to explore your options. Stay informed, ask questions, and make sure your health insurance fits your needs in 2025 and beyond. Contact us to learn more about your options and find a plan that works for you.

Unlocking the Benefits of Working with an Insurance Broker

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 19 Feb 2025 16:45:00 GMT

Why You Should Consider Using an Insurance Broker

Finding the right insurance plan for your needs can feel overwhelming. With countless options and complex industry jargon, it’s easy to get lost in the details. That’s where an insurance broker comes in. By offering personalized guidance, brokers simplify the process and help you make informed decisions. Whether you need health, life, or business insurance, here’s why working with a broker could be the smartest move for your financial well-being.

What Does an Insurance Broker Do?

Insurance brokers act as independent advisors who work on your behalf to find the best insurance solutions. Unlike agents who represent a single insurance company, brokers have access to multiple providers, giving you a broader range of options. Their expertise allows them to assess your unique needs, compare policies, and recommend coverage that offers the most value.

Some of the key responsibilities of an insurance broker include:

● Evaluating your individual or business requirements.

● Researching and comparing policies from various insurers.

● Explaining complex terms and conditions in simple language.

● Assisting with claims to ensure smooth processing.

By prioritizing your needs, brokers provide tailored recommendations rather than pushing a one-size-fits-all solution.

Benefits of Working with a Broker

Access to a Wide Range of Options

Brokers collaborate with numerous insurance companies, giving you access to a diverse selection of policies. This broader reach means they can identify plans that suit your specific needs and budget, ensuring you don’t overpay for unnecessary coverage.

Expert Guidance

Navigating the insurance landscape can be confusing, especially if you’re unfamiliar with the terminology or legal implications. Brokers simplify this process by explaining your options clearly, highlighting the pros and cons of each policy, and answering your questions. Their expertise ensures you understand what you’re purchasing and why it matters.

Time-Saving Solutions

Researching insurance policies, comparing quotes, and reading fine print takes time—a lot of it. Brokers handle these tasks for you, freeing you up to focus on other priorities. They’ll streamline the entire process, from identifying suitable plans to finalizing paperwork.

Claims Assistance

Filing an insurance claim can be stressful, particularly if you’re already dealing with an emergency. Brokers act as advocates during this process, helping you submit the necessary documentation and liaising with insurers to resolve issues quickly. Their support ensures you receive the benefits you’re entitled to without unnecessary delays.

Tailored Recommendations

Every individual and business has unique insurance needs. Brokers take the time to understand your situation, offering recommendations that align with your goals and risk tolerance. Whether you’re looking for medicare , comprehensive health coverage, or specialized business insurance, they’ll help you find a policy that fits.

Debunking Common Myths About Insurance Brokers

They Cost More

One of the most common misconceptions about brokers is that their services add to your expenses. In reality, brokers are often compensated by insurance companies, meaning their expertise usually comes at no extra cost to you. Additionally, their ability to find competitively priced policies can save you money in the long run.

They’re Biased Toward Certain Insurers

Another myth is that brokers favor specific providers. While brokers do have relationships with insurance companies, their primary obligation is to their clients. Their recommendations are based on your best interests, ensuring you receive unbiased advice.

You Don’t Need One if You’re Tech-Savvy

While online comparison tools can be helpful, they lack the personal touch and expertise of a broker. Brokers go beyond surface-level comparisons, considering factors like exclusions, claims processes, and long-term value. Their guidance can make a significant difference, especially for complex policies.

How to Choose the Right Insurance Broker

Selecting a broker is an important decision. Here are a few tips to ensure you find the right fit:

Check Credentials: Ensure the broker is licensed and has relevant certifications.
Ask About Experience: Look for brokers who specialize in the type of insurance you need.
Read Reviews: Customer testimonials and reviews can provide insights into the broker’s reliability and service quality.
Understand Fees: While most brokers are paid by insurers, some may charge a fee for specific services. Clarify this upfront.
Assess Communication: Choose a broker who listens to your concerns and communicates clearly.

Taking the time to vet potential brokers can help you establish a productive partnership that delivers lasting benefits.

Why Personalized Insurance Matters

Every person’s circumstances are unique, and generic insurance plans often leave critical gaps. Insurance brokers provide personalized coverage recommendations that cater to your specific needs, whether you’re a family seeking tailored health and life insurance , a small business needing industry-specific protection, or a freelancer looking for flexible, affordable options. This customized approach helps avoid over-insuring or under-insuring, ultimately saving you money and reducing stress.

Ready to Simplify Your Insurance Journey?

Navigating the insurance market doesn’t have to be daunting. With the help of a knowledgeable broker, you can confidently select policies that protect your future and fit your budget. Whether you need assistance with health, life, or business insurance, partnering with a broker ensures you get the best coverage possible. Don’t hesitate to contact us !

How to Pick the Right Health Insurance Plan for You

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 12 Feb 2025 19:45:00 GMT

Your Guide to Picking the Best Health Insurance

Navigating the world of health insurance can feel overwhelming, especially when you're faced with a variety of plans and options. Choosing the right health insurance is a critical decision that impacts both your budget and your access to care. By understanding your needs and comparing plans effectively, you can make a confident and informed choice.

Understand Your Health Care Needs

Before diving into plan options, assess your personal or family health care requirements, including how often you visit a doctor, any chronic conditions requiring regular treatment, necessary medications, upcoming procedures, and coverage needs for dependents. These details will help you prioritize the benefits that matter most to you.

Compare Different Plan Types

Health insurance plans come in various forms, each offering unique advantages. The most common types include:

Health Maintenance Organization (HMO): HMOs typically have lower premiums but require you to use a network of doctors and hospitals. Referrals from a primary care physician are usually necessary for specialist care.
Preferred Provider Organization (PPO): PPOs offer more flexibility in choosing providers and don’t require referrals. However, they tend to have higher premiums.
Exclusive Provider Organization (EPO): EPOs combine elements of HMOs and PPOs, requiring network care but without the need for referrals.
High-Deductible Health Plan (HDHP): Paired with a Health Savings Account (HSA), these plans have lower premiums but higher out-of-pocket costs. They're ideal for those who are generally healthy and don’t expect frequent medical expenses.

Take note of each plan’s strengths and limitations, focusing on what aligns best with your health care needs and budget.

Evaluate Coverage and Costs

When reviewing plans , it’s essential to look beyond the monthly premium. Health insurance costs also include deductibles, copayments, coinsurance, and out-of-pocket maximums. Here's what to examine:

Premiums: This is the monthly amount you pay for coverage. Choose a plan with a premium that fits your budget.
Deductibles: How much will you pay out-of-pocket before the plan starts covering expenses?
Copayments and Coinsurance: What portion of costs will you share for doctor visits, prescriptions, and other services?
Out-of-Pocket Maximum: This is the maximum amount you'll spend in a year before the plan covers 100% of costs.

A plan with a higher premium but lower out-of-pocket costs might be better if you expect frequent medical visits, while a lower-premium plan might work for minimal care needs.

Check Provider Networks

Each health insurance plan comes with a network of preferred providers. To avoid unexpected costs, ensure your preferred doctors, specialists, and hospitals are in-network. If you already have trusted health care providers, confirm their inclusion in the plan’s network.

If you’re exploring new providers, consider the plan’s network size and the availability of nearby health care facilities. Narrow networks might limit your choices, so weigh the trade-offs carefully.

Review Prescription Drug Coverage

If you rely on medications, reviewing prescription drug coverage is essential. Confirm whether your current medications are included in the plan’s formulary—a list of covered drugs—and check for any restrictions like prior authorizations or quantity limits. Also, consider cost factors such as copayment tiers and whether the plan requires specific pharmacies for lower costs, as these can significantly affect your overall expenses.

Take Advantage of Tools and Resources

Many insurers and employers provide tools to simplify the decision-making process. Use online calculators to estimate potential costs based on your anticipated health care usage. Compare plans side-by-side to identify differences in coverage, costs, and benefits.

If you’re still unsure, consider reaching out to the insurer’s customer service or consulting with a licensed health insurance broker for personalized guidance .

Make the Most of Open Enrollment

Open enrollment is the period when you can sign up for, renew, or change your health insurance plan. Missing this window may limit your options unless you qualify for a special enrollment period due to life events like marriage, the birth of a child, or job loss. Mark important dates to ensure you don’t miss the opportunity to choose or adjust your coverage.

Don’t Forget About Supplemental Insurance

Supplemental insurance plans can fill gaps in your primary coverage. Options such as dental, vision, or accident insurance can provide added financial protection for specific needs. If these are important to you, check whether your employer offers them or consider purchasing them separately.

Choose Wisely for Peace of Mind

Choosing the right health insurance plan doesn’t have to be daunting. By evaluating your health care needs, understanding plan options, and carefully reviewing costs and benefits, you can find coverage that supports your well-being without breaking the bank. Remember, it’s always worth taking the time to make an informed decision for yourself and your loved ones.

For more insights and resources, don’t hesitate to contact a licensed health insurance advisor who can guide you through the process.

Simplifying Employee Benefits Software with Innovative Programs

mira@sackettinsurance.net (Sackett Insurance Services) — Mon, 27 Jan 2025 23:00:01 GMT

Employee Benefits Software Made Easy

Employee benefits present unique challenges for businesses in California. From navigating compliance regulations to meeting the expectations of a diverse workforce, managing benefits often overwhelms HR teams and business owners. Employee benefits software streamlines these complexities, helping organizations deliver competitive packages with minimal stress.

California’s diverse and dynamic economy adds another layer of complexity. Employers must address the needs of workers in various industries, from technology and healthcare to agriculture and entertainment. Customizable options allow businesses to create benefit programs that suit their unique workforces. In doing so, they stay competitive and maintain high employee morale in a fast-paced market.

Why Businesses Need Advanced Benefits Management

California’s employment laws set a high bar for compliance. Businesses must follow mandates like offering health insurance under the Affordable Care Act (ACA) and addressing employee needs with comprehensive benefit packages. Meeting these requirements demands a well-organized benefits program.

Manual processes often create errors or inefficiencies that delay enrollment or lead to compliance violations. Automated employee benefits software eliminates these risks by centralizing data, automating reporting, and simplifying updates. California’s competitive job market makes robust employee benefits essential for attracting and retaining top talent, and advanced software gives your business the edge.

Core Features of Employee Benefits Software

Effective software provides features that improve efficiency and enhance the employee experience. Businesses in California benefit most from solutions that address local needs and integrate seamlessly into their operations. Here are some key features to prioritize:

Automated Compliance Monitoring: Compliance poses a constant challenge. Top-tier software automatically updates your system to reflect the latest changes, ensuring your business remains compliant without manual oversight.
Streamlined Enrollment Processes: Employee enrollment becomes a straightforward process when software automates paperwork and eliminates manual tracking. Systems guide employees through plan options, simplifying their selections.
Centralized Data Management: Businesses need a single platform to store employee information securely and access it quickly. Centralized data management reduces administrative burdens and ensures accurate reporting.
Integration with Payroll and HR Systems: The best software integrates with existing payroll and human resource systems. This feature ensures seamless data flow across departments, minimizing redundancies and enhancing efficiency.
Mobile Accessibility: Employee benefits software with mobile accessibility empowers employees to access information, make updates, and communicate with HR teams from anywhere, ensuring a smoother user experience.

The combination of these features creates a more dynamic and user-friendly approach to benefits management. Software tailored to these capabilities not only enhances productivity but also fosters stronger engagement from employees, leading to greater satisfaction and loyalty.

California-Specific Considerations

Local laws require that your benefits package aligns with California’s high standards. For instance, businesses must offer certain benefits, like paid sick leave and access to health insurance. Employers also face stringent anti-discrimination laws, ensuring all employees receive equal access to benefits.

Employee benefits software includes tools for compliance with ACA requirements, tracking hours for eligibility, and addressing state-specific regulations. California’s environmental and social priorities also influence employee expectations. Employers increasingly include green initiatives, mental health support, and flexible working benefits. Utilizing a program designed for the local market ensures your business delivers exceptional value to employees.

Choosing the Right Software for Your Business

Selecting the best solution requires evaluating your company’s needs. Consider the following steps:

Assess your current process: Identify pain points and inefficiencies in your existing benefits program.
Determine required features: Focus on software that addresses compliance, enrollment, and integration.
Test user-friendliness: Employees and administrators must navigate the system with ease.
Compare options: Review tools like Sackett’s benefits management software, which caters specifically to California businesses.

Businesses should involve both HR teams and employees in the decision-making process to ensure the chosen software meets everyone’s needs. Feedback from employees about their preferences and challenges can guide your selection, ensuring higher adoption rates.

Streamlining Benefits for Long-Term Success

Employers across California recognize that efficient benefits management delivers more than convenience. It builds a foundation for long-term business success . Employees who experience a seamless benefits process feel valued, which fosters loyalty and improves productivity.

Effective software not only saves time but also reduces costs associated with manual errors or non-compliance. Over time, these savings contribute to improved profitability and organizational stability. By investing in innovative tools, California businesses position themselves as leaders in their industries, capable of meeting employee expectations while navigating complex legal landscapes.

Strong benefits management also supports organizational growth. As businesses scale, advanced software adapts to new requirements, ensuring smooth transitions and consistent service for employees.

Transform Your Employee Benefits Software Today

Modern employee benefits software offers businesses in California a chance to overcome administrative challenges while prioritizing employee satisfaction. With options like Sackett’s benefits management tools, your organization can simplify compliance, streamline processes, and enhance the employee experience. Contact Sackett & Associates Insurance Services today to discover how their expertise and tools can transform your benefits program.

Decoding Out-of-Pocket Maximums: A Key to Smarter Health Insurance Choices

mira@sackettinsurance.net (Sackett Insurance Services) — Sat, 11 Jan 2025 01:15:00 GMT

How Health Insurance Brokers Can Impact Your Out-of-Pocket Maximums Costs

Navigating health insurance alone can feel overwhelming, especially when evaluating how out-of-pocket maximums influence overall costs. These limits are important when determining the financial protection your health insurance plan offers. A licensed health insurance broker can help guide you through these considerations to ensure you make the best decisions.

What Are Out-of-Pocket Maximums?

An out-of-pocket maximum represents the highest amount you will pay for covered healthcare services in a given year. Once you reach this limit through deductibles, copayments, and coinsurance, your health insurance covers all remaining costs for covered services. Premium payments do not count toward this maximum.

For example, if your plan sets an out-of-pocket maximum at $8,000, this cap ensures you will not spend more than that amount on covered healthcare costs in a single policy year. Keep in mind, though, that expenses for out-of-network services or non-covered treatments may still fall outside of this limit.

Balancing Premiums and Out-of-Pocket Costs

The relationship between premiums and out-of-pocket maximums can significantly influence your total healthcare costs. Plans with lower premiums often feature higher out-of-pocket maximums, while higher-premium plans typically lower your maximum limit. This trade-off requires careful consideration of your healthcare needs and financial priorities.

To select the right plan, assess how frequently you visit doctors, whether you require regular prescriptions, and the likelihood of major medical events. For individuals with minimal healthcare needs, a lower-premium, higher-out-of-pocket plan may save money. However, those managing chronic conditions may find higher premiums and lower maximums more cost-effective over the long term.

Impacts on Medicare Choices

Medicare plans also include out-of-pocket maximums, but they vary based on plan type. Original Medicare does not impose a maximum unless paired with supplemental coverage. Medicare Advantage plans, on the other hand, feature built-in caps that safeguard enrollees from excessive costs.

Choosing the right Medicare plan involves evaluating how out-of-pocket maximums fit within your overall budget and expected healthcare needs. Licensed health insurance brokers specialize in guiding California residents through these choices. Whether you are exploring Medicare Advantage or supplemental plans, an expert's opinion can simplify the decision-making process.

Out-of-Pocket Maximums and Individual Health Insurance

Individual health insurance plans vary widely in terms of coverage and costs, making it essential to evaluate details carefully . An out-of-pocket maximum limits your financial responsibility for covered medical expenses during a policy year. Reaching this cap ensures that your insurance takes over most or all additional costs for covered care. However, high maximums can still result in substantial spending, especially when unforeseen medical emergencies occur.

When reviewing a plan, check whether your deductible contributes to the out-of-pocket limit, as many plans include deductibles, copayments, and coinsurance under this cap. Be aware that certain exclusions may apply, such as out-of-network care or non-covered treatments.

Implications for Group Health Insurance

Employers offering group health insurance plans must also weigh the role of out-of-pocket maximums. Their satisfaction often hinges on access to affordable healthcare, and plans with lower maximums can enhance perceived value. Employees with access to plans that protect them from catastrophic healthcare costs often feel more secure .

Employers should collaborate with a health insurance broker to design group plans that meet employee needs without exceeding budget constraints. Brokers provide insights into plan comparisons and ensure compliance with state regulations. Additionally, a well-designed plan with reasonable out-of-pocket limits can serve as a strong recruitment and retention tool.

Tips for Making Cost-Conscious Decisions

When comparing health insurance plans, follow these tips to evaluate out-of-pocket maximums effectively:

Understand Coverage Details: Ensure you know what expenses count toward the out-of-pocket maximum and what costs remain outside the cap.
Estimate Annual Healthcare Needs: Consider the number of expected doctor visits, prescription costs, and potential emergency care. This calculation provides a clearer picture of your potential spending.
Use Preventive Services: Take advantage of preventive services, often covered at no cost, to minimize medical expenses and maintain overall health.
Compare Plan Networks: Check if your preferred healthcare providers fall within the plan’s network. Out-of-network costs can significantly increase your total spending.
Consult Experts: Partner with a licensed health insurance broker who can clarify plan details and recommend options that align with your needs. Professional advice ensures you understand the long-term financial implications of your choice.

These steps will help you make better decisions when navigating the complexities of health insurance.

Making the Most of Your Health Insurance

Out-of-pocket maximums are just one piece of the puzzle when choosing health insurance and navigating the complexities alone can prove daunting. Sackett & Associates Insurance Services simplifies this process by connecting individuals, families, and employers with plans that balance affordability and comprehensive care.

Speak with a licensed health insurance broker to explore your options and gain peace of mind in your healthcare choices. For more information on how out-of-pocket maximums affect your health insurance decisions, contact Sackett & Associates Insurance Services today.

What is an Independent Health Insurance Broker?

mira@sackettinsurance.net (Sackett Insurance Services) — Mon, 30 Dec 2024 22:30:00 GMT

How Independent Health Insurance Brokers Simplify Your Coverage Options

Navigating the complexities of health insurance poses challenges for individuals, families, and businesses. The abundance of plan options, variations in coverage, and evolving regulations make choosing the right health insurance overwhelming. Working with an independent health insurance broker provides unique benefits. Independent brokers offer personalized service, broad access to plans, and unbiased advice tailored to client needs.

What Makes an Independent Health Insurance Broker Unique?

Unlike captive brokers affiliated with specific insurance companies, independent brokers operate as standalone entities. Their independence allows them to represent multiple carriers , offering clients a wide array of plan options. This structure distinguishes them from captive brokers, whose recommendations focus solely on their employer’s offerings.

Client-Focused Service

Independent health insurance brokers prioritize the needs of their clients. This client-centered approach involves understanding unique circumstances and identifying the most suitable coverage options. For businesses, brokers assess workforce needs and recommend group health insurance plans that balance affordability and comprehensive benefits.

Anyone navigating the health insurance landscape often encounters confusion over coverage details and terminology. Independent brokers simplify this process by breaking down options and addressing questions. This level of personalized service enables clients to make informed decisions with confidence.

Extensive Access to Plan Options

One of the primary advantages of using an independent health insurance broker lies in their access to a broad range of insurance products. Brokers analyze policies from multiple carriers, comparing features, benefits, and costs. This process allows clients to explore a variety of options and find plans that meet specific needs.

For example, businesses in Santa Rosa benefit from this expansive access when seeking group health insurance plans. Sackett & Associates Insurance Services connects employers with insurance carriers offering competitive rates and comprehensive coverage options. By leveraging their network, we create customized solutions that enhance employee satisfaction while managing employer expenses.

Unbiased Advice and Advocacy

Captive brokers often face limitations in their ability to provide impartial recommendations due to their ties to specific insurance companies. In contrast, independent brokers operate without such restrictions, allowing them to offer unbiased advice. They focus entirely on client needs rather than promoting specific products to meet sales quotas.

This independence builds trust. Clients know their broker advocates on their behalf, whether recommending plans, resolving claims disputes, or addressing policy questions. This commitment to client advocacy ensures everyone receives transparent guidance throughout their health insurance journey.

Cost Savings and Long-Term Value

Working with an independent broker often leads to significant cost savings. By comparing rates and negotiating with insurers, brokers identify cost-effective options that maintain essential coverage. For businesses, this means finding group health insurance plans that offer robust benefits while controlling expenses.

Additionally, independent brokers deliver long-term value by maintaining relationships with clients and proactively adjusting coverage as needs evolve. For example, a growing business may require expanded coverage to accommodate new employees, while an individual’s changing health circumstances might necessitate policy adjustments.

Specialized Expertise in Medicare

Medicare , with its intricate structure, often confuses individuals approaching eligibility. Independent brokers serve as valuable resources for understanding Original Medicare, Medicare Advantage, and supplemental plans. They guide clients through the enrollment process and help determine the coverage that best suits their health and financial goals.

Flexibility in a Changing Market

The health insurance landscape experiences frequent changes due to regulatory updates and market trends. Independent brokers stay informed about these developments, allowing them to provide clients with timely advice. They help businesses and individuals understand how new regulations impact their policies and recommend adjustments to maintain compliance.

Building Lasting Partnerships

Independent health insurance brokers emphasize relationship-building over one-time transactions. Their client-focused approach fosters trust and loyalty, resulting in long-term partnerships. Regular communication ensures brokers remain aware of changing circumstances, enabling them to recommend updates that keep coverage relevant.

This dedication to forming lasting connections underlines the value of choosing an independent broker to navigate the intricacies of health insurance. By focusing on the client’s evolving needs, brokers provide a service that adapts over time.

Supporting Santa Rosa and Beyond

Businesses and residents looking for a health insurance broker in Santa Rosa face unique challenges when selecting health insurance. Independent brokers provide invaluable assistance by offering tailored solutions and expert guidance. Their team combines extensive experience with a deep understanding of the local market, ensuring clients receive the support they need.

Whether exploring individual plans, managing group health insurance, or navigating Medicare, Sackett Insurance remains a trusted resource for California clients. Our approach emphasizes transparency, client advocacy, and cost-effective solutions, setting them apart in the competitive health insurance market.

Take Control of Your Health Insurance Decisions

Sackett & Associates Insurance Services delivers personalized support to individuals, families, and businesses. Our expertise simplifies the health insurance process, empowering clients to make informed decisions. Contact Sackett & Associates Insurance Services today for more information on how an independent broker can help you secure the best coverage.

For more information on how to find great health insurance options, visit Sackett & Associates Insurance Services to explore your options to get started today.

Can I Update My Medigap During Open Enrollment?

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 13 Dec 2024 23:30:00 GMT

Rules for Changing Your Medigap Plan During Medicare Open Enrollment

The annual Medicare Open Enrollment period creates opportunities for Medicare beneficiaries to evaluate their coverage. However, many individuals remain unclear about whether they can change their Medigap supplement during this time. Residents of California, including those in Santa Rosa, can work with a Medicare plans broker to explore options.

Understanding Medigap Policies and Their Purpose

Medigap, or Medicare Supplement Insurance, helps cover costs that Original Medicare does not pay , such as copayments, coinsurance, and deductibles. Medigap policies differ from Medicare Advantage plans. Beneficiaries with Medigap coverage use it alongside Original Medicare, whereas Medicare Advantage plans replace Original Medicare and often include additional benefits.

Medigap plans, sold through private insurance companies, offer standardized coverage under federal law. Each plan provides specific benefits depending on the chosen letter (Plan A, Plan G, etc.). Though Medigap plans follow standardization , prices vary between insurers.

Annual Open Enrollment and Its Purpose

The Medicare Open Enrollment period, from October 15 to December 7, focuses on Medicare Advantage and Part D prescription drug plans. Beneficiaries can switch from Original Medicare to a Medicare Advantage plan, move back to Original Medicare, or enroll in, change, or drop Part D drug coverage during this time.

However, the annual Medicare Open Enrollment period does not apply to Medigap policies. Beneficiaries seeking to change their Medigap plan during this time must navigate different rules and requirements. A Santa Rosa Medicare plans broker can help clarify the distinctions and guide individuals through the process.

Changing a Medigap Policy: Key Considerations

Changing Medigap policies can be challenging, especially after the initial Medigap open enrollment period. This six-month period begins when you first enroll in Medicare Part B and ensures guaranteed issue rights. During this time, insurers cannot deny coverage or impose higher premiums based on health conditions.

After the initial period, Medigap policy changes become more complicated. Most states, including California, allow insurers to deny new coverage or impose waiting periods for pre-existing conditions unless specific exceptions apply. These exceptions include:

Moving to another state with different Medigap options.
Losing current Medigap coverage due to reasons beyond your control.
Switching within six months of purchasing the current Medigap policy.

Without guaranteed issue rights, insurers may decline applications or impose probationary periods. Beneficiaries should consult a Medicare plans broker to review their situation and explore feasible options.

Reasons to Consider Changing a Medigap Policy

Though changing a Medigap policy involves hurdles, beneficiaries may find valid reasons to explore new options. Common motivations include:

Cost savings: Finding a similar plan at a lower premium from a different insurer.
Enhanced benefits: Upgrading to a plan offering more comprehensive coverage.
Satisfaction issues: Resolving problems with customer service or claims processing from the current insurer.

Thoroughly evaluating these factors ensures that any decision to change aligns with long-term health and financial goals.

State-Specific Rules for Medigap Changes

Medigap regulations vary by state. While federal law provides basic protections, states can implement additional rules to expand enrollment opportunities. California, for example, offers a "birthday rule." This rule allows beneficiaries to switch Medigap policies without medical underwriting within 30 days of their birthday.

States like California also provide extended guaranteed issue rights under specific circumstances. Understanding these state-specific rules ensures beneficiaries do not miss opportunities to adjust their coverage.

Steps to Changing a Medigap Policy

Taking the right steps ensures a smooth transition while avoiding unnecessary complications like lapses in coverage.

Evaluate your current coverage: Assess whether your existing policy meets your needs and budget. Identify gaps or concerns prompting a potential change.
Research alternative plans: Compare options from different insurers to identify policies offering better value. Use resources like a Medicare plans broker for professional guidance.
Understand your rights: Confirm whether guaranteed issue rights apply to your situation. Research your state’s specific rules for switching Medigap policies.
Apply for the new policy: Submit an application to the chosen insurer, providing all necessary health information. Be aware of potential underwriting requirements.
Cancel the existing policy: Once approved for new coverage, cancel your old Medigap policy. Avoid coverage gaps by ensuring no lapse between policies.

Switching Medigap policies requires diligence and attention to detail, especially when navigating underwriting or state-specific rules.

The Role of a Medicare Plans Broker

Navigating the complexities of Medigap policies requires expertise. A Medicare plans broker provides valuable support by analyzing your needs, comparing policies, and clarifying enrollment rules. They act as a resource for understanding both federal and state-specific regulations, ensuring you explore every available option.

Santa Rosa beneficiaries benefit from working with a Medicare plans broker who understands California’s unique rules, such as the birthday rule. This local knowledge ensures residents receive tailored advice and practical solutions.

Finding the Right Medigap Policy for Your Needs

Understanding your rights and options for changing a Medigap supplement empowers you to make the best decision for your healthcare needs. For more information on how a Medicare plans broker can help you navigate this process, contact a trusted resource to explore your individual health insurance options.

Rising Healthcare Costs: How Employers Can Prepare

mira@sackettinsurance.net (Sackett Insurance Services) — Thu, 21 Nov 2024 18:15:00 GMT

Healthcare Costs Surge: Key Insights for Employers in 2025

In the United States, health care costs affect both employers and employees, and the costs have projections to jump by the fastest rate in 15 years. The Business Group on Health estimates the costs will jump by 8% in 2025.

They also predict a sharp increase in pharmacy expenses, new treatments, and ongoing health conditions to drive the bulk of the surge. Knowing which trends to watch helps business owners prepare for the upcoming challenges.

Why Healthcare Costs are Rising

The reasons why health care cost increases are complex, but there are a few main reasons. Pharmacy costs play a large role, including a big jump on prescription medication spending. Throughout 2023, roughly 27% of all health care dollars went to pharmacy expenses, and this is a jump from 2021’s 21% spending. Additionally, some health conditions and weight management medications are playing a part in the cost increase.

The Role of Pharmacy Costs

The cost for prescription medications is putting a big strain on employers. Many employers have valid concerns about the increasing costs of GLP-1 medications. To help curb and manage these expenses, some employers are starting to maximize manufacturer copay programs and work more closely with their Pharmacy Benefit Managers (PBMs) . These are short-term solutions, so the long-term outlook is still shaky.

The Major Health Conditions Driving Costs

The most expensive and common health conditions affecting employees drives healthcare spending. In 2024, the top concerns are:

Cancer
Musculoskeletal conditions
Cardiovascular disease

For example, 80% of employers said that cancer was the leading cause of the increase in expenses. A lot of companies already took steps to help detect the disease early with the hope of lowering the long-term treatment expenses, like implementing cancer screening programs.

The Impact on Employee Out-of-Pocket Costs

In spite of the rising health care costs, employers are working to absorb the bulk of the cost to help make health care affordable for their employees. In 2024, the estimated total cost for these plans for the employer is $18,639. This is a jump from 2023’s $17,201 total.

However, the out-of-pocket costs the employees face are supposed to stay stable. The average cost for 2024 is $1,825, and this is almost the same as in 2023. Individual health insurance plans come into play here because they offer more tailored solutions without going over budget.

GLP-1 Medications and Their Effect on Healthcare Costs

GLP-1 medications are another big factor pushing health care costs higher. People use them to treat obesity and diabetes, and roughly 96% of employers cover the cost if the employee uses it for diabetes. For obesity treatment, roughly 67% offer coverage. However, these medications have a high price tag attached, and many employers require prior authorizations to ensure the employees use them correctly and follow a treatment plan.

Managing Long-Term Costs of Weight Management Drugs

There is a rising concern over the long-term costs associated with any weight management drug, especially GLP-1. While the drugs are effective, they’re also expensive and need more than one-time use. Employers are trying to figure out how to balance offering coverage for these medications while staying on budget. A lot of them are going with group health insurance plans to help be more effective at managing costs while balancing employee benefits.

Strategies Employers are Using to Control Costs

Another thing many employers are doing in the face of rising costs is to take another look at their vendor relationships and their pharmacy benefit strategies. A lot of companies are looking at more transparent models to help get a handle on their expenses and improve the overall quality of care. Also, employers are looking at key pieces of information to help make better decisions, including vendor transparency and claims data.

Reevaluating Partnerships

When it comes to choosing healthcare vendors, employers are starting to adopt data-driven approaches. The request for proposal (RFP) process is not an important tool employers use to help negotiate better prices and pick high-performing vendors. Data quality and transparency are factors employers consider when they make these decisions.

What to Expect in the Future

Looking ahead, the rising trend regarding health care costs shows no signs of slowing down. Employers have to prioritize being proactive in managing these increases by looking into creative solutions and considering programs that encourage employee health. Pharmacy costs, especially revolving around weight management medications, are a focal point.

At the same time, health plans that focus on common conditions like cardiovascular disease and cancer are important for controlling costs. Exploring plans like Medicare could also be a viable solution for employees around retirement age or those who need supplemental coverage.

Adapting to Rising Healthcare Costs

With healthcare costs on the rise, it’s important that employers act quickly to help ward off future increases. At Sackett Insurance, we’re ready to offer expert guidance to help businesses understand these challenges and the best solutions. Contact us to learn more about your options and keep your healthcare costs under control.

Sources:

● Business Group on Health

● Mayo Clinic

● American Progress

● Healthcare.gov

● GoodRX

● Universal Service Administrative Co

● Harvard T.H. Chan School of Public Health

● NIH

What the 2024 Election Means for Health Insurance

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 01 Nov 2024 20:00:00 GMT

How the 2024 Election Could Impact Health Insurance Access

Millions of Americans might not be able to get health insurance, depending on the election’s outcome. It determines whether the country stays with affordable and readily available health care or goes back to more costly, limited insurance options.

People might find themselves having to pick Medicare, workplace health plans, and individual health insurance as a result of the policies of both the main political parties, which hold opposing views on the subject of healthcare.

The Role of Health Insurance in the 2024 Election

There were millions of Americans with no insurance in 2023, and many more didn’t have enough coverage. They faced limited coverage and high deductibles despite paying premiums. The Affordable Care Act (ACA) introduced changes that improved access to affordable healthcare, but it didn’t fix the problem.

As voters gear up to head to the polls this year, health insurance will be at the forefront. Will policies continue to build on ACA improvements, or will efforts to scale back health programs take center stage? To get an understanding of what’s at stake, you have to look at how the outcomes could impact Medicaid expansion, premium costs, and consumer protections.

The Potential Impact on Individual Health Insurance

If you use individual health insurance , enhanced premium tax credits are at risk. The government introduced them during the pandemic to make ACA plans more affordable. They expire in 2025, and they’re tax credits that lowered premiums for millions of people. If they get extended, they’ll help ease insurance costs. However, failure to extend the program will lead to premium increases.

Medicare and Medicaid are Key Battlegrounds

Medicare and Medicaid are necessary healthcare options for low-income families and older adults. There are proposals to expand healthcare that would increase the coverage for these groups. The proposals also lobby to lower Medicare’s eligibility age and fill in the Medicaid gap for states that didn’t adopt the Medicaid expansion plan under the ACA. This could help millions gain access to affordable health insurance.

Medicare beneficiaries may also see changes in cost protections and coverage, depending on the election’s outcome. Expansion efforts might include adding more preventive services and prescription drug cost controls, while rollbacks could limit these benefits.

What Group Health Insurance Looks Like

Employers and employees are also keeping eyes on the election to see how it impacts group health insurance policies. Employer-covered plans do provide coverage for a large amount of working-aged Americans, but out-of-pocket costs are concerning.

Proposed reforms could change cost-sharing and premium contributions to make employer plans more affordable for low-income workers. However, other policies try to make it more affordable for employers, and this changes the structure group health benefits runs on.

Discussing Equity in Health Insurance Coverage

One issue in the 2024 election is the question of healthcare access equity. There are several longrunning coverage disparities based on:

● Race

● Income

● Geographic location

Expanding Medicaid coverage in the 10 final states that haven’t adopted it yet could help insure over a million people. Also, there are ongoing debates about offering protection for gender identity, pre-existing conditions, and sexual orientation. These will all play a large role in how accessible coverage stays for more vulnerable populations.

Potential Outcomes

The incoming administration could take away or enhance protections that try to ensure every American has access to comprehensive, affordable health care. It’s possible you could see policies created to help reduce discrimination with insurance extend or restrict coverage opportunities for groups the health care system historically marginalized.

What Voters Should Consider in 2024

There are many issues at stake in the 2024 election, so it's a good idea to look into each candidate's health care proposal . You want to see how it might impact the coverage you have.

The long-term impact on Americans' ability to pay for healthcare coverage may change due to any regulation that affects Medicaid, Medicare, individual, or group health plans. Problems such as medical debt protection, reduced costs, and more equal access to treatment are hotly debated topics.

Securing Your Health Coverage in a Changing Landscape

For personalized help in understanding how changes to general health care policies may impact your coverage, or if you need help picking the right insurance coverage option for your needs, contact Sackett Insurance . We’ll give you expert advice, whether you’re trying to understand the finer points of the Medicare system or trying to find the best group or individual health solution for your company, our experienced brokers are ready to help.

Sources:

● The Commonwealth Fund

● KFF

● Protect Our Care

● Washington Post

● US Dept of Health and Human Services

● Rollins School of Public Health

● National Academy for State Health Policy

How Small Businesses Can Secure Affordable Health Insurance with Covered California

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 04 Oct 2024 14:00:17 GMT

Affordable Health Insurance for Small Businesses via Covered California

Finding health insurance for your small business can be a daunting task, but Covered California for Small Business (CCSB) offers a solution that is flexible, cost-effective, and easy to manage. This state-sponsored service provides high-quality health and dental coverage options for your employees, helping you attract top talent to your organization while keeping your budget in check.

Why Choose Covered California for Small Business?

Covered California for Small Business (CCSB) is a state-run program designed to connect small businesses with affordable, brand-name health plans. By offering health benefits through CCSB, you can attract great employees and potentially qualify for federal tax credits to offset the cost of these benefits.

Flexibility and Options:

CCSB allows small business owners to choose from four tiers of coverage—Bronze, Silver, Gold, and Platinum—provided by three well-known health insurance companies: Blue Shield of California, Kaiser Permanente, and Sharp Health Plan. These tiers offer a range of plans to fit different budgets and employee needs. Your employees can also pick from one of four dental insurance plans that best suits their dental care needs. Partnering with a group health insurance broker can help you better understand these options and select the best plan for your company.

Simplified Billing

One of the key advantages of CCSB is the simplicity it brings to managing health insurance for your employees. You’ll receive a single, consolidated invoice each month, regardless of how many plans or insurance providers are involved. This streamlined billing process helps reduce administrative burdens and makes it easier to keep track of your expenses.

Tax Credits and Financial Benefits:

Another advantage of offering health insurance through CCSB is the potential to qualify for federal tax credits. To be eligible, your business must cover at least 50% of the cost of your employees' health insurance. The amount of credit you receive depends on the size of your business, the average wages of your employees, and the amount you contribute to their premiums.

Smaller businesses with fewer than 25 full-time equivalent (FTE) employees and average annual wages below $62,000 typically receive the most significant credits. For-profit businesses can receive a maximum tax credit of up to 50% of monthly premiums, while non-profit organizations can get reimbursed up to 35%.

How to Qualify for CCSB

To participate in CCSB, your small business must meet specific criteria:

● Have between 1 and 100 FTE employees.

● At least one employee must receive a W-2, and most employees must live in California.

● The employer must contribute at least 50% to the premium of the lowest-cost reference level tier for their employees.

If your business meets these requirements, you can start offering health insurance through CCSB. Working with a group health insurance broker can help you navigate the application process so you can begin providing essential healthcare benefits to your employees.

Complying with Legal Requirements

For businesses with 50 or more FTE employees, offering health insurance is not just an option—it’s the law. Under the Affordable Care Act (ACA), businesses of this size are required to provide health coverage to their employees or face potential penalties. This makes securing affordable health insurance through CCSB a good option for mid-sized businesses looking to comply with legal requirements.

Options for Sole Proprietors and Self-Employed Individuals

For sole proprietors and self-employed individuals without W-2 employees, CCSB offers individual and family plans. These plans are also eligible for financial assistance through Covered California, making it easier to find affordable coverage even if you’re running a one-person operation.

How CCSB Health Plans Work

CCSB gives both employers and employees a variety of options:

● Employer Contribution: Business owners can define their contribution to health care benefits, allowing them to control costs.

● Employee Choice: Employees can choose their own plans based on their individual needs, including whether or not to include dental coverage. All health plans cover essential health benefits, such as prescription drugs and emergency services.

Employees can select from a range of plans offered by trusted insurance companies. The available metal tiers allow employees to balance their coverage level with their budget, ensuring that they get the best possible plan for their needs.

Managing Your Plans with MyCCSB

Once your business is enrolled in CCSB, managing your health and dental plans is straightforward. MyCCSB , an online management tool, allows you to enroll, compare, and manage plans, make changes, renew policies, and handle billing—all in one place. This streamlined process saves time and reduces administrative burdens, making it easier to focus on running your business.

How to Apply for CCSB

Applying for CCSB is simple and can be done at any time of the year. Unlike individual applicants, small businesses are not restricted by enrollment periods. New applications are accepted each month, with the official monthly cutoff for same-month coverage being the first of the month.

For assistance, you can contact a CCSB agent free of charge. They will help you navigate the process and provide a quote within two business days, allowing you to quickly secure the benefits your employees need. Once you secure benefits for your employees through CCSB, you can use Sackett Insurance’s benefits management software to simplify your benefits search and onboarding process for new team members.

Making the Most of Your Health Insurance Benefits

Covered California for Small Business offers a practical solution for securing affordable health insurance, with extensive benefits for your company and employees. By exploring CCSB’s offerings, you can ensure that your small business provides competitive and cost-effective health coverage while supporting your employees' well-being.

If you are looking to secure affordable health insurance for your company, contact us at Sackett Insurance to speak to one of our insurance agents. We can provide you with more information on the Covered California plan to see if it is the right fit for your small business.

Trump vs. Harris: Approaches to Healthcare in the 2024 Presidential Election

mira@sackettinsurance.net (Sackett Insurance Services) — Mon, 23 Sep 2024 16:00:12 GMT

Comparing Stances on Healthcare Policy: Trump vs. Harris in 2024

As the 2024 general election approaches, health care remains a critical issue for voters. Understanding how Democratic nominee Kamala Harris and Republican nominee Donald Trump approach key aspects of healthcare policy is essential for understanding the future of U.S. health care and health insurance.

The Future of Healthcare Programs

Historically, Donald Trump and Kamala Harris have taken vastly different approaches to policies affecting the Affordable Care Act, Medicaid, and Medicare . The results of the 2024 elections could determine the direction of U.S. healthcare policy for years to come, impacting both insured and uninsured Americans.

Affordable Care Act (ACA)

During his presidency, Donald Trump made several attempts to repeal and replace the Affordable Care Act (ACA) , which would have significantly increased the number of uninsured Americans. His actions included eliminating the individual mandate penalty, which required most Americans to have health insurance or pay a fine. This move, coupled with cutting outreach funding, undermined the ACA’s foundation, leading to higher premiums and reduced coverage options. Despite his criticisms of the ACA, Trump has yet to present a clear replacement plan.

On the other hand, Kamala Harris has been a key figure in strengthening the ACA. The Biden-Harris administration expanded ACA subsidies through the American Rescue Plan Act (ARPA) , making healthcare more affordable for millions of Americans. These subsidies were further extended by the Inflation Reduction Act (IRA), which helped to lower monthly premiums and out-of-pocket costs. The Biden-Harris administration also reversed Trump-era policies that weakened ACA coverage, ensuring better protection and more comprehensive options for those in need.

Medicaid

Trump's approach to Medicaid focused on reducing federal oversight and involvement. He advocated for cutting federal funding for Medicaid and shifting costs to states, which could have led to reductions in benefits and coverage for millions of low-income Americans. Trump also supported implementing work requirements for Medicaid recipients, potentially excluding many from receiving necessary health care services.

In contrast, Harris has championed Medicaid expansion leading up to the election. Under her leadership, the Biden-Harris administration has encouraged states to extend postpartum Medicaid coverage to reduce maternal mortality and provided incentives for states to close the coverage gap, particularly in underserved communities. Harris continues to propose policies aimed at streamlining Medicaid enrollment and improving access to care, ensuring that eligible Americans receive the support they need through this program.

Medicare

Donald Trump has consistently pledged to protect Medicare , but his administration's actions risked accelerating the insolvency of Medicare’s trust funds. Without a clear plan for Medicare’s long-term sustainability, there is concern about the program’s future viability under another Trump administration.

Harris has proposed raising Medicare taxes on high earners to support the program's financial stability. She has also supported the Inflation Reduction Act, which includes provisions to lower prescription drug costs and cap insulin prices, making Medicare more affordable and accessible. Harris continues to focus on enhancing Medicare within its existing framework, improving coverage, and ensuring that seniors have access to necessary medical services without facing excessive costs.

Reproductive Care

Reproductive care has been a highly contested issue in the months leading up to the 2024 election, with significant differences between Trump and Harris’s approaches. Their views on abortion and contraception will likely impact healthcare policies and the ability to access reproductive care through their health insurance for years to come.

Access to Abortion

Trump takes credit for the Supreme Court's decision to overturn Roe v. Wade, leaving abortion laws to individual states. This has resulted in a patchwork of restrictive abortion laws across the country, with some states imposing severe limitations on access to abortion services. Trump has also suggested the possibility of a national abortion ban with certain exceptions, though this remains uncertain.

Kamala Harris is a staunch advocate for reproductive rights. She has been a leading voice in the Biden-Harris administration’s efforts to safeguard abortion access nationwide. Harris supports federal legislation to restore the protections previously guaranteed by Roe v. Wade and has taken steps to ensure that women in restrictive states still have access to necessary services.

Contraception

During his presidency, Trump took steps to restrict access to contraception. This includes barring family planning clinics like Planned Parenthood from receiving federal Title X funds and allowing employers with religious or moral objections to opt out of providing contraceptive coverage under the ACA.

The Biden-Harris administration has worked to expand access to contraception. They reinstated Title X rules requiring clinics to offer a comprehensive range of contraceptives and pregnancy options counseling. Additionally, the administration approved the first over-the-counter oral contraceptive pill, making it easier for individuals to obtain birth control without a prescription.

Public Health and Prescription Drug Pricing

As American citizens continue to struggle with rising prescription drug costs and other public health challenges, Trump and Harris offer contrasting strategies that could shape access to healthcare for millions of Americans.

Public Health

Trump’s approach to public health, particularly during the COVID-19 pandemic, has been marked by skepticism toward scientific consensus. His administration often downplayed the severity of the pandemic and shifted much of the responsibility for pandemic response to individual states. Trump continues to propose budget cuts to many federal public health programs.

On the other hand, the Biden-Harris administration has implemented a science-driven approach to public health. They implemented federal mask and vaccine mandates, expanded testing, and bolstered the public health workforce. Harris has continued to emphasize the importance of evidence-based responses and comprehensive pandemic preparedness to protect public health.

Prescription Drug Pricing and Health Care Costs

Trump made several moves to reduce prescription drug costs, including a voluntary model capping monthly insulin costs at $35 for Medicare Part D enrollees and allowing states to import cheaper drugs from Canada. He also introduced the No Surprises Act to protect patients from unexpected out-of-network medical bills. Trump’s 2024 campaign continues to focus on reducing drug prices and health care costs, with promises to lower health insurance premiums.

Harris has also been active in addressing drug pricing and health care costs, playing a key role in the Inflation Reduction Act. This legislation allows Medicare to negotiate drug prices and caps monthly insulin costs at $35 for both Medicare Part B and Part D, and expands price transparency rules. The Biden-Harris administration has also advocated for reducing medical debt and tackling anticompetitive practices in the health care sector.

Approaches to Mental Health and Addiction

As mental health and opioid challenges continue to affect countless Americans, the next administration’s response will affect healthcare policies that increase accessibility to care.

Mental Health

Trump’s mental health policies included a controversial return to institutionalization for the severely mentally ill, departing from community-based treatment approaches. His administration’s support for Medicaid cuts also reduced access to behavioral health services. During his presidency, he did support some mental health initiatives, such as establishing the 988 crisis hotline for individuals in mental health crises.

Harris, under the Biden administration, focused on expanding mental health care access, especially for underserved populations. The Biden-Harris administration launched the National Maternal Mental Health Hotline and extended Medicaid coverage for postpartum mental health. Improvements in crisis care, including the enhancement of the 988 hotline and mobile crisis services, reflect Harris’s commitment to better mental health support.

Opioid Use Disorders

Trump took an aggressive stance on the opioid crisis, declaring it a public health emergency. His 2024 campaign proposes even tougher measures, including stricter border policies and severe penalties for drug traffickers. Trump also advocates for faith-based treatment programs, though his approach leans heavily on law enforcement rather than healthcare and mental health programming.

Harris supports a comprehensive strategy to address opioid use disorders, including reducing the supply of illicit drugs like fentanyl and expanding access to evidence-based treatments. She has also backed state and tribal grants for opioid response and enhanced treatment options in correctional facilities.

Looking Ahead: Healthcare in the 2024 Election

As the 2024 election nears, the healthcare policies of Donald Trump and Kamala Harris present contrasting visions for the future of U.S. healthcare. These stark differences in healthcare policies will significantly impact how individual and family health insurance policies and healthcare options are approached post-election.

To understand how these proposed changes in healthcare policies might affect your health insurance and overall care, contact us at Sackett Insurance Services. Our insurance advocates are here to help you navigate these potential changes and ensure you’re prepared for whatever comes next.

Planning Your Golden Years: Essential Insights on Full Retirement Age

mira@sackettinsurance.net (Sackett Insurance Services) — Thu, 22 Aug 2024 21:30:00 GMT

Understanding Full Retirement Age and Your Best Options

Leaving the workforce can be challenging, and you may struggle to decide the best time to retire. Typically, individuals will aim for full retirement age to maximize their benefits.

However, when doing so, it’s important to understand full retirement and consider additional factors such as your health and changing standards. This article explains the ins and outs of full retirement age so that you can confidently take the necessary steps to retire.

Overview of Full Retirement

Full retirement age or “normal retirement age” refers to the age at which you become eligible to receive the total amount of Social Security benefits without reductions. This age varies according to the year you were born, but the general rule of thumb is that it falls between 66 and 67.

Those born before 1954 are eligible at age 66. Due to amendments, those born in the transitionary period between 1955 and 1960 have different standards. During this period, the full retirement age increased by two months per year, until reaching a new standard. Currently, anyone born after 1960 must be 67 to access their Social Security benefits.

These changes are to preserve the health of the social security system in the face of longer life expectancies. The goal is for future retirees to receive the same benefits as those before them.

Retiring Outside of Full Retirement Age

You can retire as early as 62. However, deductions to your monthly Social Security payout can make this a less desirable option. The exception to this rule is when you file for Social Security disability. In this case, you might be eligible for the full payout even though you didn’t reach full retirement age.

Alternatively, working beyond your full retirement age can yield you extra benefits. Any earnings beyond your full retirement age contribute to your lifetime earnings. This can produce a higher payout when you retire. By delaying your retirement, you receive an extra 8% on your benefits for each year you work beyond retirement age until you turn 70.

Understanding your Social Security Benefits

Social Security awards benefits based on lifetime earnings, the number of years worked, and when you choose to retire. Making informed decisions about when to retire requires careful consideration. It may benefit you to contact a financial advisor or social security representative to clarify your situation.

When retiring at full retirement age (FRA), you will receive a monthly payout equal to a percentage of your pre-retirement earnings. Those who earned lower wages can expect a higher percentage. Medium or high earners receive a lower percentage, but likely a higher amount.

Keep in mind that retiring before your FRA will likely yield a lower payout. For example, retiring at 62 will cause you to lose roughly 25% to 30% of your monthly income, depending on your full retirement age. If you retire at 65, you will still face deductions, but by a lower percentage than if you retire at 62.

Most financial advisers suggest that individuals need about 80% of their monthly earnings to retire comfortably. This amount includes not only your social security benefits but also personal investments.

Health Insurance Benefits for Retirees

As you age, it’s more likely that you will need more frequent care and, subsequently, more comprehensive health insurance. When retiring, it’s not only the monthly payout you can expect; you also have access to Medicare as a benefit.

Medicare is the most common form of federally regulated healthcare available to individuals over 65. This means you can apply for Medicare before you retire. Part A of Medicare covers hospital visits and is often free to those who have contributed to it during their working years. You can determine what medicare benefits you are eligible for by contacting a medicare health insurance broker in your state.

If you are not eligible for Medicare or want individual health insurance instead, there are plenty of options for those of retirement age. Navigating different regulations and finding a premium that is affordable on retirement income can be difficult, so it’s best to work with an insurance service to find what is best for you.

Navigating Important Retirement Decisions

Deciding when to leave the workforce can be challenging, especially when making decisions about your financial and physical well-being. Understanding the benefits you can receive and assessing your options is crucial to retiring comfortably.

Even if you’re still unclear, the good news is that you don’t have to go it alone. California residents can contact Sackett and Associates for more information. They can offer guidance regarding Medicare and post-retirement individual health insurance.

Does Social Security Overlap With Medicare?

mira@sackettinsurance.net (Sackett Insurance Services) — Mon, 05 Aug 2024 17:00:00 GMT

Understanding the Overlap: Social Security and Medicare Explained

If you’re nearing retirement age, you’re probably feeling excited about the transition, but might also feel apprehensive.

While these years afford more freedom to enjoy your interests, they also come with a potentially confusing shift to Medicare insurance from individual health insurance . You’ll also start to collect Social Security. So what, exactly, is the difference between the two programs?

What Social Security Covers

Social Security is not medical insurance. This is a government program you pay into throughout your working life so that you have access to a monthly retirement stipend and a few other benefits. Social Security may also provide disability benefits to you or family members in certain circumstances.

Unlike Medicare, you cannot choose from different types of Social Security plans; the benefits are standard for all retirees unless there are special circumstances (e.g., a disability). This makes Social Security a little more cut and dry, which is why it’s generally easier to navigate than Medicare.

What Medicare Covers

Conversely, Medicare takes the place of private insurance or Medicaid after you hit retirement age (between ages 65 to 67, depending on when you were born)—and it’s a bit more complicated. The Centers for Medicare and Medicaid Services provides funds for health services such as hospitalizations and doctors’ visits, as well as prescription drugs and long-term care.

However, there are four Medicare plans you can select, and each provides a different level of coverage.

Part A

Part A picks up the tab for inpatient medical services and long-term care, as well as hospice and home health care. This plan primarily covers hospitalizations of any duration.

Part B

Part B is similar to your typical private insurance in that it covers mostly preventative care. If you need to pay a visit to the doctor or another outpatient provider, it’s likely Part B Medicare that will provide the coverage to do so.

Part C

Part C is also known as Medicare Advantage. It’s basic Medicare (Parts A and B), plus a complement of extra coverage that’s outsourced to a private insurance company. Under a Medicare Advantage Plan, you’ll have a few extra options when it comes to your supplemental coverage. Some will give you broader access to a variety of different providers, while others will offer extra perks like wellness programs.

Part D

This Medicare plan covers prescription drugs, an important component for anyone living with a chronic disease.

Can You Have Both?

Yes—and most people do. Since Social Security and Medicare provide different benefits, anyone of retirement age is eligible to tap into both of these programs. Some may be able to secure Medicare coverage before retirement if they’ve been using Social Security disability benefits for more than two years.

What About Private Insurance?

Some may opt to continue paying for private insurance even after retirement, since this may come with fewer restrictions in terms of where you access your medical care. However, keep in mind that even Medicare coverage can include some convenient components from private insurance if you opt for a Medicare Advantage plan.

How to Find the Ideal Coverage

Now that you know the basics of Social Security versus Medicare, you might be wondering which Medicare plan would be best for you. Sackett & Associates can help with that. Our insurance advocates are available to help you sift through the sometimes confusing world of Medicare and determine which level of coverage makes the most sense for you, and then help you to enroll.

If you want to learn more, send a message to Sackett & Associates or give them a call to determine the best next steps.

Your Guide To The Best Self Employed Health Insurance

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 12 Jul 2024 20:00:00 GMT

Top Health Insurance Options for the Self-Employed in California

Navigating health insurance as a self-employed individual in California can be challenging. Whether you’re a freelancer, a small business owner, or an independent contractor, understanding your options is crucial for maintaining your health and financial security. This guide will help you explore the best health insurance plans available through Covered California, focusing on both individual and group plans for those who qualify.

Understanding Health Insurance Options for the Self-Employed

Self-employed individuals have two primary health insurance options: individual health insurance plans and group benefits plans. The right choice depends on whether you meet specific qualifications.

Individual Health Insurance Plans

If you don’t have any W-2 employees (excluding a spouse), you’ll need to explore individual health insurance plans. These plans are ideal for freelancers and independent contractors who need comprehensive coverage without the complexity of managing a group plan.

For more information on individual health insurance options, visit our individual health insurance page.

Group Benefits Plans

If you have at least one W-2 employee (other than a spouse), you may be eligible for a group benefits plan. These plans can provide comprehensive coverage for you and your employees, often at more competitive rates than individual plans.

Explore our group health insurance options to see if you qualify.

Covered California: Your Health Insurance Marketplace

Covered California is the state’s health insurance marketplace, offering a variety of plans for individuals and small businesses. It’s the only place where you can access financial assistance to lower your monthly premiums and out-of-pocket costs. Below are some of the benefits of using Covered California.

Subsidies and Financial Assistance

One of the primary benefits of Covered California is the availability of subsidies and financial assistance. Depending on your income level, you may qualify for subsidies that significantly reduce your health insurance premiums and out-of-pocket expenses.

Wide Range of Plans

Covered California offers a diverse selection of health insurance plans from multiple providers. You can choose from different plan levels—Bronze, Silver, Gold, and Platinum—each designed to fit various needs and budgets.

Standardized Benefits

All health plans available through Covered California include essential health benefits mandated by the Affordable Care Act. These benefits encompass preventive care, prescription drugs, emergency services, hospitalization, maternity and newborn care, mental health services, and pediatric care, among others.

Choosing the Best Health Insurance Plan

Selecting the right health insurance plan involves evaluating several factors, including coverage, cost, and flexibility. Here are some tips to help you make an informed decision.

Evaluate Your Health Needs

Consider your current health status, medical history, and any ongoing health conditions. This will help you determine the level of coverage you need. If you primarily need coverage for routine check-ups and preventive care, a Bronze or Silver plan might be sufficient. If you have chronic conditions requiring frequent doctor visits or medications, consider a Gold or Platinum plan with lower out-of-pocket costs.

Compare Costs

Look beyond the monthly premium and evaluate the total cost of each plan, including deductibles, copayments, and coinsurance. Monthly premiums are the amount you pay each month for your health insurance. Deductibles are the amount you pay out-of-pocket before your insurance starts covering expenses. Out-of-pocket maximums are the maximum amount you will pay for covered services in a year.

Consider Flexibility and Network

Ensure the plan you choose provides access to your preferred doctors and hospitals. Check the provider network to avoid unexpected out-of-network charges. HMO plans have lower premiums but require you to use a network of doctors and get referrals for specialists. PPO plans offer more flexibility in choosing healthcare providers and do not require referrals but often come with higher premiums.

Tips for Self-Employed Individuals

Navigating health insurance can be daunting, but these tips can help you make the best choice for your situation.

Use a Health Insurance Broker: A licensed broker can help you compare plans, understand your options, and apply for financial assistance.
Review Annually: Health insurance plans and your healthcare needs can change yearly. Review your plan during the open enrollment period to ensure it still meets your needs.
Take Advantage of Tax Deductions: Self-employed individuals can deduct health insurance premiums on their tax returns, reducing overall taxable income.

Choose the Right Health Insurance Plan in California

Choosing the right health insurance plan as a self-employed individual in California is crucial for your health and financial well-being. Whether you opt for an individual plan through Covered California or qualify for a group benefits plan, understanding your options and making an informed decision is key.

For more information on how to choose the best health insurance plan for your needs, contact us at Sackett & Associates Insurance Services. Our experienced brokers are here to help you navigate your options and find the perfect coverage.

Difference Between HMO, PPO & EPO Plans in California

mira@sackettinsurance.net (Sackett Insurance Services) — Thu, 27 Jun 2024 23:15:00 GMT

Comparing HMO, PPO, and EPO Health Plans in California

Choosing the right health insurance plan can be a daunting task, especially with the variety of options available in California. Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Exclusive Provider Organization (EPO) plans each offer unique benefits and limitations.

Understanding the differences between these plans can help you make an informed decision that best suits your healthcare needs. In this guide, we’ll explore the key features, advantages, and drawbacks of HMO, PPO, and EPO plans, focusing on what’s available in California.

What is an HMO Plan?

Health Maintenance Organization (HMO) plans are known for their cost-effectiveness and structured network of healthcare providers. These plans require members to choose a primary care physician (PCP) who manages their overall healthcare and provides referrals to specialists within the HMO network.

Key Features

HMO plans are cost-effective, offering lower premiums and out-of-pocket costs. Coverage extends to healthcare providers within the HMO network. Members must choose a PCP who coordinates all healthcare services, and they need a referral from their PCP to see a specialist.

Advantages

HMO plans generally offer lower monthly premiums and reduced copayments. The PCP ensures that all aspects of healthcare are coordinated efficiently, emphasizing preventive care and early detection.

Drawbacks

HMO plans have limited flexibility, restricting members to network providers and offering no coverage for out-of-network care except in emergencies. The need for referrals from the PCP for specialist visits can delay care.

What is a PPO Plan?

Preferred Provider Organization (PPO) plans offer greater flexibility in choosing healthcare providers and specialists. Members can see any healthcare provider, both in-network and out-of-network, without a referral.

Key Features

PPO plans provide the freedom to choose any healthcare provider without needing a referral. They offer lower costs when using in-network providers, but coverage is available for out-of-network care. Typically, PPO plans have higher premiums compared to HMO plans.

Advantages

PPO plans provide access to a wide network of healthcare providers and the ability to see specialists without referrals. They also cover out-of-network care, although at a higher cost. Additionally, they offer easier access to specialists and healthcare services without PCP coordination.

Drawbacks

PPO plans come with higher premiums and out-of-pocket expenses compared to HMO plans. The broader network results in more complicated billing and paperwork.

What is an EPO Plan?

Exclusive Provider Organization (EPO) plans combine features of both HMO and PPO plans. They offer the flexibility of PPOs without the need for referrals but restrict coverage to a network of providers like HMOs.

Key Features

EPO plans have network restrictions, with coverage limited to a network of providers and no out-of-network benefits except in emergencies. There is no need for referrals to see specialists within the network. EPO plans typically have moderate costs, with premiums lower than PPOs but higher than HMOs.

Advantages

EPO plans provide flexibility within the network, allowing members to see any in-network specialist without a referral. They generally have lower premiums than PPO plans and offer simplified billing, making healthcare expenses easier to manage with a network-based system.

Drawbacks

EPO plans offer limited out-of-network coverage, with no benefits for out-of-network providers except in emergencies. This restriction can limit your choice of providers, requiring you to stay within the network to receive benefits.

Choosing the Right Plan

It’s a good idea to take the time to browse various health insurance plans to find the right option for your unique circumstance. When selecting a health insurance plan, consider the following factors to determine which type suits your needs best:

Healthcare Needs: Assess how often you visit doctors, need specialist care, or have ongoing health conditions.
Budget: Consider your budget for premiums, copayments, and out-of-pocket costs.
Provider Preferences: Determine if you have preferred doctors or specialists and whether they are in-network.
Flexibility: Decide how much flexibility you want in choosing healthcare providers and accessing care.

The Importance of Professional Guidance

Navigating the complexities of health insurance plans can be challenging. Consulting with a licensed health insurance broker can provide valuable insights and help you choose the best plan for your needs.

Learn More About HMO, PPO and EPO Plans in California

Understanding the differences between HMO, PPO, and EPO plans is crucial for making an informed decision about your healthcare coverage. Each plan type offers unique benefits and limitations, and the best choice depends on your specific healthcare needs, budget, and preferences.

For more information on how to choose the right health insurance plan in California, contact us at Sackett & Associates Insurance Services . Our experienced brokers are here to help you navigate your options and find the best coverage for you and your family.

Guide to 2024 Affordable Care Act Subsidies (and How a Health Insurance Broker in Santa Rosa Can Help)

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 24 May 2024 20:30:00 GMT

2024 ACA Subsidies and How a Health Insurance Broker Helps

The Affordable Care Act has offered a practical way for many Americans to access health care for over a decade. However, new regulations and eligibility updates can make it challenging to understand what you qualify for, which is why many people get the assistance of a health insurance broker in Santa Rosa.

Still, it never hurts to educate yourself about your options before discussing things with a professional. Take a look at this quick breakdown of the ACA guidelines for 2024 and how a broker can help.

How a Health Insurance Broker in Santa Rosa Guides You Through Using Subsidies

This breakdown can only scratch the surface of ACA subsidy essentials. Still, you’ll notice significant updates, some of which could change or expire in the future with new administrations.

Navigating these ever-changing statutes can become confusing, but it doesn’t have to be. Just as you rely on dedicated professionals for guidance in other matters, your broker can help you understand your options for health insurance. Then, you’ll work together with your health insurance broker in Santa Rosa to get the right deal for your family by maximizing the available subsidies.

The General Guidelines for ACA Subsidies

Like many government benefits, your annual household income determines your eligibility. With the ACA, you compare your estimated 2024 income with the “benchmark” plan — that’s the next-to-lowest-cost Silver plan on the Health Insurance Marketplace.

You qualify for a subsidy if that plan exceeds a particular percentage of your modified adjusted gross income. Currently, that percentage is 8.5% .

That subsidy can initially come to you through reduced insurance premiums. Once you share your projected household income, the government offers a Premium Tax Credit that discounts your rate to no more than 8.5% of your income. However, if you overestimate your income, whatever you paid in excess will be a credit that reduces your tax burden or comes back to you as a refund.

How You Calculate Your Modified Adjusted Gross Income

Remember, the government doesn’t look at the adjusted gross income you put on your tax return. Rather, you calculate your MAGI , which is a modified value. To get this number, you start with your AGI but add any tax-exempt Social Security benefits. You also add any money you excluded as tax-exempt interest or foreign income.

Understandably, you might worry about calculating this figure correctly. Fortunately, a health insurance broker in Santa Rosa walks you through the process to help you not miss out on the subsidies you are due.

Important Changes to the Law

A few pieces of legislation recently expanded the number of individuals who are eligible for subsidies. Therefore, do not assume that you don’t qualify, even if you weren’t eligible in recent years.

For example, the American Rescue Plan temporarily removes the restriction for subsidies from higher-income households. Before 2021, you couldn’t get a subsidy if your income was more than 400% of the Federal Poverty Level. Now, you can generally get a subsidy for Silver plans when the cost exceeds 8.5% of your income, no matter how much you earn.

Furthermore, the plan allows those receiving unemployment benefits to get low-cost or even free low-deductible plans. People with lower incomes (below 150% of the FPL) can access no-cost plans.

Also, a member of your household can get plans through the marketplace, even if you have an employer plan. Such flexibility allows you to tailor a solution that fits your family, and a qualified health insurance broker in Santa Rosa will help.

Other Options for Coverage

Your income might be too high or too low to get a plan from the Marketplace. For instance, those with earnings below 100% of the FPL don’t qualify. However, these households typically qualify for free care through Medicaid.

If your income is so high you don’t qualify for a subsidy, you shouldn’t just pick a plan on the exchange. Talk to your broker about private plans that offer the same (or better) benefits for a lower price. Likewise, senior citizens should look at Medicare coverage and determine whether dual coverage with an ACA plan or private insurance would be beneficial.

Get Matched With the Right Plan Using a Health Insurance Broker in Santa Rosa

As you can see, the rules for 2024 vary from previous years. It may be possible for you to get a better deal on health insurance for your family, but you have to understand the regulations and guidelines.

Instead of spending hours agonizing over these rules, let us help. Our team at Sackett Insurance is ready to be your health insurance broker in Santa Rosa. For more information, don’t hesitate to contact us so we can help you get the subsidies you deserve.

What You Need To Know About Selecting a Medicare Plan

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 15 May 2024 13:45:00 GMT

Selecting a Medicare Plan That's Right For You

Medicare is a collection of health insurance plans issued by the federal government for those over the age of 65 or younger with disabilities. Although Medicare plans exist to help mitigate the cost of health insurance as people get older, they don’t cover everything.

It’s a complicated topic, and Medicare health plan broker Sacket & Associates is here to help you understand the nuances so that you can get the most beneficial coverage for your situation.

Understanding How Medicare Works

If you’re 65 or older and a U.S. citizen, you can sign up for several different Medicare plans.

Part A covers inpatient hospital and skilled nursing facility care.
Part B covers preventative care and doctors’ visits.
Part C, or Medicare Advantage, is a combination of Parts A and B (also known as Original Medicare) and benefits that can help with dental care, hearing, and vision.
Part D covers brand-name and generic prescription drugs.
Medigap, or Medicare Supplement Insurance, is private health insurance that fills any coverage gaps in your Medicare plan.

You must already have Medicare Parts A and B before you can apply for a Medigap plan. You are eligible for open enrollment for six months beginning the first month that you have Medicare Part B if you are 65 or older.

The Cost of Medicare

If you have worked and paid Medicare taxes for long enough (usually about 10 years), there is no premium for Part A. If you do not qualify for premium-free Part A, your monthly out-of-pocket expense will be either $278 or $505.

The premium for Part B depends on your income, and it starts at &174.70 per month. This premium is subject to change each year. Premiums vary for Medicare Advantage depending on your plan choice. These amounts can also change annually.

Part D plans also vary according to income. It is important to note that if you don’t sign up for Part D during your initial enrollment period, it may cost you a penalty if you decide to sign up later and you don’t have existing qualifying prescription drug coverage.

In addition to premiums, you will be responsible for costs such as deductibles and copays .

Points To Consider Before Applying for Medicare

When determining your eligibility for Medicare, several considerations influence when you can apply and when the coverage will take effect.

Employed Past 65

Medicare enrollment is more complicated if you or your spouse continue to work after the age of 65. You must consider factors such as existing coverage, what type of insurance you have, and COBRA.

Marketplace Coverage

The Healthcare Marketplace has no effect on your Medicare enrollment or coverage. You should apply during the enrollment period around your 65th birthday.

Disability Benefits

If you receive disability benefits and you are under 65, you will automatically join Medicare Parts A and B either when you turn 65 or after you have received disability benefits for 24 months.

ALS (Lou Gehrig’s Disease)

If you have an ALS diagnosis, apply for Social Security disability benefits first. Then, you will be automatically enrolled in Medicare.

End-Stage Renal Disease

Medicare takes effect as soon as you enroll if you are in end-stage kidney failure.

Special Enrollment

There are a number of circumstances that will allow you to sign up for Medicare without a penalty if you miss your initial enrollment period.

How To Enroll in Medicare

If you received Social Security benefits for at least four months before turning 65, enrollment in Parts A and B is automatic. However, you must apply for Part D, Medicare Advantage, and Medigap.

Enrollment Periods

Unless you have special circumstances or were automatically enrolled when you turned 65, you have a seven-month window to sign up for Medicare plans. It begins three months before your birthday month and ends three months after. For example, if your birthday is in July, your open enrollment period is April through October.

If you miss the window, you can still apply, but you may be subject to a late enrollment penalty if you do not qualify for a Special Enrollment period. Additionally, after you enroll in Medicare, you can only change or add coverage (Medicare Advantage and Part D) during the two yearly open enrollment periods.

Enrollment Steps

First, you must determine your eligibility. If this is not straightforward, Sacket & Associates can help you find your eligibility status.

Next, complete an application by:

Meeting with a Medicare health plan broker at Sackett & Associates
Applying online at the Social Security website
Calling Social Security at (800) 772-1213
Contacting your local Social Security office

The online application usually takes about 10 minutes to complete. You may have a long wait if you walk into a Social Security office; they recommend making an appointment.

Partner With Sacket Insurance as Your Medicare Health Plan Broker

Sacket & Associates helps the aging and disabled community afford healthcare with appropriate Medicare plans. We can answer questions and assist you with your Medicare application when you are ready. For more information on how Medicare plans work and how you can get started, contact us today.

Celebrating 45 Years of Excellence: Sackett & Associates Insurance Services

mira@sackettinsurance.net (Sackett Insurance Services) — Thu, 02 May 2024 15:15:00 GMT

45 Years of Trusted Insurance Solutions: Sackett & Associates' Journey

Sackett & Associates Insurance Services is proud to mark a significant milestone in its journey—45 years of providing exceptional insurance solutions to individuals and small businesses in Sonoma County and beyond. Since its inception in 1979, Sackett & Associates Insurance Services has been a beacon of reliability and excellence in the insurance industry.

What began as a humble endeavor offering brokered health insurance plans has transformed into a comprehensive insurance agency. Today, with three full-time licensed insurance brokers, Sackett & Associates offers a diverse range of services to meet the evolving needs of its clients. From Medicare health plans to life insurance options and a robust benefits administration platform tailored for small to medium businesses, they have expanded their offerings to ensure comprehensive coverage.

As an independent agency, Sackett & Associates takes pride in hand-selecting the best insurance plans to suit their clients' unique needs. Their commitment to personalized service and attention to detail has earned them a reputation as a trusted insurance partner in the community.

Teri Sackett, President of Sackett Insurance, expressed her gratitude on this momentous occasion, stating, "As we celebrate 45 years in business, we are immensely grateful for the trust and support of our clients and community. Our journey has been defined by dedication to excellence, innovation, and a steadfast commitment to serving the needs of our clients. We look forward to continuing this legacy of service for many years to come."

One of the hallmarks of Sackett & Associates Insurance Services is its status as a completely woman-owned and led company, embodying values of diversity, equity, and inclusion in every aspect of its operations. Their team of professionals is dedicated to empowering clients with the knowledge and resources they need to make informed decisions about their insurance coverage.

Located in Sebastopol, California, Sackett & Associates serves individuals and small businesses throughout Sonoma County and beyond. Their comprehensive suite of services includes health insurance administration for small to medium-sized businesses, Medicare health insurance plans, and individual health insurance plans directly through carriers or through the Covered California Affordable Care Act marketplace.

As they commemorate this significant milestone, Sackett & Associates remains committed to delivering unparalleled service and support to their clients. With a continued focus on innovation and excellence, they are poised to continue their legacy of success for generations to come. Join us in celebrating 45 years of excellence with Sackett & Associates Insurance Services!

Understanding Your Explanation of Benefits

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 19 Apr 2024 22:30:00 GMT

Learn How To Read and Comprehend Your EOB (Explanation of Benefits)

You will receive a detailed breakdown of pricing and compensation each time a healthcare provider bills your health insurance company for services rendered. This is an explanation of benefits, and it is very commonly confused with a medical bill. It is not, but it is still important to understand how to read one and what you can do if there is a discrepancy.

What Is an Explanation of Benefits?

Healthcare providers, such as physicians, hospitals, and labs, must submit an invoice for covered procedures to insurance companies so that they can receive payment. For transparency, the insurance company will then send you an explanation of benefits.

An EOB summarizes the total cost of the procedure, the amount the health insurance covers, and any balance that you might owe. It is vital to understand that this is not a medical bill; don’t send money to your insurance company.

Keep this paperwork in a safe place. You can use it to track your and your family’s medical history or to see how your insurance has helped you through the year. You may also need it if you itemize your medical expenses when you file taxes.

What Are the Components of an EOB?

Laws, such as the Affordable Health Care Act , and regulations, such as the Health Insurance Portability and Accountability Act , dictate what information can and cannot be included on an EOB.

General Information

This is the information usually included at the top of your EOB. It includes your name and address, the billing practitioner’s information, and any other specific identifiers. It will list the beneficiary’s name, account number, plan number, and group ID. If the insurance issued a check to your doctor, it will also include the check’s date.

More importantly, it will show a phone number for you to call if you have any questions about your EOB.

Benefit Detail

While the specific format varies by health insurance provider, most EOBs will contain some, if not all, of the following:

Dates: When the service began and ended
Amount Billed: Total amount of the procedure
Not Covered: Amount not included with your insurance benefits
Discount Amount: Contractual discount given to healthcare providers
Allowed Amount: Maximum allowed charge after the Not Covered and Discount Amount have been applied
Deductible Amount: Charges you are responsible for before the coverage takes over
Copay: Amount you pay your healthcare provider when you receive the service
Covered Amount: Eligible charges covered by your plan
Paid At: The percentage of the covered amount that your benefits will pay
Payment Amount: Any remaining charges you are responsible for

The detail section will also list special codes for remarks, procedures, and discounts.

Summary Information

Underneath the benefit detail, your EOB will give you the total amount paid, if applicable, an explanation of any codes listed, and your plan status. The plan status summarizes your benefits for the year, including how much of your total deductible you’ve paid and how close to your out-of-pocket maximum you are.

Why Is an EOB Important?

Your EOB serves as a necessary record of billing and payments made by your doctor and insurance plan as well as a record of treatments and procedures received throughout the year. Paying attention to and understanding your EOB can also educate you on the cost of healthcare and insurance benefits.

However, it is more important to review each EOB you receive to make sure that your practitioner charges for the correct procedures and your insurance company applies the correct deductibles and payment amounts. In addition, always compare your EOB to any actual medical bills you receive. If the charges don’t make sense or you notice any irregularities, your EOB will be instrumental in resolving those issues.

How Do You Take Action Based on an EOB?

You should take action immediately if any of the information on your EOB is incorrect or missing or if there are any discrepancies with the bill from your doctor . Before you contact your health insurance company, do the following:

Collect all the paperwork, including the medical bill if there is one
Compare the codes listed on the EOB and the bill and look for errors
Make sure the information is correct, including your name, plan number, services you received, and that the billing is in agreement with your plan.
Review the itemized bill (request one if necessary) with your medical provider and ask for explanations

Then, ask your health insurance company about any differences you find. Write down the dates and names of the person you spoke with, details that will help you remember the conversation, and any actions to take by any party, including yourself. Continue to follow up until the results are satisfactory.

Work With Your Local Health Insurance Broker

When you partner with Sacket & Associates as your health insurance broker, understand that we work for you, not the big insurance companies. We have been providing customized health insurance coverage for individuals, businesses, and Medicare participants since 1979. Contact us for more information on how we can serve you today.

Small Business Health Insurance Costs: What Can You Expect?

mira@sackettinsurance.net (Sackett Insurance Services) — Tue, 26 Mar 2024 21:45:00 GMT

Understanding Small Business Health Insurance Costs

Offering health insurance benefits is an excellent way to draw talent to your company. However, the cost isn't insignificant, so it's essential to plan your budget carefully. One approach is to work with a health insurance broker in Santa Rosa to customize your options. Of course, you must first understand the various costs associated with employer-provided health insurance.

A Health Insurance Broker in Santa Rosa Breaks Down Costs

Group health insurance is cheaper than single insurance since more entities bear the cost. Larger companies have an advantage since they have hundreds or thousands of employees paying into the system. While small businesses use the same model, they may have to shoulder higher costs to offer similar benefits.

There are also regulations to consider. Depending on your state, you may have a legal obligation to offer health insurance if your workforce includes 50 or more full-time employees. Fortunately, there's good news — the federal government offers programs to assist small businesses in providing health insurance without breaking the bank. A health insurance broker in Santa Rosa can help you navigate this complex system and find the best deals.

Factors Affecting Costs

Several factors impact the price of insurance:

Your industry
Your location
The number of employees
Employee risks
Plan type

Your industry plays a role in cost because the work environment directly impacts employee health. If your workers routinely work with toxic chemicals, the risk of medical issues is higher. As a result, insurance companies may charge more.

Insurance markets vary by location. The cost of living and the number of competitors change between states and even cities, impacting your options. A health insurance broker in Santa Rosa should know the typical area rates, helping you identify reasonable premiums.

Additionally, the size of your workforce impacts expenses in two inverse ways. First, the more employees you have, the more diluted the risk pool, which can lower the cost per employee. Second, you'll pay a higher total for a larger workforce since you must cover more people. With careful consideration, you can strike a balance between these opposed factors.

The demographics of your workforce also play a major role in price. If your employee pool skews older, you'll likely have higher premiums since that demographic has a greater risk of health issues. Certain habits, such as smoking, also increase the risk of developing medical conditions, and premiums reflect this accordingly.

The one factor you have complete control over is the insurance plan type. There are four, with increasing costs and benefits:

Bronze
Silver
Gold
Platinum

While platinum plans have the most coverage and lower deductibles, they also have the highest premiums. A gold or silver plan may be better for your employees since they provide affordable basic coverage. A health insurance broker in Santa Rosa can help you evaluate your needs and find policies that fit.

Expenses To Consider

Premiums are the easiest to compare across plans because they're a single payment due every month. However, there are other expenses to consider:

Copayments
Deductibles
Coinsurance

While insurance companies ideally take on the majority of medical expenses, individuals are still responsible for paying a portion of every doctor's appointment and prescription cost. These expenses, called copays, vary by prescription and appointment type. For instance, the copay for a specialist (such as a cardiologist) may differ from one for a general practitioner.

Deductibles significantly impact employees' healthcare costs, and they've tripped up more than one insurance customer. Health insurance companies only start paying medical expenses once customers meet the deductible. Even then, most companies only pay a portion of the bill, an approach called "shared costs."

Coinsurance describes the portion of medical expenses customers pay after meeting the deductible. Plans usually express this as a percentage. For instance, a customer may pay 30% coinsurance while the insurance company pays 70%. Your local health insurance broker in Santa Rosa can help you compare the various options and determine which provides the best savings.

What costs do you, as the employer, have to worry about? While employees must account for all the above expenses, you only need to pay a portion of the premium.

Why consider the deducible and coinsurance, then? Employees don't have to join plans offered through your company — if they find another option through the health insurance marketplace, they can purchase that instead. However, you need a certain percentage of employees to sign onto your offered plan for it to work. It's in your best interest to get as many employees on board as possible.

Your Health Insurance Broker in Santa Rosa Helps Customize Plans

Let Sackett Insurance be your health insurance broker in Santa Rosa. For more information on how to customize your small business insurance, call (707) 823-3689 or request a quote online.

What Percentage of Health Insurance Costs Do Employers Cover?

mira@sackettinsurance.net (Sackett Insurance Services) — Thu, 14 Mar 2024 19:30:00 GMT

Figuring Out What Percentage of Employee Premiums To Cover

Employees love quality health insurance coverage since it offers protection and peace of mind. It is also a benefit for employers, as it helps them recruit top-tier talent and boost productivity. Healthier employees make good business sense all around. If you’re an employer, consulting with a health insurance broker in Santa Rosa can get you on track to offering group coverage. However, one question may be what percentage of your employees’ premiums to cover.

Patterns in Business Size and Individual or Family Coverage

In California, about 47% of the population has some type of employer-sponsored health insurance coverage. These employers take a few possible approaches.

For example, when it comes to individual and family premiums, a business could opt to cover 100% of individual premiums while asking employees to contribute to family premiums. The Kaiser Family Foundation outlines a few important stats:

About 29% of small-business employees with coverage through their employer have 100% employer coverage for individual premiums.
The percentage for 100% individual premiums coverage falls to 5% for larger companies.
In small businesses, about 31% of employees with coverage pay more than 50% of their family health plan premiums.
In larger companies, just 5% of employees pay more than 50% of their family health plan premiums.

In other words, if you run a small business, it would be fairly common for you to 100% cover employees’ individual premiums. If they opted for family plans, you’d probably need them to contribute a somewhat significant chunk of premiums, perhaps more than half. About 4.2 million small businesses operate in California and employ about 47.9% of California employees .

Types of Employer Contributions

Employer-sponsored plans follow three main models for premium costs: fully funded, cost-sharing, and defined contribution. In the fully funded model, employers cover 100% of the premiums. Employees make no direct contributions.

In cost sharing, both the employer and employee share the costs. Usually, the employee pays the larger percentage through the form of payroll deductions.

With defined contribution plans, employers give a fixed dollar amount for employees' premiums. Employees choose their health insurance plans with this fixed amount in mind. Any costs they incur beyond the employer's contribution are their responsibility.

Factors That Businesses Can Use To Determine Percentage

Health insurance plans can vary widely. The percentage that you, as an employer, pay for premiums can depend on factors such as these.

Company industry and size
The specific plan the employees choose
The tier or level employees choose

Size of Company and the Type of Industry

The larger your business, the more negotiating power you may have to get lower premiums. Smaller companies with fewer resources may choose to offer relatively basic plans. These plans might have fairly low premiums that employers can afford, especially for individual coverage. For employees, basic plans may come with downsides such as higher deductibles and copayments.

However, a health insurance broker in Santa Rosa can walk you through these nuances and give you options for group health insurance . As for the type of industry, specific plans may be available in some sectors.

Plan Type

PPOs (preferred provider organizations) tend to be more flexible with more provider options. They can be more expensive, so employers might not cover as much of the premium. HMOs (health maintenance organizations) may have limited provider networks and mandate specialist referrals. They may be less expensive, and employers might be more inclined to cover a larger percentage of these premiums.

A single employer can offer both HMOs and PPOs as well as other plan types such as HDHPs (high deductible health plans). Multiple types of plans are less likely with very small employers.

Plan Tier or Level

Gold-tier plans may have higher premium costs. Accordingly, employers might not cover these premiums percentage-wise to the extent they would a bronze or silver plan. Bronze-level plans are more likely to have less coverage and more cost-sharing. Employees should choose their plan and tier carefully, keeping in mind their healthcare needs.

Common Pros and Cons of Employer-Sponsored Group Health Insurance

Offering group health insurance as an employer offers many benefits. For instance, it increases your odds of getting qualified, motivated employees. Good coverage can also mean healthier employees who appreciate their job. Employer contributions may be tax deductible as business expenses, too.

However, rising health costs can strain employers' budgets. It can be tricky to make sure plans meet regulatory requirements, too, and employees may expect a great deal from their employers and insurance plans.

Contact a Health Insurance Broker in Santa Rosa

A health insurance broker in Santa Rosa can help your company find affordable plans and make informed choices. Contact Sackett Insurance today.

Retiring Early? Here's 6 Options You Can Explore for Health Insurance

mira@sackettinsurance.net (Sackett Insurance Services) — Mon, 26 Feb 2024 14:00:01 GMT

Explore 6 Insurance Options Before Deciding You Can't Retire

With early retirement, people can reduce their stress, explore hobbies, and enjoy more free time to travel or be with family. It can be a great move if you are financially secure. However, health insurance is one concern that keeps some people from retiring early, even if they are financially comfortable. Fortunately, a health insurance broker can help you explore various options and find a plan.

6 Ways You Could Have Good Health Insurance if You Retire Early

About 22% of workers plan to retire between the ages of 60 and 64, while 13% envision retiring before 60. Having quality health insurance can offer a lot of peace of mind during these years. With one of the options below, you may be able to retire early and have good health insurance.

1. Your Spouse's Health Insurance

If your spouse is working, you could explore the feasibility of joining their employer-sponsored plan. In some situations, this can be affordable and means only a small premium increase for your spouse. In other situations, though, the premium increase can be considerable. Regardless, it is worth running the numbers with a medical health plan broker to find out.

2. Part-Time Work

Part-time work does not exactly correlate with early retirement, but it has several advantages. For example, you can ease into complete retirement over a few years, meet new people, and explore jobs you always wanted to or would otherwise not have looked into.

Some part-time jobs offer health insurance, too, although the coverage might be limited. However, it could be enough to meet your needs, whether by itself or in conjunction with another option.

3. Medicaid

If your household income is below certain limits, you might be able to enroll in Medicaid for your health coverage. Eligibility varies by state and usually depends on the household’s average income per month.

4. Health Insurance Marketplace or State Exchanges

Through the federal health insurance marketplace or one of the state exchanges, you can shop for individual and family health coverage. The marketplace and the exchanges feature plans from various insurers with different prices and types of coverage.

If you have specific health issues or concerns, take extra care to read all of the print thoroughly so you can be sure you are getting the coverage you think you are. A health insurance broker can also help ensure you get the right coverage for your needs and investigate whether you qualify for government subsidies to cover various health care insurance costs on the exchanges.

5. Private Plans

There are many health plans you will not find through federal or state exchanges. Instead, you work with a medical health plan broker or the insurer itself to explore your options. You can get more plan customization this way and may have access to benefits and services not available through exchange plans. A broader network of doctors and specialists may also be available and with fewer restrictions versus marketplace and exchange plans.

6. COBRA

The Consolidated Omnibus Budget Reconciliation Act lets people continue to get the same health insurance benefits for as long as 18 months after they leave a job. However, getting COBRA can be expensive as the employer does not have to pay its portion. Instead, you pay it as well as any extra fees, if applicable.

Why Health Insurance Can Give People Pause When They Think About Retiring Early

Health insurance can be an obstacle to retiring early for several reasons. For example, retirees often get Medicare coverage, which they qualify for if they are 65 or have a qualifying disability. Early retirees tend to not be eligible, though, since they do not meet the age requirement.

Moreover, health care costs can quickly accumulate. That's true even for younger people, and older people are more likely to have chronic health issues and other conditions.

As you think about whether insurance options such as a private plan or state exchange plan could work for you, do a few other things.

List your current health care needs and your predicted future needs.
Account for chronic conditions and medications.
Create an overall budget, and see how much room you have for health insurance.
Factor in monthly premiums, deductibles, copayments, coinsurance, and other out-of-pocket expenses.
Enlist the help of a broker instead of trying to figure it all out alone.

Talk With a Health Insurance Broker

Retiring early could be more possible than you thought. We are a medical plan health broker in California that helps people find plans and navigate various insurance and Medicare complications. For more information on health insurance for retirees, contact us today .

ACA Enrollment Surges in 2024 as Affordability Improves and Medicaid Coverage Unwinds

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 14 Feb 2024 17:45:00 GMT

2024 ACA Enrollment Reaches New Highs

Heralding great news on the healthcare front, a record 20 million Americans signed up for Affordable Care Act Marketplace coverage. This signifies a massive increase of 4 million compared to last year's record sign-up high of roughly 16 million. How did factors like unwinding Medicaid and improved Marketplace subsidies contribute to record ACA Marketplace signups for 2024? Health insurance brokers from Sackett Insurance take a closer look.

Understanding Medicaid Unwinding

In March 2020, as part of COVID-19 relief provided by the Families First Coronavirus Response Act, Congress gave states additional Medicaid funding. One condition of the extra resources was implementing a "continuous coverage" requirement. Under this provision, states couldn't end most Medicaid beneficiaries' coverage until after the public health emergency.

During the pandemic, states allowed continuous Medicaid enrollment, but that policy expired in April when disenrollments resumed. Sometimes, people were disenrolled because they didn't qualify for the program, but others were disenrolled because they couldn't complete the renewal process. The good news for those disenrolled because of procedural reasons is they may still qualify for coverage.

“Unwinding” is the term for states resuming yearly Medicaid eligibility reviews at the end of the continuous coverage requirement. According to the Marketplace , unwinding Medicaid is one of the major contributors to 2024’s record-high ACA enrollment.

Accessing More Affordable Coverage

Another factor helping Americans secure healthcare plans in 2024 is more affordable coverage. Greater ACA subsidies made private plans more accessible and eased the shift from Medicaid to private coverage for low-income people. Owed to a federal marketing budget and navigator and in-person assistance funding increase, more Americans learned about extra premium subsidies. Besides benefiting new enrollees, the improved subsidies also help those already enrolled in a plan keep their coverage.

At the end of 2025, ACA's improved subsidies will no longer remain on the table. When that happens, Congress must decide whether to tap more federal funding to extend them.

Bolstering Individual Market Growth

Besides more affordable coverage and Medicaid unwinding, mid-year individual market growth outside the open enrollment window bolstered the ACA's recent enrollment success. Between early April 2023 and the end of September that same year, enrollment in the individual market, which includes the ACA Marketplaces and off-exchange plans, increased by roughly 6% . Such a mid-year individual market enrollment increase is a rarity.

In the recent past, Americans shopped for healthcare plans at the Marketplace while between coverage. Whenever people would leave the Marketplace mid-year because they were priced out of plans or had other sources of healthcare coverage, the number of Americans exiting the market usually dwarfed the number entering the market. This is because the market doesn't provide many chances for special enrollment. Even then, proving you qualify for mid-year signup can prove challenging.

2021 was the only other time the market experienced mid-year growth, thanks to the American Rescue Plan Act's greater subsidies and more chances for mid-year enrollment.

Navigating the ACA Marketplace

If you're considering signing up for ACA Marketplace health coverage this year, tips from a health insurance broker can help you find an ideal plan:

While exploring options, consider your current and future medical needs. For instance, do you or anyone in your family plan to undergo surgery or become pregnant? If you spent money on health insurance last year, do you expect that amount to change in the future? Knowing your most essential considerations helps narrow your plan options.
Do you currently have a preferred clinic or doctor? If so, check if they are in-network in the available ACA Marketplace plans.
For lower monthly health insurance premiums, consider a High-Deductible Health Plan. This kind of plan may benefit you if you're in good health, don't anticipate needing a medical procedure, and don't expect any major upcoming medical costs. Make sure you always have money to cover your deductible and additional out-of-pocket costs.

Still need more help to find the best coverage? Sackett Insurance health insurance brokers are here to help!

Take the Pain Out of Health Insurance With Sackett & Associates Insurance Services

Although the ACA Marketplace saw record signups, finding the perfect individual health insurance plan can feel daunting. Sackett & Associates Insurance Services takes the pain and confusion out of the process to help you find the perfect coverage for you and your family. For over a decade, we've used our connections with major insurance providers to help California residents enjoy affordable, personalized health insurance.

For more information on PPOs, HMOs, Affordable Care Act subsidies, and more, contact one of our experienced independent health insurance brokers. Call (707) 823-3689 or send us a message to see how simple it is to enjoy peace of mind and better health with the right healthcare plan.

Can I Get Hospital Treatment Without Insurance?

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 26 Jan 2024 00:30:00 GMT

Hospital Treatment Without Insurance: Costs, Coverage, and Alternatives

If you have a medical emergency, healthcare providers can’t turn you away without essential services if you don’t have medical insurance. The Emergency Medical Treatment and Labor Act (EMTALA) requires healthcare facilities to provide essential lifesaving services to anyone with a medical condition, no questions asked.

However, after fulfilling this legal obligation, a healthcare provider will require payment. If you don’t have healthcare coverage, the hospital will bill you for every service provided. They will need you to foot the hospital bill, covering everything from doctor’s fees to medical costs. With a healthcare plan to cover some of these services, the bill from even the shortest emergency stays can be astronomical.

How are Medical Bills Paid?

You’re on the hook for the total cost of healthcare services when you receive treatment without health insurance. Typically, the hospital provides an itemized bill detailing the services, procedures, medication, and supplies provided during your hospital stay.

Without coverage, your charges will likely be higher because the chargemaster rates do not apply to you. These are preferential prices that insurance companies or government programs negotiate with healthcare providers for covered services and medication.

When you have coverage, your healthcare plan will cover a portion of your medical bills. The exact amount covered depends on your specific plan, as different types of health plans, such as Medicare, Medicaid, and individual health coverage , provide varying levels of coverage.

Typically, health insurance covers the lion’s share of your medical bills, leaving you to foot only a tiny portion as deductible , coinsurance, or copayment.

A deductible is the amount of money you pay out-of-pocket before insurance coverage kicks in. After meeting the deductible, you may have to pay a small portion of treatment costs as coinsurance.

For instance, your health plan may cover 80% of the cost of a health procedure, leaving you only to pay 20%. Some services, such as doctor visits or prescription medications, may carry a copayment and may require you to pay a small portion, usually less than 30%, of the total costs.

Negotiate a Discount or a Payment Plan

It may seem inconceivable, but hospitals can be pretty accommodating to uninsured patients. You can tactfully negotiate discounted rates for services or a payment plan to help you clear the bill. Ideally, you should initiate negotiation before treatment if going in for an elective service.

While you may engage the billing department, you will have better results negotiating with the hospital’s ombudsman . Unlike the billing department, which is primarily concerned with revenue collection, an ombudsman is charged with resolving patient issues.

Start by explaining your circumstances and provide supporting documentation, such as proof of income to prove financial hardship. You can inquire about the hospital’s financial assistance programs, discounts, and payment plans. Some hospitals may offer sliding scale rates for low-income patients. Non-profit hospitals are legally required to provide charitable care to patients with financial challenges.

Consider Using Urgent Care

Urgent care centers are an excellent option if you need prompt medical attention but don’t have coverage or are short on cash. The cost of an urgent care visit may be less than half a typical trip to the ER.

Unlike a doctor’s office, urgent care centers are staffed by nursing practitioners. They can help you address non-emergency medical issues such as minor fractures, burns, and infections that require prompt attention. Depending on your circumstances, the staff may advise you to seek medical care or visit the ER.

Urgent care centers provide affordable healthcare because they have lower operating costs and can pass the cost savings to patients. You’ll only incur a consultation fee, any lab fee, and prescription drugs. Conversely, the cost of an ER visit is more expensive because it covers the doctor’s fee, hospital fee, hospital stay, prescription, and lab fees.

While cheaper, you’ll need to pay upfront for services when visiting urgent care if you don’t have health coverage.

Safeguarding Your Health without Incurring Medical Bills

A study by the Kaiser Family Foundation found that 1 in 10 Americans are burdened by huge medical bills. More than 11 million people owe $2,000, while 3 million patients have more than $10,000 in unpaid hospital bills.

The Centers for Disease Control and Prevention (CDC) estimates 27.6 million Americans are uninsured. The figure correlates closely to the 23 million people that the KFF survey found grappling with massive medical bills. Therefore, you may struggle with massive medical bills if you lack health insurance.

A medical health plan such as Medicare or Medicaid covers the lion’s share of your hospital bill, leaving you only to foot a small portion. Coverage makes healthcare more accessible while allowing you to safeguard your health without going into debt.

Talk to Skilled Health Insurance Broker

With so many options available, getting the best Medicare or individual plan can prove challenging. Working with the skilled Medicare health insurance experts at Sackett & Associates can help you make an informed choice. Contact us today for more information or assistance with Medicare or individual plans.

Medicare's Drug Price Negotiation Program Set to Revolutionize Prescription Drug Coverage

mira@sackettinsurance.net (Sackett Insurance Services) — Tue, 09 Jan 2024 19:00:00 GMT

Medicare Drug Price Negotiation Program Set to Change Healthcare

More than 8 million Medicare Part D enrollees are set to benefit from the Medicare Drug Price Negot iation Progr am . The program empowers Medicare to negotiate with drug manufacturers and lower the prices of select medications covered under Medicare Part D.

The initiative by the national healthcare provider seeks to increase access to critical medication by stemming the cost of prescription drugs. By negotiating favorable terms with manufacturers, Medicare aims to secure the best prices for covered medication and pass the cost savings to Medicare Part D enrollees.

The First Tranche of Medicare Part D Drugs

On September 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a list of the first 10 Medicare Part D drugs selected for negotiation. The list comprises medications with the highest Medicare Part D spending, lack generic equivalent and have been on sale for at least seven years.

The 10 Medicare Part D drugs in the first round of negotiations are prescribed as treatment for various severe medical conditions, including:

Blood clots – Eliquis and Xarelto
Heart failure – Entresto and Farxiga
Psoriasis – Stelara and Enbrel
Rheumatoid arthritis – Enbrel
Crohn's disease – Stelara
Blood cancer – Imbruvica
Diabetes – Farxiga, Januvia, Fiasp/NovoLog, and Jardiance

Upon successful negotiations, the CMS will publish the maximum fair price for the drugs by September 1 ^, 2024, and the new prices will take effect on January 1 ^, 2026.

Unrestrictive Drug Form and Dosage Coverage

Under the Inflation Reduction Act , Part D enrollees will access any of the 10 selected drugs in any dosage and form that suits their health needs. Currently, Part D plans to restrict the form in which enrollees can access these critical drugs.

For instance, while enrollees can access Xarelto (blood thinner) in tablet form, only 78% are covered for oral suspension. While the 140mg oral capsule of Imbruvica, a cancer drug, is available to all enrollees, only 77% have coverage for the 280mg oral tablet. The Inflation Reduction Act seeks to provide universal coverage and eliminate variations to help patients conveniently get the necessary variations.

Transparent Drug Categorization

Insurance companies offering Part D plans use a formulary placement to categorize covered drugs into four tiers: tier 1, tier 2, tier 3, and tier specialty. All levels have different cost implications for patients. Lower tiers carry lower out-of-pocket costs , while higher tiers require higher co-insurance or copayments.

Under the new law, the CMS will require insurers to justify placing any selected drugs on the higher, expensive tiers. Only six of the chosen drugs (Farxiga, Entresto, Januvia, Jardiance, Eliquis, and Xarelto) are covered in preferred tiers. The formulary placement increases drug accessibility and utilization because they attract an average copayment of $47 monthly.

However, some enrollees aren't so lucky. These drugs are covered under the non-preferred tiers, where they attract a copayment of up to 50%. For instance, enrollees whose plan covers Eliquis (blood thinner) under the non-preferred tiers pay up to $100 in monthly copayments.

The Inflation Reduction Act seeks to have Part D plans shift the most commonly used drugs into the lower tiers to make them more affordable. In January 2023, the IRA instituted a $35 copayment cap for covered insulin products. The move allowed enrollees to access Fiasp/NovoLog (an insulin product) without paying more than $35 in monthly copay, regardless of the tier placement.

Shifting medication to lower or preferred tiers can make them more affordable and accessible to more Part D enrollees while reducing out-of-pocket expenses.

Easing Restrictive Utilization Management

The CMS will closely monitor how Part D plan providers use utilization management tools for the 10 selected drugs. Health insurance companies use these tools to restrict or manage drug prescriptions. For instance, a Part D plan may institute prior authorization and require doctors to secure approvals from the insurer before prescribing a specific drug.

Nearly all Part D enrollees with Enbrel, Stelara, and Imbruvica coverage require prior authorization from their plans before they can get prescriptions. Almost all drugs selected by the CMS had quantity limits. Only 2% of the enrollees had Fiasp/NovoLog restrictions, but nearly all had Januvia and Jardiance restrictions.

CMS will require Plan D service providers to justify any move to impose more restrictive utilization management measures on the 10 selected drugs. Insurers will need to explain the criteria they use to apply more restrictions to these drugs compared to other medications in the same class.

The ultimate goal of the increased scrutiny is to grant patients easier and faster access to critical medication. CMS seeks to eliminate unnecessary delays or hurdles the Part D plans impose. The move would allow patients to access their prescribed medication without enduring too much red tape.

Get the Best Healthcare Coverage

While the best Medicare health insurance plan can help you safeguard your health, choosing the right option can prove challenging. The expert team at Sackett & Associates can guide you through this complicated process and ensure you get the best coverage.

For more information on how to pick the best Medicare Part D plan, contact us today.

ACA Marketplace Enrollment Trends

mira@sackettinsurance.net (Sackett Insurance Services) — Mon, 04 Dec 2023 23:30:00 GMT

Health Insurance Trends - ACA Marketplace Rising and Other Plans Losing Members

The federal government’s ACA Marketplace is seeing more signups than ever since its creation after the Affordable Healthcare Act was passed in 2010. In this year’s open enrollment, the Marketplace could see its highest number of new signups ever. While the ACA Marketplace is getting more enrollment, private individual plans off Marketplace are becoming less popular.

Health Insurance Broker Expects a Boost in Marketplace Enrollment

According to the U.S. Department of Health and Human Services, more than 16 million people signed up for an ACA Marketplace plan during last year’s open enrollment. That number is expected to increase even more during 2023’s open enrollment, due to more potential renewals, fewer people qualifying for Medicaid and an increase in subsidies to lower premiums.

Enrollment in Marketplace plans peaked in early 2015 but then experienced sharp declines from 2016 to 2020 due to the Trump administration’s limits of federal cost-sharing reduction, which increased health insurance premiums from Marketplace.

After 2021, Marketplace enrollees started to increase. The new Biden administration and the passage of the American Rescue Plan Act brought in more subsidies to attract uninsured or underinsured consumers to the Marketplace. Throughout all of the group health insurance industry, all plans have seen increases in enrollment since 2021.

Buyers Rely on Enhanced Subsidies

The Biden administration has continued to expand and enhance subsidies for consumers shopping for health insurance on Marketplace. The Inflation Reduction Act (IRA) in 2022 added more subsidies for health insurance buyers until 2025. Out of the current enrollees in the Marketplace, more than 14 million receive subsidies for lower premiums.

Current subsidies from the IRA allow Marketplace buyers to receive discounted premiums as long as their income levels are no more than 400% of the federal poverty limits. A family of four, for example, could receive subsidies if their income is $120,000 or lower. With rising costs throughout the country for the basics, such as food and other grocery store items, this helps consumers access more affordable healthcare.

Additionally, many consumers who currently have plans off Marketplace may be now eligible for discounted premiums through the federal government’s healthcare portal due to the IRA. As more people discover how much money they could save by shopping for health insurance on Marketplace, the number of enrollees continues to expand.

Non-ACA-Compliant Plan Enrollments at Record Lows

At the opposite end of the spectrum in the health insurance industry is what’s happening with non-ACA health insurance plans through other private companies. These plans are losing enrollees and popularity as more consumers choose Marketplace options. Non-ACA plans are health insurance offerings from private companies that don’t accept federal government subsidies.

During the Trump era, the federal government promoted these plans and passed policies that helped boost their membership numbers. Now that there is a Democrat in the White House, the plans have lost some of their support and have seen drastic losses in new enrollment sign-ups.

Despite the fact that the Marketplace plans are cheaper for most people, there are still some consumers who choose a non-ACA plan. Customers who may not qualify for subsidies are more likely to go with these health insurance plans. Additionally, undocumented immigrants and employees of businesses that offer affordable plans with benefits management can’t get Marketplace subsidies.

Premium Increases and the Future

In 2024, it’s likely that costs for health insurance coverage will rise. For consumers enrolled in a non-ACA plan, that means higher premiums are potentially coming soon. Enrollees in Marketplace plans may not see higher premiums while the IRA is in effect until 2025. It’s likely that the next two years of open enrollment will see more increased enrollment in the Marketplace plans.

Depending on the next presidential election, the future beyond 2025 is unclear. With the federal government’s support of subsidized healthcare, the ACA Marketplace may continue to see rising enrollment in the near future as non-ACA plans lose footing due to affordability. Any expert health insurance broker may recommend enrolling in an ACA Marketplace plan.

Choose the Right Plan for Your Health Needs with a Health Insurance Broker

Finding the right health insurance for you, your family or your business is not a decision to take lightly. With Sackett & Associates Insurance Services you can get advice about which health plans can meet your needs without hurting your wallet. Contact the team at Sackett to learn more about how you could benefit from a health insurance broker.

How To Navigate Medicare Open Enrollment 2023: Your Top FAQs Answered

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 29 Nov 2023 15:30:00 GMT

Medicare Open Enrollment Guide 2023

Open enrollment 2023 is happening soon for Medicare. From October 15 to December 7 each year, Medicare recipients can make changes to their coverage. Medicare health insurance options can be tricky to navigate. Check out some of the most common questions people have to feel more informed during open enrollment for Medicare health insurance.

How Does Open Enrollment Work for Medicare?

There are different reasons why you may want to change your Medicare plan, such as aiming to save money, finding a better matching plan for your healthcare needs, getting more robust coverage, or taking advantage of new features or better benefits with some plans. During open enrollment, you can switch from Medicare Advantage to a traditional plan or vice versa. You can also make changes to your prescription coverage for Medicare.

Medicare recipients who are happy with their coverage should still take advantage of the Medicare open enrollment period and check out different options. If you don’t make any changes to your current coverage, the plan you already have will continue to provide coverage for you next year.

If you make changes to your plan, the new coverage will go into effect after the new year on January 1, 2024. Medicare recipients and their families can research various coverage options by going to the Medicare website’s coverage overview for open enroll ment or by calling 1-800-MEDICARE. You can also find out more information by reaching out to your local State Health Insurance Program (SHIP) for your state of residence.

What Do I Need To Know About Medicare?

You can qualify for Medicare coverage once you reach 65 years old or if you have a disability. Unfortunately, if your spouse is 65 and you are younger, you may still not qualify for coverage. Individuals who are younger than 65 can choose a health insurance Marketplace plan as an alternative or may qualify for Medicaid if their income is lower than 138% of the federal poverty level.

Once you’re eligible for Medicare coverage, you have to decide which plan you want to go with. Traditional Medicare may include Medicare Part A , Medicare Part B or both. These plans include medical coverage and hospital insurance coverage. Another option for Medicare is Medicare Part C, which is a private insurance plan that includes a premium. This is also known as Medicare Advantage.

Medicare recipients can also choose a prescription plan coverage called Medicare Part D. When you first turn 65, you have a limited window to choose your initial Medicare plan. Enrollment starts three months before you turn 65 and ends three months after you turn 65. Then, during open enrollment periods each year, you can change your coverage plan.

How Do I Change My Medicare Plan?

The first step in changing your coverage for your Medicare plan is to do your research. Review the different options for your situation on the comparison website to see what works best for you. Consider your age, your health conditions, your providers and your income level to see which plan fits your lifestyle.

Using the compare tool through the Medicare website, you can estimate co-pay costs, deductibles, premiums and other fees associated with your Medicare plan or your prescription coverage. You can also learn about any extra benefits you may get with private insurance options through Medicare Advantage.

Once you have decided which changes you want to make, log into your account and make your elections for the new year. After you submit your preferences and confirm any plan changes, your new coverage will begin starting January 1, 2024. Additionally, when open enrollment happens again next year, you can make changes once again with your health insurance broker.

What About Other Situations Outside of Open Enrollment?

Generally, the only time to change your plan is through open enrollment. However, sometimes emergencies happen. People impacted by natural disasters, such as wildfires, hurricanes or other emergencies declared a disaster by the Federal, State or local government in 2023 have more options. In this situation, you may qualify for a Special Enrollment Period (SEP), allowing you to sign up for initial enrollment or make changes.

Special Enrollment Periods may also open for beneficiaries experiencing life changes or unique circumstances. If you move abroad and come back to the United States, you may qualify for a SEP. Moving into or out of a facility, moving to a new service area or having your plan terminated by Medicare may also qualify you for a SEP.

Anyone who has missed their initial enrollment window for Medicare Part B and can’t enroll during a SEP may have to pay a late enrollment penalty. This may add an additional 10% of the monthly premium to the standard fee for coverage.

Understand Your Options During Medicare Open Enrollment

Navigating the confusing steps of open enrollment for your Medicare health insurance plan can be a challenge. Learn more about private health insurance through the Marketplace and Medicare options with guidance from Sackett & Associates Insurance Services. Contact the team of advisors today to find out your next steps.

Sackett & Associates Insurance Services, Inc Announces Promotion of Emma Fitzpatrick to Vice President

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 15 Nov 2023 22:11:01 GMT

Decade of Dedication: Emma Fitzpatrick’s Promotion to Vice President Paves the Way for Sackett & Associates Insurance Services to Offer Medicare Insurance Plans

SEBASTOPOL, CA, UNITED STATES, November 15, 2023 - Sackett & Associates Insurance Services, Inc is thrilled to announce the promotion of Emma Fitzpatrick to the role of Vice President. Having been an integral part of Sackett & Associates Insurance Services since 2013, Emma is renowned in her region for her understanding of Medicare Health Insurance Plans . As she celebrates a decade with the company this November, her new role as Vice President is a testament to her invaluable contributions over the years.

Emma’s journey with Sackett & Associates Insurance Services has been marked by her unwavering dedication to helping clients navigate the often complex and confusing landscape of health insurance options, saving them thousands of dollars in premiums on plans that weren’t the right fit for their needs. Her dedication to client service and her ability to demystify the intricacies of insurance policies have made her a trusted broker in the field.

“We couldn’t be more excited to announce Emma’s promotion to Vice President,” expressed Teri Sackett, President of Sackett & Associates Insurance Services. “Her decade-long journey with us has been nothing short of extraordinary. Emma has consistently gone above and beyond in her service to our clients, and her expertise in Medicare Plans is second to none. She is a treasured member of our team, and this promotion is a well-deserved recognition of her hard work and dedication.”

Since its inception in 1979, Sackett & Associates Insurance Services, Inc has been committed to providing top-notch insurance solutions to individuals and small businesses in Sebastopol and throughout Sonoma County. As an independent agency, they carefully select the best insurance plans to fit their clients' needs, ensuring personalized and reliable service. Emma’s promotion is reflective of the company’s ongoing commitment to excellence and leadership in the insurance industry.

“Working with Sackett & Associates over the past decade has been an incredibly rewarding experience,” said Emma Fitzpatrick. “I am honored to step into the role of Vice President and continue my work in helping our clients find the right health insurance solutions. I am grateful for the opportunities for growth and development that Sackett Insurance Services has provided me, and I look forward to contributing to our future successes.”

Emma taking on the role of Vice President is a key part of the company’s strategic plan to grow and diversify their service offerings. With her on the leadership team, they are poised to become the go-to resource for Medicare Health Insurance Plans in Sebastopol and the greater Sonoma County area.

About Sackett & Associates Insurance Services, Inc

Sackett & Associates Insurance Services, based in Sebastopol, California, has been providing trusted insurance solutions to individuals and small businesses since 1979. As an independent agency, they are committed to finding the best coverage at the most affordable price for their clients. With a focus on personalized service and client satisfaction, the Sackett Insurance team is dedicated to ensuring the well-being and peace of mind of their clients. For more information, please visit www.sackettinsurance.net or call (707) 823-3689.

Emma Fitzpatrick is licensed with the California Department of Insurance (CDI) and appointed by multiple insurers to transact on their behalf. License number: 0I76890.

Media Contact:
https://www.sackettinsurance.net

Teri Sackett
Sackett & Associates Insurance Services, Inc
+1 707-823-3689

Getting a Flu Shot Protects Everyone

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 20 Oct 2023 00:45:00 GMT

Protecting Everybody From the Flu Starts With You

Fall is a great time for apple picking, touch football, corn mazes — and flu shots. While flu vaccines are available for multiple months, getting one as early as you can offers maximum protection for yourself and others. If you don’t have insurance, a Medicare health insurance broker can help you find an insurer to cover flu shots and other essentials.

Common Flu Myths and How They Are Wrong

Unfortunately, flu misconceptions prevent some people from getting their flu vaccines. The reality is that when you get your shot, you protect yourself and a lot of other people. Here are some top flu shot myths.

I Have Never Gotten the Flu So Don’t Need a Vaccine

Why risk getting the flu now? Even a moderate case may give you fever and chills, cough, sore throat, body aches, headache, and fatigue for days. It may mean taking time off work and getting people around you sick.

The flu virus is pretty contagious, and some people spread it before knowing they are sick. People with weaker immune systems remain contagious for longer, too. Getting the flu shot protects you and others since you are less likely to spread the flu.

The Shot Doesn't Work

The shot reduces a person's chances of getting the flu by 40% to 60% . For people who do get the flu, the shot typically makes them less sick. The odds of having to see the doctor or be hospitalized are much lower.

Furthermore, if enough people get vaccinated, then community immunity can result. When much of the population has flu shots, the virus has a harder time spreading. These barriers are a great help to young infants and other people with certain medical conditions who cannot get vaccinated.

A Flu Shot Won’t Protect Me for Long Enough

The flu season lasts about six months, and some people wait to get their shots thinking that a vaccine can't protect them that long. If they get a shot halfway through, they feel they might be protected for the remaining three months.

The good news is that a flu shot provides protection for the entire flu season. If you get it in September or October, you give your body even more time to build antibodies for comprehensive protection. A Medicare health insurance broker can help you find insurance coverage options today.

A Shot Is My Only Option

Flu shots are the most common way people get vaccinated, but a nasal spray alternative is available. Many people ages 2 to 49 can get it. Talk with your doctor or pharmacist if you're thinking of going this route since you should not if you have certain conditions.

I'll Get Sick From the Shot

In the majority of cases, soreness or redness at the injection site is the only side effect. Some people do experience further effects such as muscle aches and fever. They typically remain mild and last a few days. The flu, meanwhile, has much more serious repercussions.

It Might Give Me the Flu

Vaccines do not contain active flu viruses. You cannot get infected with the actual flu from the vaccines.

Common Questions About Getting Flu Vaccines

Here are some common questions that Medicare health insurance brokers hear to further clarify the truth behind these flu myths.

Why Get the Flu Vaccine?

The flu vaccine protects you and the people around you, including your family members, friends, colleagues, and many more. Babies, senior citizens, and pregnant people are at higher risk of flu complications. So are people with asthma, diabetes, heart disease, and other chronic illnesses.

The shots are usually affordable. Health insurers typically cover them, and it can be a big time saver to get the shot at the same time as another medical appointment.

When Should I Get the Vaccine?

September and October are the ideal times since you get protection before the flu season kicks into full swing. The shot needs about two weeks to work as fully as possible.

Should Everyone Get the Shot?

Most people at least 6 months old should get the vaccine. Talk with your doctor about whether you might be one of the rare exceptions.

Health insurance can help you proactively prevent and manage many conditions such as the flu and save you considerable money on various expenses. Contact us at Sackett & Associates Insurance Services today for help finding the right plan for your needs.

How to Attract Top Talent With the Right Health Benefits

mira@sackettinsurance.net (Sackett Insurance Services) — Mon, 09 Oct 2023 22:45:00 GMT

Will Offering the Right Health Benefits Attract the Right Employees?

Healthcare benefits are important, and for many people, having benefits they can depend on is one of the primary reasons for taking a job. If you own a business, you will have to offer healthcare benefits to attract the top talent in your industry. If you don’t offer industry-standard benefits, you risk driving away loyal employees and losing the talent you’ve worked so hard to attract. When working with a Medicare health insurance broker, or any other type of health insurance broker, they can help you understand how to attract and retain talent by offering the right group health insurance benefits .

Keeping and Attracting Talent With Healthcare Benefits

Attracting and maintaining talent is one of the top concerns for businesses of all sizes. If you want to attract and keep excellent workers, you must know what they want and expect from your company. Health insurance is one of the key benefits of having a job, and if you want to please potential job seekers and your current employees, you must offer them benefits to show you care about them and are concerned about their well-being.

Offering comprehensive, competitive health insurance benefits is one of the best ways to keep and attract the best employees, especially if you are a small business on a tight budget. It may not always be possible or financially feasible to offer the highest wages possible, but if you offer good health benefits, you could offset this potential problem. It is important to keep in mind that job seekers consider both their regular salary and employer-provided benefits when deciding whether to take a job. In other words, by offering great benefits, you can entice exceptional workers to join your team.

Types of Health Benefits

There are three primary “health benefits” typically offered by employers. Health insurance covers the majority of medical expenses, but you should also be sure to offer dental and vision insurance as well. Here is a breakdown of the three primary types of health benefits:

Medical Insurance – This type of insurance is frequently referred to as “healthcare” or simply “health insurance.” When a person sustains an injury or contracts an illness, this insurance pays for a portion of their medical care. There are multiple levels of coverage, and when choosing a plan, you must consider the many costs associated with the plan, such as the deductible, copays, and coinsurance. Medical insurance is the most expensive type of health benefit, especially when employees must pay for it themselves.
Dental Insurance – Most medical insurance plans do not over dental coverage. Employees must take care of their oral health, and for most people, paying for dental care out of pocket is simply not possible. Compared to medical insurance, dental insurance is relatively cheap and easy to add to an employer-sponsored health benefits package.
Vision Insurance – Like dental insurance, vision insurance is low in cost and necessary for many employees. Vision insurance typically covers eye exams, glasses, and contacts.

What to Consider When Choosing a Plan

Once you have an understanding of key health insurance terms, such as deductible, coinsurance, and copay, you can start comparing plans. Consider the following factors when choosing a plan for your employees.

Networks

In general, the more expensive a plan is, the wider the network of medical professionals and facilities your employees will have access to. Having an extensive network can be highly beneficial if you want to attract top talent with your health insurance plan. Extreme limitations on where an employee can seek care and who they can seek care from can turn potential employees off.

Costs

Do you have an in-depth understanding of all the costs associated with health insurance? The higher the deductible is, the lower the premium will be. On the other hand, the lower the deductible, the higher the premium will be. Potential employees will also be looking for low copays.

Benefits

What does each plan cover and what is excluded? If your health plan has a significant number of exclusions or doesn’t provide the benefits most employees seek out, you may have trouble attracting talent.

Talk to a Medicare Health Insurance Broker

If you are ready to choose a plan that will attract the best workers in your industry, Sackett & Associates Insurance Services is here for you. Our brokers understand the world of health insurance and we are more than confident we can help you find the right plan or benefits management software for your business. Talk to a Medicare Health Insurance Broker today to learn more .

The 8-Month Rule for Medicare: What You Need To Know

mira@sackettinsurance.net (Sackett Insurance Services) — Thu, 21 Sep 2023 01:30:00 GMT

The 8-Month Rule for a Medicare Health Insurance

Health insurance can be complicated, particularly when you enter a period of transition. The main transition periods include leaving a parent or guardian's plan, being added to a spouse's plan and retiring. Medicare health insurance brokers can assist you as you prepare for and navigate the retirement transition.

What Is Medicare and Why Do You Need a Health Insurance Broker?

Medicare is health insurance that the federal government provides for three groups:

People aged 65 and older
People under age 65 but who have qualifying disabilities
People who have been diagnosed with End-Stage Renal Disease (ESRD)

A Medicare health insurance broker specializes in helping people get the healthcare coverage they need from their Medicare insurance policies. The broker may work with employers, individuals or both.

Who Qualifies

If you fall into one of the three eligible groups, you should qualify. However, several other factors may influence your eligibility:

Whether you're signing up for Part A or Part B
Whether you're signing up during the General Enrollment Period or a Special Enrollment Period
Whether you're joining a plan such as the Medicare Drug Plan (Part D) or the Medicare Advantage Plan
Whether you want additional coverage

Medicare Part A

Part A is hospital insurance, providing coverage for:

Inpatient care at hospitals
Hospice care
Home healthcare
Admittance to skilled nursing facilities

Medicare Part B

Part B is medical insurance. It provides coverage for various types of outpatient care, including:

Visits to your primary care physician
Medical equipment
Home healthcare
Preventive services, such as annual checkups and vaccinations

Medicare Part D

Part D provides coverage for drugs, including:

Prescription medications
Vaccinations

You will not automatically qualify for this part of Medicare. Instead, you will need to join a Medicare Advantage Plan or a Medicare drug plan through a private insurance company.

Medicare Supplemental Insurance

You can also purchase Medicare supplemental insurance (also called Medigap) from private insurance companies. These policies provide additional insurance coverage to help people cover out-of-pocket medical expenses.

How To Apply

Some people, such as those already receiving Social Security benefits, will be enrolled in Parts A and B automatically.

If you aren't automatically enrolled, you can sign up for both Part A and Part B when you turn 65, during the Initial Enrollment Period. This period begins three months before your birthday month and extends three months after your birthday month.

Every year, there is a General Enrollment Period between January and March. There are also Special Enrollment Periods, covering unusual situations such as:

Exceptional conditions prevented you from signing up during the Initial or General Enrollment Periods
Being abroad during the Initial or General Enrollment Periods

If you are still working or are still covered by a spouse's insurance policy, you can choose to delay signing up.

When you're ready to apply, you must decide whether you want to sign up for only Part A or for both Parts A and B. You can apply for coverage online or download application forms to fill out and submit them via fax or mail.

Healthcare Insurance Brokers

If you need more information or assistance applying for Medicare or determining whether you qualify, you can contact a Medicare health insurance broker. A representative can explain:

When the coverage begins
What you qualify for
What enrollment periods and special enrollment periods are
Whether you should sign up for Part D
Whether you should apply for Medicare supplemental insurance

What Is the 8-month Rule?

The 8-month rule refers to the maximum period of time a person has to enroll in Medicare after one of two scenarios:

His or her employer coverage ends
He or she stops working

The enrollment period begins after whichever scenario occurs first. You do not need to wait for both scenarios to occur before you sign up.

Being aware of this rule can help you plan ahead to avoid leaving any gaps in your health insurance coverage.

What You Need To Know

It's important to keep the 8-month rule in mind when you plan and apply for Medicare. If you don't, you run the risk of paying penalties. By following the 8-month rule, you will save money.

For example, if you don't sign up for Part A within the 8-month enrollment period, you will be required to pay penalty fees each month you do not have coverage. The amount of the fee may also increase the longer you take to sign up.

Make sure you talk to your employer, your benefits administrator or a health insurance representative when you're planning your Medicare coverage. They should all have experience helping people make the transition and will be able to advise you on enrolling or delaying coverage and answer your questions.

Talk To a Medicare Health Insurance Broker Now

Don't Wait! If you have any questions or need guidance, a Medicare health insurance broker can help you. For more information on or assistance with Medicare, contact us today.

Can I Get Medicare as Soon as I Retire?

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 06 Sep 2023 20:00:43 GMT

Are You Eligible for Medicare?

For many people, turning 65 means becoming eligible for Medicare . However, not everyone will qualify at 65, and there are some factors that can influence your eligibility. In addition to being the appropriate age, you must have worked and paid Social Security taxes for at least 40 quarters (10 years). If you are retiring before 65, you may or may not be able to qualify for Medicare. Here is some basic information you may want to discuss with a Medicare health insurance broker.

When Will I Qualify for Medicare?

For many people, retiring at 62 is often the best option. However, if you want to qualify for Medicare, you will need to wait. You cannot get Medicare if you retire at 62 unless you have a qualifying disability. You may be able to obtain other types of coverage, such as coverage through the Health Insurance Marketplace or an employer. It is important to note that although you are eligible for Social Security benefits as early as 62, Medicare adheres to a different set of eligibility rules.

Medicare Spouse Eligibility Rules

You should also note that even if your spouse is old enough to qualify, you still won’t be able to receive benefits until you turn 65. Unlike employer-sponsored health insurance plans, Medicare is not a group plan.

Your age will not impact how much your spouse pays for Medicare, but the plan they choose will, whether they enroll in Medicare Advantage from a private insurance company or the government’s original Medicare plan. The cost of their coverage will also depend on the number of years they’ve worked.

When your spouse turns 65, they will automatically qualify for traditional Medicare, which is sometimes referred to as Original Medicare. Medicaid Part A, which covers hospital costs, and Medicare Part B, which covers doctor visits, are included. If your spouse wants additional coverage for vision, hearing, dental care, or prescription drugs, they will need to enroll in either a Medicare Supplement Plan or Medicare Advantage Plan (Part C) that incorporates all types of coverage into one policy.

More than likely, your spouse will need to pay a monthly premium for Part B (nearly everyone does), but they won’t need to pay for Part A. This is because if your spouse meets the working requirement, some of their income has been paid to Medicare, so there is no need to pay a premium for Part A. If your spouse (or you when you turn 65), has not worked for 10 years, you will need to pay a premium for Part A. This premium can be as high as $499 monthly. Part B will cost at least $170.10 monthly.

When Should You Sign Up for Medicare?

The ideal age to sign up for Original Medicare depends on your individual needs. If you are not working and eligible for Medicare, you should probably enroll when you turn 65 if you want to avoid penalties. However, if you are still employed and have employer-sponsored health coverage, you may be able to delay enrollment without penalty.

You may be eligible for Medicare if you are under 65 if:

You have collected Social Security disability benefits for at least two years. If this applies to you, you’ll be automatically enrolled in Medicare in the 25 ^th
You have end-stage renal disease (ESRD) . You will still need to enroll on your own and you will need to visit the Social Security website or contact them directly to apply.
You suffer from amyotrophic lateral sclerosis (ALS) , which is commonly known as Lou Gehrig’s disease. If you have ALS, you will be automatically enrolled in Medicare the same month you start receiving Social Security disability benefits.

Will You Need to Enroll Yourself?

You will be signed up automatically for Medicare if:

You are under 65 and have been receiving benefits from Social Security for 24 months. You will be enrolled in your 25 ^th month.
You are already receiving Social Security retirement benefits when you turn 65.
You are under 65 and have ALS. You will automatically be signed up when you start receiving your Social Security benefits.
You will need to enroll yourself if:
You live in Puerto Rico. Even if you are automatically signed up for Part A, you will still need to enroll yourself in Part B.
You are 65 and not receiving Social Security benefits.
You are under 65 and have kidney failure (End-Stage Renal Disease).

Types of Medicare

You’ll be eligible for Medicare Part A and Part B once you become eligible for Medicare. If you want additional benefits not offered by Original Medicare, you may want to enroll in:

Medicare Advantage (Part C) – This plan often includes additional benefits such as prescription drug coverage, hearing, and vision.
Medicare Part A and B Coverage – Referred to as Medigap.
Medicare Supplement Insurance – Private insurance that works in tandem with your Medicare.
Medicare Part D – Stand-alone prescription drug coverage.

Learn More From a Medicare Health Insurance Broker

A Medicare health insurance broker from Sackett & Associates Insurance Services can help you navigate enrollment. Contact us today to learn more about Medicare enrollment.

No Longer Qualify for Medi-Cal? Here’s How to Stay Covered

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 04 Aug 2023 18:00:00 GMT

No Longer Qualify for Medi-Cal? Here’s How to Stay Covered

Your health coverage is important to you. If you reside in the state of California, you may be wondering if your Medi-Cal coverage will continue. If your coverage is ending, the important thing to remember is that you do have options for health insurance . It is also important to remember that finding and enrolling in a health plan has never been easier, and depending on your income level, you may even be able to get help to pay your premium. When your Medi-Cal coverage ends, you can still enroll in a plan with Covered California with the help of a health insurance broker.

A Health Insurance Broker Can Help You Determine if You Are Still Eligible for Medi-Cal

During the COVID-19 health emergency, Medi-Cal stopped regularly checking the eligibility of its enrollees. This meant you could stay enrolled without having to provide up-to-date information regularly. Now that the country is no longer in a state of emergency, the standard Medi-Cal renewal process is now being used again, and because of the process’s return, up to two million California residents are in danger of losing their Medi-Cal coverage. If any of your personal circumstances have changed within the last three years, such as the size of your family or income level, you may be at risk of losing coverage.

Covered California is a free state service that helps residents find and pay for quality, brand-name health insurance. Depending on your income, your insurance may be at no cost, must like Medi-Cal. If your eligibility for Medi-Cal has ended, Covered California is here to make sure you have health insurance coverage.

Keeping Coverage

To keep coverage, you must first find out if a health plan was chosen for you. According to a 2019 state law, a plan will automatically be chosen for you by the state if you qualify for financial assistance. You can still find and enroll in a plan if you do not qualify for financial assistance or your income cannot be verified.

You will receive an eligibility notice for financial assistance and coverage in the mail based on the information you provided Medi-Cal with. This letter will include important details, such as an access code and your case ID number, both of which will allow you to create a Covered California account. If you already have an account, you can just log in with your username and password. The letter will also list the steps you need to take to keep health coverage.

Enrolling in a Plan

If a health plan was chosen for you, the enrollment process is relatively simple. The plan selected for you is the lowest-cost Silver plan (this allows you to get the most financial assistance). The cost of this plan is dependent on your yearly income, and if your income is low enough, your monthly premium may be as low as $0 per month due to tax credits. You will need to confirm if you want to stay enrolled in the chosen plan or select a new plan. If you do not make a choice, your plan will be canceled and you will lose coverage altogether.

If Medi-Cal wasn’t able to verify important details such as your income or address, or if you don’t qualify for financial aid, you can still enroll in a health insurance plan. You will need to act immediately to prevent a gap in coverage. To keep coverage, take one of the following steps:

Correct information – If you need to correct an information error or report changes, you can contact Medi-Cal directly via the Medi-Cal Member Helpline (800-541-5555).
Enroll in a plan – You can browse a number of brand-name insurance plans and obtain financial assistance on the Covered California website. Use the site’s calculator to find out how much you can save – you won’t have to pay more than 8.5 percent of your income for a plan.

You have 60 days from the final day of your Medi-Cal coverage to enroll in a new insurance plan. If you do not take action during this special enrollment window, you may have to wait until the next open enrollment period.

Work With a Health Insurance Broker

Finding a health insurance plan using Covered California on your own can be difficult. There are so many options to choose from and it can be easy to feel overwhelmed. Fortunately, by working with a Sackett & Associates Insurance Services health insurance broker, you can simplify the process and find a plan that fits your needs and budget. Contact us today to learn more.

Budget Deal Delivers Billions for California Healthcare Sector

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 19 Jul 2023 20:44:21 GMT

California Healthcare Sector Receives Massive Funding Boost in Budget Agreement

California state government and healthcare interests have achieved an agreement on the spending of billions of dollars generated by the Managed Care Organization tax on insurance plans. The deal is intended to underpin a major investment in healthcare in California, particularly for providers and facilities that serve low-income individuals. The plan, agreed as part of the state’s latest budget, is projected to inject approximately $19 billion of state funds into the Medi-Cal program.

What Is the Insurance Tax Deal and Why Was It Needed?

Similar taxes have been applied to California insurance plans in the past, but this will be the first time the proceeds will be targeted toward investment in healthcare infrastructure. As recently as a year ago, the tax had been expected to be allowed to expire. California's huge number of Medicaid users means that demand for care is much larger than the number of physicians willing or able to accept Medi-Cal at current reimbursement levels. Offering more support and higher reimbursement for facilities and physicians serving California’s low-income population was a primary goal of negotiations about the renewed tax.

Past versions of this tax were not earmarked for healthcare spending, but were instead used to pad the state's coffers more generally. For the new budget, stakeholders throughout the healthcare industry and government insisted that tax money raised from the tax on managed healthcare plans be used for healthcare-related improvements. The investment will bring in matching funds from the federal government due to the federally supported funding model for Medicaid programs. With the addition of federal funds, the agreement could allow for as much as $35 billion to be pumped into Medi-Cal.

How Did the Deal Get Done?

The stakeholders who worked to build the landmark agreement included hospitals, community clinics, physicians and government officials. Negotiations have been ongoing since November of 2022. The combined healthcare industry stakeholders joined under the banner "Coalition to Protect Access to Care" to persuade the governor and legislature that directing the insurance tax to healthcare spending was essential. While each segment stressed the specific concerns of their members, the various health insurance broker, hospital and physician interest groups were united in their belief that the Medicaid sector needed urgent investment.

Though insurers broadly agreed to the renewal of the tax earlier in the year, finalizing the deal has meant months of wrangling over how to divide the proceeds among the various healthcare sectors. In addition to how much will be spent and on what, government, industry and citizens groups have disagreed over when and how fast the money will be spent as well. The final deal has cut the timeline for implementing the new spending down from a proposed ten years to five years. The Coalition has also put forward the notion of making the increased funding permanent through a future referendum for an amendment to the California constitution.

How Will the Tax Revenues Be Used to Boost Healthcare?

Most of the targeted spending from the tax will begin in 2025, and several provisions will address expanding the number of healthcare providers across the state. In addition to increasing reimbursement for some physicians, the plan also includes spending millions of dollars to attract newly graduated med students to physician residencies in hospitals that serve lower-income California residents. The University of California will receive $75 million for the purpose of enrolling more students in the state university's medical degree programs. It is hoped that these investments will ease the shortage of physicians that is currently a barrierto access for many patients.

In addition to the medical school and residency funding, there are also provisions designed to shore up poorer hospitals and clinics that a primary means of accessing care for Medi-Cal patients . Part of the hospital support will include millions of dollars in loans to struggling nonprofit hospitals. Millions will also be invested in providing inpatient care for people experiencing mental health conditions, to redress a critical shortage of mental health facilities. California's Department of Health Care Services will administer the new hospital and clinic spending based on where the lack of access to healthcare is most urgent.

California has been one of the most active states in evaluating and implementing policies to ensure healthcare coverage for all of the state's residents. For more information on how new government plans and regulations may affect your health insurance plan, contact Sackett & Associates Insurance Services .

Qualifying Life Events and the Special Enrollment Period

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 30 Jun 2023 22:30:00 GMT

What Are Qualifying Life Events?

Health insurance helps provide individuals and families access to care and can make a difference between illness and health. In the U.S., there are about 327 million people , most of whom have private health insurance. If you need to join the ranks of the insured or if your health insurance coverage no longer suits your or your family's needs, it may be time to approach a health insurance broker to change your coverage.

In the U.S., there is a specific window of time when you can enroll or change your healthcare coverage. This period is called the Open Enrollment Period. OEP tends to last from November to mid-January. However, if you need to enroll outside of the typical timeframe, there are life events that can qualify you for a Special Enrollment Period.

Approaching a Health Insurance Broker About the Special Enrollment Period

To obtain insurance, a broker can assist you in finding and applying for adequate coverage for your situation. Brokers may work with single health insurance companies or several, but all brokers can help you navigate the SEP. The SEP allows you to enroll in health insurance outside of the normal OEP. However, you must undergo a specific life change or qualifying life event to trigger the SEP.

The SEP begins from your qualifying life event date and will extend for about 60 days. The specifics of your SEP window depend on the state you live in. For example, some states will give you a 60-day window before and after the QLE to seek coverage.

Understanding Qualifying Life Events

The basic understanding of QLEs is that QLEs change your individual or household's status. Another term for QLE is a qualified status change.

A Change in Marital Status

When you marry, divorce or legally separate, your household size changes. You typically have 60 days from your wedding date to enroll in a plan with your spouse or to add a spouse to an employer-sponsored plan.

In the case of a divorce, the person who does not hold the policy will have to purchase a new policy through the SEP. You may need to present your divorce decree or proof of separation to qualify.

An Increase or Decrease in Household Size

Starting a family is a reason to seek a health insurance broker for a new plan. Remember that pregnancy does not count as a QLE; the baby's birth does count as a QLE. In addition to giving birth, adoption also makes you eligible for a special enrollment period.

In addition to births, deaths in the family can also qualify you for a change in your coverage. You are eligible if you share coverage with another family member and he or she passes away.

A Move Outside of Your Coverage Range

Moving out of your health plan's coverage range generally qualifies you to change your insurance plan. Moving can include leaving a transitional house, shelter or moving to a college campus.

Changes To Your Job Status or Income

No matter how you lose your job, if you lose your job, you are eligible. You don't have to wait until open enrollment, even if you voluntarily quit. Likewise, if you are covered under your spouse's plan and he or she changes employment, both of you qualify.

Additionally, you may be eligible if you are covered under Medicaid and your income increases or you no longer receive Medicaid.

Determining Whether You Have a QLE

The special enrollment window applies to most people who lost their health insurance involuntarily. Most qualifying events are ones the individual or family had little control over. The fact that you lost your insurance has to be a byproduct of the event.

However, if you give up your insurance voluntarily, you do not qualify for the SEP. Voluntary insurance loss includes not paying your insurance premium or dropping out of an insurance plan.

Trusting a Health Insurance Broker To Guide You During a SEP

The open enrollment period for health insurance doesn't always work for everyone. You cannot always predict when you'll have to change coverage and because of life's uncertainties, there are special enrollment periods where you can still seek the insurance you need.

To navigate the complexities of the insurance market, you may want a health insurance broker. For more information about enrolling in private or family health care insurance coverage outside of open enrollment, contact Sackett & Associates Insurance Services at (707) 823-3689 today or request a quote on our website.

5 Tips When You’re Shopping for Group Health Insurance

mira@sackettinsurance.net (Sackett Insurance Services) — Thu, 22 Jun 2023 23:00:00 GMT

Finding a Group Health Insurance Broker For Your Company

Do you own a small business and employ a group of people? If so, you are likely interested in finding a group health insurance broker to help you find insurance plans that meet the needs of you and your employees. When choosing group health insurance, it's important to know what you're looking for and how to get the best deals. Luckily, there are plenty of tips to help you do just that.

Talk to a Group Health Insurance Broker

Hiring a group health insurance broker to help you find the right group health insurance plan could save you money in the long run. They know which plans are most popular in your local market as well as which providers are included within each network. Insurance brokers work for you. Since their goal isn't to please an insurance company, they focus on finding the right group plan to meet your needs and the needs of your employees. Additionally, if you work with a broker, you'll receive help during enrollment and as needed throughout the year.

Finding the right broker is essential, though. The right one will not only be licensed but will have experience in providing group health insurance plans, including managing them, comparing them, and making changes when needed. Look for a broker that has a strong and positive reputation within your community. Finally, be sure that you hire someone who you feel comfortable with.

Consider Whether You're an Applicable Large Employer (ALE)

If you started as a small business and have grown to the point that you need group health insurance plans, then you may be considered an applicable large employer or ALE. This means that you have certain responsibilities to uphold. When the Affordable Care Act came to be, it designated ALEs as any employer that has at least 50 full-time employees or the equivalent.

Whether you're considered an ALE depends on the average number of employees you had in the previous year. If you are an ALE, you are responsible for employer-shared responsibilities. This means you have to provide minimum coverage to at least 95% of employees and their dependents. You may be subject to penalties if you don't. Understanding how your business must operate ensures you find the right plan.

Compare the Plans Thoroughly

When comparing group health insurance plans with your group health insurance broker, consider the types of coverage, copays required, and providers in the network. There are several types of plans available, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), high-deductible health plans (HDHPs), health savings accounts (HSAs), and exclusive provider organizations (EPOs). Each one has its own advantages and disadvantages and healthcare.gov provides more information on them.

The first thing to consider is which providers are in the networks you're considering. Each plan has its own network of providers. If you use an HMO or EPO, using providers outside of the network can be quite expensive. Most plans provide no out-of-network coverage unless it's an emergency, which means it's important to choose a plan that includes a wide variety of providers. Keep in mind that HMOs and some EPOs also require each member to choose a primary care provider who is responsible for referring the patient to specialists as needed. Some EPOs allow clients to make their own referrals within the network. PPOs typically allow members to refer in our out of the network, but keep in mind that out-of-network care costs more in terms of copay and coinsurance.

The next thing to consider is costs. Out-of-pocket costs vary greatly depending on the plan you choose. Most include a deductible. This is the amount you need to pay out of pocket before your coverage kicks in. Copays are important as well. Typically, this means paying anywhere from $25-$100 per visit before insurance kicks in to cover any other costs. Coinsurance is also common. This means that you pay a percentage of the cost of an office visit and the provider pays the rest. Consider deductibles, copays, and coinsurance requirements when choosing your group health insurance plans.

Look For Extra Benefits

Group health insurance plans provide benefits beyond medical ones. Many of them offer discounted or free gym memberships, savings on prescription drugs, and a number of other benefits related to health, fitness, and well-being. You might even save money on going to the movies, seeing sporting events, or attending other entertainment venues. When comparing plans with your group health insurance broker, if you have two that offer the same medical benefits, consider whether there are added benefits such as travel savings, food delivery options, online learning choices, or warehouse club memberships.

Think About Exchange Options

There are also options called private or public health exchanges. These exchanges used to be known as the Small Business Health Options Program. When you use an exchange, you and your employees will have access to multiple health plans and coverage options. You decide how much you want to contribute to their insurance via a fixed percentage or dollar amount.

Schedule a Consultation With a Group Health Insurance Broker

Are you reading to talk to a group health insurance broker about finding the right health insurance plans to meet your company's needs? Contact the professionals at Sackett & Associates Insurance Services. We are ready to help!

What Is the CalChoice Group Health Insurance Program?

mira@sackettinsurance.net (Sackett Insurance Services) — Wed, 31 May 2023 23:00:00 GMT

What Is the CalChoice Program for Group Health Insurance?

When business owners want to understand options for company health coverage, one question that a group health insurance broker often receives is about CalforniaChoice. Discover what the program is, when it can be a good choice for small businesses, and what alternatives are available.

What Can a Group Health Insurance Broker Tell Me About CaliforniaChoice?

CaliforniaChoice often goes by CalChoice for short and refers to a private health insurance exchange. This marketplace allows an employer to provide coverage from various statewide and regional insurance firms instead of only offering one plan to everyone in the organization.

What Are the Advantages of Using CalChoice?

CalChoice can simplify how a company offers multiple health insurance options to employees. The service bundles plans from many insurers so that a business does not have to work with each one separately.

Many small businesses appreciate that CalChoice allows them to offer the Kaiser HMO and Anthem Blue Cross PPO plans. The underwriting guidelines for these programs can be difficult for smaller companies to achieve otherwise, but a group health insurance broker can help a company ensure they meet the requirements under CalChoice.

Additionally, employees place a premium on benefits such as vision, dental, chiropractic, and life insurance. CalChoice can make it easier to offer these ancillary benefits, which can help companies attract top talent who value having those coverages.

What Are the Challenges To Using CalChoice?

CalChoice mandates that clients have 70% participation. Individual insurance companies may ask for as little as 25% participation, making it easier to comply when using just one insurance firm.

CalChoice also has additional administrative fees of $30 or $50. This is not part of the insurance coverage, and a representative may neglect to mention it in the initial quote. The additional expense may be an unwelcome surprise to companies on a tight budget.

Another challenge to using CalChoice is that it has many insurance choices, which seems to be a good thing on its surface. However, employees may struggle to make decisions about coverage and delay choosing a plan.

Confusion about coverage might also occur because plans from the same provider can vary, and doctors who are in-network on one program can be out-of-network on another one from the same insurer. A good group health insurance broker can work with an organization to help employees understand their options.

One other consideration is if employees want a Preferred Provider Organization health plan, the only option currently available with CalChoice is Anthem Blue Cross. PPO plans tend to offer access to more doctors and hospitals, which can be an advantage for individuals who travel often or want to have more choices in which medical organizations they use.

What Is an Exchange?

The term exchange can be confusing to people shopping for insurance. The word simply refers to a single marketplace or forum to purchase various types of health insurance. When the Affordable Care Act went into effect in 2010, states set up public exchanges to help individuals, families, and small businesses purchase affordable insurance.

California’s state exchange is Covered California, which has distinct offerings from CalChoice. CalChoice is a small group private exchange and is currently the only one of its kind in California. A group health insurance broker can help anyone shopping for insurance to compare both options.

While the Covered California public exchange ensures everyone has access to affordable insurance, a private exchange like CalChoice can offer additional options as it operates to compete in the free market. Public exchanges usually only provide medical and dental coverage. Private health insurance exchanges can offer more options for vision and hearing services, as well as 401(k) integration and other kinds of insurance products.

How Can a Group Health Insurance Broker Help?

Small business owners are busy and rarely have the time to research thoroughly which exchange or plan could be best for their company. Just as intelligent entrepreneurs rely on experienced consultants to guide them in professional, legal, or investment matters, a health insurance broker can help a person make a sound decision regarding company health insurance plans.

Where Can You Find a Reliable Group Health Insurance Broker?

When you’re trying to decide whether to use CalChoice, Covered California, or some other option, the assistance of an experienced professional is invaluable. Talk to a group health insurance broker at Sackett & Associates Insurance Services . We’ll help you simplify your options and take the pain out of health insurance.

Company Health Insurance: Breaking Down the Cost of Hiring a Health Insurance Broker

mira@sackettinsurance.net (Sackett Insurance Services) — Fri, 19 May 2023 16:30:00 GMT

Company Health Insurance: Breaking Down the Cost of Hiring a Health Insurance Broker

A strong benefits package is critical to your company's ability to thrive in the market. When you hire a health insurance broker, you are hiring an intermediary between your company and the insurance provider. How you spend your company's money finding an insurer is up to you, but brokers can help you find deals you wouldn't otherwise have access to. Understanding how you pay for help may help you see a broker's value.

How Can a Health Insurance Broker Help You Remain Within Budget?

A major misconception is that independently finding group insurance is more affordable than working with a broker. Brokers can be integral to keeping your business's insurance hunt under budget.

Fewer Legal Risks

Businesses that don't meet federal and state insurance requirements can face various penalties, including heavy fines. Unfortunately, laws can change every year and most business owners need more time to keep up with every law and regulation regarding health insurance. Brokers, on the other hand, come prepared with the knowledge. To sell insurance, brokers must pass an exam.

Budget Safeguards

When you hire a broker, you have an opportunity to explain your budget and your financial limitations. The broker uses his or her expertise to determine the best policies for your company while also staying within your budget . A professional will deliver options that match your monthly and annual budget and explain any health tax credits you qualify for.

How Are Health Insurance Brokers Paid?

Most small businesses pay more than $500 per month per employee for a health insurance plan. Before you ask a health insurance broker to break down the costs to you, it's normal to want to understand how much money goes to him or her.

Payment for Client Retention

If an insurance broker cannot retain clients, the broker loses money each month. Once the broker of record letter is signed and you have a health insurance policy, the broker continues to work with you as your company grows and changes. If your health insurance needs to change, he or she can guide you through finding a more suitable option.

Brokers receive payment based on how many employees remain enrolled in a healthcare plan. If you change plans but keep the same broker, the health insurance broker will continue to receive compensation.

Commissions From Health Insurance Companies

Brokers earn money via commissions from health insurance companies. Generally, the brokers can provide quotes, enrollment assistance and information about different plans at no cost. Instead, the broker offers various services to encourage clients to work with them. The commissions incentivize brokers to maintain a good rapport with the clients.

Brokers receive a commission from the monthly premiums paid for health insurance. However, the Affordable Health Care Act requires that at least 80% of the money paid to health insurance companies from insurance premiums go toward healthcare costs. 20% of those premiums can go towards marketing, administrative costs and broker commissions. Most insurers will pay a fixed percentage of the premium, but others might pay a flat fee per policyholder.

Pay Structure for Health Insurance Brokers

A common misconception about health insurance broker commissions is that brokers receive a lump sum when you first sign onto a policy. The reality is that the broker only gets a commission once a month. Typically, brokers also receive graded commissions. The insurance company pays the largest percentage for the first dollars of the premium. As the premiums increase, the company will decrease the rate given to the broker. A graded structure allows brokers to receive reasonable compensation on small accounts and incentivizes working with large and small companies equally.

How Much Control Does Your Broker Have Over Costs?

Most states regulate the cost of health insurance premiums. Your broker cannot increase the costs of your premiums to line his or her pockets with more money. While your broker has incentives to enroll all of your employees in a healthcare plan, he or she will not be biased toward any one plan. The system is set up to keep brokers from biases based on their pay.

Brokers tend to make more money on new policies because they receive a higher rate. Generally, they receive a lower rate for renewals.

Find a Health Insurance Broker for Your Company

Insurance brokers provide an invaluable service to small and large businesses alike. For more information on how to find a health insurance broker for your company, contact or request a quote at Sacket & Associates Insurance Services.

Exploring Health Insurance When You're Self-Employed

Fri, 28 Apr 2023 21:30:00 GMT

Exploring Health Insurance When You're Self-Employed

It can be tricky for self-employed professionals to evaluate their insurance options. For example, just knowing where and how to get started can be confusing. Also, some people wonder whether they need insurance in the first place. This post breaks down information on options, cost considerations, and if you truly need insurance.

What Are Good Self-Employed Options for Health Insurance?

Brokers and online comparison tools make it simpler for consumers to compare their health insurance choices. While understanding factors such as co-pays, deductibles, and premiums is a bit easier, the process remains confusing for many people.

Insurance brokers offer a personal touch and do much of the work for you. They can clarify the various factors at play so the process becomes less stressful. Here is a look at brokers and other options that self-employed people have for getting health insurance.

Health Insurance Brokers

Many self-employed professionals purchase their plans through brokers. Brokers work with you to understand your particular needs and wants, and they find the best insurance plan to meet these criteria. They can help whether you are seeking coverage for just yourself, your family, or for your employees .

Brokers have access to many health plans from top providers and can easily compare them. Through a broker, you can talk with real people and get regular health insurance and/or plans for dental, vision, life, and Medicare. You can also explore various options for savings. Brokers do much of the legwork for you, taking the hassle out of health insurance shopping.

Insurance Providers

You can also purchase insurance directly through an insurance company or provider. You can do so online, on the phone, or even in person. Like with brokers, you may find rates or special deals you might not on the marketplace.

State or Federal Marketplaces

The health insurance marketplace lets you compare many plans in one place. Some states use their own marketplace, while others use the federal marketplace. As a result, the look and ease of your shopping experience can vary depending on where you live.

Many people buy their insurance during yearly enrollment periods, typically from fall into early winter. Qualifying life events can trigger special enrollment outside of these time frames, though. Marriage, divorce, income changes, job changes, moves, and gaining a dependent are a few examples. You might have up to 60 days after the event to apply for insurance.

Marketplace plans (as well as the private plans you purchase through brokers and insurance providers) offer these 10 critical benefits per the Affordable Care Act: preventive care, pediatric care, prescription drugs, maternity care, hospitalization, emergency services, mental health, outpatient services, lab services, and rehab services and devices. It is illegal to deny you coverage based on pre-existing conditions.

Marketplace plans are bronze, silver, gold, and platinum. Platinum plans have the highest premiums but cover the largest percentage of medical expenses. Bronze plans have lower premiums and lower coverage levels.

State Health Plans (Medicaid)

Depending on your income, you might qualify for a state-managed health care plan. For example, California’s is Medi-Cal. You should be able to apply through your state marketplace and other methods.

Do You Need Insurance as a Self-Employed Person?

You are the person most familiar with your life and situation, but it is a good idea to get the best plan you can afford . Medical bills can get expensive fast, and it is impossible to predict health emergencies. Health insurance makes costs manageable and eases stress in the big picture for consultants, freelancers, independent contractors, entrepreneurs, and other self-employed people.

What Are Health Insurance Cost Considerations for Self-Employed People?

Self-employed insurance costs typically include deductibles, copays, and out-of-pocket maximums. Deductibles are how much money you must pay before your plan kicks in to cover you. Copays are fees you pay for services such as a doctor's appointment. Out-of-pocket maximums are the most you have to pay in a year for covered care.

Fortunately, you can deduct your premiums on your yearly tax return. Many self-employed people get refunds or lowered tax bills this way. It is also possible to get write-offs in certain circumstances.

Contact a Health Insurance Broker Today

Health insurance can be confusing for self-employed professionals. To simplify the process, contact us today at Sackett & Associates Insurance Services or request a quote .

A Look at How Dental Insurance Works

mira@sackettinsurance.net (Sackett Insurance Services) — Mon, 17 Apr 2023 18:15:01 GMT

Key Things To Know About How Dental Insurance Works

With a dental plan, you can take care of your teeth and gums, catch certain health issues early or prevent them altogether, and spend considerably less money on checkups and teeth cleanings. Dental insurance can be confusing, though. For example, some people think it is part of regular health insurance. This post explains what dental policies cover and how to get them.

The Basics of Dental Insurance

Dental insurance is similar to regular health insurance in a lot of ways. You pay premiums, and the insurance plan covers part of your dental costs. Preventive services such as cleanings, checkups, and X-rays tend to be 100% covered.

Insurers typically cover part of the cost for common non-preventive procedures and many major procedures. It's unlikely you would have to pay the dentist in full for fillings, crowns, root canals, or simple extractions under dental insurance.

How To Get Dental Insurance

A health insurance broker can help you get a dental plan . Brokers have access to numerous insurance policies from big and small providers. Real people you talk to work for brokers, and they find plans to fit your needs and circumstances. You can find dental plans, regular health insurance, vision insurance, and other types of insurance for individuals, families, and employees (group plans).

Brokers are an excellent way to simplify a confusing process, but you can also try purchasing dental insurance directly through providers or health exchange marketplaces. Employers often offer dental plans, too. If you are eligible for Medicare, you could seek coverage under a Medicare Advantage plan.

Discount plans are another alternative. Rather than insurance contributing to the costs of care, you get discounts on the dental services you receive.

No matter what method you use to find dental insurance, pay attention to the language in policies as you compare them. Focus on common terms to be sure you understand the scope and limitations of the proposed coverage.

Annual Maximum Benefit

This is the most money that a dental insurance plan spends on care within a benefit period (typically a calendar year). Maximums often run from $1,000 to $2,000 for each person. It is very unlikely you’ll meet your maximum unless you happen to need considerable dental work.

Implants, veneers, full-mouth periodontal surgery treatment, and full-mouth dental reconstruction are examples of pricey procedures. If you believe you might need one of these in the next few years, a health insurance broker may be able to help you find coverage to meet your needs and lessen the financial impact on you. Similarly, dental insurance coverage for braces varies wildly. You do have more flexibility if your braces are deemed medically necessary.

Dental Insurance Deductible

You must pay a specific amount of money before your insurance plan contributes to costs. That amount of money is called your deductible. It should not apply to most or all preventive services since insurance plans usually cover them 100%.

The different non-preventive services have varying deductible amounts. You pay the deductible, and then your insurance company pays the agreed-upon percentage of the rest. Look at the deductible amounts listed with each service on your summary of benefits before you enroll.

Dental Coinsurance

Coinsurance can be extra confusing because some people think their insurer pays the full amount left after a deductible. This is often not the case.

Basic, non-preventive services tend to have 80% coinsurance coverage. What that means in practice is this:

You pay the deductible.
Your plan covers 80% of the remaining amount.
You pay the 20% that is left.

Dental Insurance Waiting Period

There is usually a waiting period before you can get most treatments or expensive treatments such as crowns. The waiting period can be two months up to even a year. Waiting periods typically do not apply to cleanings and regular checkups, though.

Waiting periods protect dental insurers. Otherwise, people might apply to get insurance right after they learn they need an expensive procedure. For this reason, some consumers get their waiting periods waived when they show they have had continuous dental coverage.

Contact a Health Insurance Broker for Dental Plans

Dental insurance functions similarly to health insurance, which means it can be tricky to understand. For more information on how to simplify the process of getting dental insurance, contact the health insurance brokers at Sackett & Associates Insurance Services or get a quote today .

Health Insurance Broker Reminders About Using Your 1095-A Form

Thu, 30 Mar 2023 23:15:00 GMT

Health Insurance Broker Guidance About Your 1095-A Form

Finding the right health insurance coverage requires diligent planning and the help of a good health insurance broker. After completing the paperwork during the open enrollment period, tax season soon comes around, and a Form 1095-A may appear in your inbox or mailbox.

What is this document for, and how do you use it to complete your tax returns?

Health Insurance Broker Reminders About Marketplace Insurance

The Affordable Care Act reformed health care by establishing the minimum coverage that health insurance providers had to offer to taxpayers. The legislation created marketplaces for consumers to review plans and benefits.

A health insurance broker can guide a person through the many available plans to make the right choice. Though programs may have similar costs, what one offers may be substantially different from another. The difference may be thousands of dollars in health care costs over a year.

The system offers subsidies to help individuals and families with low income levels cover health insurance. People must meet the requirements to qualify for aid. The assistance comes through tax credits from the government.

When To Expect Your 1095-A Form

The government sends out 1095-A forms near the middle of February. Anyone who received marketplace coverage during the previous year should expect a form. You should usually have an email on file with HealthCare.gov, where they will send an electronic copy. They may also send a paper copy in the mail.

A change in residence or marital status could mean that a person gets more than one form. If family members enroll in a different plan or file taxes separately, you should typically receive a form for each plan.

If you do not receive your 1095-A by the last week of February, talk to your health insurance broker. You may need to double-check your email inbox, spam, or bulk folder. If your physical mailing address is not current and you did not set up forwarding, the form may have gone to the wrong location.

Regardless of the reason for the missing form, you should be able to log into HealthCare.gov and download and print an additional form. If you need assistance, your health insurance broker is glad to help.

The Information on Your 1095-A Form

The 1095-A breaks down into three sections, plus an introductory letter and additional instructions. You use the information to fill out Form 8962 for your taxes. The data determines your premium tax credit and whether you owe more or will receive a refund.

Introductory Letter

The form includes an introductory letter from the Health Insurance Marketplace that contains basic reminders. The document should alert you whether you need to file a federal income tax return.

The letter will also share information about who receives Form 1095-B and 1095-C. The letter also mentions how to void or correct the statement. The IRS gets a copy of the document, so you do not submit it with your taxes. You should keep a copy for personal records. Your health insurance broker may be able to make recommendations as well.

Part I

The first part contains your information in 15 boxes. Boxes 1 through 3 list your policy identifier, number, and name. Boxes 4 through 9 are for your name, spouse’s name, Social Security numbers, and dates of birth.

Boxes 10 and 11 display your policy start and termination dates. Boxes 12 through 15 hold your address.

Part II

This section mentions the names of each individual with coverage under the plan, including the Social Security numbers and start and end date for each person. Verify that this information is accurate.

Part III

The final section lists each month of the year and a row for totals. Column A lists the monthly enrollment premiums you paid and that a subsidy covered on your behalf.

Column B is for the monthly second-lowest-cost silver plan premium. This figure helps you determine your ultimate premium tax credit.

Column C lists the advance payments of a premium tax credit. This amount refers to advance payments on your behalf to cover monthly insurance premium costs.

Instructions for Recipient

The final pages will contain instructions and explanations of each line on the form. Your health insurance broker can help clarify other questions about your plan.

How a 1095-A Form Affects Your Taxes

During the open enrollment period for health insurance, you must estimate your annual income. The government determines your advance credits by income estimation. You must resolve your actual credit when you file your taxes at the end of the year.

If your income exceeds your estimation, your tax credit will be lower. You will have to repay the difference. If you underestimated your income, your premium tax credit is higher. You can receive a refund for the difference in the overpayment when you file your taxes.

A Health Insurance Broker That Can Help You Understand Your Options

Sorting through the health insurance plans and their tax requirements can be overwhelming. Fortunately, you can rely on the help of a knowledgeable health insurance broker. Sackett Insurance has a friendly and experienced team that works to make insurance easy for you. Contact us to find out how.

How To Save on Small Business Health Insurance

Fri, 17 Mar 2023 22:15:00 GMT

Tips To Make Small Business Health Insurance Affordable

Offering good benefits is integral to your ability to recruit and retain great employees, and health insurance is undoubtedly one of the employer-provided benefits that people value most. For many small businesses, affording good group coverage can be extremely challenging. Working with a knowledgeable health insurance broker and exploring strategies to save could help you spend less on this crucial line item. Here are a few tactics that could allow you to fit your healthcare plan into your budget more manageably.

Survey the Marketplace With Your Broker

To find the most competitive rates for group health insurance coverage , you don’t have to approach every single carrier individually. Working with a broker is the ideal way to do a comprehensive search for affordable coverage with all of the most popular and affordable providers.

A lot of the best brokers already have well-established working relationships with major carriers. Those connections can be advantageous for getting responsive communications from carriers, detailed presentations of the different ways that you can structure coverage, and a thorough breakdown of different plans' benefits.

Choose Plan Tiers Smartly

Having employees choose coverage from just one or two tier options might have some drawbacks. While it may seem like a way to simplify benefits administration, it could force people to get more coverage than they really need. Practically speaking, this means higher premiums without substantive advantages.

Consider purchasing coverage from a health insurance carrier that allows enrollees to choose from multiple plans. Flexible options give people more freedom to get the insurance that fits their individual needs. People who don't have any health conditions and don't need to include dependents on their plans can access more affordable premiums, and your share of the responsibility for premiums payments will also be less expensive.

You could also opt to require employees who elect a higher tier of coverage to bear a larger percentage of the premiums. So long as you're communicative and consistent about setting employees' responsibilities based on their choice of coverage, you can steer clear of potential liability issues.

Get a Different Type of Plan

If you're currently enrolled in a PPO plan for small businesses, making a switch to an HMO or EPO could yield considerable savings on premiums. In general, these plans don't entail sacrificing specific benefits or making big compromises on covered services. However, they require enrollees to receive care from providers who participate in the carrier's network. This means that people may access treatment from only network participants, which may mean that they have fewer hospitals or practitioners to choose from if they need care. HMOs and EPOs also generally require insureds to get referrals for specialists from a primary care physician.

Offer a Wellness Plan

Including a wellness plan in your employee benefits may not seem like an obvious or immediate way to reduce insurance costs. In fact, this add-on may represent a moderate increase in coverage costs within the first year that you offer it. However, it could generate long-term savings on premiums and also carry a couple of other distinct advantages.

These programs promote good preventative care and help people enhance their awareness about their health. Features such as nutritional counseling, smoking cessation support, or group fitness opportunities can empower your workforce to develop healthy habits. By making people healthier, wellness plans can reduce their utilization of their primary health insurance plan. Lower utilization rates can make renewing coverage more affordable.

A healthier workforce may also result in decreased utilization of other costly benefits such as short or long-term disability plans. Likewise, giving personnel resources that help them manage their health makes them less susceptible to injury, illness, or progressive health conditions. Consequently, a wellness plan can reduce absenteeism. It may also make employees more productive on the job. Furthermore, showing your workforce that their wellness is a priority can bolster your efforts to cultivate a strong company culture.

Monitor Medicare Utilization

If you have employees who are over 65 years old, you do not have to include them in group coverage. As a compliance matter, you have no obligation to cover individuals who are eligible for medicare . Be sure to formalize this policy in your employee handbook, and apply it consistently to avoid perceptions that people are being excluded unfairly.

Get Professional Input About Current Coverage Trends

It’s a good idea to get professional insight about emerging trends in small business health insurance from an experienced broker. Make it a point to seek out guidance from someone who has a thorough understanding of the financial obstacles that carriers are currently facing and how those obstacles are affecting their small business clients. A broker can give you practical guidance about what you can do to stay ahead of potential issues, steer clear of unexpected costs, and strategize about problems involving overutilization.

For help evaluating the best health insurance options for your small business, contact Sackett & Associates Insurance Services . We can work with you to find affordable coverage for your workforce.

Top Health Insurance Broker Tips for Negotiating Medical Bills

Fri, 24 Feb 2023 02:30:00 GMT

Health Insurance Broker Advice for Settling Health Expenses

Medical spending continues to increase , making covering bills more difficult for everyday people. However, you're not without options. Consider how to lower your bills using negotiation tactics and discover how a health insurance broker can help.

Seeking Advice From a Health Insurance Broker

A health insurance broker is a professional who understands the ins and outs of the healthcare marketplace and can help patients find the best deals. Price is not the only factor for health insurance. Two plans with the same premium may cover different items and have differences in copays and out-of-pocket expenses.

Insurance only gets more complex with changing laws and requirements. An expert can help you find affordable individual and family plans that meet your needs.

Searching for Government and Hospital Resources

Numerous sources exist to help patients ease the burden of medical care. Low-interest loans and financial reimbursement programs can assist those with limited income or extenuating circumstances.

Medicaid and Medicare are traditional federal insurance plans for low-income folks. In some cases, Medicaid can even assist with bills you accrued before you applied for the service. Your health insurance broker can help you determine which benefits you qualify for.

Many hospitals work with nonprofits and other charitable causes that help individuals eligible for aid. Sometimes assistance is dependent on the type of illness you have. Other organizations provide access to specific medical services and devices.

Don't forget to consider what help might be available from local groups in your community. Neighbors may be able to offer a little support, and crowdfunding has raised billions of dollars when people do it correctly. Research your options and apply for anything you might be eligible for.

Working With the Right Billing Party

It may shock you to learn that your doctor doesn't always know the cost of your treatment. Many hospitals have a separate financial department that handles all accounting so doctors can focus on providing the best care. A health insurance broker may have informational materials that explain more about how these systems work.

Medical teams might also outsource billing to a third party. This arrangement is often how groups of specialists deal with payment. Whatever the case, ensure you're talking to the right people when you work out a payment plan or bargain for better rates.

Finding Prescription Drug Discounts

Online pharmacies and nonprofit groups offer greater access to low-cost medicines. Your drug manufacturer may even have a charity care program that you can apply to for assistance.

Verify the safety of online pharmacies before ordering. Your doctor or health insurance broker may even be able to give you some advice in this regard.

Negotiating a Discount Plan

Some creativity and flexibility can open up other options. You may be able to defer paying on other loans to put down cash for health expenses. Share your income and budget with whoever is in charge of your billing to demonstrate your need.

One way to cut payments is to ask for a longer payment period. Show good faith by paying what you can while working out a deal. Even if you can't cover an entire bill, you can stave off the collections process by offering something. Remember to be honest about your situation so the responsible parties can provide sufficient help, whether that's your doctor, medical billing department, or health insurance broker.

Understanding the Explanation of Benefits

The EOB explains the care you received and the charges for the treatment. The document isn't your bill, but it should correspond to the charges on your invoice. Ensure you get a copy of this form any time you leave a care facility.

Since your insurance company processes the EOB, you may receive more than one if different specialists treated you in a single visit. If the information doesn't show a payment from your insurance company, you may have to wait on the processing to catch up. Reach out to your health insurance broker or insurance support line to clear up any discrepancies.

The EOB can also help you find coding errors on the bill. Medical coding is complex, and mistakes slip through more often than people realize. Checking for issues can save you from paying charges you don't owe.

Coordinating All Parties

Share your situation with your doctor, insurer, assistance program, or medical biller. Keeping everyone on the same page is another way to avoid mistakes and challenges.

Work with your health insurance broker and care facility before an issue arises to determine which institutions and practitioners accept your coverage. If you negotiate a rate with the help of a charitable service or some other program, double-check your documents to verify the terms are as you agreed upon.

Finding Assistance From a Trustworthy Health Insurance Broker

Medical bills show no signs of getting any less expensive. Look to a trustworthy health insurance broker who has your interests at heart. For additional information on how to determine the right plan, contact our team at Sackett & Associates Insurance Services. We guarantee you'll talk to a human and receive exceptional service.

6 Things Everybody Needs To Know About the No Surprises Act

Thu, 16 Feb 2023 15:15:01 GMT

Understand the No Surprises Act's Impact on Medical Bills

According to the American Medical Association, people in the U.S. spend more than $4 trillion on healthcare services annually. This figure may sound exaggerated, but if you’ve sought out medical treatment recently, you know just how costly healthcare can be. You also know that the bill you receive may contain costs that you didn’t expect. If you’re a patient or health insurance broker, you need to understand how the No Surprises Act may change this.

1. A Health Insurance Broker Can Help You Find the Right Coverage

There are many factors that impact how much a patient pays for medical services. One of the most important of these is the health insurance policy that they carry. Policies that include coverage for a bigger network, for example, tend to incur lower costs for patients. Similarly, a health insurance policy that offers generous coverage for prescription medication can reduce the out-of-pocket costs you face. An insurance broker is a valuable resource for finding the right coverage.

2. Balance Billing Will Be Banned

One of the most important aspects of the No Surprises Act is its ban on balance billing. Balance billing refers to the practice of charging patients for out-of-network care after collecting partial coverage from an insurer. The act prohibits this action for patients who receive emergency services. The bill dictates that providers cannot issue balance billing for any of these services:

Anesthesiology
Pathology
Diagnostic testing
Surgical care
Radiology

The bill further requires insurers to treat all emergency services as an in-network expense without prior authorization. This eliminates many of the surprises that can emerge after receiving emergency care, and it allows a health insurance broker to offer better coverage options, too.

3. Out-of-Network Billing Now Requires Patient Consent

Although the No Surprises Act shields patients from out-of-network costs for emergency services, patients who seek standard care outside their insurer’s network will still have to contend with increased costs. The act aims to mitigate the impact of these expenses, though, by ensuring that patients understand the cost before they seek services.

Out-of-network providers will now have to obtain written consent from patients in order to issue balance billing. If a patient does not waive their exemption from balance billing, though, the provider is entitled to refuse service — even if a health insurance broker advises patients that their care is covered.

4. Patients Have the Power to Dispute Their Bills

Despite all of the aforementioned protections that the No Surprises Act provides, there will still inevitably be charges on bills that patients don’t expect and don’t agree with. When this happens, the bill allows patients to dispute the cost and request that it be removed. This relies on the provider’s good-faith estimate for the cost of services, which a patient can request at any point during treatment. If the bill is then more than $400 over the estimate, they can submit a dispute or look for a new plan with a health insurance broker.

5. Providers and Insurers May Enter an Arbitration Agreement

Insurers also have the ability to dispute charges from medical providers. If an insurance provider receives a bill that includes contested expenses, for example, the insurer will enter an arbitration process with the healthcare provider. Patients are not involved in this process, and it typically does not affect the amount that they pay. According to research, over 157,000 health insurance claims have entered arbitration since the No Surprises Act went into effect. This benefits every patient and health insurance broker who wants to ensure that medical providers bill fairly.

6. There Are Some Exceptions to the No Surprises Act

The No Surprises Act has massively improved medical billing practices for millions of patients and providers. It hasn’t eliminated the issue of surprise billing completely, though, as there are still some exceptions to the protections that it provides. While the bill does extend coverage to air ambulances, ground ambulances are exempt from coverage. Similarly, while care in a hospital or emergency room is covered, care in a clinic or urgent care facility is not. Patients should consult with their health insurance broker to determine their coverage.

7. Partnering With a Health Insurance Broker May Minimize Medical Costs

The No Surprises Act is set to make a major difference in the lives of many Americans. Too many people are saddled with medical debt, exorbitant bills, and unnecessary stress simply because they needed emergency medical care. Thanks to this new policy, you don’t have to worry about receiving a shocking bill after treatment — you can focus on your recovery instead.

Partnering with a health insurance broker can further ensure that your coverage shields you from unexpected expenses. Patients who want to simplify their healthcare can trust Sackett & Associates Insurance Services to help them do so. For more information on how to get a coverage quote, reach out to us at (707) 823-3689 or contact us online .

Understanding a Few Mysteries of Health Insurance Coverage

Tue, 31 Jan 2023 02:00:00 GMT

Health Insurance Coverage Demystified

Everyone should have individual health insurance . The benefits of having a policy outweigh the costs. However, it is not always clear how paying monthly premiums is a benefit, which is why you should talk to a licensed health insurance broker.

A Health Insurance Broker Breaks Down Health Insurance Conundrums

The health insurance marketplace is confusing. It is challenging for people without a broker's license to understand the tier levels and overall differences between policies. Thankfully, several straightforward responses exist for many of the most common queries.

The Reason for an Enrollment Period

One of the most frustrating experiences when talking to a health insurance broker is the specific enrollment period. Many people believe that having a single enrollment period, lasting from November 1st to January 31st, is absurd.

Living in a free and capitalistic society, people want to buy what they want when they want it, but that doesn't work for insurance companies or the government. The truth is a limited enrollment period is an essential part of the healthcare marketplace.

An annual enrollment period, open for only three months, helps insurers keep costs down; it also motivates people to purchase insurance as a preventative rather than a response to health crises. If people buy insurance only when needed, the behavior will increase costs for everyone else.

Talk to a health insurance broker if you are experiencing a life-changing event and need insurance. Some situations, like job loss, marriage, or pregnancy, may qualify you for special enrollment dates outside of open enrollment.

The Financial Benefit of Health Insurance

It should come as no surprise that healthcare costs in the U.S. are astronomical, even simple outpatient procedures cost thousands, and a hospital stay could land you in the poorhouse if you don't have insurance. Still, health insurance is not cheap.

A healthy individual looking at an insurance price of $200 or more per month may find it difficult to justify the expense, especially if they are young and physically fit. You cannot look at health insurance as a current monthly expense; you need to consider it as potential future savings.

As any health insurance broker will tell you, policies are preventatives. You invest in insurance plans now so you aren't caught off guard by medical expenses later. No one knows what the future holds.

While everyone hopes and prays for health and safety, accidents and illnesses happen. When you realize treatment and recovery for sickness and injuries can cost tens of thousands, if not more, it is relatively easy to justify the current investment in insurance.

You may also reduce your health insurance costs by investigating various state-run programs. For example, Covered California is a free service that can help eligible people save money on monthly insurance premiums.

Ultimately, it is a mistake to look at the investment into insurance premiums as a burden. The appropriate way to view insurance is as an investment in your future health and well-being.

The Reasons for Deductibles and Copays With Premiums

Any health insurance broker will explain that many insurance policies have three components: premiums, copayments, and deductibles. The premium represents your basic monthly costs to have coverage. A copayment is a set amount of money you must pay for doctor visits or treatments. Finally, the deductible is the amount you must pay before your full coverage kicks in.

While not all policies will include both deductibles and copays, many do. Policyholders often voice frustration with such cost-sharing tactics, but they are necessary and permit insurance companies to offer the coverage they do.

You can often reduce your deductible or copay obligations by investing in a higher premium plan. Essentially, if you are willing to pay more per month, the insurer is willing to take on more risks. You will notice the differences in the marketplace between Bronze, Silver, Gold, and Platinum tier plans. While each plan offers the same benefits, the balance of costs changes between you and the insurer at each level.

A health insurance broker can help you understand the role of deductibles and copays. They can also help you select the insurance plan that best suits your financial and health needs.

The Anxiety of Pre-Existing Conditions

Before the Patient Protection and Affordable Care Act, insurance companies could deny policies for people with pre-existing conditions or charge them unfair premiums. The adoption of ACA protects individuals with pre-existing conditions, meaning no insurer can deny coverage.

Under the law, all Americans have access to quality and affordable healthcare coverage. While there are still some questions about the affordability of policies, eliminating discriminatory practices against people who genuinely need and could benefit from coverage is a step in the right direction for the American healthcare system.

A Health Insurance Broker Can Help

Are you ready to speak with a licensed health insurance broker about open enrollment or making changes to your existing policy? Contact Sackett & Associates Insurance Services for more information.

The Family Glitch Fix of 2023 and How It May Help

Fri, 13 Jan 2023 00:45:00 GMT

Finalized Family Glitch Fix To Help Families

Signed into law in 2010, the Affordable Care Act was meant to open affordable healthcare access to all Americans. As with any law, the optimism surrounding it was short-lived, especially as people realized it was not as accessible as initially thought. People still need a health insurance broker to decipher many of the benefits and plans. Also, so-called "safeguards" resulted in one of the most significant hiccups of ACA, the family glitch.

Due to ACA's "firewall" provision , people with access to affordable health plans from an employer could not qualify for premium subsidies. Unfortunately, the provision forced many families to spend exorbitant amounts on individual health insurance .

While the family glitch was a consequence of the final law and provisions of 2014, it hasn't received a proper solution until now, almost a decade later. Still, the solution is not perfect and will not resolve every issue, but it is a step in the right direction.

A Health Insurance Broker Defines the Family Glitch

The family glitch made people ineligible for premium subsidies through the healthcare marketplace if they had access to employer-sponsored health insurance providing minimal value at an affordable rate. The provision looked at only the cost to the initial employee and not the additional costs of adding family members.

The "firewall" provision deemed family members ineligible for premium subsidies if they could join another family member's employer-sponsored plan. The adjustment to ACA meant that many families were paying well over 10% of household income for health insurance, which should have qualified them for subsidies. In many cases, families were forced to pay 25% or more of their household income, creating significant financial strain.

The family glitch began in 2014, and the IRS hopes it ends in 2022. With the proposed and approved solution, many families should see some reprieve from astronomical healthcare costs in 2023.

The IRS Solution or "Fix"

The finalized IRS solution will significantly affect the health coverage of American families. Official estimates suggest that between 600,000 and 2.3 million people will become eligible for premium subsidies, and the IRS projects that between 80,000 and 700,000 uninsured people will now get insurance.

While using a health insurance broker can help ensure families don't continue to fall through the cracks of ACA's affordability provisions, only time will tell how effective the IRS solution is for the existing family glitch.

Estimates place nearly 5 million Americans as victims of the family glitch. Even the best projections do not resolve the crisis for all Americans. The new rule only opens the door for family members to apply for premium subsidies. It is possible with access to a family member's employer-sponsored insurance, the rule change may not really change anything, should the employer-sponsored plan be deemed affordable.

Examples and Possible Scenarios

While touted as a solution, any health insurance broker will explain the IRS fix is primarily a bandage; it will help some people but not all. For example, consider a family of four — mother, father, and two children. The household income is over $50,000, potentially providing a substantial marketplace subsidy. Mom's employer offers health coverage at about 5% of the family's household income, which is considered affordable.

The dad's job, unfortunately, does not offer health coverage, meaning he either needs to purchase from the marketplace or become an addition to the mom's employer-sponsored plan. To add the dad and children to the plan would increase the insurance expense to more than 25% of the family's household income.

Despite the astronomical cost, pre-fix, the family was ineligible for subsidies. As of 2023, they will save because the law will consider the expense of adding members to an employer-sponsored plan.

Other families still have a problem when their income is just above cutoff levels. For example, a family with a household income of 60,000 may have one person with an employer-sponsored plan that only costs $200 per month. The lowest marketplace plan for the second individual cost about $250 in 2022. As subsidies are based on the second-lowest-cost silver plan, the overall cost to this family is 5.8%, meaning they are ineligible for premium subsidies. It doesn't matter that together the family actually spends about 10% of its household income on health insurance.

The Solution Isn't Perfect

The solution to the family glitch is far from perfect, but it will make a difference for many families. The best thing you can do is work with a licensed health insurance broker to take advantage of the parts of the solution that may help. As with any insurance investment, you must weigh the pros and cons to find what works best for you.

A Health Insurance Broker Can Help

The health insurance marketplace is somewhat confusing, especially for people unfamiliar with the process. Hiring a knowledgeable and licensed health insurance broker can make all the difference. Contact for Sackett & Associates Insurance Services more information.

Understanding California Health Insurance Laws

Sun, 11 Dec 2022 23:30:00 GMT

In California, Mandated Insurance Saves the Taxpayers Money

A good health insurance broker will tell you that health insurance is an absolutely essential component for maintaining good health. Sometimes, people only think about getting treatment for something that has become an emergency scenario. However, there are so many times when preventative medicine and treatment can help a person to avoid emergency scenarios. This is only one of the many reasons that the state of California has made health insurance a requirement for every Californian.

There are different types of health insurance coverage in California. Private health insurance and HMOs, as well as public programs like Medicare and Medi-Cal are not the same. Different government agencies regulate each of these programs, as each has a singular set of rules.

Why Should People Have Health Insurance?

Health insurance protects people from high and unexpected medical costs. The amount you pay for covered health care services is greatly reduced from the amount that you would have to pay if you didn't have any insurance. If your appendix busts or if you have a heart attack or stroke, you're going to need medical treatment that is going to be exceedingly costly. As the patient, and the reason for the costly care, you're at much greater risk of absorbing any and all costs when you don't have insurance.

Another consideration is for people who have health conditions that require them to take medicines or receive treatment. Folks with asthma, high blood pressure or diabetes, for instance, need to take medications that must be filled faithfully and frequently. In most cases, costs would exceed their ability to pay, were it not for insurance coverage. You like to think that the best health insurance is available to you and your family.

How Did Health Care Reform Affect Californians?

The more people who have health insurance, the lower the cost of health insurance for everyone. This is one of the central tenets of California's decision to create a health insurance mandate for its citizens. It also decreases the number of uninsured treatments that all residents wind up having to pay for. When people who do not have insurance go to the emergency room and cannot pay the bill, the costs of treatment tend to go up for everyone. Taxpayers are affected by this.

When Obamacare passed in 2010, there were two salient points. First, patients couldn't be denied coverage for pre-existing conditions. Second, a federal individual mandate was established, which meant that having health insurance that meets specific conditions became a requirement under law. Under the terms established by this system, by making sure that everyone paid into the system, the sickest members of the community could receive proper coverage without costs spiraling out of control for everyone. Those who chose to go uninsured were subject to a financial penalty at tax time.

In 2019, the Tax Cuts and Jobs Act changed this, eliminating the requirement and the penalty. When this change was enacted, insurance prices began spiraling out of control. That's why, in 2020, California, along with four other states, implemented its own individual mandate. In California, the open enrollment 2023 runs until January 15.

Why Invest in Health Insurance?

It is every citizen's right to expect health insurance. In most of the country, it's very possible to exist in a highly-vulnerable situation without it. In California, though, every individual is mandated to receive it. This is beneficial to the individual because there is ample opportunity for check-ups and preventative care, as well as the management of health issues like diabetes. It is beneficial to the state because it and its citizens will be able to save a lot of money. For more information on the virtues of health insurance or on particular plans, contact us at Sackett & Associates Insurance Services today.

Essential Details To Remember When Acquiring Health Insurance

Fri, 09 Dec 2022 18:27:54 GMT

Important Things To Remember When Buying Health Insurance

Picking the right health coverage makes a difference in your family's physical and financial wellness. Since open enrollment only falls during a limited time, you need to review critical factors to make an intelligent decision. Consider facts you should remember when selecting a health plan and suggestions for finding a health insurance broker who can help.

Receiving Guidance From a Health Insurance Broker

A health insurance broker is an excellent resource to help you compare plans from different carriers, find the coverage that best suits your needs, and negotiate better rates. A broker can also give you access to a broader range of options than you can find alone.

The agent is familiar with the underwriting process and can help you avoid any pitfalls that could result in your application being denied. You will have help understanding the complex language of insurance policies and riders and clearer explanations about how different plans work. While you can technically find health insurance on your own, working with a health insurance broker ensures you have someone in your corner looking out for your best interests.

Selecting the Right Kind of Plan

Many different types of private health insurance plans are available, and it can be difficult to understand the difference between them. EPO, PPO, and HMO plans are all popular options, each with distinct advantages.

An EPO, or exclusive provider organization, is a type of health plan that contracts with a specific network of doctors and hospitals. Members of an EPO plan must use providers within the network to have coverage. These plans typically have lower monthly premiums but more limited coverage.

A PPO, or preferred provider organization, is another type of health plan that contracts with a specific network of doctors and hospitals. However, unlike an EPO, members of a PPO plan are not required to use only in-network providers. An individual can receive coverage for out-of-network care, but the treatment may be subject to higher deductibles and copayments. PPO plans typically have higher monthly premiums than EPO plans but offer more flexible coverage.

An HMO, or health maintenance organization, is a managed care plan offering comprehensive coverage for medical and preventive care services. HMOs usually require members to select a primary care physician from within the network who will coordinate their care. These plans usually have lower monthly premiums than PPO or EPO plans but may have more restrictive coverage.

Choosing the Correct Coverage Tier for Private Health Insurance

You have a choice between Platinum, Gold, Silver, and Bronze plans. While you might assume that Platinum must be the best for you, determine which program offers you the best balance between out-of-pocket costs and premiums. While Bronze has the lowest monthly premiums, the higher copays and deductibles can be prohibitive. The correct tier depends on your circumstances, and many folks are happy with Silver coverage , which offer cost-sharing reductions.

Considering Your Current Care Team's Network

A plan may look like the perfect fit, but you should consider if it includes your current care team in the network. On the other hand, moving to a network with a more extensive selection can offer you greater access to health care. A change could be better for your well-being.

Reviewing Your Total Benefits

All plans cover catastrophic issues and certain essential needs. However, if you have a treatment or preventative service you want to cover, verify that the programs you are considering include those items. Prescriptions are another critical consideration. View the drug coverage to see if your current medication is on the list and how much your costs would be under a new plan.

Finding Health Insurance Broker Who Is on Your Side

You don't have to go about the process of finding quality coverage alone. For expert guidance on finding insurance that meets your needs, contact us at Sackett & Associates Insurance Services . A qualified health insurance broker will assist you in making a wise choice.

A Guide to the 2023 ACA Open Enrollment Period

Thu, 10 Nov 2022 00:45:00 GMT

Are You Ready for the 2023 Open Enrollment Period?

More than likely, if you are working with a health insurance broker, you have heard that the tenth annual enrollment period for the ACA is coming up. The enrollment period runs from November 1 ^st to January 15 ^th in the majority of states, and during this period, you may choose a new health insurance plan or renew the one you currently have. If you are used to purchasing your own private health insurance or enrolling in a plan offered by a job, this period can be confusing. Here is some important information that can help you navigate the ACA enrollment period with a bit more ease.

A Health Insurance Broker Can Help You Find the Right Plan

The great thing about this year’s enrollment period is it will be extremely similar to last year’s. Most states will continue to utilize the exchange platform at healthcare.gov while 17 will use their own exchange platforms. Subsidy rules will be largely the same, and if you qualify for a subsidy, you can drastically lower your health insurance costs. The amount you are required to pay for a benchmark plan has also been reduced. Due to the IRS’s “family glitch,” some families will find they are eligible for greater subsidies this year.

If you choose to work with a health insurance broker during Open Enrollment 023, you will be introduced to many of the plans offered on the exchange, as well as some “off-exchange” plans that are not offered on the healthcare.gov website. A broker can help you determine your personal needs and select a plan that best suits you.

When to Enroll

In most states, the enrollment timeframe will stay the same as last year. This means you will need to enroll by December 15 ^th in order for your coverage to become effective January 1 ^st . If you enroll after December 15 ^th , your coverage will start February 1 ^st . You should keep in mind, however, if your coverage terminates at the end of 2022, you have the option to select a plan as late as December 31 ^st and it will still take effect on January 1 ^st .

Insurers Exiting the Marketplace

Although most states have seen an influx of new insurers, some insurers will be exiting the exchange in select states. For example, Blue Cross Blue Shield will no longer offer plans in Nebraska and CIGNA is leaving the exchange in three separate states. Before enrolling, you should preview plans on your exchange’s website to see what insurers are offering plans in your state. Even in states where the same insurers will be present, they may offer different plans in different areas. For the previously mentioned reasons, you will want to compare plans before settling on one or letting your plan auto-renew – you may find a better plan on the exchange.

New “Family Glitch” Guidelines

Since the debut of ACA-compliant plans, many people have been ineligible for a subsidy since they are offered insurance coverage through their job. Subsidy amounts have never taken the cost to add family members to plans into consideration, and the affordability determination was influenced by the cost of employee-only coverage. In other words, if a person’s employer-sponsored plan was considered affordable, their entire family would be ineligible for subsidies. This ineligibility was referred to as the “ family glitch ,” and it has prevented countless Americans from obtaining coverage in previous years.

In early 2022, the IRS finally addressed this glitch, so new guidelines will be in place before the 2023 open enrollment period arrives. Under the new guidelines, the marketplace will perform two separate affordability calculations when a family is offered an employer-sponsored plan – one for the employee and one for the entire family. If the employee’s coverage is deemed affordable, but the family’s coverage is not, the family will be eligible for marketplace subsidies.

Pricing Changes

Before enrolling, you should be sure you are aware of any pricing changes. The cost of the average marketplace plan has increased by roughly 7.7% for the 2023 enrollment period. Fortunately, if the second lowest-priced Silver plan in your area costs more, the size of your subsidy will increase.

Are You Looking for a Health Insurance Broker?

If you are looking for a trustworthy and knowledgeable health insurance broker, you should get in touch with Sackett & Associates Insurance Services. We can help you find an affordable health plan that offers the coverage you and your family need. Contact us today to get started.

Sources:

https://healthinsurance.org/blog/open-enrollment-for-2023-aca-coverage-what-to-expect/

https://www.commonwealthfund.org/blog/2022/fix-family-glitch

5 Ways Covered California Can Help You Choose the Right Coverage

Fri, 04 Nov 2022 21:45:00 GMT

5 Ways Covered California Can Assist You

Understanding health insurance and finding the right coverage isn’t always easy. There is a lot to comprehend, and often, accessing important and practical information about health insurance can be difficult for some. This is where Covered California comes in. It strives to help Californians from all walks of life improve their health and wellness by offering enrollment and financial assistance.

Along with your health insurance broker, Covered California strives to simplify the process of choosing the right plan. In addition to this, Covered California can work for you in the five following ways.

1. Browse Plans With the Help of Your Health Insurance Broker

Finding the right health plan can be hard work, especially if you don’t know where to start. Fortunately, Covered California’s website allows you to browse a variety of plans offered in your area. You can view various plans and compare deductibles, copays, and relevant out-of-pocket costs, which can help you estimate how much you can save with each plan.

Covered California also provides online support if you need help understanding important healthcare terms or understanding your choices. By equipping yourself with the necessary information before enrolling, you can find a plan that best suits your needs and budget. Covered California believes everyone should walk into the enrollment process confidently and we aim to help you do so.

2. High Standards

Not all plans are created equal, and if you are like many healthcare consumers, you may be worried about choosing a plan that doesn’t serve you and your family. Fortunately, when you purchase coverage through Covered California, you can be sure your plan will be just as good as a private health insurance plan. This is because all insurers who offer plans through Covered California are required to meet certain standards. They must offer various essential benefits you need to maintain your health. Covered California also works directly with insurers, in addition to physicians, hospitals, and other healthcare providers to ensure patients have access to safe, high-quality care.

3. Increased Competitiveness

You may be wondering how many plans you have to choose from. Such concerns are valid, but you will be pleased to know you will have a variety of plans to select from. In recent years, the marketplace has become more competitive, which means more insurers are participating and competing for your business. This means they are forced to offer a wide range of affordable plans that provide excellent coverage for individuals and their families.

Many Covered California members save roughly $1,000 yearly by purchasing their insurance through the marketplace. Due to this increased competitiveness, the rate of uninsured Californians has dropped from 17.2 percent in 2013 to just six percent in 2020 .

4. Expanded Access to Financial Assistance

Did you know that you may be able to get help paying for your health insurance? Many people don’t, and unfortunately, many miss out on the opportunity to obtain a subsidy from the federal government. Before you enroll, you will have the option to enter your income information and see if you are eligible for a subsidy. This subsidy will be applied to the cost of any health plan you choose, and depending on the size of your subsidy, it can greatly reduce the cost of your monthly premium.

Since 2021, more financial assistance has been made available to countless low and middle-income individuals throughout the state. This means that coverage is more affordable than ever before, and in some cases, even people who didn’t qualify for a subsidy in the past will be eligible for financial assistance now.

If you are a lower-income California, you have even more of an opportunity to obtain financial assistance. In 2022, guidelines were revised to allow individuals whose household income is at or below 150 percent of the federal poverty level to enroll in coverage via Covered California at any time during the year (as long as they are not eligible for Medi-Cal). If you are interested in how much you can save on your monthly premium, you can utilize our interactive calculator to see how much aid you are eligible for.

5. More Support

As previously mentioned, Covered California strives to make the enrollment process easier. Covered California is proud to serve as an advocate, resource, and guide. If you need assistance finding healthcare, Covered California offers free help and expert advice.

Work With a Health Insurance Broker

Choosing the right health insurance plan can be overwhelming, especially with so many choices. Fortunately, by working with a health insurance broker from Sackett & Associates Insurance Services, you can find the right plan quickly and easily. Contact us today to find out how we can help you.

Sources:

https://www.coveredca.com/marketing-blog/5-ways-covered-california-works-for-you

https://healthpolicy.ucla.edu/publications/Documents/PDF/2021/access-to-care-policybrief-sep2021.pdf

Can You Deduct Private Health Insurance Expenses From Your Taxes?

Fri, 21 Oct 2022 00:30:03 GMT

Can You Deduct Private Health Insurance Expenses From Your Taxes?

Healthcare is one of those necessary budget items that many people don't like to think about but have to. According to the Centers for Medicare and Medicaid Services, national health spending is expected to grow at an average rate of 5.4% annually for the next several years. Most people obtain an insurance policy through a health insurance broker, an employer or the government to help with expenses.

Why You Need Health Insurance

With rising healthcare costs, it's easy to see why health insurance is necessary. It helps you pay for preventative care to avoid significant health issues before they become bigger problems. Routine checkups, flu shots, and annual bloodwork help you and your doctor stay on top of your health, potentially saving you money on medical bills.

Health insurance also helps cover unplanned expenses that could otherwise become financially devastating. No one plans a car accident or major illness, but insurance can cover some costs associated with diagnostic tests, surgeries, hospital visits and rehabilitation.

What Is Private Health Insurance?

Private health insurance plans are available through the private insurance industry instead of government-run programs. Private plans include:

Employer-sponsored plans
Dental and vision insurance
Supplemental plans
Short-term healthcare insurance

Private health insurance is the prevailing coverage source for Americans. The U.S. government estimates that about 65% of the population uses private health insurance.

Is Private Health Care Insurance Tax Deductible?

The government classifies monthly payments for health insurance premiums as medical expenses. You can deduct the amount from your taxes if you pay for medical insurance on your own.

You may be able to claim tax deductions for your private health care insurance. You'll need to look at your income and how you get your health insurance to determine your eligibility.

Health Insurance Through an Employer

Many companies offer health insurance to their employees. They may reimburse health insurance costs through payroll deductions. If so, your employer is already excluding insurance costs from your gross income. In addition, these reimbursements do not get taxed under state and federal laws.

If you have this type of healthcare insurance, you are already paying no taxes on it. Therefore, you can't claim another deduction for your medical insurance on your year-end taxes.

COBRA Insurance

COBRA insurance is a temporary continuation of your employer-sponsored health insurance coverage after you leave the company. You pay these premiums on an after-tax basis, so they are tax-deductible.

Marketplace Insurance

You can deduct your health insurance premiums if you obtain coverage through an insurance marketplace. However, if you can get private health insurance coverage through your spouse's employer and decline that coverage, you cannot deduct your personal premiums on your tax return.

The Effect of Adjusted Gross Income

Your adjusted gross income is a modification of your gross income. It is what you earn minus expenses such as student loan interest, alimony and IRA contributions.

The IRS allows you to deduct a portion of your medical expenses that is more than 7.5% of your adjusted gross income. You cannot include reimbursed expenses; if you didn't pay for the cost directly, you can't deduct it.

Insurance Costs for the Self-Employed

If you are self-employed and your business had a profit for the year, you may qualify for the health insurance tax deduction. However, if you were eligible for a private health insurance plan subsidized by a family member's employer, you don't qualify.

How To Decide Whether To Itemize Deductions

Before deciding whether to itemize your medical tax deductions, you need to consider the standard deduction. It is the most straightforward method of filing your taxes. Both deduction methods decrease your adjusted gross income, but one may be more beneficial.

Depending on your circumstances, itemizing your deductions may reduce your tax bill. Generally speaking, it's better to itemize when:

The standard deduction is lower than your itemized deductions
You pay property taxes and mortgage interest
You make large charitable contributions
You had a significant financial loss that insurance did not cover

The standard deduction amount is adjusted annually for inflation. It also varies when:

You are over age 65
You are blind
Another taxpayer claims you as a dependent

What Medical Expenses Qualify for a Deduction?

You can deduct other medical expenses other than your private health insurance costs. Qualifying expenses include:

Prescribed medications
Medical services from a health care provider
Medical equipment
Transportation to and from medical treatment
Long-term care facility services
Long-term care insurance

Some expenses that do not qualify include:

Cosmetic surgery
Nonprescription medicine
Personal care products such as toothpaste and cosmetics
Funeral or burial costs

Get More Information From a Health Insurance Broker

You can learn more about private health insurance tax deductions from a health insurance professional. An independent health insurance broker at Sackett & Associates Insurance Services can review your options and help you decide on the right coverage for you and your family. Contact us today to get started.

Are You Exempt From Medicare if You are 65 and Still Working?

Mon, 10 Oct 2022 12:30:00 GMT

Medicare Options for Those Who Are 65 and Still Working

More Americans are pushing the traditional retirement age and working several years more after turning 65. If you’ve decided to keep working, you may not need the traditional benefits offered to seniors, such as Medicare. Under normal circumstances, you would need to enroll in Medicare upon turning 65, but the rules can change depending on your situation. It’s best to speak to a health insurance broker specializing in Medicare concerning your Medicare eligibility, but here’s some general information to know.

Medicare Eligibility at Age 65

People aged 65 or older can access federally-organized health insurance through Medicare. It’s similar to the medical insurance offered through an employer or purchased privately, but Medicare was designed to bring affordable health care to millions of Americans who may not have the resources to acquire health insurance by other means (like an employer). Eligibility starts within three months of a person’s 65 ^th birthday, often held as the common retirement age. However, if you choose to work longer, it may not be necessary to enroll in the program.

Medicare Eligibility When Working

The current requirements concerning Medicare enrollment and continued employment depend heavily on where you are employed. If you are working for an organization that has at least 20 or more employees, you can opt-out of enrolling in Medicare. The employer’s group plan becomes the primary payer for your healthcare bills. This would allow you to delay your Medicare enrollment until the point you actively stop working and officially retire.

For those who work with a small company, you can’t delay your enrollment. You would be required to sign up as soon as you are eligible, often through a health insurance broker specializing in Medicare, or face late enrollment penalties. When you enroll, Medicare becomes the primary payer for any healthcare claims. If you don’t enroll, the company plan could refuse to pay whatever claims are filed on your behalf. This would leave you primarily responsible for the bills.

If you work for a company that has 20 employees or more, you have the option to drop out of the group coverage from the employer and continue your insurance through Medicare. To do this, you would want to make a full comparison of the premium costs and coverage terms between the employer plan and Medicare to find out which one would give you the best benefits for the cost. Once you decide to leave your job, you’ll be able to enroll in Medicare health plans or a Medigap plan without the fear of penalties.

Medicare and Secondary Insurance Benefits

Some companies offer employees health benefits for a period of time after retirement. Even though you may be eligible for one of these retiree plans, you will need to sign up for Medicare as soon as you reach eligibility. Medicare would be considered the primary insurance and the benefit plan becomes secondary insurance. Failing to enroll in Medicare could see you paying the bills for claims the corporate plan denied.

There is a similar situation with COBRA benefits . COBRA stands for the Consolidated Omnibus Budget Reconciliation Act which gave workers and their families the option to continue receiving group health benefits for a limited period of time after the voluntary or involuntary loss of a job providing group health benefits. A worker is eligible for COBRA for 18 months after leaving a job, but if you are 65, there is a conflict with Medicare coverage. Medicare would be a primary payer if you carry COBRA, meaning you would have to sign up for Medicare as soon as you reach eligibility.

Medicare Sign-Up Deadlines

By meeting with a health insurance broker who specializes in Medicare, you can avoid the consequences that come from missing an enrollment deadline. There are standard enrollment and eligibility periods, but when it comes to those who are working past the age of 65, the most important day to know is the date you leave your employer. It doesn’t matter if you will receive retiree benefits or coverage under COBRA for several months. You will have only eight months from the day you leave your job to enroll in Medicare and a Medigap plan if you choose one. This is a special enrollment period, and once the window closes, you could be without insurance for months.

Medicare has a General Enrollment period each year between January 1 ^st and March 31 ^st , and if you’ve missed your special enrollment, you would be forced to wait until the next General Enrollment to get signed up. From there, the coverage doesn’t start until July, which would leave you without insurance coverage for quite a long time. You would also be faced with late enrollment penalties on top of your premiums for Part B and Part D.

Medicare Enrollment Support

For more information on Medicare and insurance coverage during retirement, contact our team of health insurance brokers today. We work to get you the best rates for the coverage you need.

Sources

https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare

https://boomerbenefits.com/medicare-while-working/

https://www.medicare.gov/basics/get-started-with-medicare

https://www.dol.gov/general/topic/health-plans/cobra

Are You Ready for the 2023 Medicare Annual Election Period?

Thu, 29 Sep 2022 20:15:00 GMT

A Guide to the 2023 Medicare Annual Election Period

For many people, the idea of enrolling in an annual Medicare plan evokes frustration and headaches. Finding the perfect plan can be difficult, and the process of enrolling may seem overwhelming. To make matters worse, each annual election usually brings about various changes. While there is no surefire way to predict annual changes, there are ways to lower your stress levels while preparing for the enrollment process. When you work with a health insurance broker specializing in Medicare , they will usually tell you that changing your Medicare Advantage plan or Part D drug plan each fall may actually be beneficial.

Should You Change Your Plan During the Annual Election Period?

If you are like many people, you may be considering changing your plan altogether. Some of the most common reasons for changing Medicare plans are:

Rising monthly plan premiums
A desire for more comprehensive coverage provided by a supplement plan
Lack of medication coverage
Unwanted plan changes
A doctor will no longer be in network

Fortunately for those considering changing plans, there are many Medicare health plans to choose from, and with the help of a broker, finding one that fits your needs and budget may be easier than ever.

Steps to Take Before the 2023 Enrollment Period

Register at MyMedicare.gov

Registering at MyMedicare.gov is a great way to gain access to a wealth of personal Medicare information. Setting up an account is simple, and once you do so, you can view your processed Medicare claims as soon as they become available and access information about your entitlement and eligibility. The site also allows users to view their current health and prescription drug plan enrollment information, and you can even manage your prescription list from your account.

Talk to Your Healthcare Providers

If you are covered by an Original Medicare and a Medigap plan, you may want to talk to your healthcare providers. You can simply ask if they will still be accepting Original Medicare in the coming year, and if they answer yes, you can stay enrolled in your plan. If you are enrolled in a Medicare Advantage plan that changes networks, benefits, premiums, and formularies each year, you will definitely want to talk to your healthcare providers. Physicians have the option to change networks at any time, and your physician can decide not to accept your plan. In other words, don’t be afraid to ask your healthcare provider if they will participate in your plan again.

Review Your Annual Notice of Change

Have you received your ANOC letter yet? If you haven’t, you may want to be on the lookout. Each year you will receive an Annual Notice of Change for your Medicare Advantage Plan (if you are enrolled in one) or your Part D drug plan. Insurance carriers are legally required to send out notices by September 30 ^th of each year.

ANOC packets are typically large, and for some, intimidating, and it is not uncommon for people to toss them aside. Unfortunately, those who do this often forget about the January 1 ^st deadline, and once they get around to perusing the packet, it is too late to make any changes. Reading your ANOC is important, and if you don’t, you may overlook any major changes.

Familiarize Yourself With Important Dates

The time frame to enroll is slightly different from a few years ago, so don’t forget to familiarize yourself with current important deadlines. The Annual Election Period now spans from October 15 ^th – December 7 ^th and any changes you make will go into effect on January 1 ^st . Simply put, don’t assume you can make changes up until December 31 ^st .

Make a List of Your Prescriptions

You may want to consider if your plan still serves you well, especially if your prescription drug coverage has changed since last year. Maintain an up-to-date list of your prescriptions, and note whether each drug is a generic or name brand. You will also want to note how often you take the drug as well as the dosage. This information will be reviewed by your agent in October.

If you haven’t enrolled in Part D before and intend to utilize the Annual Election Period, you should know that you will be subject to a penalty if you enroll late. You will have to pay this penalty if you enroll past the deadline and you haven’t had health coverage since you turned 65.

Switching From Medicare Advantage to Medigap

You can re-enroll in the Original Medicare plan during the Annual Election period if you want to change from Medicare Advantage to Medigap. You also have the option to select a new Part D drug plan. To apply for the Medigap plan, you will be required to answer health questions, and you may not be accepted. If you are accepted, you will be automatically un-enrolled from your Medicare Advantage plan once you apply for a Part D drug plan.

Speak With a Health Insurance Broker Specializing in Medicare

If you are interested in viewing Medicare health plans or you need help enrolling, Sackett & Associates Insurance Services is here for you. By working with a health insurance broker, you can find the perfect plan and enroll before the time is up. Contact us today to speak with an insurance professional.

What You Need To Know About the Inflation Reduction Act and Your Medicare Coverage

Fri, 02 Sep 2022 18:30:00 GMT

How the Inflation Reduction Act Means for You and Your Medicare Coverage

Many Americans rely on Medicare for their health care costs. Not only that, but changes that occur to the program can have a significant impact on them. Because of this, it can be important to understand things like the Inflation Reduction Act and how it will be affecting your health care coverage. While it can seem like a lot to take in, the reality is that the better that you understand how it can impact you, the more prepared you will be for the future, and the easier it will be for you to make healthy choices.

Changes Are Coming To Medicare

Many of the changes that are coming to Medicare Part D will be related to drug costs. Additionally, these changes are on the way, due to a bill called the Inflation Reduction Act. The idea is that with the passing of this bill, Medicare will have more power to negotiate the prices of drugs. This means that those enrolled in Medicare's health program may be able to get more affordable prices on their drugs. Beyond getting more leverage to negotiate, there will be other changes, too. Some of these changes include limits on drug costs, and caps on out-of-pocket spending, as well.

Drug Prices Will Be Negotiated

One of the major points of the Inflation Reduction Act is that it will allow Medicare to negotiate prices for drugs. However, this does not mean that all drug prices will be up for negotiation immediately. Initially, only certain qualifying drugs will be up for negotiation, and they will not begin negotiating until 2026. In many cases, it will be the most expensive drugs that receive little to no competition that will be up for potential negotiation. While this may not make a significant difference in your coverage immediately, if you happen to use one of these more expensive drugs, then you will be noticing lower prices in 2026.

More Drugs Will Be Covered By All Plans

Another thing that will happen as a result of this bill is that the drug prices that have been negotiated have to be included in Medicare drug plans. In the past, Medicare was not able to set these types of requirements. If you have trouble figuring out whether or not your drugs have had their prices negotiated or whether they are covered, it can be beneficial to contact a health insurance broker specializing in Medicare so that they can help you make sense of drug costs and whether or not they will be changing.

There Will Be Caps On Out of Pocket Spending

Another thing that is included in the Inflation Reduction Act is that there will be caps on out-of-pocket spending. As early as 2025, a cap of 2,000 dollars will be placed on out-of-pocket spending for Medicare Part D prescription drugs . Also, this cap is not fixed and can change depending on Medicare's spending for that year. If Medicare spends more money on certain drugs, then the limit may rise. Some may not be excited to hear about this. That said, it is important to remember that previously there was no cap on out-of-pocket spending. This means that previously there was no limit on out-of-pocket spending, which could potentially become expensive quickly.

What this means for those with Medicare Health Plans and specifically Medicare Part D health plans is that in 2025, after they have spent 2,000 dollars, they will not have to pay any more copays or other costs for their drugs. It should be noted that premiums will still have to be paid, and also that the starting rate could raise from 2,000 dollars in subsequent years.

Premium Increases Will Be Limited

Something else to know if you have Medicare Part D is that there will be a limit on premium increases. Beginning in 2024, Medicare Part D plans will not be able to increase by more than 6% each year. So, while your premiums will still be able to increase over time, they will not be able to increase as much as they might have without the limits placed on them. This can help protect you financially, even if you do have to deal with some increases in premium limits over time.

Some Final Notes

Making sure that you have the right health coverage for yourself and your situation can seem overwhelming at times, especially when new bills are being passed, and new laws are coming into effect. While you may not be able to control these laws or how they impact your health coverage, you can take steps to make sure you're doing what is best for you. If you have questions about your Medicare health coverage or how changes will impact you, contact Sackett & Associates Insurance Services at (707) 823-3689 to learn more and get the support that can empower you to make the best healthcare choices.

The Importance of Updating Your Income Reported to Covered CA

Thu, 11 Aug 2022 17:30:00 GMT

Why Income Updates on Covered CA Are Important

The Covered California exchange provides health coverage solutions for many throughout the state, offering premium subsidies to help make the policies more affordable, too. Those subsidies are based on your income, household size, age and zip code. As a result, your health insurance broker will tell you that you need to update your income regularly for your Covered CA policy. Understanding what those updates are for and what can happen if you forget will help you to see the value in this process.

Why Does Your Income Matter for Covered CA?

You may think that your income is not important for your health insurance coverage but, if you have a policy purchased through Covered CA, your annual income matters. The healthcare exchange discounts your premiums based on subsidies you qualify for after assessing your Adjusted Gross Income as well as other factors. That premium subsidy you’re awarded is based on your estimated AGI for the year. If something materially changes, that can affect your eligibility.

When Should You Report Changes in Income?

One thing that your health insurance broker will tell you is that, when you sign up for coverage on Covered CA, one of the things that you agree to as part of the subsidy program is to notify them of changes within 30 days. That means that, according to the policy terms and conditions, you are required to notify Covered CA of material changes to your annual income within 30 days of that change.

At the very least, you should review your plan once a year to make sure that your income estimates are still in line with what you anticipate earning for the year. If you file your taxes and find that there’s been a material change, make sure you update your income on Covered CA right away to reduce the effect on next year’s tax filing.

What Happens if You Earn Less Than You Estimated?

At the end of the year, when you look at your AGI in comparison to your estimate on Covered CA, you may find that you actually earned less than you originally estimated. If so, you will typically be eligible for increased premium subsidies. The difference between what you received and what you were eligible for will be credited to your tax return, either by reducing the taxes you owe or increasing your refund amount.

What Happens if You Earn More Than You Estimated?

If your AGI at the end of the year is higher than what you estimated, that means you likely received more in premium subsidies than you were actually eligible for. The government requires you to repay that overpayment. Luckily, for those in certain income brackets, there may be a cap placed on how much of that overpayment the government can require you to repay. However, it is important to note that you will be held responsible for the repayment of at least a portion of that subsidy overpayment.

What if Your Income Is Inconsistent?

Talk with your health insurance broker if you have inconsistent income. If you work as a freelancer or in a gig economy, you need to calculate your salary as closely as possible, even if it means averaging out your earnings for a monthly figure. Then, you have the opportunity to choose how you wish to receive your subsidy, which you should consider carefully if you have a fluctuating income. Your options are:

A monthly advance of your subsidy in premium credits
Receive your full subsidy at the end of the year as part of your tax return
A combination of the two with a portion of your subsidy every month and the remainder at the end of the year

With an unpredictable income, it may be easier for you financially to elect for your full subsidy as a tax credit at the end of the year. That way, you don’t risk receiving funds that you must pay back if there’s a change in your earnings or a miscalculation. By opting to receive your subsidy as a tax credit instead, you’ll only receive what you actually qualify for based on your AGI. It does mean that you will have to pay the full cost of the policy premiums through the course of the year.

What Else Can Your Health Insurance Broker Do?

Not only can your broker help you navigate the Covered CA platform, policy options and subsidy elections, but they can also help you determine what other types of coverage you might need. Whether you’re looking for long term care insurance or any other type of health supplement insurance, your broker can help you explore your options.

If you have questions or would like more information about the policy options and coverage solutions available to you, contact us at Sackett & Associates Insurance Services for more information. We can help you find the health insurance coverage that you need.

The Facts About Long Term Care Insurance

Thu, 28 Jul 2022 17:30:00 GMT

What To Remember When Choosing Long Term Care Insurance

Growing older is inevitable, and the time may come when you need assistance with basic needs and help with tasks such as getting dressed or going to the doctor. If you don't want to be a burden on your children, you need to think about how you will pay for long term care, should you need it.

The Department of Health and Human Services recently came out with a study that found that an estimated 70 percent of people who are 65 or older may need long term care at some point in their lives. The cost of having a home health care worker come to your house can run into the thousands. Staying at a nursing home can be twice that amount. That's why long term care insurance is so important. Still, not everyone needs this type of insurance.

When You Might Need Long Term Care Insurance

If you have a nest egg or property that you want to preserve to leave to your heirs, long term care insurance helps offset the costs of that care. That way, you won't be forced to sell your home or liquidate other assets to pay for your stay in a nursing home.

When You Don't Need Long Term Care Insurance

If you have less than 100,000 saved or in assets, you likely don't need long term care insurance. Medicaid will pay for your care.

Pros and Cons of Long Term Care Insurance

There are some positive aspects to having long term care insurance. There are also some negatives to this type of coverage.

1. Pros of Long Term Care insurance

This type of insurance ensures you get the care you need when you need it and provides you with peace of mind. Having this type of insurance takes the stress off of your children and other family members. You don't have to worry about being a burden on them. It also protects you from losing your savings when paying for long term care.

2. Cons of Long Term Care Insurance

Long term care insurance is expensive, and the premiums will inevitably go up. Once you commit to an insurance company, you are locked in because you won't be able to get your premiums out. The insurance industry tends to be volatile, meaning an insurance company that is going strong today may wind up bankrupt in five or ten years.

When You Should Buy Long Term care Insurance

You must purchase long term care insurance before you need it. The longer you wait, the higher the premiums will be. Also, if you are in poor health, you might not qualify for this insurance. For most people, the best age to buy it is when they are in their early to mid-fifties.

A Health Insurance Broker Can Help You

A health insurance broker can help you find the right long term care insurance and will be with you in the process from start to finish. Unlike an insurance representative that only represents one insurance company, a health insurance broker can show you plans from several different companies. Sackett Insurance Services is a health insurance broker specializing in Medicare .

Consider a Hybrid Policy

These days it is much harder to find a simple long term care insurance policy. Insurance companies are offering hybrid policies instead. These are whole-life insurance policies that will return your premiums to your heirs even if you never need long term care.

How Much Long Term Care Insurance Costs

If you purchase the insurance when you are in your mid-sixties and you are in good health, your policy will likely cost you between $1,400 to $2,100 annually. A good rule of thumb is to pay no more than 5 percent of your income on long term care insurance.

What To Keep in Mind When Purchasing Long Term Care Insurance

Let your children or other loved ones know about the policy. They will likely be the ones filing a claim to get the care started in the future. Also, expect a wait of three months before your benefits kick in and start paying for your care.

Most policies will only pay out benefits for a maximum of three years. This should be sufficient as most people, on average, stay at a nursing home or other facility for less than a year.

Talk to a Health Insurance Broken When You're Ready for Long Term Care Insurance

Talk to a health insurance broker and look at several different plans before you commit. Make sure you understand what each policy offers and what you'll have to pay out of pocket. Also, ask what the rate hikes will be each year. Ask about discounts as well. You'll likely pay less if you are in good health and if you are married and purchasing policies with your spouse. For more information on finding the right long term care insurance plan for you, call us at (707) 823-3689 or contact us online here .

Health Care Insurance After Getting Married

Mon, 11 Jul 2022 22:15:00 GMT

Health Insurance Options To Consider After Marriage

Getting married is an exciting time. You’re making a commitment to spend the rest of your life with one person. It’s an important period of transition, and a time to change your individual health insurance plans to one with combined coverage or to even enroll in health insurance within the first two months of your marriage.

Look at the options that are available to you. Does your employer offer a health insurance plan? Do you have children together, or does your new spouse have children? If neither of your jobs offers health insurance, it may be time to contact a health insurance broker.

What a Health Insurance Broker Does

While you can also work with an insurance agent, a health insurance broker isn’t tied to one insurance company, meaning the agent will be less biased toward one particular insurance company. A health insurance broker will show you plans from several different companies, giving you a wider range of choices. Sacket Insurance Services is a health insurance broker specializing in Medicare and other health insurance services. Sacket Insurance Services can find the right plan for you.

Why You Need Health insurance

If the two of you are in great health, you may wonder why you should think about health insurance at all. If you’re living on a limited budget, you may be tempted to skip health insurance in order to save money. Keep in mind, however, that accidents could occur to anyone. If you have to go to the emergency room, the cost , if you are not insured, is on average over a thousand dollars. If you have to have emergency surgery, the price could be up to $20,000.

Consider Catastrophic Health Insurance

If you can't afford health insurance, you might consider catastrophic health insurance. These cover expenses from an unexpected injury or illness.

Whether To Share a Plan or Pay Separately

If both of you can get health care from your employer, it might make sense for each of you to have individual health insurance plans. Your out-of-pocket costs may be less that way. For example, your spouse may want to stick with a plan that has a higher premium but lower deductible if he or she needs more medical care because of a pre-existing condition. If you don’t visit the doctor often, you may prefer a plan with a higher deductible but lower premiums. The two of you would pay more if you were on one health plan together.

What To Consider When Thinking About Health Insurance

Within the first 60 days of your marriage, you and your spouse should sit down and discuss how you will pay for health insurance. Here are some things to consider.

1. How Often Do You Go to the Doctor

Pull out your calendars and take note of the number of times you each visited the doctor in the past year. If one or both of you go to the doctor often, look at a plan that offers a copay. If one of you sees a therapist or goes to a specialist regularly, that is also something you will need to discuss with your health insurance broker.

2. How Much You Can Afford

If you haven’t done this already, you and your spouse need to sit down and create a budget. Your health insurance premiums need to be a part of this budget. Look at how much it will cost if you are both covered under one person’s health insurance plan. Also, take into consideration how much you have paid in the past year for health insurance. Come up with a spending plan and an amount you both feel right about paying for health costs.

3. Who Your Doctors Are

Does one or both of you have doctors you prefer? Then you need to see if your doctors are part of a health insurance network that you can tap into. Check the policies available to you and your spouse. Or contact a health insurance broker. If you want to continue seeing a doctor who isn’t in the network, how much will it cost to see that physician?

4. If You Take Medications

If you or your spouse take medications regularly, look carefully at the prescription coverage the health plan offers. If you take several medications, and those prescriptions are expensive, see if you can find a health plan that will cover those costs.

5. What Your Future Needs Might Be

Do you and your spouse want to start a family? Look for a healthcare plan that covers maternity costs. Also, look at insurance plans that will pay for doctor’s visits for your newborn.

Whether You Need Individual Health Insurance Plans or a Combined One

A health insurance broker can help you find the right plan that works for your circumstances. For more information on how to obtain health insurance, contact us at (707) 823-3689 or click this link .

How Does Health Insurance Work?

Wed, 29 Jun 2022 15:15:00 GMT

Medicare True Out-Of-Pocket Coast (TrOOP) Explained

Health insurance exists so you won’t have to pay for medical costs out of your own pocket. For most Americans, having health insurance is a top priority, however, understanding how it works can be difficult. Health insurance can be complex, and there are many aspects of it that are misunderstood by many. If you are struggling to understand how health insurance works, you aren’t alone.

Why Do I Need Health Insurance?

The cost of healthcare in America can be astronomical, and it is necessary to have. If you cannot afford to pay for healthcare on your own, government assistance in the form of Medicaid may be available to you. Individuals over the age of 65 typically qualify for a government program known as Medicare. In general, only the wealthiest Americans can afford to pay for healthcare out of pocket.

If you don’t have adequate health insurance, you risk medical bankruptcy. Medical bankruptcy occurs when a person does not have enough to pay their medical bills, so they must declare bankruptcy. Having health insurance is just like having insurance for your home or vehicle. It protects you from having to empty your bank account in the event of a major medical emergency. Unlike other forms of insurance, you do not have to wait to utilize your benefits and receive care.

Important Health Insurance Terms

Health insurance companies offer a variety of choices for coverage, however, before you select the plan that is right for you, you must understand various terms such as copay and premium. Here are some terms you should familiarize yourself with before purchasing a health insurance plan:

Premium – You must pay your monthly premium even if you never submit a claim. Your premium helps the health insurance company pay for its expenses and ensure you maintain your coverage.
Copay – A copay is a set amount you must pay for a visit to the doctor or hospital or a prescription. For example, your health plan may require you to pay $40 to visit the doctor and $10 for a generic prescription medication.
Deductible – The deductible is the amount you must pay before your plan will cover your medical expenses. Your deductible must be paid at the beginning of each year if your plan has a calendar-year policy.
Coinsurance – The percent you must pay for medical procedures, such as hospital stays or surgeries is known as coinsurance. For example, if you have an 80/20 health insurance plan, it will cover 80% of your expenses and you will be responsible for the other 20%.

If you are like many people, you may be wondering why insurance companies require you to pay deductibles, coinsurance, and copays. Simply put, your insurance company doesn’t want you running to the doctor for every stomach ache. If no one had to pay anything towards their healthcare expense, insurance company costs would significantly increase. Fortunately for policyholders, the Affordable Care Act ensures out-of-pocket costs for Marketplace plans cannot exceed a certain amount.

Finding the Right Plan

When accounting for the details above, you might notice that choosing a health plan isn’t the easiest task in the world. You must select a plan that fits within your budget but provides you with the coverage you need. In some cases, a policyholder will prefer a plan with lower deductibles but higher monthly premiums. In other cases, a policyholder may prefer a plan with higher deductibles but lower monthly premiums. If you suffer from a chronic health condition that requires frequent visits to the doctor, such as diabetes or depression, you may want to choose a plan with a lower deductible. On the other hand, if you are relatively young and healthy and rarely visit the doctor, you may prefer a plan with a higher deductible and a lower premium.

The History of Health Insurance

Prior to World War II, the majority of Americans had no health insurance. Most policies only provided coverage for hospital stays. After the war, government officials implemented a wage freeze to prevent inflation, but this also prevented employers from paying their employees a living wage. To make up for these lower wages, employers began to offer other benefits, such as health insurance. In the 1950s, the IRS decided health insurance premiums should be non-taxable.

The Health Insurance Marketplace

If your employer doesn’t offer health insurance or the coverage they offer isn’t adequate, you can purchase coverage through the Marketplace. The Marketplace allows individuals to choose a health insurance plan that fits their needs and budget. If a person earns less than a certain amount, they can even qualify for a subsidy that will help them pay their premium. Individuals may enroll during a specific window of time, but if they need coverage outside of this window, they will need to have experienced a qualifying life event, such as losing insurance or getting married.

Contact Us

If you are seeking the perfect plan for you and your family, a health insurance broker may be able to assist you. Health insurance brokers are professionals who help individuals and companies find and choose the right health plans. Contact Sackett & Associates Insurance Services today to speak with a broker.

Preparing for Medicare Costs: 6 Things You Must Know

Thu, 16 Jun 2022 14:00:01 GMT

A Plan for Understanding Medicare Costs

Most Americans become eligible for Medicare at age 65. Before enrolling, you should begin planning for Medicare expenses. To do this, you must understand how Medicare works and what your costs will be.

1. Medicare Has Four Parts

Medicare consists of four parts.

Part A: Hospital Insurance

Part A is the first part of the plan known as Original Medicare. Most people do not pay any premiums for this part. It covers hospital stays, short-term nursing home care, home health care and hospice.

Part B: Medical Services

Part B is the second part of Original Medicare. It covers outpatient doctor visits and tests.

If you receive social security, railroad retirement benefits or civil service retirement benefits, your premium for Part B is automatically deducted from your benefit payment. Otherwise, you will be billed for Part B.

Part C: Medicare Advantage

Part C is offered through private health insurance brokers . It includes the same coverage as Original Medicare along with some additional coverage.

Extra benefits vary depending on the plan but may include services such as:

Dental
Hearing
Vision
Adult daycare
Wellness programs

The government will pay a fixed amount toward your Medicare Advantage plan, but you will likely pay a monthly premium as well. Premiums and copays are set by the carrier.

Part D: Prescription Drug Coverage

Like Medicare Advantage, Part D is offered through private insurance companies. If you have Part A and Part B, you are eligible to enroll in Part D, which covers prescription drugs.

2. There Are Penalties for Late Enrollment

If you do not enroll in Medicare when you first become eligible, your premium may increase. The penalties are different for each part.

Part A

Many people do not pay premiums at all for Part A. However, if you do pay a premium and you don't enroll when you first become eligible, your premium may increase by 10%.

For every year you delay enrollment, you pay increased premiums for two years. For example, if you enroll three years after becoming eligible, your premium will increase by 10% for six years.

Part B

Part B penalties are active for as long as you have coverage. The late enrollment penalty consists of a 10% premium increase for every year you delay enrollment.

Only full 12-month periods count, so if you don't enroll for the first 18 months of your eligibility, you pay an extra 10%. If you don't enroll for 24 months, you pay an extra 20%.

Part D

While Part D is not mandatory, you may face a penalty for enrolling late. Like the Part B penalty, this penalty is permanent.

The penalty is based on the national average Part D premium. For every month without prescription drug coverage, you pay 1% of the average in addition to your normal premium. If you are unenrolled for 12 months, for example, you pay 12%. This amount is rounded up to the nearest ten cents.

3. You Can Avoid Penalties if You Have Creditable Coverage

If you intend to keep working after age 65, your current insurance plan may be creditable coverage. This means you can delay Medicare enrollment without penalties as long as you stay on your current plan.

To qualify as creditable coverage, your plan's coverage must match or exceed that of Medicare. If this is the case, you will receive a letter, known as the Notice of Creditable Coverage, each year.

4. Your Income Matters

If your modified adjusted gross income (MAGI) is above a certain amount, you may be subject to a surcharge called the income-related monthly adjusted amount (IRMAA). IRMAA is recalculated every year based on your tax return from two years prior.

If you have a life-changing event, such as a divorce, you may be able to request that your IRMAA payment be recalculated or removed. You must file your appeal with the SSA, and you must pay the IRMAA surcharge in the meantime.

5. You May Need To Pay More for Prescription Drugs

Medicare health plans often have higher coinsurance payments for prescription drugs than employer-sponsored plans, especially high-tier brand-name drugs. If you take medication, research the costs before enrolling in Medicare so you can plan for the expenses.

6. Taking Social Security Has Advantages and Disadvantages

You can start receiving Social Security at age 62. If you receive Social Security, you won't receive a bill for Medicare Part B, because it is deducted from your benefit payment.

However, there are drawbacks to taking Social Security before your full retirement age. This is between age 66 and 67, depending on when you were born. If you take Social Security before your full retirement age, your monthly benefit will be reduced. The longer you delay, the smaller the reduction will be, so it pays to wait.

If you're a bit confused by Medicare, you're not alone. Fortunately, there are health insurance brokers who specialize in Medicare and can help you understand your options. For more information on Medicare health plans, contact Sackett & Associates Insurance Services today.

Understanding Your Medicare Drug Plan's TrOOP

Thu, 26 May 2022 19:30:00 GMT

Medicare True Out-Of-Pocket Coast (TrOOP) Explained

If you have one or more pricey prescriptions and are or will soon be eligible for Medicare, you may be thinking about signing up for a Medicare Part C or D plan in order to get prescription drug coverage. It’s important you understand not only how much a Medicare drug plan will help with the cost of your medications, but also how much you may still be expected to pay. One of the most important factors in this regard is what Medicare defines as your true out-of-pocket or “TrOOP” cost.

Defining Your TrOOP

Your Medicare health plan TrOOP refers to the maximum that you have had to pay for medications out of your own pocket during a given year. Your Medicare Part D plan’s “catastrophic coverage” will cover the costs of prescriptions after you have paid the amount that has been set for the TrOOP, which is a little over $7,000 for the current year. What this catastrophic coverage generally means in practice is that your Medicare drug plan was paying alimited amount toward your medications up until this point, but now will be paying for all approved prescriptions for the rest of the year. With a few exceptions, your relatively low co-pay and coinsurance costs will typically be your only obligations for the rest of the year after you have met your out-of-pocket maximum.

Keep in mind that your Medicare plan's TrOOP limit is an annual measurement; this means that every year, the TrOOP amount starts back at $0 rather than continuing to accumulate from the previous year. On the other hand, your out-of-pocket total amount does continue to add up throughout the year even if you decide to move from one Medicare prescription drug plan to another within the same year. Your maximum TrOOP amount is tied to your costs during the year, not to the particular plan you were subscribed to at the start of the year.

Which Payments Do and Don’t Apply?

While most of the things that are included when calculating your annual TrOOP will seem obvious, you shouldn’t assume that all your costs will count, as there are some important exclusions. If you have any doubt about whether certain payments will be included toward your out-of-pocket limit, you should check with your plan provider or health insurance brokers .

As you might expect, coinsurance and drug copays that you are responsible for throughout the year will contribute to your TrOOP, and so will your Medicare plan’s deductible. Any coverage gap or limitation that requires you to pay extra yourself, such as prices that are higher than the amount your plan will pay for approved medications, will also count towards your TrOOP total. Be sure to examine your plan’s drug formulary to check that a particular medication is approved, and if so at what level. As we will discuss in a moment, the question of whether a particular medication is approved will affect whether paying for it is considered part of your true out-of-pocket costs.

Generally, you can assume that payments that don’t actually come out of your own pocket will not count when calculating your yearly TrOOP. As an example, any amounts paid by public healthcare assistance programs like Medicaid/Medi-cal, CHIP or TRICARE don’t count when calculating whether you have reached your yearly annual maximum. Payments made by other third-party benefit programs, such as a drug company’s patient assistance scheme will also not count toward your out-of-pocket total. Some states have publicly-sponsored aid programs that help people pay for all types of prescriptions, and a few have programs geared toward helping pay for drugs related to a specific major diagnosis, like AIDS or cancer. The payments covered by these state benefits may count toward your annual out-of-pocket maximum, but you should double-check with your plan provider to be sure.

Some healthcare costs that you do actually pay for yourself nevertheless will not qualify to be included in your TrOOP calculation. If your Medicare Part C or D plan does not recognize or provide any coverage for a medication, then any amount you pay for that drug will likely not be included in your TrOOP cost for the year. Although supplements such as vitamins, herbal remedies, and diet aids are widely used, they are not included in your annual TrOOP amount. A prescription that was written in or obtained from a foreign country will also not be included; if you rely on a drug prescribed overseas, it would be best to get a U.S. doctor to write a new prescription for it if you can.

With the cost of prescription drugs continuing to escalate each year, it’s understandable that you would like to have some certainty about how much your medications are going to cost you. For more information about how Medicare health plans and the TrOOP guideline can offer some predictability, contact the experts at Sackett Insurance today.

How the Government Plans To Fix the Family Glitch

Wed, 11 May 2022 16:00:03 GMT

ACA Health Insurance Family Glitch Addressed

The intention of the Affordable Care Act was to increase the affordability of health care and reduce the number of people who had no health care coverage due to cost. Like all large pieces of legislation, however, the ACA had gaps and oversights that prevented it from fully accomplishing its goals. One of these issues has come to be called the “family glitch,” and the current administration is proposing a new rule to finally fix it.

The Existing Problem

The problem that experts call the “family glitch” is caused by the current means of determining affordability under the Affordable Care Act. This fault has resulted in many family members doing without health care coverage even when they have the opportunity to be covered under a spouse or parent’s group health insurance through work. This is because the determination of whether affordable coverage is offered has been based on how much you would pay under your employer’s plan to cover only yourself. The affordability criteria has not included accounting for how expensive it might be to add your family to your group plan.

Basing affordability only on the cost of covering the employee alone overlooked how most employer-sponsored healthcare plans work in the real world. Likely, the main thing that makes your health insurance affordable for you is the amount your employer contributes toward your premiums. However, your employer probably does not provide the same level of contribution to the premiums of your dependents, as the law does not require this. Therefore, having to cover the total cost of dependent coverage without your employer’s contribution can make adding your spouse or kids too expensive.

Affordability is one of the key requirements under the Affordable Care Act to determine whether someone shopping on the Health Insurance Marketplace has access to qualified non-Marketplace health care plans. If your employer’s plan was judged “affordable” when covering just yourself, that could prevent your dependents from getting subsidized Marketplace coverage, even if adding them to your employer’s plan would make your premiums unaffordable.

The Proposed Solution

The answer to this problem is making affordable Marketplace health plans, including those supported by federal subsidies, available to families who have been affected by the so-called glitch. The way the government is trying to do this is through a newly proposed IRS rule .

What the suggested rule would do is extend the tax credits that were created by the ACA to allow people to buy an affordable health plan through the Health Insurance Marketplace. The availability of these credits has been based on whether you had access to a plan that offered “affordable” coverage for the employee only; with the new guidance, the cost of insuring your dependents will factor into whether an available plan is considered affordable.

Who Could Benefit and How

The intent of the new rule is to allow your dependents to qualify for Marketplace plans in cases where they are technically eligible for coverage under your company health plan but where covering them would not be affordable. If the suggested rule is put in place, it has the potential to help more uninsured people obtain health care coverage. At the same time, it may reduce the cost of insurance for your family if you’ve had to rely on expensive dependent coverage through your employer’s plan.

The rule would apply only to any dependents who are actually related to you. Therefore, the changes would primarily apply to your spouse and children. If you have an uninsured spouse, you could be able to shop for federally subsidized coverage for them on the Marketplace, even if your employer offers coverage for dependents. This could be especially helpful for families whose household income makes them ineligible for state benefits or assistance of any kind.

Maybe your family has been paying huge premiums to include your dependents on your company’s health care plan; if the proposed rule is approved, you may be able to move them to a more affordable Marketplace plan, potentially saving you a lot of money. The administration is estimating that nearly 1 million people may be able to reduce their health insurance costs this way. Keep in mind that only health care premiums for dependents would qualify for potential tax credits if this new rule takes effect; if your employer’s plan meets the minimum requirements of coverage and affordability for you, the cost of your premiums for self-coverage would not qualify.

Even your employer may benefit from the proposed rule eventually. The rule could make it less likely that you and your co-workers will add your dependents to the work-based healthcare plan. What this will mean in the long run for group health plans is unclear, but it could ultimately allow a health insurance broker to offer employers lower-cost plan options if their employees don’t need dependent coverage. The rule would not require employers to contribute to dependent coverage or change how the required “affordability” of coverage is determined. So at the very least, the rule places no additional burdens on your employer.

For more information on how the “family glitch” may be affecting you and what your options are, contact us today.

Cardiovascular Health: Understanding and Caring for Your Heart

Wed, 20 Apr 2022 12:45:03 GMT

Focusing on Heart Health

Cardiovascular health and wellness is one of the main focuses in modern healthcare, and for good reason. Heart disease is still the leading cause of death both in the United States and globally. Unfortunately, many cardiovascular issues go undiagnosed until it's too late for treatment. This is one of the reasons why working with a good health insurance broker is so important. With the right coverage, people are much more likely to take advantage of preventative health care, reducing the risks for serious disease and allowing major issues to be diagnosed early.

Routine medical examinations can be life-saving when it comes to heart health, but genetics and lifestyle also play a critical role. By understanding your potential risks, learning how to care for your heart, and watching for warning signs, you can add years to your life while also improving its overall quality.

Understanding Heart Disease

Heart disease is an all-encompassing term that includes a variety of issues that may involve the heart, arteries, veins, and capillaries of the body. Some of the most common types of heart disease include:

• Coronary Artery Disease (blockages in blood vessels)

• Heart valve disease (malfunction of one or more of the four valves of the heart)

• Heart arrhythmias (irregular or abnormal heartbeat)

• Congenital Heart Disease (developmental abnormalities of the heart)

• Pericardial disease (inflammation or disease of the sac that surrounds the heart)

• Cardiomyopathy (disease of the heart muscle)

High blood pressure, which is often associated with cardiovascular issues, is not technically heart disease. It is often a side effect of heart issues or other health problems, and it significantly increases your chances of developing cardiovascular disease.

Risk Factors for Heart Disease

Some of the biggest risk factors for developing cardiovascular problems may be out of your control. Many heart issues are indeed hereditary, so it's important to take note of your family history. If heart disease runs in your family, you are likely at risk as well. Most of the time, physicians only consider immediate family members (grandparents, parents, and siblings) when analyzing family history.

Other factors that increase your risks for heart disease include:

Obesity
Diabetes
High blood pressure
High cholesterol
Smoking
A sedentary lifestyle
A diet high in cholesterol, saturated fat, and trans fat
Abnormally high or chronic stress
Being over the age of 65 (males) or 70 (females)

Fortunately, most of these can be minimized with a healthy lifestyle and good habits.

Recognizing Cardiovascular Issues

Learning how to identify the symptoms of heart disease can sometimes be difficult because every human body is different. In addition, some signs are shared with other, less serious conditions. It is important to be in tune with your body and to pay attention when you notice anything out of the ordinary, even if it is subtle.

Some of the most common symptoms that point to heart problems include:

Pain, pressure, or tightness in the chest
Shortness of breath
A slow (under 60 beats per minute) or fast (over 100 beats per minute at rest) heart rate
Fluttering in the chest or the sensation of an extra or missed heartbeat
Dizziness
Fatigue
Lightheadedness
Weakness
Swelling, especially in the hands and lower limbs

Many of these symptoms can be perfectly normal in certain situations but can be dangerous in others. If you develop any of these symptoms for unexplained reasons, it's important to see a doctor as soon as possible for evaluation. This is especially true if you have a high risk for heart disease.

How to Prevent and Treat Heart Problems

First and foremost, it is important to work with a health insurance broker so you can get health coverage for routine and emergency medical care. Seeing a doctor at least once a year for checkups and right away when symptoms arise can save your life when it comes to heart disease. However, your everyday habits are also very important for maintaining and improving heart health.

A healthy diet is the first place to start. Foods that are high in salt, fat, and even sugar can increase your risk for heart disease. Limit red meats and stick to lean protein, fatty fish, and plenty of fresh produce. In addition, you need to keep your body active and moving to work your heart muscles and improve blood flow. Just walking at a brisk pace for 20 to 30 minutes a day can significantly improve heart health. Before modifying your diet or starting any type of new exercise, be sure to meet with a physician first. This is especially true if you are high-risk for heart disease or have already been diagnosed with a heart condition.

Prioritizing your cardiovascular wellness is a critical step in living a long and healthy life. However, there's more to it than just diet and exercise. A health insurance broker can make sure you have the right coverage, keeping you and your family protected while allowing you to get the treatment and care you need. To learn more about which health insurance options and plans are right for you, contact Sacket & Associates Insurance Services today.

Current Health Benefits Trends for Small and Medium-Sized Businesses

Thu, 07 Apr 2022 17:15:03 GMT

Top 2022 Health Benefits Trends for Small and Medium-Sized Businesses

There is no doubt about it – the health insurance benefits your company offers will have a major impact on the type of talent you are able to attract. If you want to retain your best employees and attract hardworking new ones, you will need to offer healthcare benefits that reflect what employees need and want in today’s society. In other words, you must stay aware of current benefits trends to stay afloat. Before contacting a group health insurance broker Santa Rosa, take a look at the following health benefits trends for small and medium-sized businesses.

Telehealth

Telehealth benefits are steadily becoming more popular. Prior to the pandemic, the use of telehealth services increased, but it was obvious that many employees preferred to see a healthcare provider in person. However, during the first few months of the pandemic, telehealth usage increased significantly, causing many doctor’s offices to change the way they interact with patients.

Offering telehealth benefits is a great way to attract employees, primarily because telehealth visits tend to be effective, safe, and cost-efficient. Telehealth visits for primary care and mental health purposes are especially popular now, but as time progresses, additional types of offerings such as chronic care and remote monitoring will become popular as well. The telehealth revolution is also being credited with making health care more convenient and accessible for individuals and families.

Mental Health Coverage

Historically, health insurance treated mental health as a secondary need, and many employees did not have access to mental health coverage at all. In recent times, especially with the rise of the pandemic, mental health has started to receive increased attention from society. Mental health conditions such as depression and anxiety are no longer considered taboo by many. For this reason, employees now expect to have mental health coverage as part of their health benefits package.

There are numerous benefits to prioritizing mental health in the workplace. Mentally healthy individuals perform better, and this improved performance is beneficial to both employees and the company as a whole. Some employers have even started to offer health insurance packages that include a limited number of free counseling sessions. Other common mental health offerings include access to 24/7 emotional support lines and mental health-oriented apps.

Caregiver Support

Being a caregiver is difficult, and often, caregivers are left without support in the workplace. In the past, health insurance benefits have had little impact on caregivers, who often struggle with mental health issues such as extreme stress and emotional exhaustion. As the aging population of America steadily increases, workplaces around the country can expect to see more employees become caregivers in the coming years.

Fortunately, employers can help caregivers in a variety of ways. By offering a benefits package with mental health benefits, as well as caregiver support programs, employers can show their caregiving employees that they haven’t been overlooked.

At-Home Healthcare

The age of old-fashioned doctor house calls may be over, but employers are now offering benefits that take at-home health care into consideration. The demand for at-home care is rapidly increasing, especially among older Americans. At-home support is currently becoming more popular as individuals seek out benefits to cover medical, palliative care, behavioral health, and social services.

Personalized Benefits

To attract the best employees, companies will need to offer healthcare benefits that reflect today’s diverse workforce. To do this, employers are starting to see the advantages of offering personalized benefits packages to employees. More progressive employers are now taking factors such as age into consideration when offering benefits, as well as lifestyle and financial categories. To appeal to younger workers, employers are now offering increased mental health benefits as well as other benefits such as gym reimbursement. On the other end of the spectrum, older employees are often more interested in benefits such as long-term disability.

To offer the best benefits, employers will need to survey and study their employees to learn more about their wants and needs. Employers can also save money by eliminating benefits that are no longer useful or desirable to their employees.

Lower Premium Costs for Employees

Over time, the average cost of family premiums has risen sharply and outpaced wage growth by a considerable percentage. This sounds like bad news for employees, but in recent times, more employers have begun to shoulder a greater share of the costs related to premium increases. This removes a significant amount of financial pressure off of employees. High-deductible health insurance plans are also becoming a thing of the past since they don’t offer many benefits to employees.

Employees are also beginning to gravitate towards plans that offer more predictable healthcare costs and help them manage more serious medical conditions. For this reason, employers are starting to offer plans with:

More transparent pricing tools
The reintroduction of copays
Additional specialty care options
Choices for managing chronic health conditions

Offering health insurance that removes some of the financial burdens off of employees is a great way to attract top-tier talent and keep employees loyal.

Contact Us

Here at Sackett & Associates Insurance Services, we understand current benefits trends and patterns. We will do our best to help you find the right type of insurance benefits for you and your employees. Contact us today to learn more about our insurance offerings

How Can I Backdate a Health Insurance Plan?

Mon, 14 Mar 2022 13:00:08 GMT

Are All Short-Term Health Insurance Plans the Same?

What is backdating health insurance? How does it work? Backdating means coverage of your benefits is made retroactively effective by your insurance provider. Wouldn't it be great if we could all purchase retroactive coverage? As a general practice, it is illegal. A health insurance carrier will only backdate insurance coverage in some scenarios.

When Does Backdating Happen in Health Insurance?

Some clients wonder if there is any grey area on policy start dates. Buying coverage now for a prior illness is a wonderful prospect. But when exactly can you backdate a policy? Over the years, an independent health insurance broker sees all sorts of coverage in all manner of scenarios. There are some cases where health insurance coverage can be backdated. Most clients wonder and ask about backdating during the enrollment process. Let us help with some answers.

Open Enrollment Period

The U.S. federal health insurance marketplace and the state exchanges begin their enrollment period starting November 15th. The goal is to ensure coverage in time for the beginning of the new year. But, some states have a deadline as late as January 15th (or later) for signing up.

Can those people that enroll later have coverage backdated starting January 1st? In most states, getting coverage during open enrollment means you have coverage effective the first of January. There are a few different possible effective dates depending on your state.

January 1 - the effective date for most policies during open enrollment
February 1 - nearly every state has this alternate effective date for a later registration
March 1 - some states have some provider exchange options available longer

Special Enrollment Periods

Life happens, and rarely only at the first of the month. There are a few qualifying life events that allow you to sign up with a health insurance broker any time after the deadline for open enrollment.

Loss of health coverage
Changes in household
Changes in residence
Other qualifying events such as changes in citizenship or income

These plans are not usually backdated. Most plans offer coverage that starts on the first day of the next month. If you got married on the Fourth of July and bought coverage later that same month, the industry standard is that it would be effective August 1st.

Is Backdating an Insurance Policy Permitted?

In some industries, backdating business deals and start dates is a normal practice. Life insurance and auto insurance policies are often backdated for several months. In most contracts, it is considered fraudulent for an agent to list an incorrect start date on the policy. Most policies have basic terms that prevent backdating.

Waiting Period

Most policies have a waiting period of up to 90 days in order to prevent complicated overlap of benefits. This qualifying period avoids the need for backdating when changing coverage.

Effective Date

As in special enrollment periods and other extenuating circumstances, it is possible to have the date a policy is purchased be different than the day the coverage becomes effective. Even if these two dates aren't the same, the start date of your policy is more commonly called the "effective date." Once this is set, no standard benefits are available before the effective date. At the start of your new plan, this will be the agreed-upon day where your insurance company will begin to help pay for your medical expenses.

What Exceptions Allow Me to Backdate Health Insurance?

There are a few conventional situations where backdating is warranted.

New Family Members

The most typical backdated policy happens when a new baby is born or a new dependent is added to your family. Most plans give 30 days from the event to add family to your policy or to purchase new coverage.

Recission

This is a backdated cancellation of an insurance policy. It is to avoid potential fraud in a contractual agreement and usually happens when incorrect information is provided during the application process.

Other Examples

Some events allow for backdating:

Facing an exceptional circumstance such as a natural disaster or hospitalization
Changing eligibility for Medicaid or CHIP
Experiencing other QLE (qualifying life events)

Should I Contact a Health Insurance Broker about Backdating New Coverage?

Some states and incidents allow for backdating new plans. Life throws a variety of choices our way. You need individual health coverage from agents with knowledge across several insurance companies and products. The integrity of your insurance carrier is important and a reputable broker will always comply with laws and regulations to offer you the best product for your needs.

A conversation with an experienced health insurance broker will clarify whether or not you qualify for coverage and whether it can be backdated. Contact Sacket & Associates Insurance Services to have a consultation about your coverage options. We are real people with over 40 years of experience in the industry. We value taking care of our clients just as we would our own families. Our team of independent agents specializes in a variety of healthcare plans and insurance groups and will guide you through your best options for health insurance. Let us help answer all your questions today!

Sources: https://www.healthcare.gov/glossary/qualifying-life-event/

Differences in Short-Term Health Plans

Wed, 23 Feb 2022 20:45:03 GMT

Are All Short-Term Health Insurance Plans the Same?

Short-term health insurance provides temporary medical coverage if you lose your coverage due to job loss, disability, or another event. Many short-term health plans vary greatly from traditional medical plans. Short-term plans also vary depending on the carrier. Read below to learn more about the differences between short-term health insurance plans and tips for selecting the best policy.

What Is Short Term Health Insurance?

Short-term health insurance is a plan that provides you with temporary coverage outside enrollment periods, between policies, or in an emergency. While all plans offer temporary coverage, the features vary depending on the carrier.

Differences in Short-Term Health Plans

The coverage period and benefits vary depending on the carrier, monthly premium, and the plan you choose.

Coverage Options

Short-term plans vary widely in the level of coverage offered. Many plans provide at least some coverage due to illness and injury. The covered expenses may include hospital stays, surgical procedures, doctor's visits, and medications. However, most plans have a hospitalization expense cap, and some do not cover preexisting health conditions. Check your policy for exclusions and maximum coverage levels before enrolling.

Monthly Premiums

Monthly premiums for short-term health plans also vary. Health plans with low deductibles and comprehensive coverage will cost you more per month. However, you can expect to pay a lower monthly premium than traditional health plans. Temporary plans with moderate coverage levels and high deductibles are typically more affordable. Most temporary plans also require coinsurance, but these amounts vary depending on the policy.

Maximum Coverage Limits

Most short-term health plans place a cap on the medical expenses they will cover. Maximum coverage levels depend on your plan, monthly premium, and the carrier. Most health policies will pay at least $100,000 worth of covered expenses over the life of the policy. The most expensive plans pay up to $1 million.

Provider Networks

Some short-term health plans only allow you to visit doctors and hospitals in a specific provider network. However, most temporary plans do not limit the medical professionals you can see. Check to see if your doctor is in-network with your health plan before enrolling. Be prepared to see a new doctor if you do not check the service providers before signing up.

What Are the Pros and Cons of Short-Term Health Insurance?

Are you considering a temporary health plan? There are many advantages to enrolling in one of these plans. Here are some of the pros to consider:

Created to fill temporary coverage gaps if necessary
Coverage can be easily canceled without fees or penalties
You can choose a coverage period ranging from a month to a year
Many coverage levels and policy features are available

If you suddenly lose your health coverage, it is a good idea to enroll in a short-term plan. A temporary policy can provide peace of mind and help you avert financial disaster in case of an unforeseen illness or accident.

Many employers offer traditional health plans to workers, or you can purchase your own policy through the health insurance marketplace. However, temporary plans are not for everyone. They do not provide comprehensive coverage and are not adequate for those with significant medical needs. You should look for a permanent health plan if you have a medical condition or take lots of medication.

Tips for Selecting a Short-Term Health Insurance Plan

Not all short-term health plans are the same, and it takes a lot of research to find the best policy. Follow these tips to choose the best plan for your needs:

1. Look For a Plan That Fits Your Lifestyle

Consider your health needs and examine your lifestyle before you choose a plan. Prioritize your and your dependents' health and choose a plan that meets your most important requirements. If you are on a tight budget, choose a policy with a high deductible and a moderate coverage level to keep your monthly payments low. If you take a lot of medication or have a preexisting condition, you should pick a plan with more comprehensive coverage.

2. Read Plan Details and Exclusions

When researching health plans, read the policy brochure for information on coinsurance costs, coverage limits, premiums, deductibles, and exclusions. Do your best to anticipate your medical needs and choose a plan that is affordable while still providing sufficient coverage. For instance, many short-term plans do not offer coverage for maternal care. Choose a plan that covers prenatal care if you are pregnant or plan to become pregnant.

Work With Sackett & Associates Insurance Services

Are you looking for a individual health plan? Look no further than Sackett & Associates Insurance Services. We specialize in providing insurance services to families, individuals, and groups. We have been providing insurance services for over 40 years, and we specialize in all health insurance plans and options. Contact us today to receive a personalized quote for your unique situation.

What Medicare Part B Covers

Wed, 23 Feb 2022 17:25:25 GMT

What Is Covered Under Medicare Part B

When you turn 65 years old, or if special circumstances apply, you are eligible to apply for Medicare coverage. Along with Medicare Part A , Part B is one of the most important parts of original Medicare. Because Part A and Part B cover different things, most people who opt for original Medicare choose both. As health insurance brokers licensed to sell Medicare health plans in Santa Rosa, we can help you understand your sometimes-complicated options. Here is what you need to know about Medicare Part B.

What Does Medicare Part B Cover?

While Medicare Part A covers inpatient hospital care, Part B covers just about everything else involved in health care, except for prescription medications. The Centers for Medicare and Medicaid Services divide covered services into two different categories: preventive services and medically necessary outpatient services.

Preventive services include those intended to prevent you from getting a disease, such as some vaccines. For example, the pneumonia shot and flu shot are covered by Part B, while the shingles vaccine is covered by Part D prescription coverage. Some vaccines are only covered under certain circumstances. If you are at medium to high risk for hepatitis B, Medicare Part B will cover the vaccine whereas it wouldn't be covered otherwise.

Preventive services also include screenings intended to catch diseases, such as diabetes, cancer, heart disease, hepatitis C, and glaucoma, in their early stages. Early diagnosis provides the best prognosis for successful treatment or management. Examples of screenings included under Medicare Part B as preventive services include the following:

Blood tests
Pap smears
Mammograms
Colonoscopies

Part B also covers outpatient services that are medically necessary, such as doctor's visits for checkups, injuries, or illnesses. X-rays are covered under Medicare Part B. Even though emergency room visits take place in a hospital, they are covered under Part B. However, if you were to be admitted to the hospital following your emergency room visit, that would be covered under Part A.

By definition, home health services are provided on an outpatient basis. Therefore, Medicare Part B may cover some home health services, but only those deemed medically necessary.

This is a broad overview of what Medicare Part B covers. There are numerous exceptions that apply, mostly hinging on whether the service is deemed medically necessary or not. The companies in each state that process claims for Medicare make coverage decisions at the local level under applicable state laws, while CMS makes national coverage decisions according to federal law.

Furthermore, Part B only covers 80% of the costs of medically necessary services. You typically have to pay the remaining 20% out of your own pocket. However, depending on the provider you choose, you may be able to receive preventive services at no cost under Medicare Part B.

How Much Does Medicare Part B Cost?

Another respect in which Medicare Part B differs from Part A is that, while Part A is available to most people at no cost, depending on work history, Part B charges a monthly premium. The CMS sets the monthly premium, which may undergo changes from year to year. In 2022, the monthly premium for most people is $170.10. If you receive federal retirement benefits, Railroad Retirement Board benefits, or Social Security, the premium amount may be automatically deducted from your monthly check.

Not everyone who enrolls in Medicare is retired. Some people continue working even after enrolling in Medicare. These people may have a higher-than-average income. Individuals who make more than $91,000 per year or married couples with an annual income in excess of $182,000 may have to pay more for Medicare premiums.

In addition to the monthly premium, there is also an annual deductible that applies to services covered under Medicare Part B that you have to pay out of pocket. In other words, the first $233 in medical expenses that you incur are your responsibility. Once that benchmark is met, Part B covers 80% of expenses for all other medically necessary expenses.

Who Is Eligible for Medicare Part B?

Medicare Part B is available to U.S. citizens who are over the age of 65. Lawfully permanent residents are also eligible as long as they have reached the necessary age requirement and have dwelt continuously in the United States for at least five years.

There are circumstances in which people younger than 65 can qualify for Medicare Part B. You can qualify for Part B regardless of age if you have certain terminal diagnoses, such as amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig's disease, or end-stage renal disease. People who have received Railroad Retirement Board disability or Social Security Disability benefits for at least 24 months, or two years, are also eligible to enroll in Medicare Part B even if under age 65.

Make Sense of Your Medicare Options

With all the different exceptions and contingencies, making sense of your Medicare options can be a challenge. At Sackett & Associates, we have health insurance brokers licensed to sell Medicare health plans who can explain your options to you and make recommendations based on your individual needs. Contact us for more information on how to get started.

What You Need To Know About Medicare Part A Coverage

Tue, 08 Feb 2022 17:39:19 GMT

What You Need To Know About Medicare Part A Coverage

Medicare is a government service that helps millions of aging people access the healthcare coverage they need at a low cost. There are two types of Medicare: Part A and Part B. Understanding Medicare regulations are complex, but it is most important to know what health services are covered. Medicare A pays for inpatient hospital care, while Medicare Part B pays for doctors’ visits, lab tests, and preventative services and supplies. Here is everything you need to know about Medicare Part A, including covered services and costs.

What Is Medicare Part A?

Medicare Part A is considered hospital insurance. Most people have Part A and Part B coverage to pay for different medical expenses. Members typically pay a deductible or copayments for medical care, but usually at reduced rates. Part A is necessary for many aging adults, especially those that require inpatient hospitalization services.

What Does Medicare Part A Cover?

Part A typically pays for hospital stays, hospice care, and skilled nursing help, depending on your location. Medicare Part A typically pays for services received through the following providers:

Critical care hospitals
Acute care hospitals
Rehabilitation services
Inpatient mental health service
Long-term care hospitals
Inpatient research hospitals

Medicare Part A is used explicitly for inpatient medical services while Part B pays for outpatient health services. This type of coverage is also used to pay for home health services. Part A typically pays for 100% of the cost of home health care services, including skilled nursing, hospice, and in-home physical therapy. However, remember that Part A does not cover in-home personal care services if they are unrelated to your condition. Also, it does not cover 24-hour home health care if it is not necessary for your treatment.

If you need medical equipment as part of your treatment, it is typically covered under Medicare Part B. For instance, if your doctor recommends a walker, oxygen tank, or wheelchair as part of your care, it is covered under Part B. Policyholders are typically responsible for paying 20% of approved medical equipment.

Does Medicare Part A Cover Skilled Nursing Services?

Medicare Part A covers the cost of staying in skilled nursing facilities related to a covered illness or injury. However, specific exclusions apply. You must remain in the facility for at least three days, starting on the day you are admitted to the facility. The day you leave the facility does not count toward the minimum stay requirement. Only inpatient skilled nursing services are covered under Part A.

A facility must be certified by Medicare to qualify. The following services are covered at approved facilities:

Meals
Skilled nursing care
Private or semi-private room
Rehabilitation services
Dietary and nutrition services
Health supplies used in the facility
Medication used in the facility
Transportation to and from the care center

The rules for covered services vary slightly if the patient is also receiving hospice care. Part A may also pay for additional services such as counseling or grief therapy in these cases. However, Medical Part A only covers meals and room expenses if the medical staff requests temporary inpatient stays for symptoms alleviation.

What Are the Costs Associated with Medicare Part A?

The costs associated with services rendered under Medicare Part A vary depending on the patient. Most people do not pay a monthly premium for coverage under Medicare. The expenses you pay correlate with how long you worked before retirement. Those who worked for at least ten years do not pay a monthly premium. If you have worked for less than ten years, you must pay a monthly premium. Depending on other factors, you will pay between $259 and $471 a month.

Is Medicare Part A Free For People Over Age 65?

Medicare Part A is free for those who worked a certain number of years before retirement. You are eligible for a premium-free Part A policy if you are 65 or older and you meet the following requirements:

You currently receive Social Security benefits
You are eligible for Social Security benefits, but you do not yet receive them
You or your spouse is a retired government employee

There are certain circumstances when those under age 65 can receive Medicare Part A for no monthly cost. You may also qualify if you have a covered medical condition such as end-stage renal disease. You do not have to pay a premium if you have received Social Security benefits for at least two years. Make sure and contact a Medicare healrht insurance broker if you want to know more about your eligibility.

Contact Sackett & Associates Insurance Services

Are you looking for a Medicare health plan? Sackett & Associates Insurance Services is an independent insurance provider specializing in matching customers with the best health coverage. We have been helping families, individuals, and groups find the best insurance for over 40 years. Contact us today to speak with one of our licensed insurance brokers.

5 Benefits That Help Improve Employee Retention

Tue, 25 Jan 2022 19:15:02 GMT

Employee Retention Saves a Business Money and Time

Quality employees are one of the most valuable resources a business can have. When somebody leaves the company, a new hire has to be found and trained. This process takes time and money that could be better utilized elsewhere. Today, businesses need to offer competitive benefits in order to maximize employee retention and avoid high turnover rates. Here are five of the benefits that many employees value most from their jobs.

1. Health Insurance

One of the most important ways to make employees feel valued as well as ensure that they are able to continue working for you is to provide quality health insurance. Without adequate health insurance, even employees who want to stay at your company may be unable to, as insurance is a crucial part of employees being able to provide for the needs of themselves and their families. Today, employees expect benefits such as group health plans that give them peace of mind that they will be covered for their personal care needs.

2. Sick Days and Paid Time Off

Being able to take time off when needed improves employees' abilities to maintain a good life-work balance, something that can be a crucial part of whether they decide to stay with a company or not. Burnout can be one of the biggest reasons that an employee chooses to leave their job. In addition to keeping everyone healthier by not making employees feel pressured to come into work when they are unwell, providing these kinds of benefits allows for employees to recover and feel that their job is not eating into too much of their personal time.

3. Remote Work

Remote work has been increasingly common in recent years, and many employees have found that it offers the perfect flexibility to work hard and still take care of their personal needs. Many businesses have found that moving to a remote work model actually increases employee productivity while simultaneously cutting costs associated with maintaining a physical office building. While it won't work for every type of business, when possible it can be a great way to increase employee retention while also saving the business money.

4. Retirement

A good retirement plan helps with employee retention by incentivizing employees to stay with the company until they reach retirement age. Without them, employees are likely to seek other opportunities that they feel will better allow them to save up for their golden years. While it can be tempting to cut these types of benefits when money becomes tight, expect a loss in retention as a result. Instead, consider the several different types of employment plans you could offer, and try to find one that is a good fit for your company. You should also consider the tax benefits that may come along with offering quality retirement plans that may make it more financially feasible for your business.

5. Education and Professional Development

Many employees appreciate chances for enrichment and personal growth both in their jobs and their personal lives. Higher education is more important than ever to helping individuals advance their careers, and giving them the opportunity to do so while remaining employed by you is another way to increase employee retention. Education benefits can take the form of tuition reimbursement for university courses or on-the-job training that focuses on new and useful skills.

Today, remote courses are available online and education is more accessible to everyone, even those with full-time jobs. Encouraging employees to continue their education with benefits helps you by giving you access to more qualified employees without ever having to post a job listing.

Benefits and Work-Life Balance

The benefits above all help employees to feel more valued at their jobs as well as give them the resources to properly balance time spent at work with the tasks they need to accomplish in their personal lives. A good work-life balance can greatly increase employees' satisfaction with their jobs. Without it, frustration and burnout are almost certain to occur.

Providing a work-life balance means valuing employees' personal time, allowing them to properly utilize vacation days without pressuring them to show up to work during time off, and providing resources to help them take care of any healthcare-related needs. Good benefits are part of a good company culture that encourages employees to stay happily employed to you and saves you time and money that would have to be spent hiring new job candidates.

Retaining Quality Employees

Better employee retention can start with better benefits. Make sure that employees understand the benefits that are available to them, including insurance, sick days, and paid time off that allows them to take care of important events in their lives that are unrelated to work. You can start on the path to offering more competitive benefits now by looking into the group health insurance plans we can provide to businesses. At Sackett & Associates Insurance Services, employee benefits are something we specialize in. For more information on how to start today contact us at (707) 823-3689.

Benefits Management Software: Features and Advantages

Mon, 03 Jan 2022 23:45:02 GMT

Features and Advantages of Benefits Management Software

Benefits are an important tool for business owners, but the administration process can be tedious. Thanks to the advancements in automation, you can now use benefits management software to streamline the process. Take a look at the features of this software and why you should use it.

What Are the Features of Benefits Management Software?

Benefits administration typically includes a collection of tasks, including:

Overseeing billing.
Creating a benefits program to provide for employees.
Working with benefits companies to get the best services.
Communicating with employees about the services available to them.
Helping employees through the benefits enrollment process.

The company HR department typically manages benefits administration. Some companies outsource, but not having the process in-house can cause problems. There is much room for error, which is why benefits management software is an asset to any company. Consider the following features as you think about the HR needs of your company.

Sophisticated Administrative Capabilities

Benefits management software can carry out many administrative duties that would take your HR staff significantly more time to complete. It can customize benefits for each of your employees, transfer benefits selections to the appropriate providers, deduct employee benefits costs from payroll, and sort your reporting. With the amount of time saved, your team can focus on strengthening company morale and improving business operations.

Advanced Integration Abilities

Benefits management software has advanced integration capabilities that will help your company now and in the future. Cloud-based software allows you to integrate payroll processors, insurance providers, intelligence programs, and more. You can integrate elements of your onboarding process to make it faster and more efficient. There is software to meet the needs of any business.

Payroll integration is particularly important. Making mistakes on payroll is detrimental to your employee turnover rate, and if you negatively affect an employee's benefits coverage, the clean-up process can be messy. Integrating benefits and payroll together into an automated system will make information more accessible for HR and will enhance the efficiency and accuracy of administration and reporting.

Regularly Monitored Compliance

Every human resource professional knows that there are many regulations to follow in benefits administration. HR is in charge of monitoring compliance with labor laws, medical authorization, and financial regulations. If your business employs a large number of people, this can be particularly cumbersome, and avoiding errors is absolutely crucial to staying in compliance. Benefits management software monitors your compliance status for you, ensuring that you meet all mandates and responsibilities.

Manage Business Events

Keeping detailed records of benefits is an integral part of the administration process. Many life events affect benefits, and benefits management software can make fast and accurate adjustments to benefits when necessary. With automated tools helping your company through organizational communication, you will see an increase in productivity.

What Are the Advantages of Benefits Management Software?

The features listed above are inherent advantages, but there is more that benefits management software can do for you and your employees. Here are just a few of the advantages that administrative automation can do to improve your business:

Minimize Errors

This type of complex data correlation and storage leaves many opportunities for human error. With automated management software, you eliminate the potential for reading information incorrectly or losing crucial forms. Cloud-based platforms provide fast data collection and safe storage, and all updated information is available right away.

Enhance the Work Experience for Your HR Team

Automated software is a great way to facilitate consistent workflow in the HR department. Your HR staff will be able to easily access information that they need right away, making the benefits enrollment process significantly faster and more efficient.

Enhance the Company Image

Investing in software that can lower your turnover rate and improve your employees' experiences is an easy and sure way to enhance the image of your company. Keeping your HR department technologically updated also attracts innovative talent. The younger generation that is just entering the workforce is not impressed by paper forms and long wait times. They expect real-time results. Benefits management software is just one example of integrated technology, but it saves your company time and money.

Simplify the Onboarding Process

Automated software does more than just attract new talent with a speedy onboarding process. Its integration capabilities also make the paperwork aspect of onboarding easier. Having all the relevant personnel information together in one system simplifies the onboarding process. Additionally, it cuts back on the man-hours needed to get through it.

Overall, benefits management software is designed to make everything easier for all those involved. There are many moving parts in human resources, and important information can be lost in translation. Automation is a solution, and it saves time. Employees can search through benefits packages on their own and enroll with little assistance. There are virtually no disadvantages to implementing this software.

For more information on how benefits management software can help your HR department, contact Sackett & Associates Insurance Services .

Sources:

https://www.zenefits.com/workest/top-5-advantages-of-employee-benefits-software/
https://www.forbes.com/sites/forbestechcouncil/2017/11/17/this-is-how-technology-makes-your-brand-image/?sh=b558b262db50
https://www.shrm.org/resourcesandtools/hr-topics/talent-acquisition/pages/new-employee-onboarding-guide.aspx

What's New for Open Enrollment 2022

Wed, 15 Dec 2021 23:00:03 GMT

The Importance of Reviewing Your Explanation of Benefits

The Affordable Care Act , sometimes known as Obamacare, was signed into law in 2010. The reforms contained in this bill allow otherwise-uninsured consumers to purchase healthcare coverage through health insurance exchanges run by federal and state governments.

Health insurance marketplaces allow consumers to compare plans offered by participating insurance companies to find the coverage best suited to them. Government subsidies are available for many enrollees to reduce out-of-pocket costs, making policies more accessible and affordable to those who qualify. Since 2014, insurers can’t deny coverage or limit benefits to those with pre-existing conditions any longer.

Actively Manage Your Coverage

Most current marketplace enrollees are re-enrolled automatically for the following year unless they actively make changes during open enrollment. The Marketplace changes every year, and those who don’t actively choose their yearly plan may either miss out on subsidies and better rates or experience higher rates because their provider raised prices.

Updating your marketplace application yearly during open enrollment and comparing new coverage options can lower your payments and increase your savings.

Know Your State’s Open Enrollment Period

Most Americans must purchase or make changes to their health insurance plan during specific periods, known as open enrollment. These time frames vary slightly for federal and state-run marketplaces , but they are generally at the end of each calendar year.

Every year brings changes to the Marketplace, and people make more informed decisions if they are aware of the changes.

Open Enrollment Changes for 2022

Several things changed for this year’s open enrollment season, and these changes may be slightly different for state-run marketplaces and HealthCare.gov states.

New Plans and Premiums

Consumers have more choices this year. Thirty-two more insurance providers are participating in the HealthCare.gov marketplace in 2022, bringing the total to an average of 83 qualified plans to choose from as opposed to the average of 46 plans in 2021.

Premiums in HealthCare.gov states are slightly lower this year, while state-based marketplace premiums may be slightly higher.

Extended Open Enrollment Timeframes

Consumers in HealthCare.gov states can now enroll for coverage from November 1, 2021, until January 15, 2022, increasing the window from six weeks to over 10 weeks. Some state-based marketplaces are extending the open enrollment period even further.

In addition, people with meager income will have more opportunities to enroll in coverage. Monthly enrollment periods will be offered by HealthCare.gov, allowing people with sudden changes in income to register throughout the year.

More State-Run Marketplaces

Kentucky, Maine and New Mexico are implementing state-based marketplaces in 2022, bringing the total to 18 states that entirely run their own programs.

New No Surprises Act Law

“Surprise” medical bills are incurred when a patient has to get care from out-of-network providers. The No Surprises Act, effective beginning January 1, 2022, places new billing rules that healthcare providers, facilities, health insurance companies and group health plans must follow. Air ambulance services, emergency treatment and services performed in in-network facilities by out-of-network providers must now bill patients at in-network rates.

Improved Subsidies

The dollar amount of government premium subsidies increased under the American Rescue Plan Act in 2021. Those higher subsidy amounts remain in effect in 2022, allowing more people to afford health insurance policies.

Changed Legislation

Americans must estimate their yearly income when they apply for insurance coverage through the Marketplace. The premium tax credit can lower insurance premium costs, and the amount of credit received is based on household information and projected income. If your actual income results in too many premium tax credits, you will have to repay them when filing your federal tax return.

Pandemic relief legislation provided a temporary period when taxpayers didn’t have to repay these credits, but the repayment requirement will be back in effect in 2022. Be realistic when you estimate your 2022 income so you don’t wind up owing more in taxes.

The public charge rule governs criteria that immigration officials use when allowing or denying entry into the United States. Recent revisions to those rules placed strict limitations on allowing people who depend on monetary assistance to obtain healthcare coverage. Those more stringent rules were reversed for 2022, removing government-assisted coverage as a reason to deny entry into the country.

Enroll For Coverage

Although the ACA’s goal is for all Americans to have access to affordable health insurance, millions of eligible people aren’t enrolled in healthcare marketplaces. Focused outreach programs are being used to educate potential enrollees. It is hoped that more people will enroll during the 2022 open enrollment period due to extended time frames and more significant subsidies.

If you or someone you know hasn’t already enrolled, take time to see what options are available.

Contact Us for Assistance

Navigating the health insurance marketplace can be confusing, but we are ready to assist you. For more information about this year’s open enrollment and available plans, contact Sackett & Associates Insurance Services. Call (707) 823-3689 or send a message using our handy online form . We also invite you to subscribe to our newsletter to receive helpful information about insurance-related topics.

Could I Qualify for the Higher Insurance Subsidies During Open Enrollment?

Sat, 04 Dec 2021 00:45:02 GMT

The Importance of Reviewing Your Explanation of Benefits

Open enrollment is an excellent time to review health insurance plans to see which one will best meet your needs in the upcoming year. You can also find out if you qualify for federal subsidies that now make it easier to purchase a brand-name policy under the Affordable Care Act.

With the American Rescue Plan, Congress expanded the financial aid that enables the Golden State’s residents to obtain quality health insurance through Covered California's marketplace . Eligible households can see their insurance costs reduced by thousands each year. You will not need to show the previously required income levels to receive tax credits or pay reduced premiums for plans purchased through the marketplace.

What Are the Income Limits That Enable Me To Qualify?

Individuals with an annual income of no more than $19,320 can qualify to purchase health insurance that costs as low as $1 per month. Unlike many other federal assistance programs, you can now also earn a higher annual income and still receive tax credits to help cover your health care costs.

If you earn no more than $38,640 each year, your insurance plan could enable you to claim federal income tax credits. Eligible households could purchase health care through California's marketplace and spend no more than 2% of their annual income on premiums.

With the higher subsidies, households earning $57,960 could pay 6% of their yearly income on insurance premiums. If your household earns $77,280 annually, no more than 8.5% of your yearly earnings would go toward paying premiums. If you earn more than $100,000 annually, however, you could still qualify to save a significant sum through tax credits.

Can I Still Qualify for Subsidies if I’m Already Insured?

If you obtain health insurance through your employer's group plan, you could still qualify for federal assistance based on your income. The amount you currently pay for a policy issued as part of your employment benefits package determines whether you're eligible.

Your premium costs also show how much you could claim on your federal income tax return. If your cost for a group plan exceeds 8.25% of your yearly earnings, you can qualify for a tax credit. You could also receive a discount if you purchase a name-brand policy through the marketplace.

What Health Care Benefits Are Available Through the Marketplace?

The marketplace insurance policies cover the types of medical treatment that the federal government considers essential. Comprehensive plans are also required to provide benefits for breastfeeding and birth control.

The essential services categories are:

Emergency medical services
Outpatient ambulatory care
Hospitalization including overnight care
Mental or behavioral health care including substance abuse services
Devices and services for physical rehabilitation
Maternity, newborn care and pregnancy care
Prescription medicine coverage
Pediatric health care that includes vision and dental treatment
Preventative services, wellness and ongoing care for chronic diseases
Lab work and services

Greater than 260,000 Golden State residents are estimated to already have direct insurance coverage that they purchased outside the marketplace. During open enrollment, they're expected to switch to plans with the same level of coverage but instead offered through the marketplace. The difference they’ll see is the money they’ll be saving through the tax credits provided by the American Rescue Plan.

How Do Marketplace Insurance Plans Differ From Each Other?

The Covered California marketplace divides health insurance plans into four tiers: Bronze, Silver, Gold and Platinum. The Bronze tier offers two approaches; there's a conventional plan and one with higher insurance deductibles that complement a health savings account.

Plans in the Bronze tier typically pay 60% of your medical expenses. If you don't have a health savings account to cover the remaining 40%, you may prefer the Silver tier. Plans in the Silver tier could cover 70% of your health care expenses. Those in the Gold tier can pay 80% of your costs.

If you anticipate requiring substantial medical care, you may consider a plan in the Platinum tier, which could cover 90% of your expenses. With only 10% coming out of your own pocket, you could see a significant reduction in your health care costs in the upcoming year.

Could I Be Eligible for a Marketplace Plan That Can Meet All My Needs?

With so many insurance carriers providing coverage through the marketplace, you’ll find that there are several choices that can meet both your health and your budget requirements. By comparing and customizing the available policies, you can arrange a plan that will help ensure all your needs are met. There’s no reason to worry about giving up necessary health care benefits. We’re here to help. We’ll take the confusion out of getting you set up with the right policy.

If you're ready to see the financial subsidies and plans you qualify for, contact us online or by phone at (707) 823-3689 to go over your options. Sackett & Associates is an independent agency that works for you and not for the insurance companies. For those plans set to begin on January 1, 2022, open enrollment ends on December 31, 2021. We look forward to hearing from you soon!

References:

https://www.latimes.com/california/story/2021-11-01/obamacare-open-enrollment-2022-what-you-need-to-know-about-subsidies

https://www.sanluisobispo.com/news/local/article251013619.html

https://www.coveredca.com/newsroom/news-releases/2021/11/01/covered-california-launches-the-national-2022-open-enrollment-period-from-the-golden-state-with-hhs-secretary-xavier-becerra/

https://www.ftb.ca.gov/about-ftb/newsroom/health-care-mandate/personal.html

https://www.coveredca.com/california-subsidy/

https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

https://www.coveredca.com/support/before-you-buy/metal-tiers/

https://www.sackettinsurance.net/contact

Why You Should Always Review Your Explanation of Benefits Following a Medical Appointment

Thu, 25 Nov 2021 21:31:53 GMT

The Importance of Reviewing Your Explanation of Benefits

Health insurance providers send claimants an explanation of benefits for every medical claim they process. These statements break down medical providers' charges, the percentage insurers cover, and the claimants' contributions.

What Does an Explanation of Benefits Include?

The EOB statement serves as a blueprint to tell you how your insurer arrives at the amount you pay for your medical service. The following information should appear on the statement:

The patient's name and insurance identification, and group numbers, which should match those on an insurance card
A definition of various terms to help you better understand what you are reading
The service provider's name
The claim number assignment your insurer can use to look it up
A code for the type of service you received with a description
The date of your medical service
The amount your provider billed to your insurance company
The portion of the bill your insurance company covers
The percentage of the charges you are responsible to pay
The part of an in-network provider's bill that exceeds the allowable rate your provider negotiator with your insurer
The portion of a bill not covered because you received care from a provider outside your insurance network

Depending upon your insurance carrier, your statement may also indicate your deductible, which is the amount you must pay toward your medical expenses before your insurer begins making payments under your plan. Some statements track how much of your deductible remains to help you better understand how to arrive at the amount you owe.

Why Does Your Insurance Provider Issue an Explanation of Benefits?

EOBs are not bills, but they are essential for ensuring that providers bill for their services correctly and patients pay the correct fees. EOBs also help uncover mistakes or fraudulent billing practices, and insurers rely upon patients to verify that the services they receive match what appears on the statement.

Your EOB can also help patients manage their medical bills. For example, reviewing your statement can alert you that your provider's bill will be higher than you can pay all at once, allowing you to proactively negotiate a payment plan before your provider sends it to you.

What Are Some Common Issues an Explanation of Benefits Statement Might Reveal?

Healthcare providers and insurance professionals who handle thousands of claims every day sometimes make errors and oversights. In some cases, providers deliberately make billing misrepresentations. Reviewing your EOB can help you detect mistakes that increase out-of-pocket costs and potentially reduce your overall coverage.

Double Billing

Sometimes a practitioner's billing department will submit two separate bills for the same service. This mistake often happens when multiple office staff members handle billing services without adequate protocols in place.

Upcoding

Upcoding involves submitting bills for services that a patient did not receive. This practice is common among providers who hope to increase their insurance payments. For instance, a medical professional may use a diagnostic code for a more severe condition than a patient has to expand the potential for additional service and billing opportunities. Also, a medical office may submit an insurance claim using a diagnostic code that warrants a high reimbursement rate but does not reflect a patient's condition.

Under coding

Medical professionals might practice under coding that conceals some of the services they perform because they hope to avoid an audit. In addition to denying providers the reimbursement to which they are entitled, this practice negatively impacts patients who may not receive the appropriate treatment from physicians who treat them in the future.

Wrong Diagnosis Code

Incorrect diagnosis codes can have far-reaching ramifications. For example, they can lead to claim denials, excessive charges, or treatment delays if an insurer does not deem a physician's proposed treatment medically necessary for the indicated diagnosis.

Unbundling

Medical professionals sometimes use multiple billing codes for numerous parts of a single procedure to increase their reimbursement from insurance companies. However, insurers recognize that specific procedures or therapies cannot be separated for some treatments and procedures and bundle them under inclusive billing codes. Fortunately, insurers usually catch these errors, which can result in patients overpaying for medical services.

Inaccurate Coinsurance Calculation

An EOB informs patients about their payment obligation for the medical care they receive. This amount is often a percentage of the total reimbursement a provider receives. Providers frequently agree to accept reimbursement discounts from insurers for inclusion in their preferred provider networks, which gives them access to more patients. However, sometimes physicians bill patients for the percentage they owe by calculating that amount using their undiscounted fees. Patients can avoid unnecessary overpayments by carefully reviewing their EOB statements to become aware of approved service charges under their plans.

Understanding medical billing can be challenging, but you must first select a health insurance provider. Take the first step and contact one of the independent health insurance brokers at Sackett & Associates Insurance Services to help you find a health insurance plan that suits your needs.

Open Enrollment 2022 Is Here

Mon, 08 Nov 2021 19:45:02 GMT

Open Enrollment 2022 – What You Should Know

Open enrollment is the period when you can change your insurance plan or sign up for a new insurance plan. Open enrollment generally occurs in the winter months, so you can choose your coverage for the upcoming year. This period is limited, and it is difficult to sign up for a new plan outside of this window. Thus, you should analyze your current health plan and decide if you will need more or less coverage in the upcoming calendar year.

Do you need to add a new family member to your plan? Do you want to increase your prescription drug coverage due to a new medical condition? Open enrollment is the time to consider these questions and choose a new health plan if needed. Here’s everything you need to know to navigate open enrollment 2022 and choose the best insurance to meet your family’s needs.

When Is Open Enrollment 2022?

Open enrollment for 2022 begins November 1, 2021, and ends January 15, 2022. During this time, you can enroll in an individual or family plan through the Health Insurance Marketplace . Certain areas may have different open enrollment periods, as dictated by state law. Your policy start date is determined by the date you sign up for coverage. If you enroll on or before December 15, 2021, coverage begins on January 1, 2022. Coverage starts on February 1, 2022, if you register after December 15.

What If I Miss Open Enrollment 2022?

You may still be eligible for health insurance coverage if you fail to sign up for a health plan during the open enrollment period. If you have a qualifying life event, you can change or enroll in a new program at that time. A qualifying life event includes marriage, the birth or adoption of a child, or a long-distance move.

If your family is considered low income, you could qualify to enroll in a plan outside of open enrollment. This option may be available to those who earn 150% of the national poverty level. The maximum income is $19,320 for individuals and $39,750 for a family with two kids. Enrollment options for low-income families occur every month, depending on the state in which you live.

Another option if you miss open enrollment is enrolling in a short-term health policy. These policies generally provide up to a year of coverage. Short-term plans can be expensive, but they may be a good option for healthy individuals. Most short-term health plans do not provide coverage for pre-existing conditions.

What Insurance Plans Are Available?

If you are purchasing coverage from a state or federal insurance exchange, insurers are generally required to cover essential health benefits. You cannot be denied coverage due to a pre-existing medical condition. The coverage available includes:

Preventive care
Emergency care services
Prescription drug coverage
Maternity care
Mental health care services
Substance abuse treatment
Pediatric care

Health insurance plans purchased during open enrollment 2022 through the marketplace have out-of-pocket costs capped. These maximum costs are $8,700 for individuals and $17,400 for families. However, coverage may vary depending on your plan and your state.

How Much Does Coverage Cost During Open Enrollment?

The cost of your health plan will vary depending on the size of your family, your location, and the coverage level. However, the average price of policies purchased on the insurance marketplace was between $313 and $710 per month. Most states are expected to see an increase in healthcare costs in 2022. Actual rate changes are yet to be determined and must be approved by each state.

What Other Benefits Should I Consider?

You should consider your other insurance policies during open enrollment. Dental, vision, life, or other insurance options may be helpful to your family. You may also choose to alter your current coverage levels. Consider these other insurance benefits during open enrollment:

Dental : Many marketplace health plans include an option to add a separate insurance policy. Some policies include particular dental care for adults, and many have dental care for children. Check the dental coverage available before signing up for a new health policy.
Vision : Vision coverage is not available through the federal marketplace, but it may be available through specific state marketplaces. You can also purchase vision coverage directly from an insurance company.
Life insurance : Open enrollment may be an excellent time to consider life insurance. Experts generally recommend carrying insurance if you are your family’s primary income earner. The amount of your coverage should be at least five times your annual salary.

You may want to consider other types of insurance, including long-term care insurance, disability coverage, and supplemental medical coverage.

Work With an Insurance Expert

Are you looking for insurance in Sonoma County, California? Sackett & Associates Insurance Services has provided insurance to individuals, families, and businesses for more than 40 years. Get ready for open enrollment season 2022 now by exploring your insurance options. Contact us today to set up an appointment with one of our insurance advisors.

What To Consider When Choosing The Best Medicare Option for Your Health Needs and Budget

Wed, 27 Oct 2021 16:30:02 GMT

How To Choose a Medicare Plan During Annual Enrollment

Every Fall brings an opportunity to make an annual Medicare election, which often fills people with dread due to the range of choices that bombard them over the summer. A health insurance broker licensed to sell Medicare health plans in Santa Rosa can help you navigate the ongoing changes to Medicare that leave many people confused and lead to challenges in making decisions that ultimately affect coverage.

Circumstances That Would Require You To Select a New Plan

Medical insurance should cover routine and unexpected costs associated with the prevention and treatment of illness. As you age, you are more likely to rely upon your medical insurance for the frequency and variety of care you need to stay healthy; however, your Medicare insurance provider may no longer match your needs for the following reasons.

It stops covering your preferred medical providers
It provides less coverage for vital prescription drugs
Its premiums rise dramatically
It does not offer the benefits you currently need

Ways To Prepare To Change Your Medicare Plan in 2022

A health insurance broker licensed to sell Medicare health plans in Santa Rosa may advise these steps to prepare you to make your election during the 2022 Medicare annual enrollment period.

Review Your Current Coverage

Before you decide to change your Medicare coverage, it is essential to understand the details of your current plan. For example, government-sponsored Original Medicare Parts A and B and private Medicare Advantage plans provide in-hospital and routine medical benefits. However, you need a supplemental Part D plan for prescription drugs coverage if you have Original Medicare. In contrast, Reviewing your current Medicare coverage will also help you choose the best option to minimize your out-of-pocket costs.

Confirm That Your Doctors Will Continue To Accept Your Existing Plan

With an Original Medicare plan, you can visit any medical providers of your choice without worrying about coverage; however, if you have a Medicare Advantage plan, you will need to select providers in the plan's network. Medicare Advantage plans all have different networks, making it necessary to confirm that your providers are part of the network to ensure your health plan will cover treatment from them.

List The Medications You Take

Before deciding to change your Medicare plan, take an inventory of all the medication you are currently taking or planning to take. Preparing a list with dosages and brand or generic names will allow you to calculate drug costs under multiple plans and find the Medicare plan that best suits your budget.

Leave Time To Review Your Notice of Change Packet

You should receive a packet including the annual notice of changes for your Medicare Part D drug plan or your Medicare Advantage plan by the end of September. Reviewing this packet as soon as possible will ensure that you know about all upcoming changes and have time to consider new plan choices before the end of the annual enrollment period.

Find Out How a Medicare Plan Can Impact Your Other Insurance

You can choose to have a Medicare plan along with another health insurance plan, but knowing what each plan covers will ensure you gain the maximum benefits from each. For example, if you have an employer-sponsored medical insurance plan, it is usually considered the primary payer on a claim if your employer has more than 20 employees. Therefore, Medicare can pay the claim balance as the secondary payer. However, if your employer has fewer than 20 employees, the primary payer is Medicare, and your employer's plan is the secondary payer. In other instances, you may need to choose one plan to pay a claim. For example, if you have both Medicare and Veterans' insurance, you can not apply both to the same medical claim.

Check Your Eligibility Status

Knowing your eligibility for Medicare plans will save you time when choosing an option that will work for your particular circumstances. For example, before you begin your application for Original Medicare Part D prescription coverage, you must make an election for Medicare Parts A and B. Also, if you are thinking of switching from Original Medicare to an Advantage plan, you must live in the area that the Advantage plan services.

Keep Track of Deadlines

Although your Medicare plan starts on the first day of the new year, you must make your selection between October 15th and December 7th of the previous year. You cannot change your Medicare plan after December 7th and must wait one year for the next opportunity to do so.

Work With a Licensed Health Insurance Broker in Santa Rosa

The annual Medicare enrollment period leaves many people worrying about making a wrong decision, leading to high costs for vital health insurance or insufficient coverage. Fortunately, you can count on Sackett & Associates Insurance Services for helpful advice about choosing the best Medicare plan.

For more information about how our knowledgeable Medicare advocates can help you choose a Medicare plan during the annual 2022 enrollment period, contact us at (707) 823-3689.

Why You Need to Sign the Medicare Scope of Appointment Form

Mon, 11 Oct 2021 18:00:03 GMT

Understanding Why You Need To Sign a Medicare Scope of Appointment Form

Nobody likes salespeople who are pushy, or even worse, dishonest. As you likely know, though, these people are found everywhere — even in the healthcare industry. When you’re shopping for a Medicare policy, you want to avoid these people at all costs, but doing so isn’t always easy. Luckily, a Scope of Appointment form can help you combat such experiences and ensure that any meetings with representatives are only spent discussing topics you’re comfortable with. Read on for four reasons why you should sign a Scope of Appointment form before you meet with a Medicare health insurance broker in Santa Rosa.

1. Scope of Appointment Is Usually Required

So what exactly is a Medicare Scope of Appointment form, and why do you need to sign one? A Scope of Appointment form is a document that must be completed before meeting with a Medicare health insurance broker in Santa Rosa. It provides potential beneficiaries with a list of topics that may be discussed, including Medicare plans and other insurance products, so that you may indicate what you are and are not interested in discussing.

By submitting the form, you are creating a contract with the Medicare health insurance broker in Santa Rosa, preventing them from selling you unwanted products or pressuring you to sign something you are not comfortable with. In addition to being a helpful resource, a Scope of Appointment is federally required for private meetings between a potential beneficiary and an insurance representative.

2. Understand the Role of an Insurance Agent

In order to understand the importance of a Scope of Appointment form, you should first understand the role that a Medicare health insurance broker in Santa Rosa plays. A health insurance broker, ideally, is an advocate who works to connect you with the best coverage available for your situation. Some of the benefits of working with an insurance agent include:

Assistance finding the right coverage
Take advantage of deals and discounts
Get personalized advice on policies

These advantages make it worthwhile to work with an agent, but in most cases, completing a Scope of Appointment form is still a necessity. Why? Many health insurance agents sell other insurance products, too, and a Scope of Appointment form ensures that they are only permitted to market Medicare or other products that you pre-approve.

3. Know What to Expect from an Appointment

A Scope of Appointment form also helps you understand what to expect from an appointment. Typically, a Medicare health insurance broker in Santa Rosa will make an appointment with you — whether it be on the phone or in person — and they will use the appointment time to help you understand the coverage options that are best suited to your situation. You may discuss different Medicare plans or Medicare supplements such as Plan G, Plan F, or Medigap coverage.

When you complete a Scope of Appointment form, you can attend your appointment with confidence, knowing that you are prepared to discuss the topics you’ve already approved — and you’re protected from discussion of any topics you don’t want to broach. This spares you from the anxiety that can occur if there are no boundaries in place during your meeting. With a Scope of Appointment in place, you need not fear unwanted marketing efforts from a Medicare health insurance broker in Santa Rosa.

4. Get All the Info You Need, and None You Don’t

When you make the effort to set up a meeting you want to spend that time discussing the most pressing matters — like Medicare coverage and policy options — not hearing a sales pitch for a product you aren’t interested in. A Scope of Appointment Form allows you to ensure that you get all of the information you need out of your time spent with a Medicare health insurance broker in Santa Rosa and none of the information you don’t.

Scope of Appointment forms legally protects you from unwanted marketing efforts because they act as a contract between you and the insurance representative. These forms must be kept on file by the Medicare health insurance broker in Santa Rosa for ten years after the date of implementation. If you need to make any changes to the Scope of Appointment form, a new one must be completed and signed in order to replace the document that was previously held on file.

Medicare Coverage Without Complications

Your life is complex enough. When you’re shopping for Medicare, you want simplicity. A Scope of appointment form helps keep things simple and ensure that you find the right policy without enduring a high-pressure discussion of productions you aren’t interested in. A Medicare health insurance broker in Santa Rosa can guide you through all of your Medicare coverage options to help you find a plan that’s affordable, effective, and ideal for your unique situation. For more information on enrolling in Medicare coverage, call Sackett & Associates Insurance Services at (707) 823-3689 or reach out to us online.

What You Need to Know About Open Enrollment Years

Thu, 23 Sep 2021 18:00:04 GMT

Your Guide to Understanding How Open Enrollment Years Work

Health insurance is a notoriously complicated subject in the United States. Whether you're purchasing it for the first time or switching plans, keeping track of the Open Enrollment Period is critical. Here are the answers to your top questions about Open Enrollment Period (OEP) and how they affect your healthcare decisions.

What Are Open Enrollment Periods?

OEPs are the times when you can switch to a different health insurance policy. They happen once a year, and most major health insurance providers follow the same OEP schedule. Whether you purchase your own insurance plan or use your company's, the OEP is your chance to make any changes.

When Do New Open Enrollment Periods Happen?

OEPs for the next year's individual health insurance begin on November 1 each year. They close sometime in mid-December. For example, the OEP in 2019 ended on December 18, and the OEP in 2020 ended on December 15.

Why Are Open Enrollment Periods Named The Way They Are?

OEPs are named after the year in which the new healthcare plan will take effect, not the year in which plans are purchased. The OEP that closed on December 18, 2019, was OEP 2020, and the one that closed on December 15, 2020, was OEP 2021. If you're ever confused about what OEP year you're registering for, double-check when your plan starts providing coverage.

What Is Open Enrollment Period 7?

Although the OEP between November and December 2019 can be called OEP 2020, it's also called OEP7. This phrasing is common with legislators because it refers to how many years have passed since the Affordable Care Act took effect. OEP1 (also known as OEP 2015) happened in 2014, and OEP8 (also known as OEP 2021) took place in 2020. Either naming system is correct, but you're more likely to see the actual year when you're choosing health insurance.

How Long Do Open Enrollment Periods Last?

In the early years of Medicare, OEP lasted for 26 weeks until it was reduced to a few months. In 2017, the Department of Health and Human Services declared that the federal government's OEP would only be six weeks long. As a result, each official OEP follows these guidelines, but states may extend their periods as long as they like.

What if You Don't Enroll in Healthcare During Open Enrollment Period?

Although the ACA is still in effect, the part that required all people to have health insurance or face penalties has been repealed. As a result, if you don't have health insurance and you don't enroll during the OEP, you won't face any federal fines. Your state may have its own penalties to encourage residents to get coverage, though.

Some states, including California and Massachusetts, offer longer OEPs so that it's easier for people to sign up for insurance. If you're unsure when your deadlines are, reach out to your employer or state government. Keep in mind that Medicare and other federal programs are probably unavailable outside of the official OEP.

What Is the Special Enrollment Period?

If you're still not insured and a major change happens in your life, you may qualify for the ACA's special enrollment period. If you move, lose your insurance plan, get married, get divorced, have a baby, start a job, exit the military, or leave your parents' healthcare plan, you're eligible for this period. Regardless of which OEP year it is, you have 60 days to sign up for Medicare without facing fines.

When Is Medicare's Open Enrollment Period?

Medicare does not follow the same OEP schedule as other major plans. Its enrollment session is called the Annual Election Period, and it starts on October 15 and ends on December 7. This period overlaps with the OEP but ends earlier, so you have plenty of time to make an informed decision.

If you don't like your Medicare plan, the Medicare Advantage Open Enrollment Period happens every year from January through March. Unlike the normal AEP, you can't make whatever changes you want. You can, however, move from an Original Medicare plan to an Advantage plan. You can also switch between different Medicare Advantage policies.

Why Do You Need to Keep Track of Open Enrollment Period Years?

If you don't remember that the OEP for each year takes place in the fall of the previous year, it's easy to miss your opportunity to get insurance or switch plans. For example, if it's 2022 and you hear about new offers for OEP 2023, you might think that you can wait until January 2023 to take advantage of them. Some healthcare providers may allow you to sign up outside of this period, but there are often penalties or fewer plans to choose from.

Staying informed about OEP years allows you to make informed decisions about your health insurance policy. For more information on how to sign up for individual health insurance, contact our team at Sackett & Associates Insurance Services. Call us at 707-823-3689 or use our online form to ask your questions.

Sign Up for Medicare: How and When to Enroll in Medicare

Fri, 10 Sep 2021 13:30:02 GMT

Sign Up for Medicare: How and When to Enroll in Medicare

There are many paths to enrolling in Medicare. While some people are automatically enrolled, others may need to take steps to get their enrollment finalized. For information on how and when to enroll in Medicare, read below.

How to Enroll in Medicare

You can enroll in Medicare over the telephone, but different situations can require specific phone numbers. For instance, if you previously were employed by a railroad, enrollment in Medicare should be completed by calling the Railroad Retirement Board. They can be reached at 1-877-772-5772. For TTY users, the number is 1-800-325-0778.

You may also enroll in Medicare by contacting Social Security via telephone at 1-800-772-1213 or, for TTY users, 1-800-325-0778. Their office hours are 7AM to 7 PM Monday through Friday.

Enrolling in Medicare online is another option for those who are computer-savvy. You can apply online through the Social Security website .

When to Enroll in Medicare

Enrollment periods vary depending on circumstances. If you are receiving Social Security or Railroad Retirement Board retirement benefits, you will be automatically enrolled in Medicare Part A and Part B. If you reside outside of the United States or D.C., you may be automatically enrolled in Medicare Part A , but you must manually enroll in Medicare Part B.

Situation A: You Receive Disability Benefits

For those who are younger than 65 but receive disability benefits through Social Security or the Railroad Retirement Board, enrollment in Original Medicare, Medicare Part A and Part B will be automatic after you have received disability benefits for 24 months. There is an exception for those who have end-stage renal disease (ESRD). For those who have ESRD and need regular kidney dialysis or had a kidney transplant, Medicare is an option. Individuals who have Lou Gehrig’s disease or amyotrophic lateral sclerosis (ALS) will be enrolled in Original Medicare automatically when disability benefits begin.

Situation B: You Don’t Want Medicare Part B

For those who have been enrolled in Medicare Part B automatically but don’t want to keep it, you can still drop it. If you were sent a card but your Medicare coverage has yet to begin, you can simply send the card back per the instructions that came with it. If you keep the card, however, that is considered acceptance of the plan and you will be responsible for paying Medicare Part B premiums. Those who signed up through Social Security will need to contact Social Security for directions on how to cancel Medicare Part B coverage.

For those with healthcare through their employment, delaying Medicare Part B is an option. Contact your health benefits administrator to get information on how things might change if you decide to drop your Medicare Part B enrollment.

Situation C: You Don’t Receive or Qualify for Retirement Benefits

Individuals who are nearing 65 but have not yet begun to receive retirement benefits can enroll in Medicare Part A and Part B. Even if you have decided to delay Railroad or Social Security retirement benefits, you can still enroll in Medicare and accept your retirement benefits later on.

If you will not receive retirement benefits at any point through Social Security or from past employment, your enrollment into Original Medicare will not be automatic. You may still sign up during your IEP for Medicare Part A, though it’s possible you will not get yours premium-free. Your premium will instead depend on factors such as the length of time you were employed and paid into Medicare. Your Medicare Part B premium will also need to be paid.

Situation D: You Didn’t Enroll During Your IEP When First Eligible

If for some reason you chose not to enroll in Medicare when you first became eligible, you may still enroll during what is called the General Enrollment Period. For Original Medicare, this lasts from January 1 to March 31 annually. Late enrollment penalties can apply for those who did not sign up during their IEP.

Situation E: You Lost Other Coverage and Need to Enroll

If you chose not to sign up for Medicare Part B initially because you had other medical insurance, you have an option to enroll during a Special Enrollment Period if your insurance is lost or you choose to make the switch to Medicare. This special period is different for every person as it starts when either your employment or health insurance ends, whichever comes first. After this occurs, you have eighth months to enroll and usually do not have to pay a penalty for late enrollment as long as you enroll within this period of time.

Medicare Part C and Medicare Part D

In addition to the main Medicare Parts A and B, you may also enroll in Part C and Part D. Medicare Part C or Medicare Advantage is a way of receiving Original Medicare benefits that is offered through private insurance. Medicare Part D is intended to help cover costs related to prescription drugs.

Medicare enrollment can be a complicated process but getting the coverage you need is vital. For help navigating Medicare enrollment and making sure you’ll get the care you need when you need it, contact Sackett and Associates Insurance Services today.

A Guide to the Differences Between an HMO, PPO and EPO Plan

Mon, 23 Aug 2021 16:02:13 GMT

HMO, PPO and EPO Insurance Plans: What's the Difference?

Choosing an insurance plan can be difficult, especially if you don't understand the differences between them. This guide will teach you everything you need to know about HMO, PPO and EPO plans, allowing you to make an informed decision about which individual health insurance plan best fits your needs.

Health Maintenance Organization (HMO)

An HMO plan is one of the most affordable types of health insurance, making it a great option if you're on a tight budget. In this plan, you'll be required to choose doctors within the network. Once you pick a primary care physician, who you'll see for regular checkups, he or she will provide you with referrals to see other specialists, such as a dermatologist or cardiologist. Your primary care physician will also handle routine illnesses and preventative care.

Because your primary care physician is responsible for coordinating your care, it's imperative that you choose one you trust. If you do choose to see a doctor outside of the HMO network or without a referral, you'll probably have to pay out of pocket unless it's a medical emergency. Therefore, the HMO plan is a good choice if you don't have many serious medical issues. Because the HMO network can help control costs, the premiums and deductibles are generally lower than PPO and EPO plans.

Take Andrew, for example. Because he's trying to pay off his student loans, he chooses an HMO plan because it'll allow him to keep his expenses down and pay off his debt much quicker. Andrew doesn't have any serious health problems, making him a great candidate for an HMO plan. His main doctor is his primary care physician, and he'll be able to see in-network specialists through his doctor's referrals.

Preferred Provider Organization (PPO)

Often known as the plan with the most freedom, a PPO usually has higher premiums and deductibles than an HMO or EPO. However, this plan gives you the flexibility to see specialists and doctors outside of the network without having to ask for a referral from your primary care physician. In fact, some PPO plans don't require you to have a primary care physician at all. You have the freedom to go to any healthcare professional you want, regardless of whether they're inside or outside of the network.

If you do choose to stay in your PPO's network, however, you can gain access to negotiated rates on services. The copays and coinsurance for in-network doctors are more affordable than those outside of the network. A PPO plan is a great option if you're willing to pay a higher monthly premium to have more flexibility in choosing specialists and other health care options.

To help visualize who would be a good candidate for a PPO plan, take Madison. She's trying to conceive, so she chooses the PPO plan to give herself the freedom to choose the best fertility doctor in her area. Although she'll have to pay more money because this specialist is out of network, her main goal is to get pregnant and therefore is willing to make a financial sacrifice. She's able to afford a doctor outside of her plan's network, so this isn't a major issue for her.

Exclusive Provider Organization (EPO)

While an HMO and PPO are at opposite ends of the spectrum, an EPO is somewhere in the middle, combining aspects from both plans. An EPO plan is more flexible than an HMO and more affordable than a PPO. Similar to a PPO, an EPO doesn't require you to obtain a referral to see a specialist. In addition, you aren't obligated to have a primary care physician to see a specialist. However, like an HMO, you're required to pay out of pocket if you see a doctor that's outside of your plan's network. Therefore, an EPO plan is suitable if you want the flexibility to be able to see specialists without a referral from your primary care physician.

Claire has a thyroid condition and therefore sees her specialist a few times a year. Because she travels often, she knows that she needs an insurance plan that'll allow her to seek care away from home. Therefore, she chooses an EPO. Not only will she be able to find a specialist within the network, but she doesn't need a referral from a primary care physician. She's willing to pay a bit more for this convenient feature, which makes her a great candidate for an EPO plan.

Contact Your Local Health Insurance Broker

Insurance is complicated, which is why our team of skilled professionals at Sackett & Associates Insurance Services is here to help. Whether you need help choosing an insurance plan or want some more information about individual health insurance plans, our expert agents will work with you to find the plan best suited for you and your family. Contact Sacket & Associates Insurance Services to learn more about how we can help you choose

5 Tips To Help You Start Offering Health Benefits at Your Small Business

Tue, 10 Aug 2021 17:00:05 GMT

5 Small Business Health Benefits Tips

Did you know that many employees accept job offers based upon the benefits they expect to receive? Health benefits top the list of what job candidates value and can significantly impact the hiring process. Group health insurance for small business needs and other health benefits can help your company attract and retain top talent to ensure its competitive edge. Starting a new benefits plan may seem daunting, but these five tips can help.

1. Understand Why Offering Health Benefits Is a Win-Win

In addition to helping small businesses attract talented and loyal employees, health benefits achieve the following:

Better productivity and fewer sick days for employees who have access to preventative care and prompt medical treatments
Insurance premiums and medical treatment that employees can afford
Significant government tax incentives for businesses that offer health insurance
Financial savings for employees who use pre-tax dollars for premium payments

2. Do Your Research Carefully

Medical insurance is the most significant health benefit your business can offer, and researching the options starts with answering the following questions to narrow down your choices and make a decision:

How many team members do you plan to cover?
Will you offer coverage for part-time employees or dependents?
What is the average cost of health insurance premiums in your area?
What percentage of the cost can you contribute?
How frequently does your staff travel internationally?

When you are offering health insurance for the first time, you may want to ask your employees what features they consider most desirable. For example, some team members may only benefit from policies that cover pre-existing conditions.

Your business's specific requirements and budget will help you choose from these three available options:

Group Health Insurance for Small Business

This health insurance option draws from a pool of participants from multiple companies to create an economy of scale. Participating small businesses may enroll up to 50 employees, and at least 70% of their employees must opt for coverage. Family members are often eligible and help keep costs down.

Premium rates remain in place for one year, despite individual employee coverage changes. After one year, a small business may opt to continue the same plan, usually with a premium increase. Premiums, deductibles, provider network, and prescription coverage may determine the health insurance plan a business selects. Optional vision and dental coverage, which medical insurance does not include, is also available.

Health Reimbursement Account

Qualified Small Employer Health Reimbursement Accounts can pay for participating employees' medical expenses or health insurance premiums. Employers fully fund these accounts and determine eligible medical expenses reimbursable through payroll transfers or payable at the point of service with pre-funded cards. After using their allotted funds for the year, employees must pay additional costs out of pocket.

This option is available to small businesses with fewer than 50 employees that do not offer small group health insurance or flexible spending accounts. The funds are 100% tax-deductible for employers, and reimbursement is tax-free for employees.

Health Care Stipend

Small businesses with very few employees sometimes offer annual lump-sum stipends to cover medical expenses. This option essentially amounts to a pay increase or bonus without the tax advantages of traditional health insurance or HRAs. These funds are also subject to payroll taxes for employers and income taxes for employees. Employers can not guarantee that employees will use this benefit as intended. If they discontinue it, they risk inspiring resentment if employees equate losing the stipend with a pay cut.

3. Work With a Broker

Researching health benefits to offer your employees can be labor-intensive and take your focus away from your daily tasks. In addition, if you have no experience selecting benefit plans, you risk making costly mistakes. Working with a broker with the skills and expertise to understand your needs can ensure you comply with state and federal regulations without costing you anything. Instead, health plan carriers pay brokers' fees, and your company maintains a valuable partner for answering policy questions, negotiating with carriers, or helping HRA-enrolled employees choose individual health insurance plans .

4. Educate Your Staff

Employees will not appreciate the value or extent of their health benefits unless employers make them known and take the time to explain specific details concerning provider networks, deductibles, pre-approvals, telehealth options, and coverage periods. In addition, employees who recognize their employers' contributions and know how to get the most value from their health benefits have greater loyalty and goodwill for their employers than those who remain uninformed.

5. Consider Additional Health Benefits

Medical insurance does not include dental and vision coverage, which employees value, but these benefits cost very little to add to your health benefits package. Wellness benefits can also make a significant impact without breaking your budget and might include:

Distributing weekly e-newsletters with fitness tips
Offering daily 15-minute walking breaks
Closing early to accommodate a group trip to a nearby pharmacy for flu shots
Giving employees personalized water bottles to encourage hydration

Are you ready to take your small business to the next level? Contact one of our knowledgeable brokers for help putting together a competitive health benefits package.

What Do You Do When You Age Out of Your Parent's Health Insurance Plan?

Wed, 07 Jul 2021 21:13:59 GMT

What Do You Do When You Age Out of Your Parent's Health Insurance Plan?

For many twenty-somethings, health insurance is a benefit that has always been available when needed. Because their parents likely purchased a plan or were offered one by an employer, young adults rarely have to think about where their medical coverage comes from. At some point in time, however, most adults must seek out their own health insurance, a responsibility that is not always as straightforward as it might seem. Consider a few questions that may help you or your child successfully navigate the world of health insurance.

When Should You Start Looking for a Health Insurance Policy?

Fortunately, insurance companies do not kick teens off their parents' policies upon reaching the legal age of adulthood. In fact, federal laws set forth in the Affordable Care Act mandate that young people be allowed to stay on their parent's plan until they are 26. This is true even in situations where young adults are independent of their parents. For instance, a 24-year-old who lives on his or her own, has a child, or is offered an insurance plan through an employer can still choose to stay on a parent's policy.

In a number of states, twenty-somethings may be able to stay insured through their parents even past age 26. If a young adult is disabled, for example, it may be possible for him or her to stay on a parent's plan indefinitely. People that are full-time students or are not married may receive some extra time, as well.

How Much Does Health Insurance Cost?

Insurance policies vary greatly in their cost, requirements, and extent of coverage. It's essential that you find a balance between these factors that works for you. For example, plans that have low monthly premiums frequently feature high deductibles. This means that you could be surprised with a large medical bill if you fall ill or are in an accident. Make sure your budget allows for both your regular payments and the unexpected ones. Fortunately, many policies have an out-of-pocket maximum which may prevent you from having to pay an unreasonable amount of medical bills.

Can You Gain Medical Coverage Through Your Job?

One of the simplest and most affordable ways to secure a health insurance policy after aging out of your parent's plan is to accept one that is offered by your employer. Employer-sponsored health insurance can be cost-effective because employers often pay for part of the monthly premium; however, the business owner also has the power to choose exactly what type of plan you receive.

What Do You Do If Your Employer Doesn't Offer Insurance Coverage?

When you do not have an opportunity to be insured through your job, you may wish to look into the health insurance marketplace. November and December are often great times to start a new plan. You can browse all your available options online to better understand what each plan offers and what it costs. Though your insurance could potentially be a bit pricier by taking this route, you have more control over the type of policy you choose.

In some circumstances, you may have access to alternative types of insurance, as well. People of lower income, for instance, may be able to benefit from Medicaid. Additionally, if you are a student, be sure to inquire about any insurance options your school may offer.

If you were to leave a job suddenly and lose your employer-sponsored health insurance, you are not left with no recourse. Some insurance companies offer short-term plans that can hold you over until you find another source of coverage. Similarly, the Consolidated Omnibus Budget Reconciliation Act helps workers maintain coverage while searching for a new job.

Which Option Is Right for You?

There are many factors that may influence the type of plan you need. If you have dependents, for instance, you may wish to look into a family policy. If not, an individual health insurance plan may be preferable. Different policies may also place limitations on the types of medical visits they cover. If you don't feel the need to seek out your own doctors, a Point of Service or Preferred Provider Organization plan may be a good choice. Additionally, remember that dental and vision coverage are frequently optional additions to your regular health insurance plan.

Is Health Insurance Worth the Cost?

Even if you rarely experience medical problems, it's critical that you maintain insurance of some kind. After all, life can bring about unexpected circumstances that may leave you with steep medical bills. On top of that, having insurance makes it more affordable to carry out preventative health measures so you can stay healthy as you grow older.

Line Up Your Plan Today

If you are approaching the age limit on your parent's health insurance plan, or your child is about to age out of yours, start looking into new types of coverage as soon as possible. To learn more about the best policy for your circumstances, call Sackett & Associates Insurance Services at (707) 823-3689

Working With a Health Insurance Broker to Find the Right Plan

Wed, 07 Jul 2021 18:00:02 GMT

Benefits of Working With a Health Insurance Broker

Whether you’re a business owner trying to find the best healthcare plan for your employees, or you are simply in the market for a health insurance plan, utilizing the services of a broker can save you money and time. A health insurance broker can simplify the shopping and buying process associated with health insurance plans while helping you find a plan that will suit the needs of you and your family. If you are in the market for group or individual health insurance , here is some important information about working with a broker.

What Does a Health Insurance Broker Do?

If you are ready to purchase a health insurance plan, you should talk to a broker first. A health insurance broker is a professional who is licensed to help businesses and individuals navigate the health insurance selection and buying process from start to finish. Some people prefer to research plans and buy insurance on their own, which is okay, but others have difficulty choosing between plans and understanding what type of coverage they really need. Such individuals can greatly benefit from working with a health insurance broker. A licensed professional can help you differentiate between the numerous plans you are presented with and find one that fits your unique needs and budget.

Agents vs. Brokers

When it comes to helping others find and purchase a health insurance plan, there are agents and brokers. It can be difficult to distinguish between the two types of professionals, especially if you’ve never reached out for help to buy a plan before.

A health insurance agent works directly with an insurer and is almost always contractually obligated to them. This means they can only act on behalf of the insurance company they have a contract with, so they can only sell that company’s plans. For example, a health insurance agent who contracts with Anthem can only sell Anthem plans. Working with an agent can be beneficial if you already know what insurance company’s plans you want to look at. Otherwise, you may want to work with someone who can offer you a wider range of plans.

Like a health insurance agent, a health insurance broker assists consumers in finding and buying health insurance plans. However, unlike an agent, a broker is not contractually bound to a single insurer. Brokers work with numerous insurance companies who pay them a flat-fee commission or percentage on plans they sell to individuals and businesses. In other words, brokers can often offer consumers a wider range of insurance products.

Benefits of Working With a Broker

Working with a licensed insurance broker can give you the confidence you need to find the perfect health insurance plan at the right price for your family or business. Utilizing the services of a health insurance broker can also have the following benefits:

Personalized Recommendations: A licensed broker can easily explain the pros and cons of various health insurance packages. The personalized advice they offer to each client can prove to be immensely helpful.
Support: Policyholders can contact their broker directly if they have questions or concerns regarding coverage eligibility, access to care, claims payments, and other issues – which cannot be provided on a website.
In-Depth Health Insurance Knowledge : Brokers can help clients understand the ins and outs of health insurance. They can also help older consumers better comprehend their options for long-term care and Medicare coverage.

Simply put, there are numerous benefits and advantages associated with working with a health insurance broker.

Visiting a Health Insurance Broker

What exactly happens when you talk to a health insurance broker for the first time? First of all, the broker will attempt to understand your current healthcare situation. They may ask questions such as:

Do you currently have coverage?
What is your budget?
Do you see any specialists? How often do you visit the doctor? Do you need to keep your current doctor?
Which pharmacies do you visit?
Will you be adding a spouse or dependents to your plan?
Do you currently take any prescription medications?

Once your broker has an idea of what you are looking for, you will be presented with plans that fit your needs.

If you are presented with more than one potential plan, your broker will help you distinguish between them by explaining each of the different insurance plan categories (ex: HMO, PPO, POS, etc.). They can also help you better understand pricing terms and the difference between on and off-exchange health insurance policies. If necessary, your broker will help you compare provider networks as well.

Finally, your broker will help you choose and purchase the right health insurance plan. If you choose an ACA plan, your broker can help you find out if you are eligible for a subsidy. Your broker can also walk you through your policy’s summary of benefits, so there will be no surprises later.

Contact Us

Finding the ideal health insurance plan can be difficult, but it can be done. Our insurance professionals have an in-depth understanding of health insurance, and they can definitely help you find a plan that meets or exceeds your needs. Contact Sackett & Associates Insurance Services to get started today.

Should You Choose High-Deductible or Low-Deductible Health Insurance?

Fri, 02 Jul 2021 18:44:41 GMT

Low-Deductible Versus High-Deductible Health Plans

Having health insurance protects you from paying high medical bills. In the event of a serious illness or injury, your insurance company covers at least some of the expenses involved with your treatment. However, the trade-off is that you have to first pay something to obtain the coverage and then absorb a portion of the costs of treatment yourself. The price you pay to have coverage is the premium, while the amount you have to contribute toward your own care is the deductible.

You have the choice of a plan with either a high deductible or a low deductible. Each offers advantages and disadvantages. A health insurance broker in Santa Rosa can help you determine which can serve you better based on your individual situation.

What Is a Deductible?

In many cases, your health insurance doesn't cover all your medical bills automatically. Most insurers require you to pay a certain amount of the medical expenses out of your own pocket. That amount is your deductible. Once you reach that threshold, your health insurance kicks in and should cover most, if not all, of the remaining medical expenses that you incur for the rest of the year. Deductibles are usually annual, meaning that at the beginning of the year, your deductible amount goes back to zero and you will have to pay a portion of your medical expenses until you meet your deductible limit again.

Here is a hypothetical example of how deductibles work. Suppose you had an accident in which you fell and broke your arm. The total cost to treat your arm, including X-rays, physical examination, casting, and rehabilitation, is $14,000. You have a health insurance policy with a deductible of $6,000. You would be responsible for paying the initial $6,000 of your medical expenses, at which point the insurance company would pay the remaining $8,000, as well as any other medical expenses unrelated to your arm that you incur over the rest of the year.

Now imagine that you have a policy with a deductible of $1,500. In this instance, you would meet the deductible more quickly and pay less out of pocket for your broken arm. The insurance company would cover $12,500 instead of only $8,000.

A deductible may be confused with an out-of-pocket limit. Both relate to your responsibility for your medical expenses, but they are not the same thing. The deductible is the minimum amount you have to pay before insurance starts covering medical bills. The out-of-pocket limit is the maximum that the insurance company can require you to pay.

How Does Deductible Relate to Premium?

An insurance premium is sort of like a subscription rate. It is the price you pay per month for coverage by your insurance policy, regardless of whether you go to the doctor or not. Your premium amount stays the same from month to month. If you go to the doctor, you have to pay deductible expenses or co-pays in addition to your monthly premium. If you fail to pay your premium monthly, your coverage comes to an end.

There is usually an inverse relationship between your insurance premium and your deductible. In other words, a policy with a high deductible will charge you a lower premium per month, making the policy more affordable. However, if you want a low deductible, you will have to pay a higher monthly premium.

What Are the Advantages of Each?

The advantages of a low deductible should be fairly obvious. You do not have to pay as much of your medical expenses before insurance kicks in and starts covering them for you. Not only that, but low-deductible plans may offer extra benefits. A low-deductible plan can be especially beneficial if you have a chronic condition for which you need to see the doctor often. Young children often need frequent visits to the doctor for check-ups, so if you are a parent, you may benefit from a low-deductible policy.

However, if you are fairly healthy and rarely have to see the doctor, a low-deductible plan may not be to your advantage because of the high premiums. It may be better to have a high-deductible plan that would charge you less per month and put aside savings to cover the deductible if you ever have need. In some cases, a high-deductible health plan can make you eligible for a health savings account. This allows you to contribute pre-tax funds to save for qualifying medical expenses, both big and small. You can also earn interest with an HSA and invest it in mutual funds and stocks. However, the health plan has to comply with requirements set by the IRS to be eligible.

Get Help From a Health Insurance Broker in Santa Rosa

Depending on your financial situation, either a high- or low-deductible health plan may offer you more advantages than the other. For more information about the type of plan you should choose, contact us at 707-823-3689.

Do I Have To Provide My Employees With Health Insurance if I Am Self-Employed?

Mon, 24 May 2021 20:15:02 GMT

Do I Need To Provide My Employees With Health Insurance?

Health insurance can be a confusing topic, especially when you are self-employed. If you are self-employed and considering hiring employees, it can become even more confusing. As a business owner, you have to follow the guidelines of the Affordable Care Act in regards to health insurance, but do you really need to provide your employees with coverage? If you are self-employed and hiring employees, here is what you need to know about coverage under the Affordable Care Act.

Requirements for Providing Coverage

Simply put, under the Affordable Care Act, you do not need to offer health insurance benefits unless you are hiring at least 50 full-time employees. Businesses with fewer than 50 employees, whatever their formation, do not have to offer health insurance.

However, just because you don’t have to offer insurance doesn’t mean your employees will be left out in the cold. There may be Small Business Health Options Program plans available in your area. If there are such plans available to you, you may be able to obtain a small business tax credit so you can offer coverage to your employees at an affordable price.

If you have fewer than 25 employees, you may be able to obtain a tax credit for up to two years if you purchase a plan through the SHOP exchange. You will need to pay a minimum of 50% of your employees’ premiums, and your employees need to have an average income of less than $50,000.

Purchasing Coverage Through a Broker

If you don’t like the idea of purchasing a plan through the SHOP exchange, you still have other options available. You do have the option of purchasing a small group plan directly from the health insurance company with the help of an employee benefits broker in Santa Rosa. Employee benefits brokers have in-depth knowledge of the insurance-buying process and are able to answer any questions you may have about health insurance. In short, a broker can simplify the buying process and make finding the right type of coverage for your employees easier.

A health insurance broker is a licensed professional who is capable of helping businesses and individuals manage their health insurance coverage. Researching and buying health insurance for a large number of people on your own can be difficult and exhausting, and many people find themselves quickly overwhelmed by the prospect. Professional health insurance brokers can help you understand your options and sift through them in an efficient manner. They can also help you find a plan that meets your employees’ needs while fitting into your budget.

QSEHRAs and ICHRAs

As an employer, you can also encourage your employees to find health insurance on their own. You could still help out with the cost by offering a QSEHRA or ICHRA, both of which allow you to cover some of your employees’ costs by reimbursing them on a pre-tax basis.

A qualified small employer health reimbursement arrangement allows employers who do not offer health insurance coverage to their employees to reimburse them tax-free for their premiums. This applies to any coverage an employee may have, whether it was purchased on or off the exchange. In 2019, the maximum amount employers could reimburse their employees for was $5,150 for an individual and $10,450 for a family.

An individual coverage health reimbursement arrangement is a relatively new form of reimbursement that became available in 2020. ICHRAs allow any employers, regardless of size, to reimburse their employees for the health insurance they purchase on their own. Employers may reimburse employees for some or all of their payments, and many people like the fact that an ICHRA can provide additional flexibility in regards to the amount employers can reimburse an employee.

An ICHRA can offer numerous benefits, including the following:

Large employers can utilize an ICHRA to comply with the employer mandate, as long as the benefit is enough to make health insurance coverage affordable.
Employees with grandmothered and grandfathered plans may take advantage of an ICHRA.
There are no limits on how much an employer can reimburse an employee.
Employers can offer both a health plan and an ICHRA.
ICHRA-eligible employees are also eligible for a special enrollment period. This provides additional flexibility and convenience.

These are not the only benefits of an ICHRA, but they are some of the most important. With an ICHRA you can ensure your employees have the affordable coverage they need without breaking the bank.

Learn More

As a self-employed worker considering hiring employees, you have numerous options at your disposal in regards to health insurance coverage. If you don’t want to offer coverage, there are still many ways to financially support your hardworking employees. If you choose to offer health insurance coverage, there are ways to make it affordable. Reach out to Sackett & Associates Insurance Services today to learn more about health insurance for your employees.

Marching Into the Future With a New Logo and Website

Thu, 06 May 2021 19:30:02 GMT

New Logo, New Website. Same Core Values, Same Personal Experience

After many years of utilizing the same design, Sackett & Associates Insurance Services has decided to move forward with a new website and logo. This new site and logo will be a huge step forward in regards to our brand identity and company personality. From now on, you will see our new logo anywhere we advertise and you will have access to our new and improved website. We are always striving to improve and keep our clients in mind, and with our new logo and website, we can do just that.

Our New Logo

The new and old logos share many similarities, but they are fundamentally different in a number of ways. The original logo features a large ampersand that underlaps both the words “Sackett” and “associates.” The new logo still features an ampersand, but it clearly separates both words instead of underlapping them. This gives a cleaner and more defined appearance. There is also a difference between the logos in regards to the “s’ in the word Sackett. The new “s’ is slightly slimmer and somewhat smaller.

Finally, in the original logo, the words insurance services are indented to the right. The new logo features the same words, but they are directly underneath the words “Sackett & Associates.”

Changes to Our Website

You may also be wondering why we changed our website. There was nothing particularly wrong with our old site, but we felt it is time for a change. We are always aiming to ensure our website reflects our values and company goals, so we felt it was time to modernize. You will still be able to find the same important information on our new website, so there is no need to worry. Our new site is a testament to the ever-evolving nature of our business, and we hope you enjoy it.

The new website also provides improved accessibility, so you will be able to find what you need in a quicker manner. The information is also better organized, and overall, the site is more user-friendly.

The Same Core Values and Insurance Services

Although certain aspects of our company have changed, our core values and services have not. We still strive to be a major health insurance broker in Santa Rosa, so we will always be here to help you and your family find the right health insurance plan. Shopping for health insurance can be difficult, but with help from one of our professionals, you can greatly simplify the process and find a plan you and your family will benefit from. Our professionals have first-rate knowledge of the insurance buying process and will be more than happy to share it with you.

With our company on your side, you can make the search for the right insurance plan easier than you ever imagined.

Reach Out to Us

The world of insurance is ever-changing, and we hope our new logo and website can be an accurate reflection of these changes. Reach out to Sackett & Associates Insurance Services today to learn more.

Standard Set-Up Time for Small Business Health Insurance

Fri, 23 Apr 2021 20:00:03 GMT

Health Coverage Set Up Timeline for Small Businesses

To take care of your current employees and draw potential workers, you want to offer health insurance. As an experienced employee benefits Broker in Santa Rosa , Sackett & Associates Insurance Services specializes in helping small business owners protect their workforce. To aid you with establishing a timeline for your company and keep your employees in the know, we want to break down the standard checklist and wait time for setting up a health insurance plan.

Explore Your Options

Your initial step is reviewing health insurance plans that fit your company budget and employee needs. Consider asking your team what they require and desire most from a health insurance plan so you narrow your options and give your workers what they want. Besides consulting your employees, contact small business health insurance professionals to better understand what individual plans offer and personalize your health insurance.

What should you consider while researching insurance options? If your employees already have a regular physician, ask if they prefer health coverage that includes their doctor in the plan's network. Depending on the plan, they may save money and enjoy more benefits if they choose a different network. Consider whether you want to offer all your employees coverage or limit it to full-time workers. On your end, decide if you want to help pay for your workers' coverage.

Apply for Coverage

Once you have a plan you think your employees will like, your next aim is to send out an enrollment kit for your team to look over. Kits include plan rates and benefits and an application. Establish a deadline for your workers to return their completed kits, making sure you send out reminders and let your employees know whom to contact if they have questions.

While your team reviews and completes their kits, you can speak with your health insurance contact to learn what tax forms you must submit to prove your business's eligibility. This may also be the time when you make your first insurance payment, so consider setting a reminder for yourself so you do not forget.

Await Group Approval

After your employees return their completed forms and you submit all necessary documents, expect to wait roughly a week after turning everything in before receiving group approval. You may wait a few days less or more, depending on how everything falls out.

While you wait for approval, have your workers double-check that the physical home addresses they have on file are correct and current, so they receive their cards. Once you receive approval, your insurance provider mails you and your employees welcome documents and employee identification cards. Let your team know they should expect to receive future invoices for their insurance payments two to three weeks before the next month's premium comes due.

Get in Touch With Us

If you have additional questions about the small business health insurance set-up timeline, or if you need help with choosing a viable insurance plan, our knowledgeable representatives are standing by to help. For more information, submit a contact form or call us at 707-823-3689.

Tax Season Is Almost Here! 3 Tips To Consider as You Get Ready

Mon, 12 Apr 2021 21:30:02 GMT

Marketplace Plans and 1095-A Forms

It’s springtime, which means that flowers, thunderstorms, and tax season are quickly returning. Though filing your taxes may be your least favorite activity on that list, rest assured that even a confusing tax year does not have to give you a headache. We’re here to help you make sense of what you need to know to file your 2020 taxes. Consider the following tips from your friendly health insurance broker in Santa Rosa as you get ready for this year’s tax season.

1. Understand the 1095-A Form

If you enrolled in a Marketplace health insurance plan last year, you should have received a 1095-A form by early February. You’ll receive this document from the Marketplace or your HealthCare.gov account, not the IRS — so be on the lookout for this to appear either online or in your physical mailbox. If you haven’t received it by mid-March, you should contact the Marketplace Call Center. Make sure that your address and phone number (or any other relevant contact information) are correct. If you moved in 2020, even if it was during the last week of the year, change your address as soon as possible.

2. Correct Any Errors on Your 1095-A Form

This part is incredibly important because if you send in the wrong information, you risk receiving a lower refund or having to pay more in taxes this year. Make sure that your coverage information is correct, that all members of your household who are covered are listed, and that the correct monthly premium is entered on the form. If you notice an error, contact the Marketplace Call Center immediately. Don’t reconcile yet or file the 1095-A form with mistakes on it! You’ll get a new 1095-A as soon as the error is corrected.

3. Reconcile Your 1095-A Form Before You File

After you’re sure that your information is correct on the 1095-A form, you will “reconcile” your premium tax credit. This is a process that compares your advance premium tax credit used during the year to the premium tax credit you qualify for (this is income-based). The difference between the two amounts is then factored into your refund or the taxes you need to pay.

To reconcile, you will print Form 8962 along with its instructions and fill it out. This is where the 1095-A form comes into play: You will use the information on this form to fill out Form 8962. Remember, if your 1095-A is incorrect, your Form 8962 will be wrong, too. Take your time and ensure that you have completed every box and entered every amount correctly.

Do You Have Questions?

Taxes can be frustrating even in the easiest of times — which this last year certainly has not been. Trying to reconcile the past year’s financial, healthcare, and tax information in one place can be overwhelming. If you need help filing your taxes this year or understanding which policies may have changed in the last 12 months, don’t hesitate to reach out to Sackett Insurance . Get in touch with us today with inquiries related to health insurance and any questions you may have about filing your 2020 taxes.

6 Steps To Schedule a COVID Vaccination in Sonoma County

Thu, 25 Mar 2021 23:15:01 GMT

Sonoma County COVID Vaccine Scheduling

Vaccination is the key to stopping the COVID-19 pandemic and returning to normal life. The Food and Drug Administration has approved three different vaccines that are all safe and effective at preventing serious illness requiring hospitalization. As a health insurance broker in Santa Rosa, we join state officials in encouraging you and all Sonoma County residents to get vaccinated as soon as possible. However, supplies of all three vaccines are currently limited, meaning that you need to wait your turn. Here are some steps to find out how and when you can get the vaccine.

1. Know Your Group

Because of limited vaccine supplies, Sonoma County officials are prioritizing residents who are most vulnerable to contracting coronavirus or becoming severely ill from it. To identify the populations most in need, the vaccination distribution plan has several different phases:

• Phase 1A (started in December 2020)

• Phase 1B ( started in January 2021)

• Phase 1C (projected to start in spring 2021)

• Phase 2 (projected to start in fall 2021)

The vaccine will become available to the general population of Sonoma County during Phase 2. Phases 1A and 1B are further divided into multiple tiers and include the most vulnerable, including health care providers, other essential workers, and the elderly.

As of this writing, populations in Tier 1 of Phase 1B are the most recent group to which vaccines have become available. This group includes emergency workers, educators and child care providers, agriculture and manufacturing workers, grocery and restaurant workers, and people at least 65 years old. You must be a resident of Sonoma County to receive a vaccine here.

2. Find Out Where To Go

There are currently 19 vaccination sites operating in Sonoma County. The most recently added were opened in February 2021 at Sonoma Valley Veterans Memorial Hall, Heurta Gym in Windsor, and the fitness center on the SRJC Petaluma campus. Other vaccination sites in Sonoma County include 11 Safeway stores and at least one CVS pharmacy location.

3. Talk to Your Doctor

Your primary care physician has vaccination information specific to your group and individual status. He or she can inform you when you are eligible and what the next step should be.

You should talk to your doctor if you are not sure when you are eligible for the vaccine. Please do not try to make an appointment before it becomes available to your group. Otherwise, you'll only get in the way of people whose need is greater than yours.

4. Make an Appointment

Currently, vaccinations are available by appointment only. It is unclear whether walk-up vaccinations will ever be given. Most vaccination sites require that you schedule online, while some are accepting phone calls. If you cannot make your appointment, please call to cancel. This allows your appointment time to be given to someone else.

5. Receive Follow-Up Instructions

Only one of the approved COVID vaccines can be given in only one shot. The others require two shots, and you have to wait a few weeks in between. If you require a second booster, you will receive instructions on how and when to receive it. Be sure you pay attention.

6. Prepare for Possible Costs

You do not have to pay for the vaccination itself. The federal government is providing it at no cost. However, the provider who gives you the vaccination may charge an administration fee. If you have group or individual health insurance coverage , your provider may bill your insurance company to cover that fee.

Talk to a Health Insurance Broker in Santa Rosa

The government is subsidizing COVID vaccines for everyone due to the national emergency. Additionally, the Affordable Care Act may make additional subsidies available to you that make health insurance coverage less costly in general. For more information about individual and family plans, contact us at 707-823-3689.

Ways To Consider Revamping Your Employee Benefits Package During the Pandemic

Thu, 28 Jan 2021 21:04:21 GMT

How the Pandemic Might Change Your Employee Benefits Package

As the pandemic continues to take a toll on the nation's businesses, employees rely on job-related benefits more than ever. Your business can turn to its employee benefits broker in Santa Rosa to ensure that you offer the critical services to help your staff get through this difficult time.

Health Insurance

Whether your brick and mortar business is closed or remains opened, you do not want to risk your employees' or customers' health. Now is the time to encourage your staff to stay healthy, and the health insurance plan you provide can have a significant impact on your business. Your employees may be reluctant to schedule in-person appointments for various conditions. You can help by contacting your health insurance provider to negotiate coverage for telemedicine visits.

Mental Health Care

Employees working from home may feel isolated and overwhelmed without frequent contact with colleagues. Your staff may also feel anxious or frustrated due to a lack of office resources and other household members' conflicting requirements. Consider a benefits package with mental health provisions that includes therapy sessions and an employee assistance program to help with:

Financial planning
Substance abuse
Identity theft
Legal issues

Many employees are facing unprecedented challenges in their lives that make these benefits essential to their productivity.

Flex Hours

Employees who find themselves working from home may experience conflicts with various household activities. In particular, parents may have difficulty completing tasks during the hours when their children need learning supervision or meals. Workers who still attend traditional workplaces outside their homes must also adapt to dependent family members' needs or commuting stress. Maintaining salaries while offering employees flexible or reduced hours to counter these strains can help you retain valuable staff members and maintain work quality.

Childcare

Employees with young children who can not attend traditional schools due to the pandemic have unique challenges performing their jobs in a home setting or outside the home. One of the most meaningful benefits employers can provide during the pandemic and beyond is assistance with childcare. Whether parents work in or outside their homes, they can no longer count on the physical classroom's child supervision. Employers can relieve these employees' dual responsibilities by subsidizing childcare expenses during work hours. This perk can promote greater productivity, making it a valuable long-term investment.

Entertainment

One of the most significant challenges employees face when working from home is creating boundaries between their work and personal lives. Many people have difficulty defining the beginning and end of their workdays when they do not formally enter and leave their homes. One way to encourage downtime is to provide employees with a free subscription to entertainment, including movie services, magazines or online classes. Scheduling fun virtual team events, including happy hours or sing-alongs to mark the end of the workday, is another way to help your employees maintain a healthy balance and reinforces a team mentality.

Consult an Employee Benefits Broker in Santa Rosa As the pandemic continues to affect every aspect of our lives, employers can look for creative ways to support their staff physically and emotionally. For more information about how the right benefits can help you retain a healthy workforce , contact us at (707) 823-3689.

The Right Benefits Package Can Satisfy Your Employees and Your Budget

Tue, 19 Jan 2021 21:01:55 GMT

How To Offer High Quality Employee Benefits Without Overspending

Attracting and retaining top-tier employees can be challenging if your small business does not offer a desirable benefits package. Fortunately, you do not need to overspend your budget to provide the best options to suit your staff's needs. With thoughtful planning and creativity, you can give your employees the benefits they find most meaningful.

Analyze Your Employees' Needs

Although you may think it is better to offer your employees comprehensive health, dental, and vision insurance choices, you may be spending needlessly if these benefits go unused. An employee benefits broker Santa Rosa can help you determine the most meaningful options for your employees and customize the most cost-effective plan around them.

Offer Wellness Programs

Taking an interest in your employees' well-being by giving them the tools to make healthy lifestyle choices can ensure fewer sick days and health insurance claims. Consider offering free classes, seminars, counseling, and health screenings to include:

Weight and nutrition
Smoking and alcohol addiction
Cholesterol and blood pressure
Yoga and meditation

Offer Health Savings Accounts

HSAs are one of the best employee tax savings vehicles available, and they can also cut employers' costs by helping them avoid payroll taxes for funds employees place in these accounts. Offering this benefit, along with a high deductible health insurance plan, can also lower your health insurance premiums, thereby compounding your company's savings.

Scale Back 401K Matching Contributions

The ease of saving for retirement by linking a paycheck to a 401K savings account is a significant perk for most employees because it reduces their tax obligation by the amount they choose to save for their future needs. Consider suspending a matching contribution or reserve it for employees after they achieve a specific year of service. This approach can prevent costly investments in short-term employees while rewarding those willing to make a long-term commitment to your company.

Offer Tiered BenefitsCompanies with employees at various skill levels can consider offering benefits according to pay grades and experience. For example, your business might reserve life insurance or disability benefits only for critical executives but contribute a portion of the funds in the pre-tax commuter accounts for entry-level employees.

Meet With an Employee Benefits Broker in Santa Rosa

Your business can ensure it is not misspending valuable funds by reassessing its benefits packages periodically. A benefits provider can assess how your employees value various features and make recommendations to reflect actual needs. You may wish to receive coverage proposals from multiple benefits providers to ensure that your business always gets the best possible rate and value .

Schedule time for a benefits representative to explain all coverage options to your employees before implementing any changes. You may find that your employees do not use certain benefits either because they are not aware of them or do not understand them. Employee feedback can help reduce your costs and eliminate wasteful spending on unused benefit categories.

Employee benefits are mandatory for any business that wants to retain valuable employees. For more information about how we can help your business offer employee benefits within its budget, contact us at (707) 823-3689 to discuss your options.

What Your Business Should Know About the COVID-19 Vaccines

Mon, 11 Jan 2021 20:56:33 GMT

Answers To Your Staff's Questions About the COVID-19 Vaccines

The COVID-19 vaccines promise to provide significant relief in a world put on hold due to fears of contamination. The pandemic has had a devastating impact on many businesses whose employees now have questions about the vaccines. A health insurance broker in Santa Rosa can alleviate some concerns by discussing these common questions and answers with your team.

When Will the Vaccine Become Available for Employees?

At this time, the federal government owns and determines the distribution of all available doses of the COVID-19 vaccines. Vaccines may not be available for most business employees until well into 2021. When they become widely available, companies might have the ability to purchase doses they can reserve for their employees. Until then, the following individuals will receive priority:

Healthcare personnel
Nursing home and assisted living residents
Anyone over 65 years old
Essential workers
Individuals with underlying conditions

Will Getting a Vaccine Give Me COVID-19?

None of the vaccines available at this time contain the live virus, and they will not cause an individual to develop COVID-19. Instead, they will allow the body to recognize the virus and build an antibody defense against it. It is essential to know that the vaccines will not cure the virus; therefore, anyone who has contracted COVID-19 immediately before getting vaccinated is likely to experience all of the disease's symptoms or ramifications. The vaccines require approximately two weeks after entering the body to effectively deter the virus, making them ineffective for infections immediately following vaccination.

How Much Will a COVID-19 Vaccination Cost Me?

Employees insured under a company-sponsored healthcare plan can expect coverage for the full cost of vaccination for themselves and covered family members. This benefit also applies to any vaccinations employees receive from out-of-network providers.

Do Previously Infected Employees Need Vaccinations?

Getting sick with COVID-19 is not a guarantee of protection against future infections. Although resistance is possible, there is insufficient data to verify the degree or length of potential immunity following COVID-19 illness. All employees can benefit from vaccination whether or not they have had the virus.

Are Masks Still Necessary Following Vaccination?

Although we now know that it can take up to two weeks to develop immunity following vaccination, we do not know how long that immunity lasts. Everyone should continue wearing a mask during the weeks following vaccination. The amount of time needed between future booster shots is also unknown at this time.

Will mRNA Harm My DNA?

The current vaccines contain the virus's messenger RNA to allow muscle cells to create the virus's protruding spike proteins responsible for penetrating host cells and creating an infection. Although these proteins do not cause the disease, they allow the body's immune system to build a defense against them any time they appear, including when the virus is active. The creation of this portion of the virus's genetic material in no way alters a person's DNA.

How Your Health Insurance Broker in Santa Rosa Can Help

The COVID-19 vaccines' availability is a critical step in the reopening of the country. For help navigating ongoing developments that will affect your business and employees, contact us at (707) 823-3689.

Tips for Staying Safe Healthy Indoors This Winter

Mon, 21 Dec 2020 20:53:29 GMT

Remain Healthy and Safe in Your Home This Winter

Current events may keep you inside more than usual this winter, which means you may go a bit stir-crazy. Sackett & Associates Insurance Services is not only here to provide you with a quality health insurance broker Santa Rosa , we also want to help you look and feel your best. Here are several tips to stay healthy physically and mentally while at home during the colder months of the year.

Stay/Keep Active

Just because local gyms don't operate as they once did doesn't mean you can't get in a solid workout at home. One great thing about exercise is you have several options for getting your heart rate up, shedding pounds and building muscle. You can order equipment, and you can look up workout videos online if you need further guidance, motivation and instruction. Examples of great workout options include weight training, yoga, Pilates, kickboxing, high-intensity interval training and boxing. Besides the physical advantages, staying active helps you manage stress, anxiety, depression and several other mental health conditions.

Manage Your Mental Health

Speaking of mental health, make time for mental and emotional check-ins with yourself. Living in unprecedented times can take quite a toll on your mental health. Stress and anxiety can creep up on you and throw you for a loop before you realize it. Rather than wait to resolve depression, anxiety and the like, get ahead of struggles however and whenever you can. Besides exercising, you can also meditate, keep a journal, talk with a therapist, read a book, maintain a spirit of gratitude and stay connected with friends and family. Do not forget to make time for self-care and activities that bring a smile to your face.

Eat Healthily

Pay close attention to the food you eat and what you drink while navigating the world from the safety of your home. Aim for foods rich in nutrients and vitamins that your body needs. This doesn't mean you can't indulge in occasional sweets or a cheat meal, just that you're bound to feel better sticking to healthy foods. Also, healthy, clean eating supports a strong immune system, which we all need right now.

To make eating healthy easy, eat on a schedule, so there's less chance of you grabbing a quick meal packed with unhealthy calories and fat. While grocery shopping, look for vegetables and fruits that are in season. Stock your pantry and fridge with healthy snacks that can tide you over between meals. Trying new recipes can make cooking exciting while introducing you to new cuisines, cooking styles, ingredients and nutrients.

Develop Healthy Habits

Depending on how your work and social schedules look now, your daily schedule may look a lot different from what it used to. Now is a great time to create new, healthy routines and habits for yourself. Examine your old schedule and habits to see how you can tweak them to improve your mindset, lifestyle, home, mental health and relationship with yourself.

It's more essential than ever to have quality health insurance, even if you spend more time inside. Contact a Sackett & Associates Insurance Services representative to explore your options for top-quality health coverage.

Do You Know These Health Insurance Terms?

Thu, 17 Dec 2020 17:25:01 GMT

Learn These Health Insurance Terms Before Choosing a Plan

If you'll soon secure your own health insurance for the first time, or if it's been a while since you switched coverage providers, there may be insurance terms you aren't familiar with. To help you feel more confident about selecting the right policy with help from an experienced health insurance broker Santa Rosa, Sackett & Associates Insurance Services wants to ensure you know these 10 health insurance terms.

1. Preventative Care

These are health care services you tap when you feel healthy and well-balanced to stave off sickness. Preventative care includes services such as patient counseling, yearly physicals, immunizations and screenings. As long as you receive preventative care from a physician in your plan's network (more on this later), you likely do not have to pay a coinsurance or co-pay fee.

2. Premium

Premiums are the amount you pay to maintain your health insurance coverage. You can pay premiums every year, quarter or month.

3. Out-of-Pocket Maximum

This is how much you pay for medical services each policy period before your insurance provider covers all services included with your plan. Co-pays, deductibles and coinsurance contribute to this maximum, but not your regular premiums.

4. Out-of-Pocket Cost

Out-of-pocket costs are what you pay for medical services. Examples of such costs include co-pays, deductibles and coinsurance.

5. Out-of-Network

Physicians, health care facilities and other health providers who do not accept your health insurance are "out-of-network." While insurance companies do not forbid you from seeing out-of-network providers, companies do not help pay for services received from those providers.

6. In-Network

The opposite of out-of-network, "in-network" providers work with your insurance company. Before receiving health services or picking up prescriptions, double-check that you see the facility, pharmacy or doctor on your provider's list of approved practitioners and facilities.

7. Essential Health Benefits

These are specific health services all insurance providers in the Health Insurance Marketplace must offer. Examples of these benefits consist of pediatric services, newborn/maternity care, emergency services, mental health and hospitalization.

8. Deductible

Your deductible is the out-of-pocket amount you pay before your policy activates. If you have a $40 deductible, your insurance doesn't kick in until you pay $40.

9. Copay

Health care supplies and services included in your policy may require a copay. Similar to a deductible, copays are a sort of fee requirement that your insurance company requires before taking care of your medical care. For instance, you may have a $25 copay for all physician visits or prescriptions.

10. Coinsurance

This is your portion of the medical service bill once you take care of any deductible you owe. For example, if your therapist charges $100 a session and your health insurance plan has a 20% coinsurance requirement, you only pay $20 for a session as long as you've already paid your deductible.

Hopefully, you feel more confident about reviewing and choosing the right health policy. For more information, or to get help narrowing your options, contact a Sackett & Associates Insurance Services representative today. Fill out and submit an online form , or call us whenever you're ready at 707-823-3689.

Open Enrollment Is Here: Choosing a 2021 Health Plan That Works for You

Wed, 09 Dec 2020 17:21:14 GMT

Are you ready to choose a health insurance plan for 2021?

Choosing the right health plan is important for you and your family. Unfortunately, understanding the ins and outs of health insurance can be difficult, no matter what type of coverage you need. As complicated as insurance may seem, you only have one chance to enroll during open enrollment. In the state of California, open enrollment runs from November 1, 2020 to January 31, 2021, and during this time, you will be able to choose the plan that works for you. Health insurance doesn’t have to be confusing, and with just a bit of preparation and by working with a health insurance broker Santa Rosa , you can pick the perfect plan for you and your family.

Signing Up for Health Insurance in California

Signing up for an on-exchange plan via the insurance marketplace is a relatively simple process. Once you’ve created an account, you can fill out an application for coverage online. To complete your application, you will need to provide personal information that will help determine if you qualify for a subsidy, which can help you pay for your monthly premium. If you qualify for a subsidy, it will be automatically applied to your premium, and depending on your income level, it can drastically reduce your health insurance costs. If you do not qualify for a subsidy, the exchange will let you know if you qualify for other government-assisted health plans such as Medicaid or Medicare.

You also have the option to sign up for a health plan directly through a health insurance company. The vast majority of the plans offered by health insurance companies can be found on the exchange. To enroll in this manner, visit the website of the health insurance company you wish to purchase a plan from. If a plan offered by the company is on the exchange, you will be directed to the exchange website so you can see if you are eligible for a subsidy. You can also sign up for an off-exchange plan, but you will not be eligible for a subsidy.

You may also work with a health insurance broker. A broker is a licensed professional who is trained to help individuals choose a health plan. Brokers have in-depth knowledge of the health insurance industry and they can help you choose a plan through the exchange or directly through an insurer. It is also important to note that most insurance brokers do not charge a fee for their services.

Qualifying Life Events and the Special Enrollment Period

If you need to enroll in a health plan outside the open enrollment time frame, you may be able to do so if you experience a qualifying life event, such as:

Losing health coverage from an employer
Getting married or divorced
Having a baby or adopting a child
Moving to a new coverage area
Gaining citizenship

If you experience a qualifying life event, you will have the option to enroll during the Special Enrollment Period, which is the window of time outside of open enrollment.

Work With the Right Insurance BrokerBy working with the right broker, you can find the right plan that meets all your needs. Contact us today at 707-823-3689 to learn more about health insurance.

Fast Facts About the 2021 Open Enrollment Period

Tue, 24 Nov 2020 17:18:39 GMT

Understanding California's Open Enrollment Under Obamacare

Thanks to the Affordable Care Act plan, which goes more commonly by Obamacare, millions of eligible Americans have the opportunity to shop for health insurance through the Health Insurance Marketplace. During a period known as Open Enrollment, those who are eligible have access to affordable health coverage for both themselves and qualifying family members. In the state of California, Open Enrollment begins on November 1 , 2020, and carries on until January 31, 2021. For help finding a plan for either your family or your business, you can contact the agents at Sackett and Associates Insurance Services, a health insurance broker Santa Rosa residents are familiar with.

Coverage Limitations With Open Enrollment

For those seeking health insurance, there are some things to note about ACA plans through the Marketplace. First and foremost, these plans are restricted to personal, individual, or family use. Business owners cannot use this site to find group health insurance or coverage plans for their employees. While California employees may be eligible as an individual entity to apply for coverage through the Marketplace, businesses are not able to provide benefit plans through these services.

Coverage Options During Open Enrollment

When the window of enrollment opens, there are three options residents in California have when selecting coverage. They are as follows:

Residents can buy a plan through Covered California: If your total household income falls between 128% and 400% of the federal poverty, enrolling through the Marketplace can help you qualify for a tax credit (which can help lower the overall costs of the premiums).
Residents can change or renew a current plan: When open enrollment occurs, it is the opportunity to change or renew an existing plan. If you want to keep what you already have, you don’t have to take any additional steps. It may be that you have to change plans because your provider leaves the coverage network or your medications are no longer covered under the plan.
Residents can enroll in Medi-Cal: For those whose income is below 128% of the Federal Poverty Level, you will qualify for Medi-Cal. This is Medicaid for California residents.

Coverage Not Limited To Open Enrollment

The majority of health insurers in California rely on an open enrollment program to sign up new individuals. There are a few exceptions to this practice. For anyone who is eligible to receive Medi-Cal, enrollment can take place at any time. Additionally, families who qualify to participate in the Children’s Health Insurance Program don’t have to wait until open enrollment to place their kids under healthcare coverage.

Coverage Participants in Open Enrollment

Those who are United States citizens and legal or national residents of the U.S. are able to purchase healthcare from an Obamacare provider. Those holding a non-immigrant status but who have a valid worker visa, as well as asylees, refugees, and green card holders are also able to find coverage under the ACA. Those who are incarcerated or who currently carry a Medicare plan aren’t able to use Marketplace for coverage.

Coverage Advice During Open Enrollment

Under the ACA, health insurance has been made accessible for most Americans. If you need more information on how to find the right plan for your family or your business, contact the Sackett and Associates Insurance Services team of experts at 707-823-3689.

California's Mission To Prove The Affordable Care Act Is Alive and Well

Fri, 13 Nov 2020 17:15:23 GMT

Affordable Health Insurance From Covered California

With the Affordable Care Act's fate hanging in the balance, California makes a convincing case for its continuation. Covered California, the state's online insurance exchange, has announced premium increases of only 0.6 percent, a record low for the second year in a row. These favorable rates will likely raise enrollments in Santa Rosa and throughout the state during the 2021 plan year. A health insurance broker in Santa Rosa, can help guide your plan choice through the exchange or privately. Either way, individuals throughout the state of California can count on affordable health insurance.

Help for the Unemployed

The pandemic has caused millions of California's residents to become unemployed. Along with losing a paycheck, these individuals no longer have health insurance for themselves and their families at what may be the worst possible time. By expanding the enrollment period to obtain health insurance coverage, individuals who can not afford the high fees to continue their employer-provided insurance under the Consolidated Omnibus Budget Reconciliation Act (COBRA) can avoid coverage interruptions.

Factors Contributing to the Rate Decrease

A significant factor leading to more covered Californians and reduced premiums is the California legislature's reinstatement of the individual mandate after its 2019 repeal by the federal government. California's Med-Cal program also ensures that those who can not afford the lowest premiums offered on the state's exchange can still get coverage through government subsidies. New eligibility requirements for these subsidies also takes into account anyone who do not fall below the poverty line but struggles to pay for insurance. Health insurance broker and others throughout the state can help individuals make their selections at no cost. With more individuals within a coverage pool, policy premiums are substantially reduced.

Another factor affecting premium rates is the overall health of covered individuals. The individual mandate and expanded subsidies have increased the number of Californians who obtain health insurance. Whereas healthy individuals without pre-existing conditions once chose to forgo coverage altogether, the state now makes it mandatory and convenient for them to have health insurance. The inclusion of healthy people into the mix of those covered significantly lowers premium costs for everyone, whether they choose plans on or off the exchange.

Finally, whereas the federal government has decreased its efforts to make health insurance accessible for all Americans, California has stepped up its marketing and outreach to support it. Despite the size and diversity of California's population, it is evident that these efforts have succeeded in convincing a substantial number of people that health insurance is a necessity rather than a luxury. An increase in covered individuals helps to reduce the premiums for all.

How a Health Insurance Broker Santa Rosa Can Help

In current times, having health insurance is more important than ever, whether or not it is a state requirement. Without employers to simplify coverage options, many individuals will struggle to sort through the vast range of choices or fully understand their needs. Sackett Insurance Services can help you and other Santa Rosa residents understand your options and ensure that you obtain budget-friendly rates without compromising your ability to get the healthcare you need and deserve.

The Political Side of Health Care: Trump vs. Biden’s Plans

Mon, 02 Nov 2020 17:12:18 GMT

Desired Health Care Differs for Republicans and Democrats

Health care is notorious for being politicized, and election season turns up the heat on issues that affect the insured and the uninsured alike. While many citizens advocate for a more universal health care system, others feel strongly that a single-payer system , or one that further meshes health care with the government, would only increase the chaos and they would like health care to be further privatized. This year’s candidates have very different plans for health care as the country moves forward into 2021.

Trump’s Plan for Health Care

President Trump tends to favor the traditional Republican positions on health care including patients’ choice of doctor and limited governmental involvement when it comes to medical care. He, like other Republicans, does not approve of a universal system and wants to limit spending on prescription drugs.

Abolishing the Affordable Care Act Trump considers the Affordable Care Act, which is commonly known as Obamacare, to be a “horrendous disaster”. He instead wants to focus on lowering the cost of prescription drugs and reforming government-issued health care coverage like Medicare.

Privatization of Medicare Trump is opposed to a single-payer health care system, socialized health care, and Medicare for All . He does not want to get rid of Medicare, though: Instead, he wants to focus on privatizing the system in hopes of expanding coverage for elderly, rural Americans.

Returning to Normal Life with COVID-19 Trump believes that he acted accordingly when informed of the risk of COVID-19 by banning travel to and from certain countries in Europe and Asia. He is not opposed to masks, but he wants to strike down mask mandates across the country and work toward a return to normal.

Biden’s Plan for Health Care

It may not surprise voters to learn that Biden, as a Democrat, favors the government’s involvement in health care more so that President Trump does. Biden believes that the Trump administration has not done enough to prevent the spread of COVID-19, and he is concerned that many Americans will lose their coverage without certain protections.

Keeping the Affordable Care Act As Biden was Vice President when the ACA was implemented, he is naturally in favor of the act. In addition to simply keeping it around, he wants to expand several parts of its coverage for Americans including care for undocumented immigrants and women seeking birth control and options for terminating unwanted pregnancies

Expanding Medicare Biden, in complete opposition to Trump, wants to expand Medicare for the 4.9 billion Americans who do not have any kind of coverage. He does not support Medicare for All. Instead of simply lowering prescription drug prices, he wants to match them with other countries’ prices on prescription drugs.

Paid Maternity Leave It may surprise you to know that though the United States is one of the world’s richest countries, employers are not required to offer paid parental leave for their employees. Biden believes that it is essential to provide a period of paid maternity leave for all US workers.

Increasing Protections against COVID-19 Biden wants to increase mask mandates around the country as well as protections in schools, workplaces, and restaurants. While he wants the country to return to normal eventually, he believes that the threat of COVID-19 is far from over and that we must act now to save lives.

If you are an independent or undecided voter this election season, the above breakdown may provide you with clarity regarding both candidates' health care plans. Remember to do your civic duty and vote this year! For more information about health care and choosing the right health insurance for yourself and your family, contact Sackett & Associates today.

Sources:
https://www.ehealthinsurance.com/resources/individual-and-family/where-2020-candidates-stand-healthcare
https://www.wsj.com/articles/trump-calls-obamacare-a-horrendous-disaster-1496861128
https://www.theguardian.com/us-news/2020/jan/27/maternity-leave-us-policy-worst-worlds-richest-countries
https://www.healthline.com/health/what-medicare-for-all-would-look-like-in-america

Get Ready for Open Enrollment! 3 Factors To Consider Before Choosing Health Insurance

Tue, 20 Oct 2020 20:19:50 GMT

3 Important Facts About Open Enrollment in California

You may have frequently heard the words “open enrollment” as the new insurance period approaches, but you are unsure of what the term means and you are confused about which health insurance broker could help you get the coverage you need. Open enrollment in California starts on November 1, 2020, and ends on January 31, 2021. During this time, you will have the opportunity to enroll yourself, your spouse, and your dependents in a new health plan. Here are a few things you should consider while you are doing your research.

1. Pay Attention to Deductibles and Premiums

Should you select a high deductible, low premium plan or the opposite? What is a deductible, anyway? When you choose a new health insurance plan, the deductible is what you pay before your insurance “kicks in”. If your deductible is $2,000, for example, you will need to pay that much money before your health insurance starts applying heftier benefits to your account (you will usually get some free benefits like preventive care before you meet your deductible).

Usually, when you select a plan with a high deductible, your premium — the amount you pay into the plan every month — will be lower. Low premium, high deductible plans are ideal for those with no preexisting health conditions: They are designed to render the client responsible for most costs of their healthcare. High premium, low deductible plans may be preferred by those who want to meet their deductible quickly, but these plans can be hard on the monthly budget.

2. Investigate Covered California Plans

Many Californians may not be aware of this online marketplace that connects citizens to health insurance under the Affordable Care Act. These plans are different than Medicare and Medicaid and they are available to those who do not receive health insurance automatically through their place of employment. At Sackett & Associates, we can help you comb through these plans to make sure you are getting the benefits you desire and the coverage your family needs. We can also help you determine if there is additional coverage (like dental or vision) that you might need beyond the plan you select.

3. Consider Whether You Need an HSA

A Health Savings Account can be a wonderful way to set aside money specifically for medical bills and appointments — but before you choose a plan linked to an HSA, make sure you truly need this account. If you only have a few medical appointments a year, and if these visits mostly involve preventive care like checkups and minor health issues like sinus infections and sprained wrists, an HSA might be more of a drain on your finances than necessary. Most HSAs expire at the end of the year, so all that money taken out of your paycheck before taxes will not be used if you do not spend it on medical needs.

Don’t delay: Open enrollment is coming soon. Get in touch with Sackett & Associates as soon as possible for more information on how to choose the best health insurance plan for yourself and your loved ones.

Understanding How Herd Immunity Can Save Lives

Mon, 12 Oct 2020 20:46:19 GMT

Improving Nationwide Health Through Herd Immunity

People around the world are still contracting the coronavirus, with much more concerned about potential infection. Research experts are in the development phases of a vaccine, but there are still no guarantees of when such a product will be released to the public. The expert advice of a health insurance broker Santa Rosa suggests a quality healthcare plan to help with costs of medical attention should you contract the virus, but there are ways to reduce the potential for infection. Herd immunity has become the focus of many public health experts and politicians as communities struggle to slow the spread.

Using Natural Immunity to Slow a Disease
The body has a natural ability to fight off infection using antibodies that have developed through immunization against a disease or from having recovered from a disease. According to experts in the medical community, when there are enough individuals in a population that have developed immunity, it extends protection to those who have never contracted the disease. This effect is known as herd immunity. There is a higher resistance to catching the germ since fewer individuals are carriers or infected across the population.

Protecting the Vulnerable Through the Herd
For years, herd immunity has reduced the spread of deadly diseases like tuberculosis and polio. As vaccinations have developed for some of the most threatening diseases, it has been a common practice to have children vaccinated throughout their infant and elementary years. As a result, herd immunity has helped eradicate mass outbreaks of measles, smallpox, and pneumococcal infections. Older adults, those with underlying health conditions, and newborns are considered the medically fragile of the greater population, and the herd immunity that develops from immunized children and adults establishes a layer of protection for these demographics.

Realizing the Limitations of Herd Immunity
There are areas of illness where herd immunity does not apply. For many of these infectious diseases, the way a germ spreads or the unique properties of a vaccine are significant factors in understanding reduced application. Whooping cough, also known as pertussis, is a highly transmissible bacteria that can be passed between two people whether or not an individual has been vaccinated. Those vaccinated experience no symptoms, while those without immunization fall ill. For this reason, it is important for all individuals to get vaccinated. Many of the plans offered by a health insurance broker Santa Rosa include coverage for immunizations.

Looking for Herd Immunity With COVID-19
As the world still fights against COVID-19, many are hopeful that herd immunity will be a key way of halting new cases of infection. Data from the Center for Disease Control shows that many who have contracted diseases with properties of coronaviruses didn’t have a recurring infection with the virus in the timeframe soon after, but it is still too early to see if this will be true of the current pandemic. Current nationwide testing includes both a test for those who have an active infection and a test for the presence of COVID-19 antibodies.

While there are still many unanswered questions concerning COVID-19 and herd immunity, you don’t have to be without healthcare protection from other immunizations. For more information on how to insure your health needs , contact the health insurance experts at 707-823-3689.

Enrolling in Medicare if Still Working at 65

Fri, 02 Oct 2020 20:55:21 GMT

Still Working at 65? You Can Enroll in Medicare

You may still be working, whether by choice or as a matter of necessity when you become eligible for Medicare at age 65. Depending on your situation, you may have different options available from a health insurance broker Santa Rosa when it comes to Medicare enrollment . You may be able to have both Medicare and your employer coverage at the same time, in which case one becomes the primary carrier and the other provides secondary coverage for expenses not eligible for the primary.

Before you make any decisions regarding Medicare enrollment, you need to find out what options are available to you. This depends on different factors, such as the size of your workplace and your history of employment.

Medicare Parts
A meaningful discussion about signing up for Medicare requires an understanding of the different parts, which cover different services. Medicare Part B covers things like outpatient care, medical supplies, and doctors' visits, including preventive services. Medicare Part A is hospital insurance that primarily covers inpatient hospital stays. Medicare Part B charges a premium, while most people qualify for Medicare Part A for free.

Workplace Size
If you work for a small company that has fewer than 20 employees, your employer has the option of requiring you to enroll in Medicare once you turn 65. You do not necessarily have to give up your employer coverage at this point. Rather, your employer coverage becomes secondary, covering whatever Medicare does not. If and when you retire or leave the position, you can purchase Medicare supplemental insurance, or Medigap coverage, to replace your employment coverage, but only if you purchase the former within 63 days of the end of the latter.

If you work for an employer with more than 20 employees, you have more options. Neither your employer nor anyone else can force you to enroll in Medicare. You have the option of enrolling in Medicare while keeping your employer coverage, but in this situation, it is your employer coverage, not Medicare, that is primary. If Medicare provides better coverage than your employer's policy, you may decline coverage from your job. On the other hand, if your employer offers a better health plan, you may delay your Medicare enrollment until up to eight months after your employment coverage ends.

Keep in mind that this pertains to Medicare Part A. You may want to hold off purchasing Medicare Part B until after your employment coverage ends, or you could forfeit your right to federal protections when purchasing Medigap coverage. If you do not purchase Medicare supplemental insurance within six months of signing up for Part B, companies can charge higher premiums for pre-existing conditions or deny you coverage altogether.

Other Requirements
You have to be either a citizen or a legal permanent resident of the United States for at least five continuous years before you can qualify for Medicare. To be eligible to enroll in Part A with no premium, you must have paid Medicare taxes over at least 10 years of qualifying employment.

There are options for getting the most out of your Medicare coverage even while you are still working. For more information about enrolling in Medicare , contact us at Sackett & Associates Insurance Services by calling 707-823-3689.

5 Ways To Have a Healthy Lifestyle and Stay Safe During Covid-19

Tue, 15 Sep 2020 20:58:18 GMT

5 Ways To Maintain Your Health and Be Safe During COVID-19

COVID-19 has changed a lot about the way we live, so it is important to focus on how to stay healthy and safe throughout the pandemic. An active lifestyle is still possible and necessary to promote good mental health and a positive outlook. It is important to plan how you will incorporate regular routines and outings while assuring your safety.

A health insurance broker Santa Rosa reminds people that taking proper safeguards is the best way to help you continue normal daily activities. Here are five ways you can take care of yourself and be safe during this time:

Reduce Anxiety
Chronic anxiety is one of the most detrimental health issues to arise from COVID-19. This can lead to a number of other serious health concerns. Activities like meditation, reading, journaling and hobbies are all excellent ways to relieve stress and calm anxious thoughts. Eating nutritious foods and getting adequate sleep will support body functions that decrease anxiety and foster better health.

Remain Physically Active
Regular exercise is essential for good physical and mental health. Doctors emphasize that staying active is a way to protect against the coronavirus. The body’s systems need regular physical activity to function properly, so staying fit means you are better able to fight against disease and illness.

Thirty minutes of brisk walking is a great health benefit for people of all ages. No matter what type of exercise you do, be sure to remain a safe distance from other people.

Practice Self-Care
Everyone needs a time out from pandemic-related stress. Staying connected to friends and family is a great way to let down with some personal time to talk and share positive experiences.

Sending or receiving a quick text with uplifting messages gives a boost throughout the day. Ten minutes of quiet time is also a vital way to relax and reset on a daily basis.

Take Precautions
While COVID-19 restrictions are relaxing somewhat around the country, it is necessary to remain vigilant about your safety and the safety of others. One of the easiest and most important ways to protect yourself is to wear a mask. The CDC recommends that you wear a mask at all times in public.

Wash your hands regularly and use hand sanitizer when needed. Clean high-touch surfaces routinely, which can help eliminate the spread of infection.

Get Tested
Get tested if you show symptoms of the coronavirus or if you are concerned you may have been exposed. Free testing is now available in many communities at drive-through and walk-up sites. Get information on the CDC website or from your local health services about where testing is offered in your area.

Health Insurance To Meet Your Needs
At Sackett & Associates Insurance Services we believe that finding insurance doesn’t have to be a difficult process. We assist individuals and employers with finding the right plans to fit their unique needs. We always work to get you the best options at the best prices and the best coverage. For more information on our plans or to get a quote , call our Santa Rosa, CA, office at (707) 823-3689.

Insurance Companies Are Expected To Foot the Bill for COVID-19 Vaccinations

Mon, 14 Sep 2020 21:00:22 GMT

Millions To Be Protected Against COVID-19 at No Cost

It is nearly seven months into the coronavirus crisis in the U.S. and, according to the CDC, almost 1.7 million citizens have contracted the disease. This is just the number of reported cases. It does not include those that do not seek medical care nor the potentially high count for people who contract the disease but are asymptomatic. Furthermore, those without health insurance are less likely to seek care. During these times, obtaining affordable insurance from a health insurance broker Santa Rosa is critical.

The official death count from COVID-19 is nearly 180,000 and rising. Much like the case count, the real toll is quite possibly significantly higher. In the beginning months of the pandemic, there would have been numerous deaths wrongly attributed to other causes. It could take some time for those numbers to be teased out of the existing data. In addition, individuals who do not seek treatment and die from the disease may not get counted because they were not tested.

Winter Is Around the Corner
The pandemic is showing no signs of ebbing in this country. Where some areas are demonstrate marked improvements, far more are seeing sharp rises. The summer did nothing to slow the spread and winter is around the corner. The colder weather is likely to drive cases further upwards as people are stuck inside, in close quarters with others. When outdoor socialization isn’t an option, the likelihood that more people will congregate indoors is high, which significantly increases the risk of spread.

The Race Is On
With a global population sitting at 7.8 billion people, herd immunity could take generations. The only real hope for taming this novel coronavirus is through successful anti-viral medications and a vaccine. Scientist are working feverishly to develop a successful vaccine. Even so, it could be months before it is widely available. Though the U.S. government is likely to fast track approval without the typical months-long testing process normally undertaken, we are still several months away from USDA approval of a viable formula.

Clinical trials for potential candidates are currently underway. The White House has indicated that it anticipates a vaccine will be made available to the public early in 2021. The administration has further set in motion an initiative to put millions of doses into circulation quickly, covering up to 300 million within the first few months of the new year. These doses are to be distributed according to need, with those at highest risk receiving priority over those who are less vulnerable.

The Role of Health Insurance Companies
The Affordable Care Act categorizes vaccines as preventative care and expects that insurance companies cover them at no cost to the insured. The COVID-19 vaccine, when it finally arrives, will be no different in that regard. The current administration has indicated that it expects vaccine administration to be completely covered, which means that no copays will be charged to the patient. The major difference for this new vaccine is in the number of people who will need to be protected against the virus, even when millions will already have the antibodies and not require inoculation.

Get Affordable Health Insurance in Sonoma County
Sackett & Associates Insurance Services can help you find the health insurance you need at affordable prices. Contact us today at (707) 823-3689 to get covered today.

How Wildfire Smoke Affects Air Quality and Health

Fri, 04 Sep 2020 21:03:15 GMT

How Wildfire Smoke Affects the Air You Breathe

Wildfire smoke presents significant health hazards due to the deterioration of air quality. People do not have to be in a high-risk health category to be affected by unhealthy levels of particulate matter and other compounds generated by fires. A health insurance broker Santa Rosa understands the impacts that fires in Northern California have on an individual’s well-being. Here are some important questions to consider about wildfires and some important steps to help you stay safe.

How Does Wildfire Smoke Impact Air Quality?
Wildfire smoke is usually a mixture of many different and dangerous substances, which make it toxic to breathe. The spread of fires means they burn through a number of different natural resources, structures and materials becoming an amalgam of particulates, water vapor, carbon dioxide and gaseous chemicals. This leaves people near fires exposed to these noxious fumes:

Methane
Acetic acid
Formaldehyde
Carbon monoxide

Particulate matter is the most concerning because weather conditions can carry it many miles away from the wildfire. While large particles irritate the nose, throat and eyes, it’s the fine particles that enter the lungs and may cause serious problems for people.

Why is Wildfire Smoke Dangerous to Your Health?
Fine particulates can decrease lung function. This is a concern for any human in contact with smoke. Vulnerable persons with pre-existing health issues are most at risk. For these individuals, significant exposure could lead to premature death.

People exposed to smoky air often exhibit these symptoms:

Coughing
Burning sensation in lungs
Shortness of breath
Wheezing
Runny noses
Headaches
Burning or itching eyes

Healthy people frequently report respiratory problems and sometimes other serious side effects. Developing infants are particularly susceptible to illness caused by smoke inhalation.

The level of exposure matters to your health. There is a spectrum of contact for each individual, which includes the amount inhaled, the substances in the smoke, and the length of time a person breathes the polluted air. These variables determine possible health outcomes.

How Can You Protect Yourself from Wildfire Smoke?

It’s nearly impossible to determine how fires spread and what way smoke will travel, given emerging weather conditions, changing terrain and other consistently shifting factors. Sight and smell are two of the most reliable ways to anticipate problems. Fog, haze and generally poor air quality, along with irritation of the lungs and throat indicate unhealthful conditions in your area.

If smoke is an imminent threat, it is important to keep your residence tightly closed up, run your AC, use an air purifier, and limit or avoid outdoor activities. Wearing a mask outside can help in certain conditions. If staying poses a precarious risk and you are safe to leave, it may be a good idea to evacuate the area altogether and relocate to a safe location.

Choose a Knowledgeable Insurance Broker
It’s important to get the right insurance to meet your unique needs. Sackett & Associates Insurance Services assists individuals and employers with identifying and purchasing the best and most cost-effective coverage . For more information about our plans or to get a quote, call our Santa Rosa, CA, office at (707) 823-3689.

Why It Pays To Offer Benefits to Part Time Employees

Wed, 26 Aug 2020 04:33:58 GMT

Benefits for Part-Time Employees - What's the Deal?

Health insurance and other benefits form a key part of the compensation package most employers offer their workers. In some cases, providing insurance is required by law. However, many organizations employ at least some part-time team members. While you do not need to offer these employees the same benefits as full-time staff, you may want to consider doing so anyway.

The Rules Regarding Part-Time Employee Benefits

Under the current rules, governed mostly by the Affordable Care Act, employers with at least 50 full-time equivalent employees must offer health insurance to all workers who work at least 30 hours per week (making them full-time). Anyone who works less than this is considered part-time and thus does not need to be offered health insurance.

You can optionally provide them with health insurance. However, the ACA requires that part-time employees be offered health insurance through a consistent written policy. In other words, you can’t pick and choose who gets health insurance, although you can set a minimum number of hours to receive it.

Reasons Why You Should Consider Offering Benefits to Part-Timers

Many employers are hesitant to offer insurance or other benefits to part-time employees, considering doing so to be an unnecessary expense. However, there are some good reasons to consider it:

Attract More Talent: People want to find employment that provides health insurance. Other benefits such as retirement plans, paid time off and wellness stipends are also attractive. Simply put, by offering benefits, you can attract more interest and find capable part-time workers. For people looking for part-time work, benefits can be a serious deciding factor.
Reduce Turnover: In a similar vein, your team members are less likely to leave their positions if they are receiving benefits, especially health insurance. It can have a big impact on turnover. Hiring and training new people is expensive. Keeping experienced staff is usually financially advantageous.
Deduct Premiums: Many health insurance expenses are tax-deductible. So, you can expand your compensation packages while deducting the premiums, helping to recoup some of the cost.
Let Them Pay Pre-Tax: With a little paperwork, you can let your employees pay their part of the premiums with pre-tax money. This means that they can keep more money in their pockets. Again, this is an attractive option for your part-timers.
Maintain a Healthy Workforce: Happy and healthy people are more productive and less likely to need sick leave. That translates to a greater return on investment from your employees.
Improve Morale: There is a lot to be said for treating your team members well. Offering benefits can be an element of building a positive team culture.

In other words, there are substantial financial and productivity advantages for offering insurance and other benefits to part-time employees. If you take a holistic view of the decision, it may be financially advantageous to offer benefits.

Get Group Health Insurance

Whether you choose to extend benefits to part-time employees or not, it pays to find the right insurance provider. Sackett & Associates Insurance Services is a group health insurance broker in Santa Rosa that can help you find the right coverage for your business. Contact us today to learn more and get started.

5 Reasons Why You Need a Health Insurance Broker in Santa Rosa

Thu, 13 Aug 2020 04:42:50 GMT

Benefits of an Independent Health Insurance Broker

Trying to navigate the health insurance market on your own can be a nightmare, especially if this is your first venture into a private policy rather than typical employer-provided coverage. With so many plans and options, it may feel like you are comparing apples to oranges, which is why an independent health insurance broker can be such a valuable resource. Unlike an agent, who may only work with one insurance company, a broker is licensed at the state level and can be more knowledgeable about standards and benefits. Before you sign up for a new plan, consider these five reasons why you should work with a health insurance brokers in Santa Rosa.

1. Freedom of Choice

One of the more frustrating aspects of finding the right health insurance coverage is the lack of good options. You may be faced with only two or three plans, none of which feels right for you or your family. An independent broker who represents several companies can present coverage options from multiple companies to give you a wider spectrum of service from which to select.

2. Best Price

Let’s face it; health insurance costs rarely feel like a good value. Year after year, the policies are tweaked, sometimes leaving you paying more money for less coverage. An independent insurance broker can help break you break down the expenses to analyze which is the best policy for your budget and need. Imagine the amount of research you would have to do by yourself to get close to that level of practical information.

3. Personalized Protection

A good broker wants to know all about you, not to snoop, but to better understand what coverage is best for you. By reviewing your lifestyle, hobbies, history, and more, a health insurance broker can put together custom coverage, including services you need and foregoing benefits you may not ever use. In addition, a broker is more likely to review your plan at regular intervals to ensure the plan you have is still the best fit for you.

4. No Extra Fees

Are you worried how much your broker’s services may cost you? Rest easy knowing that insurance brokers get commissions from the insurance companies directly, which means you do not have to pay out of pocket for his or her assistance. The fact that you can get better coverage without added charges sounds like a good deal for any individual or family.

5. Your Neighbor

An independent health insurance broker in Santa Rosa is a part of the community, supporting the same local events, going to the same local establishments, and using the same streets and road. This is a person who is easy to reach and happy to help, a real advocate for his or her clients. By working with a local person instead of a toll-free number, you can expect a different level of customer service with a broker.

If you think a health insurance broker sounds too good to be true, try our services for yourself. Contact us online or call our office at (707) 823-3689 for a consultation. We look forward to helping you!

5 Natural Ways To Lower Your Blood Pressure

Sat, 08 Aug 2020 04:38:54 GMT

Lowering Blood Pressure Naturally

High blood pressure can put you at risk for a range of health problems, the most serious of which include heart attack or stroke. There are medications that can lower blood pressure, but these can also cause unwanted side effects. Your doctor may recommend that you try to lower your blood pressure by changing your habits and lifestyle before prescribing medication. Here are some recommendations that doctors are likely to make.

1. Walking Regularly

Excess weight is a risk factor for high blood pressure, and regular exercise can help reduce it. Some people think that running is the best exercise that you can do. However, walking is actually much better because it helps improve your circulation in the same way that running does without putting the same pressure on your joints. You do not need to take a long walk to improve your blood pressure levels. You should see improvement with only 15 minutes of brisk walking per day.

2. Monitoring Sodium Intake

You may think that you are doing enough to control your sodium levels by not adding any extra salt to your food. Though this may not compound the problem, it is not really solving it. Most foods have at least some sodium. You are most likely to find it in processed foods and fast food in which salt acts as a preservative and a flavoring agent. Keeping a watch on nutritional information to decrease sodium levels can help to lower your blood pressure.

3. Avoiding Caffeine

Research demonstrates that caffeine causes a dramatic spike in blood pressure shortly after consuming it. Regular caffeine consumption may cause some people to develop blood pressure that is higher than average. It is not entirely clear why caffeine causes blood pressure to rise. It could be because it increases adrenaline or blocks a hormone that widens arteries. Whatever the reason, caffeine is proven to increase blood pressure, so abstaining from caffeinated beverages may help to lower it.

4. Reducing Alcohol Intake

There have been some reports that moderate alcohol consumption may decrease your risk of certain health problems, such as diabetes, stroke, or heart attack. However, alcohol can also interfere with the effectiveness of some blood pressure medications, and overindulgence may lead to unwanted weight gain, which increases high blood pressure risk. If you choose to drink alcohol, keep in mind what is considered a "drink":

1.5 fluid ounces of 80-proof distilled spirits
5 fluid ounces of wine
12 fluid ounces of beer

Limit yourself to only one to two drinks per day to prevent high blood pressure.

5. Manage Stress

Everyone experiences stress once in a while, but prolonged levels of high stress can have profoundly negative effects on both your psychological and physical health. Effective stress management techniques include those that improve the mind-body connection, such as deep breathing, yoga, or meditation.

In the long run, it is much easier and better for you to prevent illness than to treat it after it occurs. A health insurance plan obtained through a health insurance broker in Santa Rosa allows you to see your doctor for regular checkups. For more information on how to obtain individual coverage, contact us at Sackett Associates Insurance Services by calling 707-823-3689.

Considering Your Healthcare Costs: In-Network vs. Out-of-Network

Fri, 24 Jul 2020 04:36:00 GMT

What Is The Difference Between In-Network And Out-Of-Network Coverage?

When working with a health insurance broker , you may have questions about your network coverage when viewing potential PPO plans. In short, any care you receive in-network will be considerably cheaper than the care you receive out-of-network. Out-of-network physicians and healthcare facilities can be utilized, but it may be a wiser decision to consider your in-network options first.

In-Network vs. Out-of-Network

In-network healthcare providers have a contract with your insurance company to provide plan members with lower-cost medical treatment. These providers often consist of:

Hospitals
Doctors
Pharmacies
Dentists
Other medical specialists

The contract between the provider and insurance company requires the provider to offer care at an agreed-upon rate. On the other hand, out-of-network providers do not have any type of agreement with your insurance company. These providers may accept other insurance plans or they may not accept insurance at all. Your insurance company will typically provide some coverage for such providers, but it will not be as extensive as the coverage provided to in-network providers. This means it will cost you more to see an out-of-network provider, even with insurance.

How Much is Out-of-Network Care?

One of the reasons out-of-network care is significantly more expensive is because there are no cost-sharing functions. These functions are as follows:

Deductibles – The amount of money you must pay before your health insurance coverage becomes active.
Coinsurance – The percentage of medical costs you must pay after receiving care or treatment.
Copay – An amount charged for medical care and prescription drugs.

Deductibles, coinsurance, and copays only apply to providers who are in-network. If you receive care from a physician outside of your network, you will be responsible for paying a higher percentage of your medical costs. The amount of out-of-network coverage you have will depend on the insurance plan you choose. More expensive plans typically provide more coverage for out-of-network providers.

As mentioned above, the amount your health insurance company will pay an out-of-network provider will depend on the plan you choose. However, regardless of the plan you select, you will typically be charged a “reasonable and customary” amount for the medical care you receive out of network. For example, if you go to an out of network primary care physician, and you are charged $200 for an appointment, your health insurance company may only cover $100 for your visit. Conversely, if you go to an in-network primary care physician, you may only be responsible for a small copay.

Is Your Provider In-Network?

To find out if a provider is in-network or out-of-network, you may be able to visit your insurance company’s website. The provider or facility’s website may also state if they take your insurance plan. Checking online is one of the easiest options, but you may not always be able to find the information you need there. If you do not know whether a provider takes your plan, you can always call the provider directly or talk to a representative from your insurance company.

Find Out More

A qualified health insurance broker can help you find and select a plan that meets or exceeds your particular needs. By working with a broker, you can find a plan with an in-network provider you can trust. Contact Sackett & Associates Insurance Services today at 707-823-3689 to find out more.

How To Navigate Open Enrollment as a Small Business

Fri, 17 Jul 2020 04:33:15 GMT

Small Business Health Insurance Broker Can Help

Some business owners treat the benefits packages they provide as a set-it-and-forget-it system. However, what might seem like the best benefits to you might not meet the needs of your current employees or the top-performers you hope to attract. This is why it’s so important to make the absolute best of the open enrollment period. Your health insurance broker in Santa Rosa can help, but it’s important to understand a few things first.

What Is Open Enrollment?

Open enrollment for health insurance coverage refers to the period that usually lasts from the start of November to mid-December. Small businesses also benefit from a special period which lasts from mid-November to mid-December. At the start of the following year, options chosen during that period become active for that calendar year. This is why re-evaluating the company’s needs and that of its employees is so important.

What Should Small Business Look For?

Many business owners agree that it’s important to use the enrollment period to re-evaluate, but knowing what to look for can seem confusing. Every business is different, but the following pointers provide a good starting point:

Savings : If you provide fewer benefits than employees can obtain via other means, not as many might enroll. This drives up the cost per person. Talk to your employees to see how to get more people to enroll to decrease the per-person costs, especially for health and health insurance.
Taxes : Some small businesses allow employees to choose more benefits and less take-home pay as part of their own tax-planning strategy. Business owners can also take advantage of tax planning strategies, such as ensuring eligibility for the small business health care tax credit.
Life Events : Employee demographics of a business change over time, especially if your employees remain for years. Some people might have gotten married, had children or are taking care of older parents. Revise benefits with applicable life events in mind.
Preferences : People can share the same demographic data and still have different priorities and make opposite lifestyle choices. Avoid the temptation to make assumptions. Employees’ preferences might also change after getting a first-taste of certain benefits.

How Do I Get the Right Information?

The only way to get accurate information for making the right benefits decisions is to have an honest conversation with your employees. If you have HR professionals in your organization, consider delegating this role to them. Note that you might receive the most honest responses when people can submit their opinions anonymously.

For instance, you might find that some health and wellness benefits employees might be interested in include counseling for depression or substance abuse recovery. However, very few might feel comfortable sharing this in a one-on-one setting.

How Do I Enroll My Small Business?

If you haven’t yet enrolled your business, then note that there are a few key criteria it needs to meet. Your business must meet legal requirements as a business as decided by state and federal laws. It should have at least one full-time employee and you should contribute at least 50% toward the monthly premiums your employees pay.

We understand that this guide only scratches the surface of the information you might need to move forward. Contact Sackett & Associates Insurance Services for more information today.

5 Smart Tips To Keep You Safe in the Sun

Wed, 01 Jul 2020 23:53:40 GMT

Sun Safety Tips

When the sun is shining, most people want to spend time outdoors exercising, playing, or just relaxing. You may love how the sun feels on your skin, but deep down below the surface, your long-term health may be at risk. With exposure to UV rays as the number one cause of skin cancer, protecting yourself from the sun should be a top priority to keep safe. These five tips make sun safety a no-brainer and allow you to have fun without damaging your skin.

1. Cover It Up

If it is hot outside, your inclination may be to go a little bare in shorts and tank tops, but your skin could pay the price. Instead of showing a lot of skin, wear light-colored clothing that reflects some of the sun’s rays, and don’t forget a hat! With thin or breathable materials, you may not even mind the extra fabric covering your arms and legs. Some clothing offers sun protection, so you may want to check labels before you buy.

2. Know Your Number

Sunscreen is essential any time you plan to spend time outdoors, no matter what the time of year. Dermatologists recommend using a broad-spectrum sunscreen with an SPF of at least 30. Apply it at least ten minutes before you go outside to allow it time to soak into your skin. The important part is that you should reapply it every two hours or so as well as after time spent in the water or sweating heavily. One application of sunscreen is not enough to last all day.

3.Plan Your Outing

If you want to go outside when the sun is out, try to avoid the hottest time of the day. Typically, the highest sun exposure occurs between ten am and four pm, when the blazing sun is directly overhead. Be sure to stay hydrated when you are outdoors to prevent heat exhaustion and find some shade or wear a hat to give yourself and your skin a break. Also, don’t expect clouds to offer protection, as up to 80% of UV rays can pass right through them.

4. Protect Your Eyes

With all the emphasis on sunscreen and shade, your eyes may not be on your sun safety radar. Sun exposure leaves your eyes are vulnerable to several conditions, from cataracts to macular degeneration, as well as headaches and trouble seeing distances due to glare. Sunglasses can make it safer to drive or enjoy the beauty of nature when you do brave the heat.

5. Freshen Your Supply

Much like medications, sunscreens do have a shelf life and can lose their effectiveness if past the expiration date. Hopefully, with regular, consistent use of sunscreen, you don’t have an abundance of old products on hand, but any sunscreen that is two or three years old may not offer the amount of protection you think it does. When in doubt, toss it out and get a fresh supply.

It does not take too much effort to stay safe when you are out in the sun, but that effort can make a big difference in your skin over time by slowing down the signs of aging and reducing the risk of skin cancer. For other helpful information to keep you healthy, contact us (707) 823-3689 or visit our website online .

It Was the Best of Times, It Was the Worst of Times

Thu, 25 Jun 2020 23:50:20 GMT

Whole Life Insurance Provides Certainty in Uncertain Times

To continue with Dickens, "It was the age of wisdom, it was the age of foolishness." Months or years from now, how will you describe the current situation? Will you think of the panic of pandemic, an age of anxiety? Or will you look back on it as a rare time you once had to slow down, reflect, and take stock of your life?

An age of wisdom can be difficult to achieve in the midst of so much uncertainty. It can feel that nothing is secure; not jobs, not healthcare, not even stocked shelves in the grocery store. And just when many of us wish to reach out to family and friends, drawing them closer for comfort, we're told that we can't. Our very instinct to rely upon each other puts our lives at risk. All these things lead to discouragement, frustration, and a feeling of helplessness.

Take heart. There are things you can do to avoid the worst of times. One of the best steps any of us can take in these unprecedented days is to prepare ourselves for what may yet lie ahead. This may mean asking mom to sew some masks. It may mean storing nonperishable food. To truly be wise, it should also mean securing a better financial future. What does that entail? Start with paying down debt, establishing a savings account, and contacting a life insurance broker in Santa Rosa.

Purchasing whole life insurance is one of the smartest decisions you can make if you seek certainty in uncertain times. Consider the following:

Companies cannot increase the cost of your coverage
The premiums are guaranteed
Policies come with non-forfeiture options in case you cannot pay your premium
Premiums can be paid from policy cash values or from an automatic premium loan

Get Guarantees With Whole Life

Whole life insurance policies offer guaranteed cash value growth. The guaranteed cash value growth is written into the policy and is not affected by changes in interest rates or the wild fluctuations of the stock market. As long as you pay the premium, the value grows. What a comfort in times when the financial markets are anything but secure.

You also get guaranteed death benefits. Although none of us like to think about using this benefit, in reality it eases the stress of a difficult time by providing money just when it's needed most. This benefit doesn't change as long as you pay the premium and is unaffected by any market performance.

Because premiums, death benefits, and cash values are all guaranteed, you can go to sleep at night counting on at least this one thing; your whole life insurance policy will always be there for you. Even when store shelves are empty, concerts are cancelled, and weddings are postponed, your policy from a life insurance broker in Santa Rosa continues to grow and earn money for you.

Instead of having fear for the future, make it the best of times by planning wisely. For more information on how to include a whole life insurance policy in your financial planning, contact us at (707) 823-3689 .

The Health Insurance Renewal Process for Small Businesses

Thu, 18 Jun 2020 23:46:56 GMT

Small Business Health Insurance Renewal

Small business owners have a lot to think about and take care of. Even though you’re the owner of a business, that doesn’t mean you have all the answers. Have you spoken with your health insurance broker about insurance renewal? Your employees are counting on it and it’s not as hard as it may seem.

Why Do It?

Your health insurance coverage won’t just carry from year to year without any effort on your part. Your employees expect that they’ll have the health coverage they need, so it’s important you take care of renewal each year. The following are some reasons it needs to be done.

Keeping coverage in place. You may not wish to change anything in your health plan, but that doesn’t mean you don’t have to renew. A simple renewal will keep your existing coverage in place for another year.
Modifying contributions. It’s possible you wish to modify the amount of contributions your company makes to your employees’ health plans. Whether you wish to contribute more or less, you can make those adjustments during renewal.
Switching to a new plan. If you’re coming to us from another insurance company, welcome! We’re happy to have you. We understand the need to switch companies sometimes, and for our current customers, we understand the need to switch to a new plan. Renewal is a process in which you can do that.
Giving employees more options. Your employees’ lives aren’t going to stay the same from year to year. One employee might get married. One might give birth to twins. Another might experience the loss of a family member. These kinds of life events could have an impact on the type of employee benefits each employee needs. During renewal, your employees can choose the plan options that are best for their unique situations.

How Does It Work?

While this may seem like a complicated process, it doesn’t have to be. At Sackett & Associates Insurance Services, a health insurance broker can walk you through the process so you end up with all the benefits you and your employees need most. Since you have already enrolled in a group health insurance program, the renewal program will take place once per year after that.

Before the renewal process, you should speak with your employees, informing them that the year mark is coming up. They can look over their benefits to determine if they have anything they want to change. They could also make requests for more employer contributions or other benefits they’d like to see you change in the overall plan.

Sackett & Associates Insurance Services will then offer you all the information about payment changes, pricing and other particulars that you’ll need to know. We take inflation, regulations, risk reassessments and network changes into consideration when changing our pricing and policies, so those will make a difference in your renewal process as well. Once you have chosen options for your employees and those employees have chosen their health plans, we’ll finish up the paperwork and you’ll be ready to go with your new policies on the start date of your cycle.

Contacting the Professionals

At Sackett & Associates Insurance Services, we are committed to helping you understand and get through the small business health insurance renewal process. For more information on how to do this, contact a health insurance broker at 707-823-3689.

Who Pays Medicare Insurance Brokers?

Mon, 08 Jun 2020 23:43:47 GMT

How Are Health Insurance Brokers Compensated?

Medicare provides state-sponsored health insurance plans through private companies to older individuals. Each year, millions of Americans across the country enroll in Medicare plans , but many don’t know their options. By working with a Medicare health insurance broker, which is free of charge, many individuals could find out about plans and coverage options they normally wouldn’t know about. Keep reading to learn more about brokers and how they are compensated when you work with them.

What is a Health Insurance Broker who Specializes in Medicare Plans?

A Health Insurance broker is an agent who works independently to represent multiple insurance carriers. Such agents can provide you with the unbiased and direct information you need to make appropriate choices regarding your Medicare plan. When you work with a Medicare broker, you will not be pushed toward a sole insurance provider, and your broker will be able to help you understand the differences between each insurer and plan. A broker’s ultimate goal is to help you find a plan that fits your particular needs and budget. Since Medicare brokers are paid by the insurance companies they represent, you don’t have to pay anything.

What Are the Benefits of Working With a Broker?

There are numerous benefits of working with a Medicare broker, including:

Brokers tend to have a broad understanding of the offerings and benefits of each insurance agent.
You can re-shop for the coverage you need during each enrollment period.
Brokers may have access to plans you can’t find anywhere else.
Brokers can help you stay current of any policy changes or options added by insurance companies.
You can find all the information you need in one place, instead of having to search for different policies with different insurance companies.

Simply put, talking to a broker can save you time and money, especially if you have never had to choose a Medicare plan before.

Who Pays a Medicare Broker?

Independent brokers are compensated by the insurance companies themselves. When a consumer pays a premium, the commission for their agent is already included in the figure. If you choose to enroll through an agent, the insurer will cover the commission and you will continue to receive service from that agent.

However, if you choose to enroll directly through the insurance company, the company will keep the commission and you will not have direct access to a helpful agent and their services.

The amount an agent earns will depend on the type of policy a person chooses and the contract between the agent and the insurance company. It is also possible for a Medicare broker to have different commission levels with different insurers.

Why Work With a Medicare Broker?

Brokers are knowledgeable for several reasons. Firstly, they have extensive experience helping regular people choose Medicare policies that fit their lifestyles. They help people from all backgrounds understand their Medicare options daily. Secondly, brokers must have specialized training before they can act on their own. This means you will never work with someone who is unknowledgeable about Medicare plans and coverage options.

Contact Us

Choosing the perfect Medicare plan can be difficult, but it doesn’t have to be when you work with Sackett & Associates Insurance Services. Contact us today to learn more about the Medicare plans in your area.

What Aid Is Available for Small Businesses Impacted by the COVID-19?

Mon, 18 May 2020 23:39:45 GMT

Economic Relief Available for Small Businesses

While many businesses and individuals have been impacted due to the required measures taken slow the progression of the COVID-19, small businesses are facing a unique set of struggles during this time. With many businesses being ordered to shut down and close their doors to the public, many companies are struggling to make significant revenue and continue providing employee benefits to their workforce. Fortunately, there are several programs in place at both a federal and state level to bring quick relief to applicants who qualify.

Federal Loans and Grants

Through the Coronavirus Aid, Relief, and Economic Security Act, which sets aside $376 billion for assisting small businesses and workers affected by the Coronavirus, there are several federal relief options available. The U.S. Small Business Administration has also expanded access to some of their programs. Here is information on the two main relief options currently available to American small businesses.

Paycheck Protection Program

The primary financial relief provided to small businesses through the CARES Act, the Paycheck Protection Program is put in place to help companies retain employees. To qualify, the business must have less than 500 employees or meet the SBA’s standards for industry size. Additionally, independent contractors, sole proprietors, and self-employed people can also be eligible. This program provides loans up to $10 million, which are provided by lenders at an interest rate of one percent with a maturity of two years. Payments are deferred for six months, and the loan is forgiven if the funding is used primarily for payroll and for rent, utilities, and interest on a mortgage.

Economic Injury Disaster Loan and Emergency Advance

If experiencing a loss of revenue, eligible small business owners can apply for a loan up to $2 million, which must be used for debt, payroll, and other needs. The loan term can be up to 30 years with a deferment of one year. The interest rate is 2.75% for nonprofits and 3.75% for businesses. Loan applicants can also request a $10,000 advance, which does not need to be repaid even if not approved for the loan.

Local Assistance

In addition to the funding available at a federal level, there are several state, county, and city programs available in some areas. While the qualifications and provided assistance vary greatly in each location, business owners are able to fine additional relief through local programs

Additional Grants

There also several grants available by various companies and foundations, which may be impacted by industry type and limited availability. For instance, fundraising platforms Hello Alice and GoFundMe have partnered with other companies to help provide additional funds to businesses financially affected by the pandemic.

Having the right health insurance broker can enable you as a small business to continue providing employee benefits to your workforce. At Sackett & Associates Insurance Services, we offer affordable small business health insurance policies that can fit your unique needs. Contact one of our representatives at 707-823-3689 to discuss what options are available today.

Medicare Health Insurance Broker Explains COVID-19 Coverage

Thu, 14 May 2020 20:13:19 GMT

Medicare Health Insurance Broker Explains COVID-19 Coverage

Older adults are one of the groups most at risk from the coronavirus pandemic, according to the Centers for Disease Control, along with those who live in a long-term care facility or nursing home. Another group at higher risk includes those with underlying health conditions or suppressed immune systems. So, it’s understandable that many seniors have questions about coverage for treatment of the new virus, COVID-19. A Medicare health insurance broker can help you understand your benefits.

Co-Pays and Deductibles

The coronavirus is an illness like any other and as such, Medicare covers treatment of it. If you have co-pays and deductibles for medication, you’ll also have them for COVID-19 treatment. If you don’t have them, you won’t pay them for the virus either. Nothing is changed. Medicare also covers the cost of lab tests to determine whether you have contracted the virus.

Employer-Paid Sick Days and Vacation

If you are now at home through self-quarantine or due to a coronavirus-related lay-off, Medicare does not cover your lost income. Your company may work with you to claim sick days and vacation days while you’re home, but that is at the discretion of your employer. If you see a doctor during this period for any reason, the standard rules for payment of medical treatment apply.

Hospitalization for Coronavirus

For those who do contract COVID-19 and require hospitalization, it is considered an inpatient stay, with the same level of coverage as other inpatient stays. Depending on your coverage, you may incur some out-of-pocket costs; however, Medicare covers any treatment, including hospitalization, that is medically needed. This includes when you otherwise may have been discharged after recovery, but must remain at the hospital due to quarantine.

Medicare May Not Cover Alternative Medicine

Because the virus is new, there are not a lot of treatment options available. Several medications are now being explored for treatment, and you may have heard them suggested by government officials or your own doctor. Be careful about alternative medicines and experimental treatments that may not be covered by Medicare. If you have questions about specific coverage, it’s a good idea to check with your health insurance provider first.

Coverage for Immunization

Immunization for COVID-19 is not currently available. Although doctors and researchers are working hard to develop one, it may not be available for many more months. Should one become available, it will be covered as with other immunizations under Medicare Prescription Drug Plans, part D.

Telehealth Services

Medicare has temporarily extended coverage for telehealth services in relation to the coronavirus. This expansion covers virtual visits for evaluation and management of virus treatments with a variety of medical professionals, including mental health counselors. For those with Original Medicare, there is no co-pay for these services.

Help Understanding Medicare Coverage

Whether you are new to Medicare or a practiced user, it’s a good idea to check with a Medicare health insurance broker periodically for updates and changes in coverage. For help understanding how Medicare coverage works for coronavirus and other illnesses, contact Sackett & Associates Insurance Services today.

Get Coverage in Wake of Coronavirus Job Loss With Help From a Health Insurance Broker

Mon, 04 May 2020 20:09:53 GMT

Find Post-Coronavirus Coverage With Health Insurance Broker

The U.S. economy will feel the effects of the coronavirus for the next several months and beyond, with many individuals already feeling the sting in their own wallets. If you are one of 47 million Americans who are expected to lose their jobs—or you have already lost it—you’re likely worried about losing your health insurance, too. There are still some options, however, for securing insurance to cover your family’s healthcare needs, and a health insurance broker can help you explore them.

Continuing Coverage Through COBRA

For those who are laid off, or furloughed, COBRA is a program that allows you to continue receiving health coverage for up to 18 months under the same group plan that covered you as an employee. That’s assuming your company is large enough to include a health plan in its employee benefits, and also that the company is still in business. The drawback to accessing COBRA for continuing coverage, however, is that the cost of premiums falls entirely on the shoulders of the former employee. The business typically picks up the lion’s share of the premium for its employees, who no longer can expect this contribution once they’ve left the company. For many, that means paying four times as much or more in premiums than they paid while employed.

Affordable Care Act Benefits

Another option for the newly jobless is buying health insurance under the Affordable Care Act, otherwise known as Obamacare. You have 60 days from your last day at work to enroll; otherwise, you’ll have to wait until the open enrollment period. Get ready to do some research to find the right plan. Here are some tips to guide you in getting started.

Where to enroll: The District of Columbia and 12 states have their own marketplaces for insurance. If yours doesn’t, you can shop the federal exchange or a private marketplace. Remember that there is a 60-day enrollment deadline for a government-run marketplace.
Compare plans : Review options in different plans to find one that works best for your family’s needs, as well as your budget. Compare the cost of co-pays for medication and physician visits, which can add up for families. Be sure to check whether your preferred doctors are in a network as well, if that is important.
Review all costs: Be careful to look at estimated yearly costs, as well as the co-pays and monthly premiums. Otherwise, you may be stuck with a high deductible and end up paying more overall in out-of-pocket costs before the deductible is met.
Government subsidies: Many states offer subsidies to help lower the cost of monthly premiums for low-income households. If your household income is under $100,000 for a family of four, support may be available, or you may qualify for Medicaid.

Get Expert Help

Whether or not you have a head for figures, shopping for health insurance can be a complicated process. Reach out to the experts, such as Sackett & Associates Insurance Services , whenever you have questions. For more information on how we can help you weigh the benefits and choose the plan that’s right for you, request a quote here.

Navigating Group Health Insurance Policies

Wed, 29 Apr 2020 20:05:31 GMT

Understanding Group Health Insurance

Health insurance plans each have their own rules, benefits and drawbacks. These can be tricky enough to work out when you're buying health insurance for just yourself, but when you're looking for a plan to provide employee benefits, a new set of questions and concerns arises. Group health insurance plans are one of the most popular solutions for employers and employees alike for many good reasons. However, it's best to understand what they entail before you sign up for one—they differ from individual plans in a number of ways.

How Group Health Insurance Works

A group health insurance policy is bought by a single person—such as an employer—and offered to a group of members and their dependents. Like individual plans, group health insurance entails a monthly premium for coverage, as well as a deductible and out of pocket maximum. Employees that opt in, though, pay a reduced premium—deducted from their paycheck—because they split the cost with their employer, who can write their payments off as tax-deductible. Some plans come in multiple tiers, where employees can opt to pay more for advanced coverage.

Like individual insurance, plans typically fall under one of three categories, and a group health insurance broker often provides multiple options:

Health Maintenance Organization (HMO), which offers a local network of doctors and hospitals, of which you pick one as your primary care provider (PCP). Your PCP will refer you to specialists when needed; otherwise, out-of-network costs aren't covered except during emergencies.
Preferred Provider Organization (PPO), where the contracted network of medical providers isn't a strong restriction; for a higher monthly premium and some small out-of-pocket costs, you can freely see out-of-network providers and specialists without a referral.
Exclusive Provider Organization (EPO), which, like an HMO, has a provider network associated with the plan but often doesn't require you to see a PCP for referrals to specialists. Additionally, networks are usually larger than those for HMOs.

Benefits and Drawbacks of Group Health Insurance

Employee benefits offered by group health insurance start with lower premiums, which stem from risk being shared and spread out among multiple people; premiums drop even more when more people sign onto the plan. Additionally, group health insurance covers whole families at a flat rate, regardless of size—in the individual market, you'll likely have to pay extra premiums for each member of the family. On top of that, employees can't be denied because of pre-existing conditions and plans generally cover maternity at no additional cost; this makes for an attractive option to many people that cannot get individual policies.

On the other hand, group policies offer the same coverage to all members and the employer's decisions are final, which can mean that some employees find they don't get sufficient coverage that a personalized plan would give them or might be paying more for coverage they don't need. More significantly, continued coverage depends on remaining employed at this business, and retiring, quitting or being fired leaves you without insurance. Additionally, because there's a minimum rate of participants in the organization for the plan to be valid, and because premiums are much higher with smaller groups, at small scales the plan may not be worth it.

While no insurance plan is one-size-fits-all, group health insurance can be a strong option for you depending on your current and predicted health, your family and your job security.

What Every Employer Needs to Know During the Coronavirus Crisis

Thu, 09 Apr 2020 20:03:07 GMT

Things Employers Need To Consider About COVID-19

Many things tax the grit of a business owner during normal operations. However, the COVID-19 outbreak and resulting forced business changes by cities and states are like nothing we've experienced as a country in modern times. The rules are changing, and, in addition, you still have to abide by the existing laws that were enacted for employee benefits. All this while keeping your customer's trust and confidence in your ability to keep them safe from the virus so that they will buy your products or services in a completely new business model.

Laws and Mandates

Refamiliarize yourself with Occupational Safety and Health Administration and Americans with Disabilities Act regulations during this time. While there are no new OSHA regulations for Coronavirus, there is a COVID-19 page on the OSHA website that you need to read. Remember, you must also document any employees who contract COVID-19 and report it to OSHA. Take care to follow privacy rules set forth by HIPPA, as well as OSHA, ADA and others.

Additionally, on March 18, 2020, there was a newly passed update to the Family Medical Leave Act called the Families First Coronavirus Response Act . Among other relief, it expands family and employee sick leave during a quarantine. City and state leaders are calling for closures and self-quarantines around the country, so you must stay aware of the changes in your area to stay compliant. If you must make the difficult decision to close your business, there are guidelines set forth by the U.S. Department of Labor that apply.

Prevention and Safety

It is up to everyone to be a good steward of public health, but even more so if you have a business. You now must have heightened awareness and practices in place to prevent the spread of the Coronavirus among your employees and your customers while being observant of employee benefits. To help, the Centers for Disease Control have issued interim guidance for employers during the times of COVID-19. Some good rule of thumb practices are:

Emphasize hygiene with posted guidelines on how to wash hands effectively
Observe distance rules
Emphasize that ANY symptoms of respiratory illness, including fever, coughing, difficulty breathing, etc. requires the employee to stay home
If an employee recently traveled, ask them to observe the 14-day self-quarantine before returning to work
Expand your leave policies

Communication and Trust

As an employer in these trying times, you need to be aware that how you respond to this challenge can make all the difference in your ongoing operations. Communication is the key to trust. Make employees feel safe about their working conditions and be accommodating to navigate childcare issues, school closings and family obligations.

Use all available options such as email, social media and advertising to communicate your ongoing but altered business operations as you conform to changing requirements. Include all the safety measures you are taking to protect both your employees and customers. Consumer confidence will ensure that they will keep buying from your business during trying times.

Now more than ever, you want to know that you have a health insurance broker you can depend on. Sackett and Associates Insurance Services is your trusted provider of individual and group insurance. Get an online quote , or give them a call at 707-823-3689 for more information today.

Knowledge Is Power: Keep Yourself Safe From COVID-19 by Staying Informed

Fri, 03 Apr 2020 20:00:09 GMT

Everything You Need To Know About the Coronavirus

The World Health Organization has declared a global pandemic and many governments are shutting down all non-essential businesses to keep citizens safe. Many people are feeling fear and uncertainty, which may be exacerbated by the flood of information online and in the mainstream media. How can you protect yourself and your family from this unprecedented threat?

Here at Sackett & Associates Insurance Services, we’ve gathered information from the Center for Disease Control and other reliable sources to help you determine fact from fiction. Here are the basics you absolutely must know to stay healthy.

What Is COVID-19?

COVID-19 is a coronavirus, which is a family of virus that causes respiratory distress. While we haven’t seen this strain before, we do have some experience with this particular family — Middle Eastern respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) are coronaviruses that jumped to humans in the past.

Coronaviruses are named so because of their unique protein structure; these proteins protrude from the virus and attach to cells. The word “corona” is Latin for “crown,” which these proteins resemble.

Why Is It So Dangerous?

As of March 2020, COVID-19 has a fatality rate of 3.4%. While this may seem like a small number, it quickly becomes devastating when multiplied by millions. There’s also the risk of serious complications that require hospitalization, which 20% of COVID-19 patients experience. Even when they recover, these patients often have permanent lung damage that leaves them vulnerable to future illnesses.

Another issue is how easily COVID-19 spreads. Currently, health officials advise that this coronavirus may take up to 14 days before symptoms appear and that infected patients are contagious during that time. This means people can feel perfectly fine, but shed virus through respiratory droplets.

How Can You Protect Yourself?

The CDC has issued several guidelines to help prevent infection:

Practice Social Distancing: The best way to avoid infection is to limit contact with infected people. Social distancing means staying away from crowded places such as bars, restaurants and stores. If you must go out, maintain a minimum distance of six feet between you and others, as this is the distance respiratory droplets can travel when someone sneezes.
Wash Your Hands Frequently: Handwashing with soap and water for at least 20 seconds is crucial to eliminating any virus that may be on your hands.
Wipe Down Frequently Touched Surfaces: If the virus is on your hands and you touch a surface, it may be able to survive on that surface long enough to infect someone else. To combat this, you should wipe down frequently touched surfaces such as door handles, facets and light switches at least once a day.
Avoid Touching Your Face: The virus enters your system through the eyes, nose and mouth, which is why you shouldn’t touch your face unless necessary. If you need to touch your face to put in contacts, apply skincare products or put on makeup, make sure you wash your hands thoroughly beforehand.

When your health is on the line, you need reliable insurance. At Sackett & Associates Insurance Services, we can connect you with companies that offer the coverage you need. To find out more or to request our services, give us a call at 707) 823-3689 or message us online .

Will Medicare Run Out of Money by 2026?

Mon, 16 Mar 2020 19:54:14 GMT

Where Does Medicare Get Money? Can It Run Out?

If you are approaching 65 and thinking about your healthcare options, you may be planning to take advantage of Medicare . This government program provides older Americans with health coverage that they may have previously gotten through private insurance. Many people worry about the state of Medicare and whether they can rely on it. Understanding how it is funded can help clear up some of these worries.

Medicare

The US federal government runs the program to help offer health insurance to Americans who are 65 and older. Some younger people with disabilities also qualify for coverage. It is broken into four parts.

Medicare Part A is hospital insurance. It helps with costs related to inpatient hospital care, skilled nursing facilities, hospice and home health care. In other words, it is for inpatient and continuing care.
Medicare Part B is called the medical insurance portion. It helps to cover outpatient care and similar doctors’ services. This includes preventative care, medical supplies and outpatient services.
Medicare Part C is called Medicare Advantage. It is an alternative to Medicare Part A, B and sometimes D through private insurers. It is still considered Medicare because the government sets certain rules for the insurance companies.
Medicare Part D is prescription drug coverage. It will help you pay for your medications.
If you sign up for Medicare and don’t opt for Part C, you will automatically be enrolled in Part A with no premium. Part B and D have premiums (as does Part C). There may also be deductibles.

How Does It All Get Funded?

The funding for Medicare is held in two trusts managed by the U.S. Treasury. The first trust is the Hospital Insurance Trust Fund, covering expenses related to Part A. This is funded primarily through payroll taxes paid by employees, employers and the self-employed. It is also funded with interest, Social Security benefits taxes and some taxes on the very wealthy.

Medicare Parts B and D are paid for through the Supplementary Medical Insurance Trust Fund. Some of the money for this fund comes from general tax revenue (meaning there aren’t special taxes for it). Another chunk of the money comes from the premiums paid by Medicare Part B and D users. The states also make payments into this fund. A portion of the money also comes from interest and taxes on benefits.

Should You Be Worried?

Some experts have warned about Medicare insolvency by 2026. However, this paints a bleaker picture than reality. Although it is true that, without reform, the Hospital Insurance Trust Fund would be technically insolvent by then, it would still be able to cover 91% of costs through 2042 and 85% through 2092. Furthermore, the government is likely to introduce some reforms.
The Supplementary Medical Insurance Trust Fund is in no danger of insolvency thanks to the premiums. So, while Medicare may need some help, it is at no risk of “drying up” in the near future.

Finding the Right Medicare Insurance

If you want to be sure of your continued health coverage during the later years of your life, Medicare Part C and supplemental Medicare insurance can help. For more information about how Medicare works and what you can do to keep yourself covered, contact Sackett & Associates Insurance Services at 707-823-3689. We are the Medicare insurance broker you can count on.

Separating Fact From Fiction on the Coronavirus

Fri, 13 Mar 2020 19:50:40 GMT

Debunking Coronavirus Myths

Amidst news of the spread of COVID-19, commonly called the coronavirus, getting caught up in misinformation is all too easy. Fears, misconceptions and desperation can make it difficult to prepare yourself when you can't get a straight answer on what to do. Do you have to fear for your pets? Is it just an overblown flu? Can your health insurance broker do anything to help? If you need help filtering out the myths, here are some common ones to address.

MYTH: "Always Wear A Mask"

Like the flu, the coronavirus spreads primarily person-to-person via coughs and sneezes, so a mask may sound vital. However, this overstates the rate of spread—you're only at risk if you're in close contact with someone who's infected, and wearing a mask 24/7 isn't really necessary. The standard flu prevention strategies are your best bet: wash your hands regularly, clean frequently touched surfaces, avoid touching your eyes and mouth and keep a good distance from someone who's sick—or someone who's healthy, if you're sick. However, when in public and close proximity to other people, if a good idea to where a mask.

MYTH: "Packages From China Aren't Safe"

Initial reports about the coronavirus originating in China have led to nasty scaremongering encouraging people to stay away from anything that might've come from there. Besides the distrust and stigmatization this can create, it also misinterprets how the disease spreads. While surfaces and objects can be contaminated, the coronavirus doesn't live long outside of a host; almost certainly, an overseas package isn't going to infect you.

MYTH: "One Weird Trick to Treat Coronavirus"

With no official cure announced and the vaccine still in development, proposed cures have popped up, ranging from misguided to malicious. Some examples:

Alcohol and UV rays may sanitize surfaces, but they'll likely harm your body instead.
Pneumonia vaccines won't work, because they don't match the coronavirus.
Antibiotics only affect bacteria.
Household cures like garlic or saline nasal rinses have no evidence of success.
Be wary of anyone selling a cure; you could face worse than getting scammed.

MYTH: "Only the Elderly Are at Risk"

Current data does indicate that most healthy individuals aren't seriously threatened by COVID-19, but the at-risk groups aren't limited to the elderly. Anyone with a compromised immune system, which can also include infants, young children and those already prone to illness, could experience more severe symptoms. More significantly, even if you're not at risk of death from coronavirus, you could still spread it to someone who is.

MYTH: "Can My Dog Give Me the Coronavirus?"

While there are strains of coronaviruses that do infect animals, these aren't related to COVID-19, which is far from the only coronavirus. It's still a good idea to mind hygiene when playing with your pets because of other pathogens that can cross from human to animal, but the coronavirus is not one.

MYTH: "Get Tested Now!"

Don't jump to conclusions if you start sneezing and feeling feverish: the CDC recommends COVID-19 testing only to symptomatic people who have been to Wuhan City, China recently and anyone in close contact with them. Besides worrying yourself over nothing, testing can be expensive and you would have to make sure that your health insurance broker can cover you.

These are just some of the major myths flying around in the wake of the coronavirus, and as researchers learn more, they may disappear or resurface. For information on what you can or should do, turn to sources like the WHO .

Did You Know That Competitive Health Coverage Is the Best Way To Attract High Performers?

Wed, 26 Feb 2020 18:19:29 GMT

Health Insurance Employee Benefits Attract Top Workers

Most people have an idea of what their dream job or dream employer is like. Workers also know the perks that come with having Fortune 500s on their resume, especially in key positions. When vacancies open up at these companies, competition is stiff and high performers move to the head of the line. However, many high performers are now looking at smaller businesses that offer great employee benefits and more flexibility.

Preparing for Greater Competition

Unemployment rates are at an all-new low in America. NBC News reports that at 3.69%, the unemployment rate hasn’t been this low since the end of 1969. This is great news for employees as it increases their bargaining power. The recent move to increase the minimum wage also means that many people saw an increase in their wages all across the country at the start of the year without needing to change jobs or get a promotion.

Because there are fewer people prowling the job market, companies have to try a lot harder to tempt workers away from their current jobs. The competition for finding, attracting and holding on to top talent is especially difficult for small businesses. How do they compete with the larger salaries and prestige that big companies can afford to offer? Using group health insurance to provide stellar employee benefits is the easy answer.

Noting Health Insurance Trends

Ultimately, how you structure your compensation packages will be affected by how your competitors do the same. Take a look at some of these health insurance trends:

Annual health insurance costs rose by $6,936 in the 10-year period leading up to 2018, while employer contributions rose by $4,744 during that same period.
73% of small firms offer some degree of health insurance coverage, compared to 94% of large firms.
3% of small firms cover more than 50% of insurance premiums compared to just 1% of larger firms.
Employees are more likely to stay with companies that offer desirable health insurance benefits.

Offering Health Insurance at Your Business

When considering health insurance, just offering any old plan won’t do. The coverage type you offer and how much you contribute to the expense helps to decide whether it’s desirable to employees or not. Consider the following tips below:

Research what your direct competitors for each job position are paying in the local area and try to either match or beat their offering.
Purchase group health insurance to pay and offer reduced premiums based on the “bulk purchase” savings.
Choose a health insurance company with a high satisfactory rating from current customers.
If you’re unable to contribute 50% or more to insurance premiums, consider partnering with a local gym to offer complimentary membership for employees.
Consider contributing 50% or more to the cost of insurance premiums for key personnel in the highest positions as, ironically, higher earners have fewer alternative health insurance options.
When you post job ads, be sure to highlight your health insurance offerings, so people know that health coverage is available.

Getting Started

Are you ready to get started? Contact Sackett & Associates Insurance Services to learn more about the best group health insurance plans on the market.

Three Ways a Health Insurance Broker Can Help You

Wed, 12 Feb 2020 18:15:51 GMT

Health Insurance Brokers - Ensuring The Best Benefits For Your Company

As an employer, you have many responsibilities to your staff. You need to maintain a hospitable workplace, encourage employee growth, and provide benefits to your full-time team members . The last of these is particularly important. Offering sufficient benefits isn’t just the right thing to do, it’s often legally mandated for employees who work at least 30 hours per week. Finding the right insurer to partner with and obtaining the best rate is a challenge, and it’s often overwhelming for big and small companies alike. If you are wondering what resources exist to help you with this process, you will likely be interested in the services of a health insurance broker—but what does a health insurance broker do? There are several ways such a professional can help you.

Negotiate the Best Deals for Your Group

Of course, money is one of the top concerns when it comes to securing health coverage for your employees. You never want to spend too much, but you also do not want to opt for a cheap and unsatisfactory option. A skilled health insurance broker can help you land exactly where you need to be by finding quality comprehensive plans that fit within your corporate budget. Brokers partner with insurers, too, so they have the opportunity to secure rates and discounts that you may not have access to on your own. Brokers typically work based on commission rather than a fee, too, so there shouldn’t be any additional cost for their services.

Provide the Power of Knowledge

Knowledge is power, and if you are seeking the best insurance policy for your company, you cannot afford to be in the dark about your options. Your research can only reveal so much, though, and sometimes information about certain policies isn’t even publicly available. How do you ensure you’re fully equipped with the information you need to make an informed choice? A health insurance broker will give you details on the following:

Pricing options and potential discounts
Network coverage and costs
Copays and deductibles for policies

Keep in mind that some of the information a health insurance broker provides may not be accessible to individual purchasers dealing with an insurer directly.

Give You An Impartial Perspective

Though brokers may receive commissions, many of them work with multiple insurers to find the coverage options that are best for their clients. If you are only dealing with representatives of individual companies, you might not get the full picture of your options, and the information you get will be favorable to that particular insurer. A broker, on the other hand, will be able to provide you with information about a number of different insurers and their plans, so they should not be biased towards or against any one provider. With an impartial advocate on your side, you can rest assured that you interests are taken seriously and you will have access to the best options available for your company, your employees, and your budget.

For more information on finding the best insurance plan for your company, contact Sackett & Associates Insurance Services at 707-823-3689.

How Much Money Do Employers Contribute to Employee Health Insurance?

Fri, 07 Feb 2020 18:13:27 GMT

Employer Contributions to Health Insurance Employee Benefits

When creating employee benefits packages , there are two main factors that decide how much an employer contributes. The first is the minimum requirement. Businesses with 50 or more full-time employees are required to provide group health insurance benefits to their employees. Covered small businesses must contribute to at least 50% of the premiums. Larger businesses tend to pay more.

The second factor is how much an employer wants to pay. In fact, a 2018 study conducted by the Kaiser Foundation found that 31% of firms that must provide health insurance paid the full cost for their employees — by choice. To add to this, 35% of covered firms paid more than the required half.

Why Offer Competitive Health Insurance Benefits

This leaves the field wide open when it comes to choosing how much you want to contribute to health benefits at your business. Employers that are not covered may decide to skip health insurance benefits altogether to save money. Those who are covered may pay just the bare minimum. This has significant drawbacks:

Employees may choose not to get health insurance at all, which could cause their health to decline.
When your employees are not healthy, that translates into more callouts from work.
Employees with families may jump ship at the first opportunity as children especially tend to need good insurance.
Top talent will go to competitors who offer better health insurance and other benefits.

How To Decide How Much To Pay

According to Turbo Tax, the money you pay toward employee insurance premiums is deductible as an employee benefit program expense . So, if you’re looking for ways to reduce your tax liability, this is a great starting point. Incorporating this into your tax planning initiatives at the start of every year can help you decide how much to pay in premiums.

Another important consideration is how much top talent means to you. Even if you don’t look for top talent to fill every role, consider offering the best compensation package you can for key roles. These workers are not short of offers. High achievers are also usually quite ambitious and may move on to the best offer if it’s not coming from you.

What Employer Contribution Trends Look Like

At the end of the day, competitive is relative. What are other companies paying? Don’t just look at your direct competitors, but the companies that compete for the employee. For instance, a company that manufactures cars needs an accountant just as badly as one that sells groceries. In most instances, you can find their pay and benefits information via job ads published online and in newspapers. Indeed, Payscale and Glassdoor may also help you find the information you need.

Also, note the following. The aforementioned 2018 study found that 28% of small firms paid more than 50% of employee premiums. Ironically, only 22% of large firms paid more than 50%. They were, however, more like to offer insurance than smaller firms. Only 6% of larger firms did not offer health insurance compared to 27% of smaller firms.

Your 2020 Health Insurance Benefits

Are you considering group health insurance to boost your employee benefits offerings in 2020? Contact Sackett & Associates Insurance Services for more information on how to take the next step. Give us a call at (707) 823-3689.

8 Questions to Ask Before Buying Employee Healthcare Coverage

Wed, 29 Jan 2020 18:10:58 GMT

Is Employee Health Insurance Worth It?

Employee health insurance is a viable option if you have more than 49 full-time employees. The question you face is whether offering an employer-sponsored health plan is a good fit for your business. If you're not sure, there are eight questions you can answer that can point you in the right direction.

1. Are You Working With a Broker?

Setting up health insurance coverage is a major investment of time and resources. You need a broker who understands your company's unique needs. The broker must also consider your budget. When you work with someone who has your best interest at hand, you're likely to get an affordable policy that's a perfect fit for your workers.

2. What Is Your Budget?

There are several variables impacting the cost of health care insurance. A few factors include employee contributions and program maintenance. Determine what you can afford based on your total annual budget.

3. How Many Workers Will You Cover?

Every coverage plan requires that you pay a deductible. The number of employees being covered affects the deductible amount. These costs differ significantly between large firms and small businesses. On average, the former plays a little over $1,400 while smaller companies pay approximately $2,200.

4. How Much Are the Contributions?

Employer and employee contributions are major cost factors in healthcare policies. For instance, employers paid nearly $6,000 and $15,000 for single-payer and family plans respectively in 2019. Likewise, employees paid around $1,200 and $6,000 for the same coverages. This gives you an idea of how much of your budget you can set aside for coverage.

5. What Do You Want the Insurance to Include?

You want to offer your team a plan tailored to their needs while staying within your budget. There are many benefits options that workers value, such as:

Vision
Dental
Medical

Additionally, look into preferred provider organizations. PPOs are the most popular option in the United States.

6. What Resources Will You Set Aside for the Health Insurance?

Sustaining an employee benefits program requires dedicated resources. Ideally, you need personnel to oversee and administer the program. Additionally, there's the need for HR technology to help things run more efficiently. Of course, these are added expenses. However, it's a worthwhile financial investment that helps ensure your company and team benefit from the health insurance policy.

7. What Role Do Benefits Play in Your Hiring Process

Competition is stiff when it comes to recruiting talented job candidates. This is one reason why many companies provide health benefits packages. It's a high-value benefit many workers have come to expect from an employer. If your competitors are offering coverage, it may be a wise move to do the same in order to recruit top-tier job seekers.

8. What Are Your Goals and Needs?

Every health plan has its pros and cons. The best program is one that aligns with your goals. It also addresses the specific needs of your employees. Once you're clear on what it is you want to achieve and the best way to serve your workers, evaluating policies becomes a lot easier.

Choose the Right Employee Benefits Policy

Answering these eight questions helps you determine if an employee health plan suits your business. If you need more information, contact us at (707) 823-3689. We work with reputable insurance providers who offer a variety of comprehensive policies.

7 Dates Every Manager Should Know for HR Compliance in 2020

Wed, 15 Jan 2020 18:08:36 GMT

7 HR Compliance Dates to Know in the 2020 Calendar

The end of the year signifies many things for businesses, but especially the wrap up of another hopefully successful quarter. However, as every year comes to a close, it means new HR compliance deadlines to be aware of for the upcoming year. Therefore, to help organize your calendar, the professionals at Sackett & Associates Insurance Services have selected the seven most important dates of the 2020 calendar year.

1. January 31st

The end of January 2020 is an important date for all businesses because the 31st is the deadline for the delivery of W-2 and 1099-MISC forms. Therefore, to avoid penalties, make sure that these documents are sent out by the deadline. In fact, it is better to send the forms out earlier to allow for corrections.

2. February 28th

1094-C and 1095-C forms must be completed and submitted by all Applicable Large Employers by February 28, 2020. Also, 1094-B and 1095-B forms must be completed by all employers with less than 50 full-time employees. These forms help employees when filing taxes, and these forms are essential to reporting minimum compliance with the Affordable Care Act.

3. March 1st or 2nd

While the typical deadline for form M-1 is March 1st, the date falls on a Sunday in 2020, which means the form must be submitted no later than the following business day, March 2, 2020. This form is essential to the Multiple Employer Welfare Agreement, which is a welfare benefit that can be offered to employees. However, check state regulations to understand specific responsibilities.

4. March 2nd

Company illness and injury records are required of companies with 250 or more employees. The summary of this report for 2019 is compiled in form 300A and needs to be submitted to OSHA no later than March 2, 2020. The data can be submitted electronically through the completion of an ITA, or Injury Tracking Application.

5. March 31st

To aid in the enforcement of civil rights across different industries, the federal government requires the completion of compliance survey EEO-1 by March 31, 2020. This report compiles information about the race, gender, ethnicity and job categories of all company staff.

6. July 31st

Some organizations are required to make their contributions to the Patient-Centered Outcomes Research Initiative by July 31, 2020. This yearly trust fund fee is collected from the issuers of some health insurance policies to aid in the research of evidence-based medicine and the distribution of information to patients, purchasers, clinicians and policymakers. Again, not all organizations are required to report to or contribute to this fund.

7. October 14th

Does your organization offer prescription drug coverage? If so, then you need to provide written notice to all Medicare-eligible enrollees. This notification must be sent out no later than October 14, 2020, which is before the annual enrollment period for Medicaid.

While the dates listed above are not extensive and do not cover every 2020 deadline, they are some of the most significant. If you would like more information about essential dates this coming year, then contact Sackett & Associates Insurance Services.

10 Tips for Picking an ACA Health Plan that Works for You

Fri, 03 Jan 2020 18:04:59 GMT

Use These 10 Tips to Select Health Insurance

Have you selected your insurance coverage for 2020? If not, then you need to get on it because while open enrollment keeps getting extended for the Affordable Care Act compliance, the extensions won’t last forever. To help you narrow down your options, the professionals at Sackett and Associates Insurance Services have compiled a list of ten tips.

1. Know the Costs

Unfortunately, many people have an unrealistic expectation of health insurance costs. Therefore, set realistic expectations. While someone receiving government subsidies can often find coverage for under $100 per month, people who do not qualify for subsidies can usually expect to pay over $400 per month for individual coverage and nearly $1,200 for a family.

2. Keep Your Doctor

Next, make sure the plan you choose works with your preferred doctor, if that is important to you. Many people are comfortable with their primary care physician and do not wish to change, so select a plan that ensures you don’t have to.

3. Check Subsidy Qualifications

Also, to help you save money, check to see if you qualify for government subsidies. If you are no more than 400% above the federal poverty level, then you may be eligible for assistance in lowering your monthly premiums.

4. Review Prescription Coverage

Are you taking any prescriptions? If so, you will want to find a plan that covers your medication at the lowest cost.

5. Understand Expenses

Also, know your copay for standard medical procedures or situations. For example, how much will you be required to pay for a doctor’s office visit or an annual checkup?

6. Know Out-of-Pocket Costs

Regardless of the coverage you find, you will have outside medical expenses. Therefore, pay attention to your deductible and maximum out-of-pocket costs. You need to be able to afford these costs in the event of an emergency.

7. Work With a Broker

Next, it can be helpful to work with a licensed insurance broker. Insurance policies are often complicated to understand, especially if you have never had insurance before. Therefore, asking an insurance professional, such as a broker, for help can make the process that much easier.

8. Look Offsite

If you do not qualify for government subsidies, then you may be providing yourself a disservice by only shopping through the government marketplace. You may be able to find other ACA compliant plans offsite that are less expensive and suit your specific needs better.

9. Avoid the Rush

While a little impossible to avoid the rush for 2020, keep in mind that selecting a plan for 2021 may be less stressful if done earlier in the year. Also, the government site is notorious for having problems toward the end of open enrollment.

10. Get Insurance

Last, while shopping for health insurance can be overwhelming, it is necessary. Don’t push off enrolling in health care. Life is unpredictable, and you never know when you may need insurance.

Are you still searching for the right insurance plan for you and your family? If so, then contact Sackett & Associates Insurance Services for some help.

Understanding the Different Proposals in the Health Care Debate

Thu, 19 Dec 2019 22:20:52 GMT

Key Terms Defined in Health Care Debate

Of the wealthy, developed nations in the world, the United States alone does not guarantee health care to its people. One in 10 Americans have no health coverage at all, and even for those who do have it, costs for health care are increasing. The United States' health care costs per capita is twice as much as other industrialized countries. Most Americans express support for plans to expand health coverage in public opinion polls. However, the health care debate has become somewhat muddied because the terms used to describe distinct proposals are often used interchangeably.

What is clear is that all of the following expansion proposals will cost the government, and therefore taxpayers, more money. Estimated amounts vary according to the proposal, but a health policy researcher at the University of California, Berkeley estimates that the cost of a universal coverage plan could cost the state of California over $17.3 billion.

The following is an explanation of some of the most common proposals and how they differ.

Public Option

A public option does not get rid of private insurance plans. Instead, it introduces a government-sponsored plan that consumers could purchase in lieu of a private plan. This means that the public option and private plans would be in competition with one another.

Socialized Medicine

Under a system of socialized medicine, the government owns the clinics and hospitals. Doctors and other staff are government employees. One of the most well-known examples of socialized medicine in the world is the National Health Service in the United Kingdom. Contrary to popular belief, however, Canada does not have a system of socialized medicine.

Single-Payer

Instead, Canada is one of many developed countries that uses a single-payer system. In this system, the government does not own the hospitals and clinics, but it does set prices for medical procedures and pays all medical bills.

Universal Coverage

Under a system of universal coverage, everyone would have health insurance. In theory, there are three ways to accomplish this:

A private company provides coverage to all Americans
The government provides coverage to everyone in the United States
The government and one or more private companies work together to provide coverage to all Americans

Medicare Expansion

Medicare is a government program that extends limited health care benefits to all Americans age 65 and older, as well as some younger citizens with disabilities. Several proposals would expand Medicare coverage to include more Americans:

Medicare Buy-In - This proposal would give people not currently eligible for Medicare the option to purchase coverage. Examples may include people who do not receive employer-sponsored insurance or people age 50 to 64.
Medicare for All - This option would enhance Medicare benefits and expand them to the entire U.S. population. Some proposals would eliminate private insurance plans, while others would limit their roles.
Medicare for More - These proposals involve gradual expansion of Medicare. One proposal would make different age groups eligible in a step-by-step process, starting with children. Another would lower the current eligibility age requirement to 50 or 55.

California has taken steps to expand coverage by extending Medicaid to undocumented adults and instituting a statewide individual mandate to subsidize coverage for middle-income earners. For more information about your health insurance options , contact us at Sackett & Associates Insurance Services by calling 707-823-3689.

California's Individual Health Insurance Penalty: How To Avoid It

Mon, 09 Dec 2019 22:16:43 GMT

How To Avoid the Individual Penalty

When the Affordable Care Act, sometimes called Obamacare, passed the United States Congress in 2010, it included an individual mandate requiring everyone in the United States to have health insurance coverage or pay a federal income tax penalty. The purpose was to lower premiums while ensuring that there was enough money available to cover the costs of the claims filed.

The Tax Cuts and Jobs Act of 2017 discontinued the ACA's individual mandate. However, California recently reinstated a statewide individual mandate to provide subsidies to help people who do not qualify for federal assistance through the ACA to obtain coverage.

The change means that, as of 2020, you could pay a California health insurance penalty on your state income taxes if you do not have coverage. However, you do have some options to avoid the penalty.

Potential Penalties

The individual mandate applies to all Californians, even children. This means that if you are a parent and neither you nor your children have qualifying coverage in 2020, you will owe a penalty for yourself, your spouse if applicable, and each of your children. The penalty for each adult is $695, while the penalty for children is half that amount at $347.50. If you owe a penalty, the California Franchise Tax Board will apply it to your state tax return upon filing.

Obtaining insurance coverage for yourself and your family is the best way to avoid paying the California health insurance penalty. Depending on your income level, you may qualify for a subsidy to help defray the cost. In 2020, you may be eligible for a subsidy if your annual income is between 100% and 600% of the federal poverty line. In the past, you were not eligible if your income exceeded 400% of the FPL.

Another option for obtaining coverage may be Medi-Cal. You may qualify if you make less than 100% of the FPL and therefore do not qualify for a subsidy.

California Health Insurance Penalty Exemptions

There are several exemptions to the health insurance penalty. Those for whom it is not practical or desirable to obtain coverage may qualify.

Exemptions are processed either through Covered California or the Franchise Tax Board . The latter include the following:

Enrollment in restricted- or limited-scope Medi-Cal or a similar program
Incarceration
Membership in a health care-sharing ministry
Living abroad or in another state
Income below the state filing threshold

The exemptions that Covered California processes fall into three categories.

General Hardship - Examples include a natural or man-made disaster, domestic violence, homelessness or eviction, and bankruptcy. If you experience an unspecified hardship, it may be considered on a case-by-case basis.
Affordability Hardship - Based on your projected income, the state may determine that health coverage is unaffordable for you. This determination may be made on the basis of either individual or household income, depending on the circumstances.
Religious Conscience - The state may grant you an exemption if you are part of a sect relying solely on religious methods of healing. You may also qualify for an exemption if your religious sect or division opposes acceptance of either public or private insurance benefits.

For more information about avoiding the California health insurance penalty by obtaining coverage, contact us at Sackett & Associates Insurance Services by calling 707-823-3689.

10 Surprisingly Eligible FSA Expenses

Wed, 04 Dec 2019 22:13:39 GMT

Is This Expense FSA Eligible?

Flexible spending accounts are employer-owned accounts available to employees for healthcare-related spending. Employees can take advantage of these subsidies by indicating the total amount they’d like placed in the account at the beginning of the year, then using those pre-tax funds for copays, prescriptions and more. To cover the funds, employers withhold a portion of each paycheck. While this system allows individuals to access money for medical care when they need it, there is one drawback: Any funds left in the account by the end of the year are forfeited. This means that as the year draws to a close, you may want to use your remaining balance. Fortunately, there are many FSA eligible expenses you can take advantage of.

1. Hand Sanitizer
When cold and flu season hits, hand sanitizer can decrease your risk of getting sick by killing harmful bacteria. Due to its preventative uses, hand sanitizer is considered a health-related item you can buy using FSA funds.

2. Gym Membership
Exercise is a great way to prevent heart disease and obesity, as well as contribute to your overall health. If you have a pre-existing condition that can be managed with regular exercise, gym membership fees may be FSA eligible.

3. Lip Balm
Your skin is your largest organ and deserves just as much care as the rest of you. Lip balm is an easy and affordable way to keep your lips hydrated, especially in cold weather. If you’re trying to use up the last of your FSA funds, consider picking up a lip balm in your favorite scent.

4. Birth Control Pills
Prescription contraception is eligible for FSA funds. When you pick up your pills at the pharmacy, make sure to use your flexible spending account.

5. Sunscreen
Sun exposure is a major cause of skin cancer and the risk of developing melanoma increases the more exposure you have. To protect your skin from UV damage, use your FSA to buy sunscreen.

6. Diaper Rash Cream
Diaper rash is a common issue for infants. With a prescription, you can get cream that soothes skin and helps rashes heal quicker.

7. In Vitro Fertilization
Some couples struggle to conceive naturally or need to seek alternative means to start a family. In vitro fertilization, also called IVF, is a reproductive healthcare technique that helps people have children in a variety of scenarios.

8. Hypoallergenic Pillow Protectors and Pillows
Allergies can lead to more serious medical conditions, such as a respiratory infection, if not dealt with. Hypoallergenic pillows and protectors can help people with allergies sleep more deeply and stay healthy.

9. Acupuncture
This Eastern healthcare technique can be used to treat a variety of issues:

Poor digestion
Pain
Trouble sleeping

Under certain circumstances, you may be able to pay for it with FSA funds.

10. AA Meetings
Alcoholics Anonymous is a free program, but you can use an FSA account to make donations. Since it’s an organization that’s saved and improved countless lives, it’s a great way to use up funds at the end of the year.

Do you need to find an insurance carrier? Sackett & Associates Insurance Services can help. For more information, give us a call at (707) 823-3689 or contact us online .

The California Guide to Health Insurance Subsidies

Fri, 29 Nov 2019 22:10:44 GMT

New California State Insurance Subsidy

t’s that time of year! As soon as October closes out and Halloween is over, Open Enrollment 2020 begins on November 1, 2019. Health insurance is important, but costs continue to rise. The Affordable Care Act (ACA) purports to make healthcare accessible to all and subsidies supplement the costs. It can be a confusing process, but here is what you need to know about subsidies and Covered California in 2020.

The Affordable Care Act provides federal subsidies for families who pay a high percentage of their income toward health insurance premiums. A subsidy is money granted by the state or federal government that is distributed in order to keep prices competitive and low. In California, a law was recently passed to help individuals and families bear the burden of health insurance costs. Dubbed California State Premium Assistance , the plan addresses the federal subsidy cliff, which is the point at which the federal subsidy ends and can result in a huge hit to the pocketbook in excess of $10,000 a year.

The Affordable Care Act Subsidy

The ACA subsidy is for people who make between 100 and 400 percent of the federal poverty level (FPL), and there are two types of federal subsidies: a premium tax credit subsidy and a cost subsidy . The former goes toward your monthly premium amount, and the latter goes toward things like your deductible and other expenses. It is possible to qualify for both subsidies depending on your income level. However, if you make one dollar more than 400 percent of the FPL, then you are no eligible for any federal subsidy, which can significantly impact your finances if you were previously eligible.

California State Premium Assistance

California’s new legislation is effective for three years beginning in 2020, and it will help supplement the federal subsidy and avoid the cliff. The state subsidy will extend the subsidy ceiling to those earning up to 600 percent of the FPL. The 2020 Covered California income limits are captured here:

The California state subsidy ranges from 9.68-18 percent of your income if you fall between 400-600 percent of the federal poverty level and don’t qualify for the federal supplement. Further, it provides coverage for those earning less than 400 percent FPL in addition to any federal subsidy received. Covered California provides a gradual subsidy transition to even out the sharp cliff of the federal one. For more information on how you can benefit from the California State Premium Assistance program and see if you qualify, give us a call .

Should I Change My Health Insurance Plan This Open Enrollment?

Thu, 14 Nov 2019 22:06:56 GMT

Changing Health Insurance Plans During Open Enrollment 2020

Every year, families and individuals are given an opportunity to change their health insurance plans for any reason. This period is called Open Enrollment , and it falls at the end of the year. For most states, Open Enrollment 2020 extends from November 1, 2019 through December 15, 2019. California’s Open Enrollment period is longer and extends from October 15, 2019 through January 15, 2020. As the day approaches, you may be wondering if you should change your Covered California insurance plan. Here are a few things you should consider before making such an important decision.

Is Your Family Changing?

If you are pregnant or your spouse is pregnant, you should consider whether your current insurance plan is adequate for your growing family’s needs. Don’t get discouraged if you don’t know. You can always talk to a Certified Covered California Agent to understand your options. He or she will help you understand the benefits and drawbacks of different plans so you can select the one that is the best fit for your family.

Do You Have a Medical Condition?

Do you or a family member have a medical condition that requires treatment and/or medication? If so, you may need to look for an insurance plan that offers more complete coverage than the one you have now. Again, a Certified Covered California Agent can help you understand if your current plan offers the greatest value for the money or if you would be better off switching to a different plan. Depending on your medical condition, you may want a plan that has fewer out-of-pocket costs. Or, you may find that a plan with a lower deductible may be a better fit for your situation.

Is Your Current Plan Changing?

Some people like to stick with the same health insurance plan, so they simply do nothing when Open Enrollment comes around. Usually, automatic enrollment ensures that you’re re-enrolled in the same plan if you don’t do anything during Open Enrollment. However, if your current insurance plan is discontinued, you may be automatically enrolled in a plan you don’t want. To keep this from happening, always sign up for health insurance during Open Enrollment , even if you want to keep the same plan.

Want To Learn More About Covered California?

Covered California insurance coverage can be confusing, which is why Sackett & Associates Insurance Services is proud to offer education and clarification. To learn more about your insurance options so you can figure out whether or not to change plans for Open Enrollment 2020, contact us at 707-823-3689 or fill out our online form .

Covered California Income Limits Explained

Tue, 05 Nov 2019 22:03:37 GMT

All About Covered California's New Income Limits

Covered California is the name for the health insurance marketplace in California. It allows eligible small businesses and individuals to buy private health insurance policies at subsidized rates. Some families may qualify for up-front tax credits when they enroll in the Covered California Health Exchange. In order to qualify for such credits, certain household income limits must be met. Here’s what you should know about Covered California income limits before keeping or changing yours insurance plan during Open Enrollment 2020.

Federal Poverty Level 2020 Program Eligibility

In order to qualify for government health insurance assistance through Covered California, your household income must be between 0% and 400% of the federal poverty level. For a family of one person, the lowest amount you can make to qualify for a federal tax credit is $0. The highest amount you can make annual and still qualify for a credit is $49,960. The larger your household size, the more money you can make while still qualifying for a federal tax credit. For example, if you have a household size of eight people, you can make up to $173,720 and still qualify for a federal tax credit.

Special Considerations

Pregnant women with household earnings greater than 138% and up to 213% of Covered California income limits may qualify for MAGI Medi-Cal. Also, expecting women with a household income greater than 213% up to 322% of Covered California income limits may be eligible for the Medi-Cal Access program.

American Indian/Alaska Natives (AIAN) qualify for Zero Cost Share if their incomes range between $0 and $37,470 for a single person. For a family of four, household income can be as high as $77,250 to qualify for Zero Cost Share.

Children under 19 years of age may qualify for Medi-Cal if their family has a household income of 266% of FPL or less. Families with an income higher than 266% and up to 322% of FPL may also qualify for C-CHIP health care coverage for children.

Proof of Income Requirements

When you sign up for Covered California health insurance , you may be required to submit documentation proving your household income threshold. These documents may include bank statements, pay stubs or other documents that verify your household income claim. It is possible to lose your health care coverage or ObamaCare subsidy if you fail to provide adequate proof of household income.

Learn More

For more information about Covered California income limits and proof of income requirements, call Sackett & Associates Insurance Services today at 707-823-3689. You can also submit any comment or question through our online form and well get back to you soon.

Open Enrollment Is Here: Now’s the Time To Sign Up for Health Insurance for 2020

Mon, 21 Oct 2019 19:38:25 GMT

Open Enrollment 2020 Is Here

Though the federal government repealed the health insurance mandate penalty via the Tax Cuts and Jobs Act of 2017, Covered California plans to restore it in 2020. This is just one of many reasons individuals should not miss open enrollment, which is, once again, upon us.

When Is Open Enrollment 2020?

Open enrollment begins on October 15 and ends on either December 15, 2019 or January 15, 2020. Benefits are effective by January 1 for those who register for coverage by December 15, and February 1 for those who enroll by January 15. Those who miss the final deadline will pay a penalty on their state tax return.

What Is the Individual Mandate Penalty?

California's individual mandate for those who choose to forego coverage mirrors that set by Obamacare in 2014. The penalty is $695 per uninsured adult in a household, $347.50 for each uninsured child or 2.5% of taxpayers' annual household income, whichever is greater. Depending on the number of people living in a household, and depending on the household's income, uninsured individuals can be looking at paying thousands of dollars in penalties each year.

The state plans to use the revenue from the penalties to help pay for tax credits for the those who plan to purchase health insurance through Covered California's site. Gov. Gavin Newsome also plans to put $1.45 billion toward credits over the next three years.

Who Qualifies for Subsidies?

To qualify for financial aid for coverage under the Affordable Care Act, your household income must be at least 100%, but no more than 400%, of the federal poverty line for a family of your size. California, however, will be the first state to offer its own form of financial aid. Not only that, but it expands the group to which it will offer subsidies to middle income enrollees.

Under Covered California, households with income between 400% and 600% of the federal poverty level may qualify for assistance. Many of these middle-class households have struggled to afford coverage in the past but, thanks to the new initiatives, more than a quarter of a million will now receive the help they so desperately need and deserve.

In addition to helping middle-class families afford health coverage, the state subsidy will also benefit lower-income earners. Those who earn between 200% and 400% of the federal poverty line qualify for state credits in addition to federal subsidies.

What Else Do You Need To Know About Open Enrollment 2020?

During the open enrollment period, you will be shown options from at least two of the 11 major carriers, including Anthem Blue Cross. During this period, you can purchase a plan, change your existing plan or enroll in Medi-Cal. If you miss the open enrollment period, you will not be able to sign up for health care for the rest of the year unless one of the following occurs:

You lose your job.
You move to a new state.
You have a baby.
You age off your parents' plan.
You get married or divorced.
You lose a spouse.

Selecting the appropriate coverage for yourself and, if applicable, your loved ones, can be a daunting task. For guidance during the upcoming enrollment period, consult with a Certified Covered California Agent , such as the ones here at Sackett & Associates Insurance Services. Contact us today to learn more.

Get Ready for 2020 Open Enrollment

Mon, 07 Oct 2019 19:35:14 GMT

Covered California Open Enrollment 2020 is Just Around The Corner

When California residents sign up for health insurance during open enrollment 2020, they will have access to new discounts and subsidies under the state's new Covered California program . This initiative is designed to expand on the Patient Protection and Affordable Care Act to help more state residents access high-quality health care through affordable health insurance coverage. Read on and review the answers to all your open enrollment questions before you sign up on October 15.

How Does Covered California Make Health Insurance More Affordable?

With this program, qualifying individuals and families will receive a state subsidy to help pay for their health insurance premiums. The amount of the monthly subsidy varies by family size, age, household income and the regional cost of health care.

Households earning less than $74,940 for one person or $101,490 for two person household will qualify for a covered California health insurance subsidy . Families earning less than 138% of the federal poverty limit ($35,535 for four people) can access the state's benchmark plan for as little as $1 per month.

When Should I Sign Up for Health Insurance?

Open enrollment extends from October 15, 2019, to January 15, 2020. However, you must enroll before December 15 for coverage to take effect on January 1, 2020. Those who miss that deadline but sign up by mid-January will have effective coverage on February 1, 2020.

Only residents who have a qualifying life event can apply for health insurance coverage outside of open enrollment. These circumstances may include:

Having or adopting a baby
Losing eligibility for coverage under a parent's health care plan because of age or graduation from college
Getting married
Losing a spouse to death or divorce
Moving to California from another state
Losing your job

If you qualify for Medi-Cal, you can enroll at any time of year. Those who qualify for the Children’s Health Insurance Program are also not confined to open enrollment.

What Are the Income Limits to Receive the Subsidy?

This year, the income threshold to qualify for a health care subsidy has been nearly doubled by Covered California. A single-person household can earn up to $74,940 and still be eligible, compared to $37,470 for 2019 eligibility. This change is projected to benefit nearly 1 million additional California residents who previously did not qualify for the subsidy.

What if I Do Not Obtain Coverage?

During open enrollment 2020, you can either buy a new health care plan, renew your existing plan or sign up for Medi-Cal if your household income is below 128% of the federal poverty threshold for your area. California residents who do not have health care coverage are subject to a tax penalty. For 2020, this will be calculated at $695 per adult without health insurance or 2.5% of household income, whichever is greater.

As an independent health insurance agency, Sackett & Associates Insurance Services helps California families get covered. If you have questions about the new subsidy program or you want to request a health insurance quote, contact us today to talk to an agent who is certified with the Covered California program.

Big Covered California Changes Coming in 2020 to Help The Middle Class!

Mon, 30 Sep 2019 19:31:56 GMT

N ew Changes to Covered California: Expansion of Financial Help, Mandate Reinstated and More

In an effort to reduce the cost of health insurance for consumers and increase enrollment rates throughout the state, the Governor and Legislature enacted initiatives designed to bring quality health care within reach of a larger demographic through Covered California . Though bold, estimates suggest that the new initiatives will save California residents hundreds of millions of dollars in monthly premiums and ensure that middle class individuals have access to financial assistance. It is hoped that by lowering the cost of health care for Californians, small businesses will be able to expand, hire more personnel, buy new equipment and realize their full potential.

A Look at the New Covered California

Californians can anticipate a number of exciting changes for health care in 2020. Below is a brief overview of what you can expect in terms of rates, mandates, financial assistance and more:

Low Opening Rate Change: The rate change in 2020 is set to be the lowest rate change since Covered California's launch back in 2014, at just 0.8%. For reference, the average increase over the past five years has been 7.9%. The hope is that by keeping costs low in spite of inflation, more individuals will be able to afford coverage.

Expansion of Financial Help: Under these new initiatives, California will be the first state in the nation to provide state subsidies to middle-income individuals. Households earning less than $74,940 for one person or $101,490 for two person household will qualify for a covered California health insurance subsidy . A quick analysis projects that state financial assistance, in addition to federal subsidies, will help an additional 922,000 Californians afford health insurance. An estimated 235,000 of those individuals will be middle class who did not previously qualify for financial assistance. Another 663,000 or so Californians who currently receive federal financial help will also be eligible for an average of an additional $15 savings on monthly premiums thanks to the state subsidy.

Individual Mandate Reinstated: Congress zeroed out the individual mandate penalty of the Affordable Care Act, a move that only served to increase premiums and reduce the number of health care enrollees. Covered California of 2020 restores the mandated penalty, a move the state anticipates will reduce premiums by as much as between 2% and 5% per carrier. This change will save consumers an average of $14 per month, or $167 per year.

In addition to the aforementioned changes, all 11 carriers plan to return to the California health insurance marketplace. The major national carrier, Anthem Blue Cross , also plans to expand, which ensures that all Californians have their choice of at least two carriers, while many will have their choice of three or more.

Open Enrollment Is Almost Here

If you're like many consumers, you may want to know how these changes will translate to cost savings for you and, more importantly, how much you can anticipate to save. When open enrollment 2020 arrives on October 15, 2019, you can begin shopping for coverage. Make sure to contact Sackett & Associates Insurance Services to shop and compare various plans and pricing. You can see if you qualify for financial assistance through the federal government, the state or both.

For more information on the new initiatives and how it will benefit you, reach out to Sackett & Associates Insurance Services. You can also request a free quote for individual and group coverage.

How An HR Platform Can Save You Time and Money

Fri, 27 Sep 2019 19:27:58 GMT

Save Time With an HR Platform for Benefits Administration and Compliance

Managing employee benefits and human resources the old-fashioned way is time-consuming and making errors is far too easy. Fortunately, technology may provide a way for HR administrators to save time and money while also ensuring greater accuracy. Sackett & Associates Insurance Services’ HR platform may help you supercharge your human resources operations.

Centralized Managed

Record keeping is essential for nearly every human resources process. Traditionally this has been keeping a paper trail. However, a digital alternative can simplify processes and keep everything centralized for you.

Our HR platform makes the hiring and onboarding processes more streamlined. It also allows you to manage all employee records from a single place. This means that some of the most important HR functions are easier, simpler and more efficient.

Handling Benefits

Employee benefits can be one of the most paperwork-heavy aspects of human resources. There is a large amount of paperwork that needs to be handled and processed for each employee. Doing this the old-fashioned way is almost asking for errors. Humans sometimes make mistakes, especially when handling documentation and benefits forms for numerous people.

Digital employee benefits management is the simple solution. It moves all that paperwork into a digital format, reducing the possibility of errors and saving substantial time. This can save everyone time and frustration. HR personnel handle paperwork more easily and other team members can complete fewer forms.

The time savings for benefits during the open enrollment period can be significant. For most organizations, this is a time of processing a lot of forms and documentation at once. The opportunity to handle this digitally can mean dozens of hours saved and less stress.

The system also makes it easier for employees to make decisions about their benefits. They get easier access to clearer information on what options are available to them. From there, they can choose to enroll in whatever fits them best.

Faster Hiring

Hiring and onboarding are perhaps the most impactful functions of human resources. After all, if no one ever gets hired, no work is ever going to get done. Processing new hires and their benefits as well as creating employee records for them can be time-consuming. Using our HR platform, you can save hours for each new hire.

This also gives your organization an extra air of professionalism. It is a clear indicator to new hires that you are running a well-oiled operation. They have an easier time choosing their benefits and you handle the onboarding and records-keeping part of their hiring process faster and more smoothly.

Discover The Better Way To Manage HR

At Sackett & Associates Insurance Services, we are committed to making insurance, HR and employee benefits simpler for organizations like yours. Using our HR platform, you can save time and money while avoiding errors on your hiring, onboarding, benefits management and record-keeping processes. It is the smarter way to manage your HR functions.

For more information on how Sackett & Associates Insurance Services’ HR platform can work for you, contact us online or by calling 707-823-3689, Like us on Facebook, find us LinkedIn, and subscribe to our blog.

4 Things You Should Consider Before Buying Medicare Supplemental Insurance

Mon, 16 Sep 2019 19:25:12 GMT

Do You Need Medicare Supplemental Insurance

The older people become, the higher their health care costs climb. In fact, a Washington Post article reported that in just one year, seniors could withdraw as much as $3,789 each from their retirement savings and nest eggs to pay for medical bills. After retirement, many seniors rely on Medicare to provide health insurance coverage. However, it will not cover all the necessary medical expenses they may have. Because of this, many may choose to seek out Medicare supplemental insurance . Before you take the plunge, here are four things you need to consider first.

1. The Overall Cost of the Plan

Like any other type of health insurance coverage, your Medicare gap policy may feature several options. The more options you add to your policy, the more expensive it becomes. One of the biggest cost factors is how much choice you have when it comes to the services available to you and selecting your own providers. Your deductibles and copay will also affect the overall cost of your supplemental plan.

2. The Available Provider Plans

How much freedom you have to choose your own doctors comes down to the type of plans available to you. While health insurance does not prevent you from seeing particular doctors, it does decide which doctors it will pay for. If you developed a relationship with a particular doctor and plan to keep seeing them, consider choosing a healthcare provider plan where the choice is up to you, or find out from your provider if they belong to an HMO or PPO network. Otherwise, you may need to choose a doctor from the networks provided by your insurance carrier.

3. Prescription Drug Benefits

As you get older, you may find yourself in need of more medication. Doctors may prescribe these to treat pain or manage specific illnesses. Over time, the costs of these add up, particularly because they may be a recurring expense. Prior to 2006, you were able to purchase prescription drug benefits under a Medigap policy. Unfortunately, Medicare.gov states that this is no longer allowed . However, you may enroll in Part D of Medicare to receive assistance with this. This is offered through private companies.

4. Any Additional Benefits

Do you need any additional health benefits not usually included in a Medigap policy? Common examples are dental, hearing, vision and X-rays. If you have an impairment or illness that relies on any of these services, you should ensure you add them to your policy, but note that the cost may increase. Some companies also provide plans for people living with special needs, chronic conditions or who live in facilities.

Getting coverage to fill the health care gaps Medicare leaves behind may help you to sleep more soundly. For many Californians, this is coverage they may have to seek out on their own. However, some employers do provide extended health care benefits to retirees to cover their Medicare gaps. Note that you become eligible for Medigap insurance after you turn 65.

As a trusted Medicare Broker in Santa Rosa, we hope you will look to Sackett & Associates Insurance Services for your insurance needs. Contact us 707-823-3689 for more information.

Are You a Business Owner Who Handles the HR Functions Yourself?

Tue, 10 Sep 2019 17:44:58 GMT

Business Owner Who Handle Their Own HR Department

One of the many challenges of being a small business owner is needing to wear many hats for your company to thrive. Even when you hire professionals to handle the final end work, you may handle a lot of the back-end activities yourself.

Maybe you do some basic accounting as well as the hiring and recruiting, plus all your regular duties. After a while, you may have considered using an HR platform to help you streamline the process, especially as it relates to salaries and employee benefits. You may have also wondered what additional steps you can take to support your workers.

Make Employee Retention a Priority

One of the costs you don’t want to grapple with as a small business is the cost of turnover. You will spend far less to retain current employees than to find and hire new ones. But how can you support your workers to ensure they stay?

Encourage Staying for the Right Reasons: According to Harvard Business Review, the top reason employees stay with a company is complacency. Simply put, nothing has yet presented either a push or pull force for them to leave. In fact, many employees with long tenures hate their jobs, but may feel they have no better options to pursue just yet.
Eliminate Push Factors: It is impossible to eliminate every conceivable factor that may encourage a particular employee to leave. However, if push factors are what often compel employees to start looking for work elsewhere, it doesn’t hurt to try. Some common push factors are unresolved grievances involving other workers or no room for growth.
Grow the Business: Focusing on employees is important, but to ensure their job security, you also have to focus on improving and expanding the business. This also provides opportunities for their personal growth through promotions and lateral movements.

Use Technology To Make Your Work Easier

Forbes points out that the paper-based HR departments hardly exist anymore. Many companies are now digitizing the HR experience with the use of HR platforms. This helps them to streamline the process, thereby saving them time and ensuring employee checks and benefits are recorded and administered error free.

Though one could argue it is an investment, the main disadvantage of using HR software is the cost. So, what if you could get access to a platform for free? At Sackett & Associates Insurance Services, we provide a complimentary platform to all the companies to which we provide services. Never pay thousands of dollars for an HR system setup and upgrade again.

This technology helps to make employee onboarding much easier by capturing all the information you need. This may range from their tax information to benefits preferences. It also helps to keep you compliant, so you never have to deal with the IRS and other government agencies if you can help it. Finally, it provides a centralized experience so you can stop wasting time on switching between apps.

For more information about our free HR platform, contact us at 707-823-3689. We look forward to hearing from you soon.

Health Insurance Companies Still Making Money Via Obamacare

Mon, 26 Aug 2019 17:41:00 GMT

ACA Benefits Health Insurance Companies

When insurance companies first learned of Covered California , they estimated that they would lose millions of dollars . According to CNN, they did. However, after a few years of navigating the system and improving other aspects of business, insurance companies finally began to make money from Covered California in 2018. Bloomberg notes that their formula for success was a simple one: premium increases . One Kaiser Family Foundation analysis found that health insurance premiums increased by roughly 32% in 2018.

Health Insurance Companies Remain Profitable

After a profitable year, health insurers now continue to make money through Covered California by selling individual plans. This is despite the fact that the new administration removed the individual mandate. Many consumers are now purchasing short-term plans that provide bare-bones coverage.

Thus, despite predictions that the market would collapse and that the Affordable Care Act was unsustainable, the actual results prove otherwise. Yes, it did take some insurance companies years to readjust, but they have not suffered. According to CNN, even though health insurance companies did not bring in huge profits from Covered California in 2016, the industry saw a 46% increase in its net income .

One big contributing factor is that they reported much lower underwriting losses. In 2015, losses added up to $2.1 billion, but for 2016, that figure stood at just $893 million. The industry also saw an especially high increase in underwriting profitability for Medicare Advantage, which rose to 279%.

The Effect on Stabilizing Insurance Costs

Because of this ongoing profitability on multiple fronts, insurance companies did not have high rate hikes for 2019. In fact, some insurance premiums declined by up to 1.5%. This helps individual market insurers to remain profitable without putting Americans who need insurance at a disadvantage. Experts estimate that modest price increases should continue into 2020.

So far, some insurers have already made early requests for 2020. These requests confirm the overall expectation. Compared to the 32% spike in 2018, they are reasonably low. Here are a few examples of average rate increase requests per state:

12.5% for Vermont
8.4% for New Yorker insurers
3.3% for Oregon insurers

That said, the ACA does fall short on one front. When people do not qualify for federal financial aid, insurance premiums are still expensive.

The Health Insurance Industry Performance for 2019

When Kaiser Family Foundation analyzed the market, they relied on loss rations and margins as their two main metrics. They found that for ever dollar health insurance companies raked in for premiums, 73 cents returned to consumers in the form of medical claims.

While this is higher than it was in the first quarter of 2018, it is much lower than the 88 cents of each premium dollar paid back to consumers in 2015. Similarly, the gross profit margins were lower than the first quarter of 2018, but still much higher than they had ever been in 2011 onward.

Contact Us

Are you looking for affordable health, vision, dental and life insurance plans for your employees in Santa Rosa, California? Contact us via 707-823-3689 or by filling out our contact form . For more updates on changes in the insurance industry, subscribe to our blog , like us on Facebook and follow us on Twitter .

Covered California Rates To See Lowest Increase in the Agency’s History

Wed, 07 Aug 2019 17:38:36 GMT

Covered California Rates To See Lowest Increase in the Agency’s History

According to CBS Los Angeles , people who rely on California’s health insurance marketplace will see an average premium increase of only 0.8% for 2020. California’s decision came in response to federal attacks on Obama’s Affordable Care Act. Rather than see millions of Californians lose coverage, the state worked the ACA into state law. It restored the individual mandate and put in place an informal rate cap funded by state subsidies. To put this into better perspective, note that California premiums typically increase by 7.9% each year, as it has since 2014.

Roughly 2.2 million people rely on Covered California for insurance and another 229,000 are expected to join due to expansions for eligibility. Some people may also wish to avoid the individual mandate penalty and take advantage of rate stabilization. This decision not only puts hundreds of millions of dollars back into Californians’ pockets; it also makes California the very first state to offer financial assistance to middle-class residents.

The Move to Keep Californians Covered

According to the LA Times, the projected average increase of just 0.8% will be the lowest in Covered California’s entire history. Supporters of the new provisions say that they came just in time as the new administration has been chipping away at the Affordable Care Act. For example, during the tax reform negotiations for 2018, Congress removed the individual mandate.

The individual mandate has been a point of contention even among liberals for some time with good reason. It was not that people wished to voluntarily opt out of health insurance, but rather that some people made too much money to receive financial aid. These consumers then faced the difficult position of paying higher insurance premiums or paying a penalty.

California eliminated this hiccup by extending state-funded tax credits for health insurance to people who earned between 200% and 600% of the federal poverty level. This means that Californians who make up to 50,000 as individuals and up to 103,000 as a family of four, may now qualify for financial aid.

Health Insurance Extended to Young Immigrants

One of the surprising benefits of California’s attempt to beef up Obamacare in the state is to extend health care benefits to undocumented immigrants. According to USA Today, the Golden State just became the first U.S. state to do so.

The $98 million initiative will provide benefits for 100,000 undocumented immigrants from the ages of 19 to 25. They will access these benefits via the state’s Medicaid program, Medi-Cal. While drafting the plan, lawmakers also considered extending health care to undocumented immigrants 65 years and older, but Governor Gavin Newsom decided the state could not afford it.

The Bottom Line

Many people believe that this act of goodwill from California will put the state in debt. However, USA Today estimates that California will now have a surplus of $20 billion, which is the highest in two decades. The California Immigrant Policy Center support the move, but are saddened by the fact that elderly undocumented immigrants could not be included.

Are you considering your insurance options before the individual mandate takes effect in 2020? Call us at 707-823-3689 to learn about our insurance offerings or request a quote today .

Landmark Federal Appeals Case Could End Obamacare

Thu, 01 Aug 2019 17:36:35 GMT

What Happens if the ACA Ends? Next Steps for Obamacare

The fate of the Affordable Care Act is at risk as a New Orleans federal appeals court examines Texas vs. the United States. A lower court judge has already ruled the ACA, popularly known as Obamacare, as unconstitutional. If the appeals court upholds this decision, millions of Americans would have jeopardized health care coverage along with countless other far-reaching effects to the economic and health care systems.

The Origins of Texas vs. the United States

Passed in 2017, the Tax Cuts and Jobs Act eliminated the ACA provision penalizing taxpayers who do not have health insurance. Then, in February 2018, a group of Republican governors and attorney generals from Texas filed a lawsuit to declare the remainder of the ACA as unconstitutional. Their petition cited a 2012 Supreme Court decision that upheld the taxing power of Congress under the ACA, arguing that negating the tax penalty provision thus negates the entire law. Federal district court judge Reed C. O’Connor ruled in favor of Texas in December of that year, effectively ending the ACA.

Defense for the ACA

Democratic leaders have widely argued for the ACA to stand. A group led by California Attorney General Xavier Becerra declared that a lack of affordable health insurance under the ACA would risk the health and well-being of every American. The Trump administration, technically the defendant in the appeal, has frequently changed positions about the constitutionality of the ACA. Most recently, an early July 2019 court filing from the White House Justice Department recommended ending the ACA only in the states involved in the lawsuit.

Since the initial lawsuit was filed, more states have become involved. The current list includes:

Plaintiff states: Texas, Alabama, Arkansas, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah and West Virginia.
Intervenor (defendant) states: California, Colorado, Connecticut, Delaware, the District of Columbia, Hawaii, Illinois, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, Nevada, North Carolina, New Jersey, New York, Oregon, Rhode Island, Virginia, Vermont and Washington

What Happens Next

Most legal scholars have argued that the underlying basis of the case is unwarranted, noting that Congress eliminating only the penalty and not the entire ACA indicates its intent to let it stand. However, the appeal and likely subsequent appeals are expected to proceed. Texas vs. the United States could be a major issue during the 2020 presidential campaign.

In July 2019, early arguments in appellate court indicated that most of the Republican judges on the panel find the tax penalty unconstitutional. However, they do not necessarily agree that removal of this provision invalidates the entire ACA. The case is expected to touch on these questions:

Which court has jurisdiction over the ruling?
Do the parties who brought the case have standing to do so?
Is the ACA’s tax penalty provision unconstitutional?
If so, can this provision be effectively separated from the rest of the ACA?

The ability of the administration to create a replacement health insurance system is a major concern of ACA proponents. Many predict a chaotic health care environment if the Supreme Court upholds Judge O’Connor’s ruling, with vulnerable Americans unable to access necessary medical services.

For affordable health care coverage from an independent agency , get in touch with Sackett & Associates Insurance Services. You can request a quote for individual or corporate medical policies and follow us on social media for the latest ACA news and updates.

Plan Now for Long-Term Medical Care Expenses

Tue, 30 Jul 2019 17:34:12 GMT

Prepare for the Unexpected with Long-Term Care Insurance

As with most medical insurance policies, long-term care insurance is designed to help put you in a better financial situation when unexpected health concerns arise. Long-term health care policies spring into action when difficult medical conditions cause individuals to lose some or all of their ability to be independent. The cost of these types of services are not often covered under the umbrella of standard health insurance policies. Long-term care requires specific assistance over an extended period of time and is best planned for well before life-altering ailment befalls your or your loved ones.

Who Needs Long-Term Care Insurance?

B ecause of the unpredictable nature of many health conditions that require fulltime extended care, just about anyone is susceptible to developing a need for long-term assistance at any time. In-home assistance is a necessity for many adults who once were very active or independent. Others need to live in care centers fulltime for proper medical attention. Planning ahead by obtaining coverage is the best way to prepare for the future health needs of any of the following individuals:

Your parents
Your spouse
Yourself

What is Long-Term Care Coverage Designed For?

While each policy is customized to the individual, a long-term health care plan is generally meant to pick-up the costs that come with health conditions which effect day-to-day activity. When a caregiver is needed to assist an individual with getting dressed, eating, or getting to the restroom, long-term care insurance can be a huge benefit.

Whether an aging parent needs someone to check-in on them, or a loved one is left disabled from unexpected health problems, a long-term care policy can give you more lucrative options. Generally, when a loved one has the sudden need for assistance, family members step-up in the best way they can to help and be supportive. When these needs last longer than a few weeks or months, caregivers can quickly become worn-down and exhausted from carrying the burden of caregiving and on top of other responsibilities.

Burnout for Unpaid Caregivers

When the cost of hiring a health aide or care center is too expensive, family members may take on the burden themselves. Millions of people work as unpaid caregivers to their loved ones each year and continue to work full-time to support their own basic needs. These individuals include but aren’t limited to spouses and children. This type of care, while noble, can leave family caregivers in a difficult place feeling many of the following emotions:

Isolation
Exhaustion
Stress
Resentment

Insurance designed for long-term health concerns comes as a huge relief to those who wish to support their loved ones in trying times as well as avoid becoming a burden to those around them.

Preparing for the Unexpected

At Sackett & Associates Insurance Services we can design a customized policy that prepares you or your loved ones to face future long-term medical expenses. Prevent the burden of long-term caregiving from falling on yourself or loved ones. To get more information about long-term care insurance, contact us at 707-823-3689. Like us on Facebook , find us on LinkedIn , and subscribe to our blog .

What You Need to Know About Insuring Part-Time Employees

Wed, 17 Jul 2019 17:30:41 GMT

Should I Provide Health Insurance to Part-Time Workers?

At Sackett & Associates Insurance Services we provide affordable group insurance coverage to help business owners and their loyal employees to thrive. There can be so much confusion surrounding recent insurance laws and requirements for coverage under the US Affordable Care Act. Some employers have questions surrounding the rules for providing part-time workers with health Insurance. The following guide informs you on the rules and benefits of coverage for part-time staff members.

ACA Guidelines for Offering Health Insurance to Part-Timers

According to the Affordable Care Act, employers with 50 or more fulltime staff members working 30 or more hours per week must offer health insurance to each of those individuals to avoid paying a penalty fee. Part-time workers, however, are not entitled to this same coverage unless an employer chooses to offer employee benefits. Should you choose to provide health insurance coverage to part-time staff members, the following basic rules will apply:

Determine the terms for which you will provide health coverage and put them into writing.
Provide equal plan availability to all part-time employees who fit within your written guidelines for part-time coverage.

In providing health benefits to individuals who do not work fulltime, it is essential to set eligibility requirements and stay consistent across the board. While some companies may opt not to provide coverage for workers under 30 hours, there are some benefits to offering benefits to all staff members.

Benefits of Providing Coverage to All Employees

While many companies see employee health benefits as an expense and burdensome requirement, many of today’s business owners are choosing to provide health coverage to all of their staff members. While the initial expense may appear as a disadvantage, the long-term benefits of offering employees health insurance for companies and their workforce can be numerous.

Better Job Performance

Are you looking for ways to bolster workplace motivation and overall employee performance? One way to do this is to help your staff feel good. Providing benefits makes employees feel valued and also allows them to take care of their wellbeing. Employees with health coverage are more likely to perform better because of the following factors:

Lower stress
Fewer sick days
Healthier, happier overall state

Improved Recruitment and Employee Retention

One large expense business owners see across industries is the cost of hiring and training new workers. With part-time employees, turnover may feel inevitable. Hiring and on-boarding a new staff member can cost months of salary just to get them integrated into the work environment. By giving part-time team members health coverage you may motivate them to stick around and feel needed in their role.

Numerous Tax Benefits

As with all employee health care plans, employers can deduct the cost of part-time employee health benefits from their annual tax forms. For small business owners who wish to help their part-time staff, the ACA now includes provisions which provide tax credits to businesses who give their employees these health benefits.

To learn more information on the pros and cons of insuring part-time employees , contact us at 707-823-3689 . Like us on Facebook , find us on LinkedIn , and subscribe to our blog .

Turning 65? Medicare Enrollment Simplified

Wed, 10 Jul 2019 17:26:40 GMT

Mark Your Calendar and Know When to Sign up for Medicare

If you are getting ready to retire and will soon become eligible for Medicare , you need to mark your calendar with information about open enrollment. As with most health insurance plans, open enrollment is the annual period when you can sign up for, change or cancel a health plan. Whether you are approaching age 65 and considering your health insurance options or want to make changes to your existing Medicare benefits, here’s what you need to know about enrollment periods.

Original Medicare

For Original Medicare, which includes hospital and medical benefits (Part A and Part B), open enrollment is called general enrollment and occurs from the start of each year until March 31. You can also enroll in Part A and Part B plans during initial enrollment, from 3 months before until four months after you turn 65. If you already collect Social Security benefits and/or will begin collecting benefits on your 65th birthday, you will automatically be enrolled in an Original Medicare plan.

Although Part A benefits are usually free, Part B benefits carry a premium. If you delay signing up for Part B beyond initial enrollment for this reason, you may be subject to a late enrollment penalty.

If you have a Medicare Advantage plan and want to switch to Original Medicare, you can take advantage of a second open enrollment period introduced in 2019. This option is available between January 1 and March 31.

Medicare Advantage

Medicare Advantage plans include both Part A and Part B benefits. These plans are administered by private insurance companies instead of by the federal government like Original Medicare plans.

Open enrollment for Medicare Advantage occurs annually from October 15 to December 7. This period is sometimes called fall open enrollment or the annual election period. During open enrollment, you can make changes to or cancel your existing Medicare Advantage plan as well as sign up for a new plan. You can also switch between Medicare Advantage plans during the period from January 1 to March 31.

Medicare Part D

If you have Original Medicare or if your Medicare Advantage plan does not include prescriptions, prescription drug coverage is available through a Medicare Part D plan. Usually, open enrollment for these plans mirrors open enrollment for Medicare Advantage plans.

Medicare Supplement Plans

These plans are designed to provide additional coverage for out-of-pocket costs, such as copayments and deductibles. Although you can purchase a Medicare Supplement plan at any time after you turn 65, doing so during Medigap Open Enrollment prevents you from being rejected because of a pre-existing condition. This period starts when you enroll in Medicare Part B and lasts for six months.

If you have questions about Medicare open enrollment for any of these categories, a Medicare broker at Sackett & Associates Insurance Services can help. Before open enrollment each year, it makes sense to review your coverage to make sure you receive the health services you need at a price you can afford. Like us on Facebook and LinkedIn and subscribe to our blog for more information about health insurance for seniors. You can also request a quote online for Medicare coverage through Medicare Advantage plans.

How To Find Healthcare Providers in Your Insurance Network

Fri, 05 Jul 2019 16:30:22 GMT

How To Find Healthcare Providers in Your Insurance Network

While having insurance is great, it’s even better if you understand it and use it in the way in which it’s intended. A key aspect of health insurance is sticking to providers currently in your network. Sackett & Associates Insurance Services is here with a few tips on finding out whether a specific physician or provider is part of your coverage network.

1. Touch Bases With Your Health Insurance Agent

It’s best to err on the side of caution when it comes to your health and your healthcare coverage. If you’re confused as to whether a provider is a member of your network, simply contact your insurance provider and ask. Providers have specific tax ID numbers your carrier can look up for you. When you contact your agent, have the provider’s tax ID number and the type of health insurance plan you currently have.

2. Call the Physician or Healthcare Provider

You also have the option of calling up the provider’s office to see if they currently accept your specific brand of insurance. Here, it’s important to bring up the fact that medical practices don’t have blanket insurance acceptance. What that means is that all the physicians at the practice may not accept the same insurance policies. This is especially important to note if you ever have to see more than one physician at the same practice. Additionally, let the provider’s office know whether you have a marketplace insurance plan, because that type of plan may not be accepted.

As an added note, pair your doctor with the medical office or facility where you received care or plan to receive care. Some doctors operate out of multiple facilities. Your insurance carrier could have restrictions regarding the location in which you’re treated.

3. Do Some Research on Your Own

If you feel up to the task, you can do some online digging to see if you can find any information regarding whether your physician and insurance provider work together. To do this, log into your insurance account online. From there, see if there’s a “find your doctor” feature you can use. Even if you’ve seen a provider before that was part of your network, it’s a good idea to always double-check before returning to that provider. There’s a chance that specific facility or doctor was recently shuffled out of your network.

Seeing Out-of-Network Providers

There could be a time when you have to visit a doctor who’s not part of your current network. Whether you’ll have to pay for your out-of-network visit depends on the type of insurance you have. For instance, PPO plans commonly take care of a percentage of your out-of-network visit. On the other hand, if you have an EPO or HMO plan, you will bear full responsibility for taking care of your visit. For out-of-network visits not covered by your plan, you can try to appeal the charge if you can successfully prove the visit was medically necessary and no one in your network handled the required medical care.

For more information on finding in-network providers, contact us online . Like us on Facebook , find us LinkedIn and subscribe to our blog .

Know Your Numbers To Achieve Healthy Blood Pressure

Sat, 29 Jun 2019 04:41:08 GMT

Answers To Your Pressing Questions About Blood Pressure

When it comes to blood pressure, you might be confused by the various numbers mentioned by your healthcare provider. Understanding the components of healthy blood pressure makes it easier to know where you stand. Left untreated, high blood pressure (hypertension) can lead to serious complications.

What Exactly Is Blood Pressure?

Blood pressure refers to the force at which the heart pumps blood to the body’s organs and tissues through the circulatory system. When the arteries become clogged, blood pressure increases because the heart must work harder to keep blood flowing. This can cause organ damage that leads to serious health problems.

What Do Blood Pressure Measurements Mean?

When you have your blood pressure taken at the doctor’s office, the nurse will provide two numbers. The top number represents the arterial blood pressure and is known as systolic pressure. The bottom number represents the heart pressure between beats, or the diastolic pressure.

Normal blood pressure is about 120/80 (read as “120 over 80”), though you’re in the normal range as long as the top number is between 90 and 120 and the bottom number is between 60 and 80. The most common type of high blood pressure affecting older adults is called isolated systolic hypertension, which occurs when arteries harden with age. With this condition, the top number will be above 130 while the lower number will be less than 80.

What if My Blood Pressure Is Too High?

Most people don’t experience any symptoms when they have high blood pressure. For this reason, this condition is sometimes called the silent killer. If hypertension is not controlled, it can lead to stroke, heart attack, heart failure, aneurysm and other life-threatening health problems. Adults who have isolated systolic hypertension may experience falls, a feeling of lightheadedness and shortness of breath.

Regular blood pressure checks are an important part of preventing these and other complications, especially for older adults and others at high risk. Your doctor may prescribe medications to bring blood pressure back to a healthy level if your number are above 130/80.

How Can I Prevent or Control High Blood Pressure?

Some factors that contribute to high blood pressure cannot be changed, such as advanced age and family history of hypertension. Race is also a risk factor as African American individuals are more likely to develop high blood pressure than those of other races.

Making healthy lifestyle changes can help return your blood pressure to a healthy range. These measures include:

Losing weight if you are overweight or obese
Limiting salt and fat in your diet
Exercising for at least 30 minutes on most days of the week
Eating fruits, vegetables and low-fat dairy
Consuming no more than two drinks per day for men or one drink per day for women
Quitting if you smoke
Getting a good night sleep and treating sleep problems such as sleep apnea
Taking steps to manage stress, such as meditation or yoga

For more information about leading a healthy lifestyle and preventing issues such as high blood pressure, visit Sackett & Associates Insurance Services online, like us on Facebook and subscribe to our blog. If you need health insurance, contact us to request a quote.

Is It Possible To Buy Health Insurance Outside of Open Enrollment?

Sat, 08 Jun 2019 04:09:04 GMT

When Special Enrollment Applies For Health Insurance Enrollment

In most cases, purchasing health insurance is only possible during the annual open enrollment period for the Affordable Care Act. For individuals in California, that means an insurance agent will be able to sell a client new policies for life insurance and other kinds of coverage year-round, but will only be able to change health care coverage for clients during a single annual window. Of course, there are always people whose needs do not fit that window, which is why the ACA makes provisions for some individuals to change coverage during the rest of the year. To buy insurance outside of the open enrollment period, you need to have experienced a qualifying life event .

Life Events That Qualify Individuals for Special Enrollment

There are a few common events that always qualify people for a chance to change coverage:

Changing employment
Losing coverage through a parent
COBRA coverage ending
Changes in eligibility for Medicaid and other public programs
Getting married or divorced
Leaving incarceration
Gaining citizenship

There are also a few life events that can sometimes count as qualifying events:

Moving to an area where your current insurance is not offered
A death in the family if it results in the loss of coverage
Income changes if they change subsidies substantially

Limitations

When an individual needs to change health insurance mid-year and has experienced a qualifying life event, they are given a window in which to make changes. This window is limited just like the open enrollment period, though, so individuals need to act promptly to get new coverage. One can begin shopping for new insurance 60 days before the qualifying event, and the enrollment period ends 60 days after the qualifying event.

This limitation is designed to keep people from having lapses in coverage during which a health emergency could strike. If possible, shopping during the 60-day window before the event can help with this goal. Of course, some events like a death in the family are unpredictable, and that is why there is a 60-day window afterward. This should be enough time for most individuals to make an informed decision with an insurance agent.

Proving Qualifications for Special Enrollment

To take advantage of the enrollment period for those with qualifying life changes, individuals need to be able to demonstrate why a change of insurance is necessary. Most of the time this is easy, as proof of a change in employment or the death of a policyholder is readily available through documentation. Agents need to include that documentation in applications for health insurance outside the open enrollment period, so it is important to provide copies when making a purchase. If there is any question about whether an event is a qualifying one, talking to an insurance agent can help clear up confusion about the right way to proceed.

Sackett & Associates Insurance can help individuals who qualify for new health care coverage outside of the open enrollment window. For more information on changing insurance, contact us at 707-823-3689, like us on Facebook , check out our LinkedIn , and don’t forget to follow the blog for more important information on insurance benefits and related topics.

Ask a Broker: What Happens if an Employee Misses Open Enrollment?

Tue, 28 May 2019 04:05:44 GMT

So You Missed the Employee Benefits Enrollment Window?

H i Emma,
We had a newly hired employee forget to enroll in our group health insurance plan during his enrollment period. What happens now?
-Santa Rosa Business Owner

Hi,
Many thanks for your question. No matter how hard you try to ensure all your employees take advantage of the open enrollment period, there may be some who fail to either change their existing employee benefits or sign up to start receiving benefits. Unfortunately, there’s not much that can be done for employees who miss the deadline, not unless those employees meet the requirements for a special enrollment period.

Exceptions to the Rule

Qualifying life events are the only way an employee will be eligible for the special enrollment period. Examples of such events include the following:

Legal separation
Getting married
Getting divorced
Death of a spouse or dependent
Adopting/Having a child

If your employee’s reason for missing the deadline falls outside any of the above reasons, there’s not much that can be done, unfortunately. S/he will have to wait until next year.

What if your employee did have a qualifying life event that kept her/him from signing up for benefits? That employee will still need to act quickly to make changes to her or his benefits package or sign up to start receiving benefits. Employees only have 30 days from the date of the life-changing event to enroll in your group health insurance plan. After that 30 days, the individual will miss the enrollment window entirely until the next year.

The 30-day window also applies to employees who unexpectedly lose their health benefits coverage. For instance, court orders related to separation or divorce, going from part-time to full-time or working fewer hours are examples of events that can cause an employee to suddenly lose coverage.

Take Action in the Meantime

Just because the deadline was missed doesn’t mean you and your employees should lounge around twiddling your thumbs. It’s better to sit the employee down with someone from HR and go over your existing benefits options so she or he can personalize a benefits package for next year’s open enrollment. The employee is likely to be upset about missing the enrollment period, but by taking the proactive approach for the next enrollment window, you can (hopefully) keep the employee happy and productive.

Don’t Take the Blame for Those Who Miss the Employee Benefits Enrollment Window

No matter if your employees make or miss the enrollment period for employee benefits , know that it is up to them to add or drop coverage. As long as you provide your staff with plenty of notice regarding enrollment and its deadline, you’re in the clear. Any losses incurred are solely the employee’s fault and no one else’s.

The right benefits can be key to bringing on viable candidates and keeping your current team happy and healthy. While there’s only so much you can do about employees who miss the open enrollment deadline, you can both work together to prepare for the upcoming enrollment period. For more information on benefits for your employees, you’re more than welcome to submit a contact form here on our site. Like us on Facebook , find us on LinkedIn and be sure to subscribe to our blog .

Best of luck,
Emma Fitzpatrick
Health Insurance Specialist
Sackett & Associates Insurance Services

3 Facts To Know Before Mailing in a DNA Kit

Thu, 16 May 2019 04:00:48 GMT

The Facts About DNA Mail-In Kits

Technology continuously changes the limits of what humans can do. With DNA testing, you can now learn more about your genealogy and may be able to determine disease susceptibility. However, there are certain limits to these tests you should know about.

Learning more about yourself from the comfort of your own home in a fast and easy manner is alluring, but it also comes with many risks. So before you mail in a DNA kit to learn more about your ancestry or disease propensity, make sure you understand three important facts.

1. DNA Kits May Provide Inaccurate Results

DNA tests are not 100% accurate. That is the simple and plain truth that many people do not understand at first. Yes, these tests can show certain geographical markers in a person’s DNA. However, that doesn’t mean the results will show your ancestry with complete accuracy and may only show partial or imprecise results.

These kits may also show certain markers for diseases, such as Alzheimer’s or dementia. However, the tests available on the market are not as scientifically advanced or medically accurate as they claim to be. Tests that claim the ability to medically determine diseases may be providing false and inaccurate information.

2. Personal Information May Be at Risk

A simple cheek swab or prick on the finger can tell you so much about yourself, but it can also tell others a great deal about you, too. It’s tempting to send in such personal information about yourself like your DNA, but you should also be cognizant of the fact that your information and the results of the test may be sold to third parties. You may then be targeted by pharmaceutical companies based on your results.

There is also the chance that insurance companies may be a third party that receives your information, which means you may also receive a change in coverage based on the findings of the DNA test. This discrimination could lead to improper or inadequate healthcare and put your health at risk, even if the results by the DNA testing company are false or inaccurate.

3. Results May Offer Misdiagnoses

Some DNA tests claim to be able to identify illnesses based on the sample. The truth is that these genetic tests can actually only identify 10 diseases as approved by the FDA. Results can lead to people being misdiagnosed due to false positives, false negatives or lack of accurate information. Therefore, people may make decisions that are not based on sufficient or accurate information.

Rather than providing a diagnosis, these tests can determine the likelihood that someone may carry a certain disease or may be likely to have that disease. It is not, however, a medical diagnosis and should not be treated as such.

DNA Testing and Your Healthcare

Sending in a DNA kit to learn about where you come from and what possible diseases may afflict you is appealing for many people. Make sure to subscribe to our blog for even more news and updates on things related to healthcare and insurance.

Do You Have a Qualifying Life Event?

Wed, 08 May 2019 03:57:39 GMT

Understanding Qualifying Life Events (QLE)

Sometimes, things in life happen that you didn’t plan for, such as losing health insurance. When this happens, you may still be able to receive health insurance due to special events. So, what is a qualifying life event?

Open enrollment for health insurance is when most Americans choose coverage, but there may be times when you need coverage outside of this period due to changes in your life. There can be several reasons why your insurance changes. Understanding what qualifying events are and how they can affect your insurance is essential to being covered.

What Is a Qualifying Life Event?

A qualifying life event, or QLE, is when something happens in your life that affects your health insurance coverage . It could also be when your policy is canceled due to circumstances out of your control or when your qualifications change. When this happens, you are eligible to purchase health insurance during a special enrollment period.

How To Get Coverage for a Qualifying Life Event?

If a QLE modifies your eligibility for health insurance, you can shop for coverage outside of the traditional enrollment period. This is called the special enrollment period and it can be at any time throughout the year when a qualifying life event changes your insurance plan.

This enrollment period usually lasts no longer than 60 days from the date your insurance coverage changes or ends. That means you need to apply for insurance within those 60 days or you may have to wait until the next open enrollment.

What Counts as a Qualifying Life Event?

What is a qualifying life event? That is a normal question many people ask when applying for insurance after the open enrollment period. There are four categories of QLEs:

Change in residence: When you move around, your insurance can change. Moving to a different state, leaving a temporary housing like a shelter and moving to or from a college are all instances of residence changes that affect insurance coverage.
Loss of coverage: Losing insurance could be from many situations, including switching jobs or eligibility requirement modifications. A common QLE in this category is when someone turns 26 and is no longer placed under a parent’s insurance policy.
Household changes: Changes in your household can affect your insurance coverage. This could be due to marriage, divorce or even having a baby.
Miscellaneous changes: There are also other changes that do not fall under the other three categories, yet are still included as QLEs. Becoming a U.S. citizen, income changes and status with AmeriCorps are all miscellaneous events that may affect insurance eligibility.

If you are not sure whether an event is a QLE, be sure to ask an insurance agent. There are exceptions to the standard list of events and an agent can help you determine if you qualify for insurance coverage outside of the customary enrollment period.

Coverage for a Qualifying Life Events

If you are concerned about your health insurance coverage after something in your life changes, don’t worry. You may be eligible for health insurance due to a qualifying life event. For more information on qualifying life events, contact us today or give us a call at (707) 823-3689. Like us on Facebook , find us LinkedIn and subscribe to our blog for updates and news.

What Is a Health Insurance Broker?

Thu, 25 Apr 2019 14:18:41 GMT

Why You Need an Experienced Health Insurance Broker

When you provide employees with healthcare through your company’s policy, there are many people you need to become acclimated with. One of the most important people to know is your health insurance broker. Brokers provide detailed recommendations about which plan is best for your company’s needs. Brokers sell plans from certain health insurers, and they typically receive commissions based on sales. They are regulated by the state and require licenses. Know why your business needs to work with a broker so that you can reap the benefits.

Get Professional Recommendations

You can buy directly from a health insurance company, but there will be an obvious bias. They want you to buy from them, so they may not mention certain downsides. Fortunately, a health insurance broker sells plans from different carriers. They will go over the pros and cons of each one. Brokers are invested in finding you the best plan and maximizing your employees’ healthcare policies. They will take into account your specific needs and find the best plan for you.

Know Marketplace Changes

Changes occur in the healthcare industry all the time. Carriers constantly enter the exit various federal insurance exchanges. Additionally, carriers will remove and add plans on a whim. You already run a business, so you do not have time to stay up-to-date on changes within your plan. Luckily, part of your broker’s job is to stay current on what is happening. As changes to federal law occur, you can contact your health insurance broker to see how it affects you and your workers.

Troubleshoot Problems With Your Carrier

Have you ever changed to get in touch with an actual human being when contacting your insurance policy? It can be an immense challenge, and you may not have time in the day to stay on hold for an hour. Luckily, your broker has ways to get in touch with a representative quickly. Therefore, if you have problems with reimbursement delays or billing discrepancies, you can remedy the situation promptly.

Get Help With Application and Enrollment

Getting health insurance can be as difficult as getting a mortgage or personal loan. There are numerous documents to fill out, and you need to ensure everything is accurate. In fact, applying for healthcare insurance for your employees can be even more difficult because you need to complete an application for each individual worker. Brokers have gone through the application process numerous times before. They understand the ins and outs extensively, so they can get you enrolled quickly.

Get All of This for Free

Brokers are ultimately salespeople who make money when they assist you and get your business. However, they also have your best interest at heart. You may need to pay for certain services, but when you have a question about a change in the marketplace, you can get an answer for free.

Find a Broker for You

Signing up for health insurance should not be a challenge. Contact Sackett Insurance when you have any questions or concerns. For more information on how health insurance broker services can benefit you, subscribe to our blog , like us on Facebook and find us on LinkedIn .

New Employee Onboarding Guide

Mon, 08 Apr 2019 14:15:07 GMT

5 Objectives of Your Company’s Onboarding Guide

All businesses need an onboarding program to introduce new hires into the working environment. Before starting an official guide, an employer first needs to determine how long the introduction process will last, what impression the new hires should walk away with and what role other employees will play. This time is also good for going over employee benefits , including your small business health insurance plan and paid time off. Here are the five objectives that you should follow throughout the onboarding process.

Let New Hires Know They Made the Right Choice

Getting a new job is a major life change. Although your onboarding guide should not function as a sales document, it should nonetheless encourage new employees. A few signs of encouragement are enough to let new employees embrace their new work environment, so your relationship gets started on the right footing.

Create a Positive Experience

Any activities involved in the onboarding guide should have some oversight. The goal throughout this process sis to encourage emotional buy-in, establish respect and create trust. This process could last for a few days or several weeks. No matter how long it takes, it should lay the foundation for years of trust between the employee and employer.

Provide New Hires an Overview of Their Training

Although there is a large emotional component of onboarding, there also needs to be some practical steps. You need to go over what skills the employee needs to learn quickly. This can include training on new computer software or becoming familiar with certain processes. You do not want a new hire to start working without this information or else he or she will sink before ever getting the chance to swim. This is also a good time to review employee benefits to have your new workers sign up for the company’s health insurance plan .

Aid New Hires in Identifying Their Roles

Another part of the onboarding process should involve going over the company’s anti-harassment policies and other expectations. The employer should provide detailed documentation on how every employee is expected to behave. The reviewer should encourage new hires to ask questions before working independently. It is better to seek clarification now rather than after a mistake has already been made.

Orient New Hires To Work Toward the Company’s Vision

All of this may seem a bit overwhelming to a new employee. However, at the end of the day, you want the new worker to fully understand how he or she works within the context of the organization. New employees should know how every task works toward a greater goal and what the company ultimately strives for. The onboarding guide is the employer’s way of setting the record straight. It will be up to team leaders, supervisors and task managers to handle the day-to-day responsibilities later on.

Get Started Today

A good onboarding guide to produce rewarding relationships for years to come. Companies that require assistance crafting this HR document, as well as any other documentation related to employee benefits, should contact Sackett Insurance. For more information on which HR services can most benefit your business, subscribe to our mailing list , find us on LinkedIn and like us on Facebook .

Do Your Part To Make Distracted Driver Awareness Month a Success

Tue, 02 Apr 2019 14:06:51 GMT

Do Your Part To End Distracted Driving Accidents

In 2016, 3,450 individuals lost their lives to distracted driving . Cellphones, GPS systems and radios were major contributing factors in these fatalities, but technology is not completely to blame. Drivers have been known to become distracted by food, which they attempt to scarf down between appointments. Many get distracted by lost items, unfinished morning routines (putting on makeup, brushing their teeth, applying deodorant, etc.) or even other passengers. In fact, approximately 15 percent of distracted driving accidents are the result of drivers interacting with one or more passengers.

Educate Yourself on the Causes of Distracted Driving

This coming month, in honor of distracted driving awareness month, we invite you to do your part to bring awareness to the dangers of distracted driving and take measures to reduce incident rates. You can begin by learning what the three major cause of distracted driving are:

Manual distractions, which require you to take your hands off the wheel
Visual distraction, which force you to take your eyes off the road
Cognitive distractions, which remove your mind from the task at hand (driving)

Regardless of how careful of a driver you are, chances are you've fallen victim to one or all of the above distractions. This month, force yourself to be intentional in your driving and to identify and stop your bad driving tendencies before you have a chance to follow through with them.

Active Measures You Can Take To Keep Our Roads Safer

It's not enough to educate yourself on the dangers of distracted driving . To have a real positive impact on our roads, share your knowledge and encourage others to participate in the movement. Some things you can do today to make our roads safer tomorrow are as follows:

Lead by example. Never let cell phones, food, passengers or other distractions take your attention away from the road.
Inform your teen driver of all the responsibilities that come with having a driver's license. If necessary, remind him or her that in many states, those with a probationary license can have their license suspended or delayed if caught driving while distracted.
Encourage your teen to speak up when he or she is in the vehicle with a friend who is driving distractedly.

Extend Your Knowledge to the Workplace

Employers have a huge influence over their workers, which they should take advantage of by making distracted driving awareness a part of their workplace safety culture. Though you cannot control how employees act outside of the office, you can encourage them to think twice about their decisions. For instance, if you make texting while driving the company vehicle a suspension-warranting offense, drivers may be more inclined to place their phones in the glovebox before putting the vehicle (whether company or personal) in drive. If you add distracted driving awareness courses to your ongoing training schedule, the lessons employees learn during those courses may stick with them after hours.

Get More Information on How You Can Help End Distracted Driving Accidents

Distracted driving is a pervasive problem and, as such, it is one that benefits from nationwide awareness. To learn more about how you can raise awareness both in and out of the workplace, contact Sackett & Associates online . You can also like us on Facebook , find us on LinkedIn and subscribe to our blog for updates and information .

Medical Claims: The Top 5 Reasons for Insurance Plan Denials

Thu, 21 Mar 2019 05:09:49 GMT

Health Insurance Denials and The Top Five Reasons

In Sonoma County, you would probably prefer to sit back, sipping on a glass of wine, rather than worrying about insurance denials. Unfortunately, denials are all part of the health insurance game, and while denials may be irreversible, some rejections can be fixed and resolved relatively quick. The one definite after receiving a denial is that you, as the insured, are entitled to an explanation. However, while you await the detailed reason for your denial and get ready to appeal the decision, it does pay to familiarize yourself with the 5 main reasons for health insurance plan denials.

1. Out of Network Provider

Many insurance plans fall under one of two headings: (1) a health maintenance organization or (2) an exclusive provider organization. If your plan falls into one of those categories, then you may have been denied because you may have gone to an out of network provider. While some providers may still offer certain benefits or coverage for out of network services, like emergent care, many do not, meaning the costs associated with the visit are your responsibility.

2. Transcription Errors

While denials are frustrating and may be irreversible, rejections that are the result of transcription errors may be resolved quickly. Transcription errors refer to minor mistakes when filling in forms, either on your part or the providers. Some examples of transcription mistakes are misspelled names, wrong birthday or any number of other typos.

3. Wrong Billing Address

Another fixable error is the use of a wrong billing address. Sometimes a doctor’s office does not send the paperwork to the right company. Other issues are if you forget to update your insurance information with the hospital or office. Make sure that your provider and practitioner have the same up to date information to avoid these types of errors.

4. No Referral or Authorization

Many insurers require prior authorization or precertification for certain procedures, like MRIs and CT scans. Therefore, if you follow through with the procedure without the appropriate authorization, then your claim may be denied. Sometimes, though, claims are mistakenly denied, so ask your doctor for assistance if this is the case.

5. Noncovered Charges

There are stipulations and exclusions with almost every policy. Therefore, before going in for dental surgery or infertility treatments, check your policy and make sure you are covered. It is important when looking for a health insurance plan that you find one that will suit all your health needs. Sometimes, while it is nice to be self-sufficient, it is beneficial to ask for help when appealing a denial or trying to find the right insurance plan.

Don’t get lost in health insurance denials, find a Santa Rosa health insurance broker today. Sackett Insurance Services will help their clients solve issues with insurance denials. It’s one of the many benefits to having a health insurance broker. Don’t waste time, contact a Sackett Insurance broker by calling 707-823-3689 or connecting with them through Facebook or LinkedIn . Also, subscribe to the blog of Sackett and Associates to stay informed on all things health related.

This Is Why You Should Offer Benefits to Part-Time Employees

Wed, 13 Mar 2019 05:07:00 GMT

Employee Benefits for Part-Time Employees

For most organizations, employee compensation accounts for the largest share of company expenses. However, employees also represent a company’s greatest asset. Because of this, it is important to not only compensate employees, but to do it well. This includes not just a competitive base salary and bonuses, but also employee benefits, such as health insurance.

Most companies are willing to do this for full-time employees, but some may be reluctant to extend those benefits to their part-time workers. However, proactive businesses that understand the importance of investing in all their workers are changing this traditional model of compensation. Here are a few reasons you should consider doing the same.

Companies Benefit from Employee Benefits

Health insurance and other employee benefits are often marketed to employees as being primarily advantageous to them. However, as many employers know, they stand to benefit from a healthy workforce as well. According to the CDC, employers face $225.8 billion in productivity loss due to absenteeism. This is often due to illnesses and chronic diseases that could have been prevented or treated in a timely manner if the workers had access to a comprehensive health care plan.

Prevent Health Care Assessments

According to the IRS , companies that meet Applicable Large Employer criteria must provide adequate and affordable health insurance benefits to their employees. Failure to do so may lead to an assessment, which may then force the company to offer health benefits even to part-time employees. The IRS considers a corporation an ALE if it is staffed by 50 full-time employees or the equivalent combination of part-time and full-time employees. If you have ever become unfavorably entangled with the IRS before, then you know the old cliché of prevention is better than cure proves true here.

Higher Tax Deductions

The more you spend on health insurance and other benefits, the more you can claim in tax deductions for your business. This includes contributions to both full and part-time employees. Tax deductions help to reduce your annual, quarterly and monthly tax bills. However, be sure to confirm with your accountant to ensure your company remains in the green. Tax benefits are also passed on to the employees, because the IRS does not include health benefits when calculating employees’ wages.

Attract and Create Better Talent

Truly talented workers are in high-demand and will have more than their fair share of choices in the job market. Often, this includes working for themselves, and thus, becoming a potential competitor for your business. To ensure the best of the best is a part of your workforce, you must offer competitive compensation packages that attract them, and health insurance plans top the list. In addition to this, according to Forbes , good health boosts productivity. This provides the perfect incentive to turn even your lowest producers into happy, healthy and engaged workers.

For more information on how providing small business health insurance and other benefits to all your employees is beneficial to your business, see more articles like this in your inbox or on your social media feed by liking us on Facebook , following us on Twitter , adding us on LinkedIn and subscribing to our blog. To get the ball rolling, call Sackett & Associates Insurance Services today at 707-823-3689.

Understanding Health Insurance: Employer Contributions

Tue, 05 Mar 2019 06:03:08 GMT

Employer Contributions and Your Responsibilities

Mandatory Health Plans

Thankfully, when it comes to health insurance, the passing of the Affordable Care Act mandated employer offered health plans . While such a mandate ensures that you will have access to health plans, it does not stipulate that an employer must provide the insurance at no cost to you, the employee. Therefore, most provided policies work through what is known as an employer contribution plan, which means that both you and your employer pay into a health insurance policy, making it more affordable for both parties.

Employer and Employee Responsibilities

The requirement to offer coverage and any employer offered contributions means that the responsibility of cost is shared. This sharing of costs means that both parties have certain obligations and expectations. It also means that an employer cannot be held accountable for the expense of any additional premiums. Also, the government mandate only extends to persons who are actually employed, meaning that dependents do not have to be covered by an employer policy.

Contribution Requirements - Your employer will likely be required to cover at least 50 percent of the premium cost for employees by most insurers and plan providers. This percentage helps to eliminate adverse selection, which can result in higher premiums in the long run.

Dependents and Premiums - As an employee you are responsible for paying when it comes to dependents. This added expense includes the increase in your premiums for any additional users of your policy. Essentially, while the Affordable Care Act requires employer offered plans, it does not require your employer to pay for nonworkers.

California Requirements of Employer Contribution

While the health insurance mandate is federal, most states have amended the requirements to meet their state needs, and California is no different. California guidelines are in place to protect both the individual and the business. Therefore, there are two major stipulations for employer contributions and provided health plans: participation and waivers and declines.

Participation - While the standard employer contributions are around 50 percent, the expected participation in health plans is around 60 to 70 percent of the workforce. Again, the reason for this requirement is to avoid adverse selection, and to have a balance between healthy and unhealthy individuals enrolled.

Waivers and Declines - The participation wavers and declines requirement is meant to help with the small business health insurance requirement. Essentially, employers, when performing the participation calculation, are permitted to remove certain employees from the data set for the small group insurance plans.

If you need assistance understanding employer contributions, or your responsibilities with an employer health care plan, then reach out to Sackett Insurance Services. You can contact us at 1-707-823-3689 or follow us on Facebook , Linkedin and Twitter . Subscribe to our blog for more information on health insurance plans and topics.

Vaping Is a Serious Health Threat to Our Youth

Sat, 23 Feb 2019 05:53:57 GMT

Vaping Is the Next Generation of Nicotine Addiction

There is always some concern about the health challenges we face. Cancer, heart disease, diabetes and smoking are important topics in this commentary. Advances and breakthroughs make us feel like we are making progress, and that the end is in sight. Any Santa Rosa health insurance broker can tell you that is not the case. Vaping is a perfect example of a significant new health threat .

In their current form, electronic cigarettes came on the scene as a tool to help smokers quit. With an e-cigarette, the smoker gets the nicotine without the lung-damaging tars. The device then weans the smoker from the nicotine by reducing the amount delivered. Eventually, the smoker is smoke-free.

Vaping Suddenly Became Big Business

Tobacco cigarette manufacturers do everything possible to make their cigarettes more addictive. They use tobacco with the highest nicotine content. They added filters and menthol to make them more pleasurable.

E-cigarette manufacturers realized that they could make vaping fashionable. Unlike tobacco, it was an unregulated and untapped market.

The Nicotine in E-Cigarettes Is Addictive

This is hardly breaking news. Everyone knows that nicotine is addictive. With e-cigarettes, the manufacturers carefully control the nicotine dosage. This determines the level of addiction they inflict. At least tobacco cigarette manufacturers could blame it on the potency of the plant.

Vapers Inhale Harmful Chemicals With the Nicotine

Smoking e-cigarettes sounds safe. By not smoking tobacco cigarettes, you are avoiding the tars and toxic chemicals. Think again. Flavors and other chemicals enhance the smoking experience and are part of the vapor. They include:

Diacetyl, a chemical linked to lung disease
Benzene
Heavy metals including tin, lead and nickel
Ultrafine particles

Vaping Has Negative Affects for the Young

Smoking and vaping are particularly worrisome when it comes to young people. The Surgeon General of the United States has concerns about vaping and its effect on the young. The nicotine negatively affects brain development and behavior.

Nobody Saw This Threat Coming

E-cigarettes and vaping crept in under the regulatory radar. They became a booming business before the regulations caught up. Now, bringing the vaping industry into line is like trying to get the genie back in the bottle.

Here at Sackett & Associates Insurance Services we share the Surgeon General’s concern. Call us today at 707-823-3689 . Let us know how we can help. Or, you can request a quote through our online form. You can sign up for our blog and stay up to date with health and insurance topics. We are also on LinkedIn and Facebook . If you have a chance, surf in and check us out. We appreciate it when people like us on social media.

How the Apple Watch, AFib and the FDA Changed the Future of Medical Diagnosis

Thu, 14 Feb 2019 05:51:05 GMT

Your Apple Watch Series 4 Is an FDA-Approved Cardiac Monitor

The early diagnosis of medical problems is key to making health care more affordable. Seeing your doctor today costs less than a trip to the emergency room next week. Saving money is always good. Your health insurance provider is a big fan of saving money.

Recently, the diagnosis of cardiac problems took a giant leap forward. Apple can now claim that their Watch Series 4 detects atrial fibrillation (AFib). Food and Drug Administration (FDA) approval made this possible. This watch is the first with embedded FDA-approved cardiac diagnostic tools.

Untreated AFib Is a Serious Medical Issue

In simple terms, patients with AFib have an irregular heartbeat . Some affected patients have a normal heart rate with irregularly-spaced beats. They might not be aware of the problem until their doctor informs them of the problem. In others, AFib manifests itself as a very rapid heartbeat. Shortness of breath and heart palpitations could make it feel like a heart attack.

If AFib goes untreated, there is a risk that a blood clot will form in the heart and travel to the brain, causing a stroke. There are medical procedures that attempt to cure AFib. These procedures don't work for everyone. That leaves the option of treating AFib with blood-thinning medication. Many patients live long, productive lives with AFib and medication.

The Apple Watch Series 4 Gives a Glimpse of the Future of Self-Diagnosis

Think back. We have come a long way from only being able to diagnose cuts, bruises and broken bones. Oral thermometers have been around a long time. Automatic blood pressure measurement devices are newer more recent. Mobile devices permitted the development of cardiac and diabetic testing devices and applications. Today, we have cardiac monitor watches . More than ever, our health management is heavily dependent on the tools at our disposal.

What’s next? Expect to see these devices linked to doctors, hospitals and health insurance companies. When you suddenly develop AFib or another cardiac problem, you shouldn’t need to call the doctor. The doctor should be calling you. Your health insurer should monitor all this. They will make sure you receive proper care.

Don’t Miss Out on the Future of Health Care

Call Sackett & Associates Insurance Services today at 707-823-3689 . To see what is possible, request a quote using our online form. Are you interested in reading about cutting-edge health insurance topics? You can subscribe to our blog . We are on LinkedIn and Facebook . If you like what you see, please leave us a note or, better yet, like us.

New Law Now Requires Hospitals To List Prices Online

Tue, 05 Feb 2019 05:48:43 GMT

Law Mandates Hospitals Post Pricelists Online

Health service consumers across the country will now enjoy the ability to view and compare hospital price lists online. A new federal law that went into effect on January 1, 2019, requires hospitals to post their prices, or chargemasters, in a downloadable format that users can import into a spreadsheet.

The new law goes a little further than the California statute enacted in 2006 that required hospitals to post prices on California’s Office of Statewide Health Planning and Development centralized website. Lawmakers believe access to pricing information can potentially help patients prepare for out-of-pocket expenses not covered by their health insurance plan .

Negotiable Pricing

When you first start looking at hospital websites to compare pricing, you will probably notice that there are significant differences in prices from one hospital to another. A key point to remember is that most hospital pricing is somewhat flexible. Depending on a variety of factors, what you end up paying may be vastly different than what you saw listed on the chargemaster. A few aspects that may influence actual charges include:

Your annual income (if the hospital is non-profit)
The level of advanced technology in use by the hospital
Your type and level of insurance coverage
The ultimate outcome of the procedure

Since prices may vary widely, you may be wondering why it is useful for hospitals to list their prices at all. The law intends to provide consumers with a starting point to help them better prepare for the costs involved in medical treatments they require.

Advantages of Price Transparency

Having a general baseline from which to begin allows health service consumers to have some idea of what their final costs will be. It also allows insurance companies to have firmer footing as they negotiate for lower charges on behalf of the patient. Just as significant, however, is to give lawmakers a more natural way to research health care costs so they can fully understand the problems and possibly arrive at better solutions that work in favor of all the stakeholders.

Any steps toward making hospital charges more accessible and easier to understand will ultimately help you make better, more informed decisions about your own healthcare. Having the list prices for a particular health service at hand can help you tremendously when it comes time to discuss any billing or payments questions that may arise.

Your Trusted Guide

At Sackett & Associates Insurance Services, we applaud any step the government makes to simplify the healthcare delivery system. Arming consumers with knowledge is one way that patients are empowered to make good choices concerning their health. As the premier Santa Rosa health insurance broker , we’ve had the privilege of serving the residents and business owners of Sonoma County for four decades, and we plan to continue doing so for many more.

Our goal is to build trust by providing reliable solutions, custom-fitted to meet your individual needs. We proudly work for you, not the insurance companies, offering individual and group health , dental, vision, life and LTD from a variety of carriers. Request a quote today and begin enjoying the personalized attention you deserve.

Can Fasting Help You Lose Weight?

Fri, 25 Jan 2019 05:38:25 GMT

Benefits and Risks of Fasting

One of the largest industries in the world is weight loss. Advertisers spend millions of dollars promoting products. Consumers spend hundreds of dollars on programs and books that suggest they’re the next thing to lose weight. Fasting has been one of the methods that is on trend. But does it work?

What Is Fasting, Exactly?

Fasting is when you limit your food or drink intake for a certain time frame. It can mean that you don’t eat any food and just drink juice and liquids. It can also mean that you don’t eat at specific hours of the day. Many religions practice fasting as a part of the spiritual tradition. For example, Jews fast for 25 hours on Yom Kippur for atonement and repentance.

Fasting is making its way into the weight loss market to help people manage how much they eat. It’s also though to help reduce the risk of diabetes, cardiovascular disease and cancer. Intermittent fasts, short 24-hour fasts, are being studied for therapeutic purposes. More research is needed, but early studies suggest that short fasts can eliminate or reduce the need for diabetic medication.

Benefits of Fasting

One researcher out of the University of Southern California found that short-term fasting trimmed abdominal fat, reduced blood glucose levels and reduced a protein that was associated with cardiovascular disease. Subjects in the study only ate 1,200 calories for five days each month, then they would resume their normal habits. It’s believed that this fasting promoted regeneration of stem cells, too.

Fasting is thought to be a good option when a person finds it difficult to stick to a regimented and restrictive diet plan. Rather than monitoring your caloric intake every day, you simply fast occasionally. However, even though researchers believe there are benefits to fasting, more studies do need to be done with larger groups of people.

Potential Risks of Fasting

Restricting calories is a difficult way to lose weight because it can be very difficult to adhere to the program for a long period of time. You may actually slow down your metabolism by fasting, which will have the opposite results. Your body may retain weight, thinking that it isn’t going to get any food. Fasting can also be a precursor for eating disorders. The medical community disagrees on whether fasting works or not.

Fasting can cause dehydration, which can be very serious. You may also lose water weight and muscle mass during a fast, rather than the fat that is causing problems. Some medical conditions can be aggravated by a fast. Even though fasting may help diabetics, there is a concern of low blood sugar during a fast. People with a chronic kidney condition may not benefit from a complete fast, because water is needed to keep the kidneys going.

Work With Professionals to Lose Weight

Losing weight fast is not good for your body. Use the resources from professional nutritionists, dieticians and healthcare providers to help you create the plan that works for you. Ask your Santa Rosa health insurance broker what resources your insurance program has to offer. Contact Sackett & Associates Insurance Services for more information.

Five Ways Your Small Business Benefits by Providing Employees With Health Insurance

Tue, 15 Jan 2019 05:24:40 GMT

Small Businesses’ Health Insurance Plans are a Win-Win Arrangement

Are you considering offering your employees health insurance? If your small business employs 50 or more full-time workers, it’s a matter of compliance. Regardless of your headcount, however, your business benefits in addition to your employees. Here are five reasons why small businesses’ health insurance plans provide gains for employers also.

1. Your Business Attracts Better Job Candidates

As your business grows your recruiting needs typically grow with it. You’ll need the best job candidates to cover expansion needs or employee replacements. In either case, your business will be best served by attracting quality job candidates. Because most job seekers look for health insurance benefits , offering a plan will attract better candidates. Surveys show that most employees are willing to take a job that offered less pay if it provided better benefits.

2. You Retain Good Employees and Reduce Turnover Costs

Health insurance benefits make a significant difference in whether employees stay with you or seek employment elsewhere. It’s in your best interests to retain good people; the cost of turnovers, recruiting and new-employee training can take a bite out of your profit margin.

3. Healthier Employees Are More Productive

Employees with health insurance show greater productivity. They’ll see a doctor rather than let minor illnesses develop into issues that can result in time off from work or a slow-down in performance. It’s also easier for employees to remain focused on their work when they’re less stressed and most people connect their peace of mind at work to the benefits provided.

4. A Health Care Plan Fosters a Positive Workplace Culture

When employers demonstrate a concern for and investment in their employees’ health, a more positive workplace culture develops. In addition to centralizing access to plan details, it builds a greater sense of community. This helps foster a workplace environment in which teamwork, dedication and effort are increased.

5. Your Business’s Reputation Improves and Your Customers Take Notice

When the benefits you provide create a positive workplace culture your customers can take notice. Your reputation as a service provider or seller is seen in a more favorable light and customers are enthusiastic about doing business with you. The inverse is true also. Unhappy employees not only lessen the quality of your goods or services, they can also communicate to your customers a lack of appreciation for their employer. This can be particularly significant when unhappy or stressed employees have direct customer contact.

Learn More About Health Insurance

Choosing the health insurance plan that works best for both your business and your employees needn’t be difficult. Helping you determine the right plan at the right cost is what we do. Sackett & Associates Insurance Services provides businesses in Sonoma County with individualized plans that fit their unique and specific needs. Small businesses’ health insurance plans aren’t designed to be a one-size-fits-all solution. We’re here to help you discover the many health insurance options available for building your business’s ideal plan.

Contact us at 707-823-3689 to learn more. You can also receive our informative newsletters and health insurance updates by subscribing to our blog . Get to know us and what we can do for you. You’ll find us on LinkedIn and we hope you’ll like us on Facebook !

Why We Need To Start Treating the Flu Like the Serious Disease It Is

Fri, 04 Jan 2019 05:18:49 GMT

The Dangers of Downplaying the Flu

As a society as a whole, we do not treat the flu seriously enough . This is in large part because it is something that everyone has been exposed to at one point or another. When one is exposed to anything on a frequent basis, be it an illness, tragic news coverage or natural disaster, one becomes numb to it and gives it little attention. As any Santa Rosa health insurance broker knows, that inattention can be dangerous and even life-threatening when it comes to influenza.

Know the Signs of the Flu and Get Treatment

The flu is characterized by many uncomfortable symptoms, including chills, fever, muscle aches and respiratory issues. These symptoms are often so severe that even healthy individuals become bedridden for a week or longer. When left untreated, the flu can become something much worse, such as pneumonia or bronchitis. Pneumonia and bronchitis are always dangerous, but for infants, elderly, pregnant women and unwell individuals, the conditions can result in dire consequences.

Flu Can Exacerbate Underlying Health Conditions

Because the flu weakens the body so drastically, individuals with weakened immune systems have a harder time fighting the virus. The virus, in turn, can make certain health problems much worse. For instance, individuals with diabetes may have a hard time controlling their blood sugar levels when so critically ill, which can cause their blood glucose levels to spike. Some other common conditions that worsen from the virus include:

Chronic lung disease
Asthma
Kidney disorders
Liver disease
Blood disorders
Obesity

If you or a loved one begins to experience flu-like symptoms and lives with any of the above conditions, contact a health professional right away.

Influenza and Underlying Heart Failure

Some of the most at-risk populations for flu complications are those with underlying heart failure, coronary disease and arrhythmias. If allowed to progress untreated, the flu can result in emergency health conditions such as heart attack or stroke. This is because the flu puts an increased level of stress on the heart, thereby increasing one's blood pressure , heart rate and stress hormone levels. If the virus triggers an infection, inflammation may occur, which may lead to myocarditis, or inflammation of the heart muscle. Myocarditis is a condition in which the heart becomes so weak that it is unable to pump blood on its own without mechanical support or medications. While some patients recover from myocarditis, the condition is often fatal.

Another heart condition of which ill individuals must be aware is pericarditis. Pericarditis occurs when the lining of the heart becomes inflamed. This inflammation can result in chest pain or buildup of fluid in the sac surrounding the heart. If the latter occurs, and if the person does not receive immediate medical attention, the condition can lead to death.

Prevention Is the Responsible Thing To Do

The flu shot may not be 100 percent effective, but the antibodies within the vaccine can help your body fight the virus if you should become infected with it. With the additional help, your risk for developing complications lessens. Moreover, the flu shot can help prevent the spread of the virus, making getting it the socially responsible thing to do.

Beyond getting the flu shot, you should have a backup plan should you contract the virus. That backup plan should include good insurance and a reputable healthcare provider. Contact Sackett & Associates Insurance Services for healthcare quotes . Also, don't forget to like us on Facebook , find us on LinkedIn and subscribe to our blog .

3 Signs That Covered California Is Thriving

Sat, 15 Dec 2018 05:16:03 GMT

Affordable Care Act Thrives in California

Reports of the demise of the Affordable Care Act have been greatly exaggerated. Despite the concerted efforts of the current administration to undermine it, defame it, defund it, and sow confusion and doubt about it in the minds of the public, the ACA is thriving today, continuing to provide affordable health coverage and pre-existing condition protection to citizens who would otherwise not qualify or not be able to pay for insurance.

The news is even better for citizens of California and other states who manage their own exchanges separately from the nationwide federal exchange. As the open enrollment period for 2019 coverage commences, here is a look at three signs that demonstrate how the ACA and Covered California continue to survive and thrive.

Insurance Company Presence on the Exchanges Is Expanding

Despite some politicians' claims that health insurance companies are bailing on the exchanges due to financial issues, the facts show that the exact opposite is true. Even in the face of the individual mandate repeal, 23 new insurance plans will be offered on the exchanges in 2019. More insurance companies are joining the exchanges as well, bringing the percentage of counties with only one insurer down to 39 percent nationwide, a significant drop from 56 percent.

Covered California Enrollment Is Increasing

Nationwide, last year's enrollment numbers dropped off by 3 percent, an impressively small figure in light of the administration's efforts to intimidate people from signing up for coverage through the exchanges. Furthermore, in California and other states that manage their own exchanges, enrollment numbers are actually on the rise. In March 2018, Covered California saw a growth of enrollment of 3.7 percent. In fact, enrollment in Covered California has seen an increase almost every year since 2014. The exception is 2017, which saw a negligible decrease of only 1,260 enrollees, perhaps as a reflection of uncertainty about the long-term prospects of the program in the wake of the 2016 election. However, enrollment during the 2017-2018 enrollment period came roaring back; as of March 2018, 1,437,410 people were enrolled with Covered California , an all-time high.

Costs Are Decreasing

Part of the purpose of the ACA is to control the growth rate of health care costs, and the evidence suggests that it is succeeding. Health care costs have moderated in the eight years since passage of the ACA, and compared to the George W. Bush administration, health care costs have grown considerably less during the same amount of time.

Furthermore, after a one-time spike in 2017, premiums are now down for 2019. Average premiums decreased 1.5 percent for the benchmark silver plan, according to the Centers for Medicare and Medicaid Services, and some states are seeing even greater declines. Those who receive employer-sponsored insurance are seeing an average premium increase of 3 percent for individuals and 5 percent for families, while those who are subsidized through the ACA are seeing a premium increase of only 2 percent; good news for self-employed individuals who do not receive group benefits .

Despite all the good news about the Affordable Care Act, getting the insurance you need can still be confusing. Fortunately, Sackett & Associates Insurance Services is here to guide you through the process. For more information about enrolling in Covered California, contact us at 707-823-3689. Like us on Facebook , find us on LinkedIn , and subscribe to our blog for more insurance-related content.

How the Affordable Care Act Helps Small Businesses Insure Employees

Tue, 04 Dec 2018 04:10:38 GMT

Assistance for Small Businesses To Provide Health Coverage

When you own a small business, it may sometimes feel that the odds are stacked against you in favor of big corporations. This is certainly true when it comes to providing health insurance for employees. Large employers pay an average net premium of $4,516 for individual coverage for a single employee, while small business pay a net average of $4,548 for the same individual coverage. While large companies are required by law to provide health insurance coverage for their employees, they also have more tools with which to do so in the form of buying power and an advantageous negotiating position.

However, while it has often been criticized as being harmful or burdensome to small businesses, the ACA actually provides provisions for small business owners to provide their workers with some measure of health coverage without breaking the bank.

Small Businesses Health Insurance Helps You and Your Employees

You may be relieved to know that you are not required to provide your employees with health insurance if your company employs fewer than 50 workers. However, even the smallest of small businesses stands to gain from providing health insurance if at all financially feasible. When it comes to employee benefits, health insurance is the number-one priority of job seekers. With unemployment numbers currently at a record low, potential employees can afford to be choosy, and if you do not provide the health insurance they require, they will go work for somebody who does.

Furthermore, providing health benefits helps to provide you with a fit and stable workforce. Employees with health insurance are able to see a doctor promptly and take advantage of preventative care so that small health issues have less chance of developing into long-term debilitating conditions. Investing in the health of your workers potentially stands to pay dividends in the form of increased long-term productivity.

SHOP Program Helps Small Businesses Cover Their Employees

Despite the talking points that you may have heard from certain politicians, the goal of the Affordable Care Act is to help as many people as possible obtain health insurance coverage. The legislators who wrote the law understand that small businesses sometimes have difficulty affording health insurance for employees, and that's why they created the Small Business Health Options Program (SHOP) to help make health and dental benefits more affordable for small businesses to offer to full-time equivalent employees.

In order to enroll in SHOP, your company must meet the following requirements:

SHOP coverage offered to all full-time equivalent employees
At least 50 percent of employees' premiums paid
Fewer than 25 full-time equivalent workers employed at the company
An average annual salary of $50,000 or less paid to full-time equivalent employees

The Small Business Health Care Tax Credit , which can lower premium costs, is only available to small businesses who enroll in SHOP. It is important to note that only employees are eligible for SHOP benefits.

The cost of providing health insurance to employees can seem prohibitively expensive, but it doesn't have to be, and doing so is beneficial not only to your employees but to the health and longevity of your business. For more information on how Sackett & Associates can help you insure your employees, call us at 707-823-3689. Like us on Facebook , find us on LinkedIn , and subscribe to our blog for more ideas about how you can save money on insurance.

Don’t Miss California’s Open Enrollment Dates for Health Insurance

Fri, 30 Nov 2018 04:08:33 GMT

Let a Health Insurance Broker Help You During Open Enrollment

If you don’t yet have health insurance in the state of California or wish to switch to a new insurance provider, know that open enrollment for the health exchange is now in full swing. Here at Sackett & Associates Insurance Services, we know how overwhelming it can feel to have so many options for insurance coverage, which is why we recommend working with an experienced health insurance broker. Additionally, we suggest you familiarize yourself with the finer points of the health insurance open enrollment period.

Time Is of the Essence

In California, you have until January 15, 2019, to sign up for a health insurance plan . While that may sound as if you have plenty of time, you have to bear in mind the fact that the holidays will be here before you know it, and you may find yourself busy preparing and spending time with family and friends, which could lead to you forgetting to make sure you and your health are covered with a good insurance plan. We recommend that you go ahead and take care of the task as soon as possible, several months ahead of the deadline, so that you aren’t scrambling at the last minute to get coverage.

Employers Need To Pay Attention to the Deadline As Well

If you’re an employer with a smaller company and have a health reimbursement arrangement , also known as QSEHRA, you need to ensure that you meet the open enrollment deadline as well so that you and your employees know for a fact that all your QSEHRA reimbursements are as tax-free as you plan on them being. Additionally, your employees are sure to appreciate you taking the proper steps to make sure they’re covered; never underestimate how much your team appreciates having quality health coverage.

You’ve Only Got One Window

Individuals in need of health coverage who don’t have a qualifying life event and miss the open enrollment period will have to wait for 2020’s enrollment period until they’re able to sign up. There’s no telling what may happen to you in that space of time, and you’re sure to have better peace of mind knowing that you have proper health insurance.

Let a Professional Broker Help You Find the Right Plan

You could easily choose a new health insurance policy on your own, but you could quickly and easily find yourself feeling indecisive about which plan and type of coverage is best for your health, your budget and your unique needs. An experienced and knowledgeable insurance broker can explain plans to you so that there’s no misunderstanding about what you’re getting or how your plan works. The key to maximizing your health insurance is knowing it inside and out. The best perk of all, you don’t pay anything for help from a health insurance broker.

No matter if there’s currently an open enrollment period for the California health insurance exchange, know that Sackett & Associates Insurance Services is here to help with your individual and employee needs for health, vision, dental and life policy needs. For more information on choosing the best plan for yourself or your employees, submit a contact form . Also, be sure to like us on Facebook , find us on LinkedIn and subscribe to our blog .

Medicare Advantage Plan: Do I need it?

Tue, 06 Nov 2018 15:05:08 GMT

What Seniors Must Know About Medicare Advantage Plans

If you're eligible for Medicare , you can opt to receive your benefits through either Original Medicare (Part A and Part B) or the Medicare Advantage Plan, also called Part C. With a traditional Medicare plan, your covered health benefits are paid for directly by the government. With Medicare Advantage, you receive benefits from a private insurance company, who is then paid by the government. Here's what you need to know about each route to ensure you have the coverage to stay healthy.

Benefits of Medicare Advantage Plans

An approved Medicare Advantage insurer must provide coverage that is equal to or better than the coverage you would receive under traditional Medicare. If you enroll in Medicare Advantage, however, you will still receive hospice benefits under Part A. Many Medicare-eligible seniors opt for an Advantage plan because:

These plans often provide benefits beyond what is covered by traditional Medicare, including but not limited to vision, hearing and dental care, gym memberships or wellness programs and prescription drug coverage. Those with Medicare Part A and B must instead enroll in a separate prescription drug plan (Part D).
Although costs vary by plan, Part C typically has a lower out-of-pocket cost than other Medicare plans because the provider network of doctors is able to coordinate care and offer decreased fees for subscribers.
Most Part C plans carry a cap on your out-of-pocket costs. Once you reach this threshold, your health care costs should be completely covered for the rest of the year, provided you stay in network.
Medicare Advantage Special Needs Plans are available for those who have both Medicare and Medicaid coverage, need skilled nursing care and/or have a chronic condition that needs ongoing care.

Drawbacks of Medicare Advantage

For some individuals, traditional Medicare may be the better option. You may want to stick with Medicare Parts A and B if:

You are concerned about out-of-pocket costs, which can increase each year with Medicare Advantage and vary significantly depending on your insurer.
You don't want to switch insurance plans again. An insurance company can offer an Advantage plan one year and discontinue it the next, which means your coverage search would begin anew.
You want to avoid getting referrals for specialty care or being restricted to doctors within the plan network.
Insurers do not offer Medicare Advantage plans in your area.
You take several prescriptions and need dedicated prescription drug coverage. It's important to compare the costs of your medications under the Advantage plan you're considering to those charged by Part D.
You prefer to have a higher monthly premium in exchange for lower copayments and coinsurance costs. Keep in mind that although some Medicare Advantage plans do not have a monthly premium, you will still need to pay your monthly Part B premium.

Sackett & Associates Insurance Services is your trusted Medicare insurance broker in Sonoma County and surrounding areas. Call us at 707-823-3689 to speak to an experienced representative who can help you shop around for the best health care coverage for your needs. To learn more about Medicare and related topics, please like us on Facebook, find us on LinkedIn and subscribe to our blog .

Open Enrollment Is Here: Are You Covered Yet?

Tue, 06 Nov 2018 04:03:10 GMT

Open Enrollment Time - Are You Coverd For 2019?

It’s that time of year: the Health Insurance Marketplace’s annual Open Enrollment Period. Now you can evaluate benefits, calculate subsidies and determine the best plan for you and your family. Granted, insurance can get complicated, and if you’re not working with a health insurance broker, it can be difficult to manage all the important information coming your way. To help, we here at Sackett & Associates Insurance Services have compiled this list of things to keep in mind as you navigate enrollment for 2019.

Check Out Subsidy Eligibility

Depending on your annual income, you may be eligible to receive a subsidy. This can have a huge impact on your choice of insurance as, in some cases, subsidies can effectively lower the monthly premium of certain plans down to zero. In other cases, you may see hundreds of dollars knocked off potential monthly premiums, allowing you to choose a plan with lower deductibles.

Estimate Your Income

How do subsidies come into play? They’re determined by your projected annual income, which you’ll have to provide to your health insurance broker during open enrollment. It’s vital that you report your estimated income as accurately as possible to ensure that your subsidy eligibility is correctly determined. If you underestimate and receive subsidies you don’t actually qualify for, you’ll likely have to pay them back.

Compare More Than Just Premiums

There’s not doubt that premiums are a huge factor when it comes to purchasing health insurance. After all, it’s an expense you need to cover every month. However, a lower premium can mean higher prices in other areas, and you don’t want to be surprised by a bill for uncovered services when you need vital medical care. You’ll want to evaluate available plans for out-of-pocket costs and other factors, such as:

Deductibles
Co-pays
Prescription coverage
Out-of-network costs

Depending on your price range, subsidies and even location, this can be a lot of information to sift through. If you’re having trouble figuring out which plan benefits you the most, a health insurance broker can help compare offerings and determine which best meets your healthcare needs.

Enroll Before the Deadline

Perhaps the most important thing to remember is that the health insurance Open Enrollment Period has a deadline: January 15, 2019. Once this date passes, you’ll have to apply for a Special Enrollment Period in order to purchase insurance through the Marketplace. This can be tough, as Special Enrollment is generally only available under specific circumstances.

It’s also vital to realize that while January 15th is the last day of the enrollment period, you actually need to be enrolled by December 15, 2018, if you want coverage effective January 1, 2019. If you enroll after December 15, 2018, your health insurance won’t come into effect until February 1st,2019. So when you mark your calendar, be sure you’re circling the right date.

Find Assistance

Sackett & Associates Insurance Services is proud to offer health insurance services for both small businesses and individuals. As an independent agency, we work to provide insurance solutions that are both reliable and competitive. For more information on how we can help you meet your health insurance needs, contact us at (707) 823-3689 or visit us online . To find

All You Need to Know About 2019 Health Insurance Open Enrollment

Tue, 23 Oct 2018 03:00:15 GMT

Yes, Open Enrollment for Health Insurance is Happening

It seems like health insurance in the United States is constantly changing. With all the changes taking place in the last few years, you may be concerned about your ability to enroll. A lot of people don’t even know if or when there will be an Open Enrollment Period. In fact, 76% of Americans didn’t know the dates for Open Enrollment in 2018 and the confusion continues.

Although some details of the Affordable Care Act (ACA) are different now, you don’t have to fret–there will still be an Open Enrollment Period so you can get the coverage you need.

Open Enrollment 2019 Dates

The enrollment period in California is different than the federal enrollment period. This is because California runs its own exchange rather than partaking in the federal marketplace. For Covered California plans, Open Enrollment starts on Oct. 15 and ends on Jan. 15., 2019. For states that operate under the federal rules, the period is only from Nov. 1 through Dec. 15.

Gather Important Documents Now

Shopping for health insurance can be stressful, so it’s better to prepare yourself sooner rather than later. Health insurance providers require personal details during the application process. You may need the following information:

Details about dependents
Social Security Number
Tax filing information
Income and employer for household members
Home address
Mailing address (if different from home address)
Current insurance details (if applicable)
Immigration documentation (if applicable)

However, you should know that some insurance companies may ask for additional information.

Research Coverage Options

You can get through the enrollment process faster and with less stress if you have an idea of what you want before you start. There’s no reason to scramble when enrollment begins when you can get ahead of the game now. Start learning about the different plans here and contact our experts at Sackett & Associates Insurance Services.

No More Individual Mandate

Another important piece of information you should know is that there is no longer a fee for not having health coverage. There are plenty of alternative plans for individuals, families, and businesses to consider.

Understanding and applying for health insurance can feel dreadful, but we’re here to make everything easier for you. As a leading Santa Rosa health insurance broker, Sackett & Associates Insurance Services make getting health insurance easy and affordable. For more help on how to apply for health insurance, get a quote here .

Medicare Open Enrollment 2019 – Sign Up or Make Changes Now!

Sat, 13 Oct 2018 05:43:48 GMT

Contact Your Medicare Broker in Santa Rosa During Medicare Open Enrollment 2019

Surveys show that most people who sign up for Medicare are overwhelmingly satisfied with their care . If you are eligible for Medicare but haven’t signed up yet, open enrollment for 2019 runs from October 15, 2018 to December 7, 2018. Now is the perfect time to talk to your Medicare broker in Santa Rosa about how you can enroll or make changes to your plan before open enrollment ends.

If you miss the open enrollment period, you’ll be unable to enroll or make changes until the next enrollment period in 2019. If you want to switch from Original Medicare to Medicare Advantage but miss the enrollment period, you may be able to enroll in a Medigap plan that gives you interim coverage until the next open enrollment period arrives.

Changes You Can Make During Open Enrollment

You can make a variety of changes to your current Medicare coverage during the Medicare open enrollment 2019 period, including:

Switch from your current Medicare Part D plan to another
Switch from Medicare Advantage to Original Medicare, or vice versa
Enroll in Medicare Part D if you didn’t immediately do so when you became eligible (although you may be subjected to a late enrollment penalty)

If you miss the annual enrollment period (AEP), you may still be able to make certain changes to your plan during the Medicare Advantage Disenrollment Period (January 1 – February 14). You can generally only make two types of changes during this time: Enroll in a standalone prescription drug plan and switch from your Medicare Advantage plan to the Original Medicare plan.

How To Enroll in Medicare Advantage

Are you thinking about enrolling in a Medicare Advantage plan? If so, you need to make sure you meet certain criteria, including:

You must already be enrolled in both Medicare Part A and B
You can’t be diagnosed with End-Stage Renal Disease (exceptions may apply)
You must live in the service area for the plan

In addition to delivering Medicare Part A and Part B benefits, the Medicare Advantage plan also includes additional coverage options like routine vision services, prescription drug coverage and other benefits. Since the Advantage plan can change from year to year, you’ll receive an Annual Notice of Change every fall. Read through the notice carefully to understand the benefits your plan will offer in the coming months.

Learn More

Sackett & Associates Insurance Services knows how to help individuals enroll in Medicare. For more information about how to enroll or change your plan during Medicare open enrollment 2019, contact us at 707-823-3689 or send your questions to us through our online form. We also invite you to like us on Facebook , find us on LinkedIn and subscribe to our blog .

4 Requirements to Receive the Small Business Health Care Tax Credit

Sat, 06 Oct 2018 05:41:00 GMT

Do You Qualify for the Small Business Health Insurance Tax Credit?

As a small business owner, you want to save money whenever possible while also taking care of your employees. Receiving the small business Small Business Health Care Tax Credit may be the only way you can afford to offer group insurance. Most small businesses may receive up to 50 percent of the premiums they pay, excluding non-profits which can get up to 35 percent. Either way, that’s a huge amount of money to get back. Here are the four requirements you must meet to qualify for the tax credit.

1. You Have Fewer Than 25 Full-Time-Equivalent Employees

You may be wondering what full-time-equivalent (FTE) means. Generally, one FTE comes out to 2,080 hours worked per year. This means two half-time employees count as one FTE. According to the IRS , there are some workers you can exclude from your calculations, including:

Seasonal employees who work no more than 120 days per year
Owners of more than 5 percent of the business
Shareholders owning more than 2 percent of an S corporation
Partners in a partnership
Sole proprietor

Keep in mind that the requirement for full-time employees, in this case, is different than other Affordable Care Act provisions that view anyone who works 30 hours weekly as an FTE.

2. Your Employees’ Average Salary is $53,000 or Less

This part can be confusing because it changes every year. The salary changes every year due to inflation. Be aware that the amount was $52,000 for tax year 2016, but it’s bumped up to $53,000 for tax year 2017. Figuring out your annual wage is easy–simply divide the total wages by the number of FTEs. For example, if you have 20 FTEs and pay out a total of $300,000, your average wage would be $15,000.

3. You Provide An Approved Group Plan to Your Full-Time Workers

To receive the tax credit, you must offer coverage through the Small Business Health Insurance Health Options Program (SHOP) Marketplace. Certain businesses can enroll for SHOP plans any time of the year. The agents at Sackett & Associates Insurance Services can help you purchase a SHOP plan that’s right for you.

4. You Cover at Least Half of Employee Premiums

Another important piece of criteria is if you pay at least 50 percent of employee health care coverage. This doesn’t mean you need to pay at least 50 percent of dependent or family coverage.

Learn how Sackett & Associates Insurance Services can help you offer employee benefits and receive the tax credit.

Are You Ready for Medicare Open Enrollment?

Fri, 21 Sep 2018 05:38:21 GMT

Are You Ready for Medicare Open Enrollment?

The dates for Medicare Open Enrollment have stayed the same since 2011. The annual enrollment period for 2019 runs from October 15, 2018 to December 7, 2018. If you want to choose a Medicare Advantage plan, you’ll need to enroll during this period. Even if you’re currently happy with your plan, it pays to look into your options. You may find a more affordable plan that suits your needs even better. Here are some things to remember during the fall enrollment period.

Make Changes During Open Enrollment

If your current Medicare coverage doesn’t suit your needs, you can pick a new Medicare Advantage plan or Part D plan during open enrollment. For most people, the only time you can change plans is during the enrollment period. However, any changes you make to your plan do not take effect until January 1.

You Can Keep Your Current Plan

If you don’t want to make changes to your current plan, you don’t have to do anything. Your plan will auto-renew, provided that it continues to be available. If your plan isn’t going to be available in 2019, you will receive a non-renewal notice. You will have to enroll in a new plan to ensure you have the right coverage.

Confirm Information

When you look at Medicare plans online, it is a good idea to confirm the information with the insurance company itself. If you call a plan, make notes about who you speak with, the date and the next steps. This can protect you if a representative provides misinformation, but it can also help you as you compare benefits.

The Difference Between Medicare Open Enrollment and Federal Marketplace Open Enrollment

The Exchanges, or federal Marketplaces, are not the same thing as Medicare. The Marketplaces are typically for uninsured or underinsured Americans who are not eligible for Medicare. The enrollment periods may overlap, which can be confusing. If you are eligible for Medicare, you should use the Medicare Open Enrollment Period to make changes to your coverage.

What If You Don’t Like Your Medicare Advantage Plan?

If you enroll in a Medicare Advantage plan in the fall, but decide that it doesn’t fit your needs, you can disenroll. The Medicare Advantage Disenrollment Period occurs from January 1 through February 14 in the new plan year. You can join Original Medicare during this time. Changes made will take effect on the first of the following month.

Help Is Available

Medicare does want you to be informed. The Plan Finder tool can help you find plans for your area and help you compare plans based on your own health needs You may also want to talk to a Medicare broker in Santa Rosa about your options. Consider things such as your prescription drugs, current doctors and conditions.

For more information on 2019 Medicare Open Enrollment, contact us at (707) 823-3689 or use our online form . Like us on Facebook . Find us on LinkedIn . Subscribe to our blog and get more tips about insurance .

Support Heart Health at the Northbay Heart Walk

Wed, 12 Sep 2018 05:35:18 GMT

Join Our Walk for Healthy Hearts in Santa Rosa

You never have to think about it, but your heart works around the clock for you. Many people dealing with heart attack, stroke and heart disease are not so fortunate. Whether your life or that of someone you love has been touched by heart troubles, join us in support of heart health at the Northbay Heart Walk .

Join the Heart & Vascular Institute of Santa Rosa Memorial Hospital at the 2018 Northbay Heart Walk put on by the American Heart Association. This year’s event allows you the option of a one, two or four-mile non-competitive walk around beautiful Howarth Park.

About the American Heart Association

The American Heart Association (AHA) was founded in 1924 by six cardiologists who believed that better treatment options were possible for heart disease, America’s number one killer. In the 94 years since the organization’s formation, it has secured funding for the research that led to such advancements as pacemakers and heart valves. As of 2014, the AHA has reached the $3.5 billion mark in research funding for heart disease and stroke making it the largest funder of research for these ailments outside of the United States government.

About the Walk

Join your Sonoma County friends and neighbors as we raise funds and awareness for the AHA at the 2018 Northbay Heart Walk. The walk will take place rain or shine in Howarth Park on Sunday, September 23 from 9am to 12pm. Water and restrooms are available, as is a kid’s activity zone sponsored by Wells Fargo. The route is handicap accessible and dog-friendly for leashed, behaved dogs.

Choose between a one, two or four-mile route either on your own or with a team of friends. If you’d like to help fundraise, you can help us reach our goal of $390,000. Simply register for the event and spread the word to your family and friends to support your walk.

Register or Donate Now

Have fun while participating in a worthy cause! To join a team, fill out the information here . If you can’t make the walk but still want to contribute, fill out the information here to donate . Every dollar helps save lives.

Sackett & Associates Insurance Services is proud to promote this event. If you need help deciphering the complexities of healthcare insurance or to learn more about health insurance plans, contact us at (707) 823-3689. You can also connect with us on Facebook , LinkedIn or subscribe to our newsletter .

Let’s join together and walk to support healthy hearts and strong communities!

How Necessary Is Group Health Insurance?

Thu, 06 Sep 2018 05:32:46 GMT

Is Group Health Insurance Necessary?

When you own a business, it is important to take care of your employees. It is also crucial to keep your operating costs down to make sure your profit margin is as large as possible. When it comes to employee benefits, it is vital to understand which ones are required by law and which ones are optional so you can make an educated decision about what to include in the benefits package for your employees.

Employer Mandate for Small Businesses

The Affordable Care Act of 2016 requires all businesses with at least 50 full-time equivalent employees to offer health coverage that meets certain minimum standards. Any business without such a plan in place could end up paying significant fees. You might be subjected to monthly penalties if your business:

Has no minimum standard coverage offered to 95 percent or more of full-time equivalent employees
Provides no coverage for a minimum of 60 percent of the cost of necessary services
Has coverage that costs the employees over 9.66 percent of their yearly household income in premiums

If you are wondering about what your fines would look like if your business doesn’t meet the legal requirements, a small business health care insurance broker can help you estimate your payments.

Federal Law Health Insurance Requirements

According to federal law, there are certain services small-employer plans must cover. Known as essential health benefits, these services include:

Emergency services
Newborn and maternity care
Laboratory services
Pediatric services
Outpatient care without hospitalization
Substance abuse programs and mental health services
Necessary surgery and associated hospital time
Prescription drugs
Preventative care and chronic disease management
Necessary physical therapy and medical devices

These benefits aren’t required to be covered by your health plan if it was purchased before March 23, 2010.

Costs of Health Insurance For Small Businesses

When it comes to health insurance, every small business owner is looking for the best coverage for the best price. Because every business is different, the cost will vary based on a variety of factors. The number of employees you have as well as their age can affect your payment. The biggest factor of group health insurance price is the level of coverage of the specific plan.

The Best Broker For Your Business

When you need a small business health insurance broker, you deserve to work with the best. For more information on which group health insurance plans and rates are right for your small business, contact Sackett & Associates Insurance Services today at (707) 823-3689. Find us on LinkedIn , like us on Facebook and subscribe to our blog for a better idea of who we are and what our clients have to say about us.

4 Things to Know About Medicare

Thu, 23 Aug 2018 23:50:39 GMT

4 Useful Facts About Medicare Health Insurance

Just because you aren’t looking to retire in the next several years doesn’t mean that you should put off learning about Medicare Health Insurance. In fact, it’s better to understand how the government health program works well before you qualify for it so you can make the best of the coverage when you reach the qualifying age. With that in mind, your friends at Sackett & Associates Insurance Services would like to share four things you should know about Medicare

1. Think About Medicare in Your Early 60s

There’s a lot for you to think about before you enroll in Medicare at the age of 65. For instance, you need to know which doctors are covered under with the individual plan you choose. Switching doctors when you’re older can be a bit of a hassle, so it’s good to choose one who can keep taking care of you when you’re on Medicare.

You’ll also need to check to ensure any medications you might be taking when you’re ready for Medicare are covered. Plan on traveling when you’re in your 60s? Find out if your coverage can make the trip with you, and be sure to have a solid idea of how much your deductibles and premiums will be, as well.

2. Know That Medicare Coverage Is Not Always Automatic

While Social Security Part A and Part B are automatic when you turn 65, the same can’t be said of Medicare. You also have the option of delaying Social Security benefits when you come of age and signing up for Medicare instead, but you’ll need to call to sign up, making sure you contact the Social Security offices to inform them of your choice. No matter which option you select, it’s vital that you make a decision and act on it well before you turn 65, at least four months before your birthday.

3. Understand Parts A, B, C and D

And just like Social Security benefits, there are different parts of Medicare; four parts, in fact. Part A takes care of your inpatient care bills while you’re in the hospital, but you’ll need to both qualify for Medicare and have contributed to your Social Security taxes for a least 10 years. Part B handles home health care, physician visits and hospital outpatient care. Part C is a combination of Parts A and B, but it also includes prescriptions and hearing as well as vision services. Part D is solely for prescriptions, but know that there are several different tiers to this particular part.

4. Use a Medicare Broker to Help Pick the Best Options

As with any type of insurance, your options for Medicare can be more than a bit overwhelming. That’s why we recommend working with a Medicare broker in Santa Rosa to help narrow down your options and choose the best one for your particular circumstances. Not only that, but your broker can better ensure that you don’t have to pay unnecessary late penalties for missing enrollment periods without having any other kind of accepted coverage.

For more professional information on Medicare, contact us here on our site. You’re also free to hit us up on Facebook and find us on LinkedIn , and don’t forget to subscribe to our blog .

Health Insurance Trends: PPOs, HMOs and HSAs

Wed, 15 Aug 2018 05:27:58 GMT

Trends in PPOs, HMOs and HSAs Employers Should Know

Small business owners often struggle to provide employee benefits like health insurance coverage to their employees. Understanding the options available and the trends in your region can help you choose the best health plan for your business and for your employees. Currently, employers have three basic options to choose from: PPOs, HMOs and HSAs.

Preferred Provider Organization (PPO)

Nationally, Preferred Provider Organizations are chosen by small businesses nearly twice as often as other insurance plans. PPOs cost a bit more because of their flexibility, but PPO enrollees can seek care from an out-of-network physician and still be covered. They can choose a specialist without a primary care physician referral and aren't even required to have a primary care physician on record. However, patient out-of-pocket expenses are higher for out-of-network doctors.

In 2016 and 2017, enrollment in PPOs was 52% and 51% respectively for the western region of the United States.

Health Maintenance Organization (HMO)

Health Maintenance Organizations are more restrictive than PPO. For this reason, small business owners choose them less often than PPOs. While it tends to cost less, an HMO requires enrollees to select a Primary Care Physician (PCP) from their list of network providers. Visits to specialists are only covered when the patient is referred by their PCP to a specialist who is also in the network.

Nationally, enrollment in HMOs was 25% in 2016 and 26% in 2017. In the western states those numbers rose to 33% and 34% respectively.

Health Savings Accounts (HSA)

Health Savings Accounts are a viable option for employers who want to lower the cost of providing medical insurance. Employers pay less to provide a high deductible health plan which is HSA-eligible. Money is taken pre-tax from employee pay and deposited in the account to use in paying the higher deductible, coinsurance, and copayments. Because the money is untaxed, the employee receives additional savings.

In 2017 only 6% of employers nationally offered policies that qualified for HSAs. That number dropped to 5% for western states where HMOs remain popular.

Trends to Watch

While Health Savings Accounts are declining in attractiveness, Preferred Provider Organizations and Health Maintenance Organizations remain quite popular. Employers seem to prefer managed care over cost-sharing alternatives. It's also important to note a trend among a significant number of employers in offering other types of coverage. For instance, some areas are seeing a rise in alternative health insurance solutions such as:

Exclusive Provider Organizations (EPOs)
Localized Networks
Consumer-driven plans
Accountable Care Organizations (ACOs)
Hybrid plans

The world of employee benefits and health insurance is constantly changing, and it's often difficult to keep up with those changes. Working with the qualified insurance professionals at Sackett and Associates ensures you're getting the right coverage for your employees at the right price for your business. Call us today at 707-832-3689 or send us a message via our website . Be sure subscribe to our blog, like us on Facebook and find us on LinkedIn . Our agents are experienced in handling small business health insurance and welcome the opportunity to assist you with your insurance needs.

Ask a Broker: Is My Health Insurance Broker Scamming Me?

Tue, 07 Aug 2018 05:25:33 GMT

Watch Out for Broker Practices That Cross the Line

Hi Teri,

We are looking into changing health insurance brokers. The new broker is telling us that in order it to quote us for health insurance, we need to sign a letter that says he is our new broker. Does this sound right?

Thanks,
Mikayla
-Local Santa Rosa Business Owner

------------

Hi Mikayla,

You are correct to suspect that something isn't right here. Some brokers, unfortunately, engage in several varieties of questionable practices. Asking you to sign this letter is just one of them.

You are correct to suspect that something isn't right here. Some brokers, unfortunately, engage in several varieties of questionable practices. Asking you to sign this letter is just one of them.

You Do Not Have to Change Brokers to Get a Quote

By signing a Broker of Record letter such as this one, you will actually turn your business over to this prospective broker. This means you are also officially taking your business from your current broker. This means the new broker will begin receiving the commissions instead of the old broker, who will also become unable to handle anything for you, including your current insurance contract.

So, do you really need to fire your current broker and hire another one just to get a quote? No. Most often, the broker just needs to be able to answer questions about the prospective client and provide an accurate employee count. Asking for a BOR letter just to request a quote is considered a bad broker practice.

Insurance carriers may strive to protect businesses by instituting a waiting period before they will honor the new BOR. Some may also let your old broker know about this development so he or she can discuss this issue and make sure you truly want to switch. However, you cannot always count on the insurer picking up on this bad practice and protecting you, so you are right to watch out for your interests.

Other Bad Practices to Watch Out For

A broker who is willing to resort to unethical ways of getting your business may use more than one shady technique to achieve this. One of them is misrepresenting facts. Some brokers will tell you untruths about insurance plans and terms, with the goal of making the plan they want to push sound better. It can be hard for a business owner to untangle the facts. However, if you catch a prospective broker bending the truth or being unethical in one instance, you no longer have grounds to trust him or her in other instances.

Rebating

Some brokers make tempting but illegal offers to prospective clients they want to attract. Whether a broker is offering to give you part of his or her commissions, or to provide other types of goods in exchange for signing up, you should be aware that this is not legally permissible. Generally, a broker has the right to offer you one thing: his or her professional services. Anything else can potentially fall into the category of illegal rebates.

What You Can Do

While some types of conduct – such as pressing for a premature BOR letter – may be merely bad practice, others may actually be illegal. You can report activities such as defamation or rebating to the California Department of Insurance.

Getting a Reliable Broker

An honest broker you can rely on is your key to getting the insurance product you need. For more information on health insurance services for your business, contact Sackett Insurance Services at 707-823-3698. You can also like us on Facebook , find us on LinkedIn and subscribe to our blog to get helpful updates.

What Do I Need to Set Up Health Insurance for My Small Business?

Tue, 31 Jul 2018 05:21:51 GMT

Small Business Guide to Health Insurance

One of the ways to keep good employees is to offer good employee benefits, such as health and life insurance. The ACA requires small businesses with more than 50 full-time employees to offer a qualified health plan to eligible employees, ensure that the health plan is affordable and to complete the required paperwork for the IRS. This may seem like a daunting task, especially if you don’t have a full-time HR person on staff. But there are many guides that can help you through the process.

Dealing with an insurance broker or health insurance agent , you can find plans that will fit your business needs and get quotes about different plans. There are thousands of different plans, but your broker can help you narrow your options to find the one that makes sense. But once you’ve found that plan, you’ll need to gather some documents to set it up.

Your Document Checklist

Here are the basic things you’ll need to get your healthcare plan ready for your employees:

Business name, federal EIN, business start date and address
Workers’ comp insurance
Your health insurance provider will want to make sure that your employees are covered if they get injured at work. You’ll need to provide the current levels of workers’ comp insurance that you provide.
North American Industry Classification (NAICS)
This code classifies your business for statistical agencies who collect and analyze data. The health insurance company uses it when it passes on information to the government.
Proof of payroll

You need to provide information about the number of employees who will be signing up for health coverage. The health insurance company will eventually need names, addresses, ages, and dependent information, but at the beginning, you should just look at eligible employees. If you’re covering one full-time employee, you must cover them all.

Going through the steps of getting a group plan can seem overwhelming, but the benefits to your business are great. Healthy employees are productive employees. Even if your business is too small to be mandated to provide health insurance, it might be something you should look into.

One good tip for selecting the right plan for your employees is to ask them what they want in their insurance. By understanding their priorities, you can make better decisions. Of course, you’re never going to be able to please everyone, but at least you can find some balance. For more information about offering employee benefits and health insurance , like us on Facebook , find us on LinkedIn and subscribe to our blog .

How To Calculate Full-Time Employees Under the Affordable Care Act

Tue, 17 Jul 2018 02:58:26 GMT

Counting Full-Time Employees Under the ACA

Under the Affordable Care Act (ACA) , employers with more than 50 full-time employees are subject to employer-shared responsibility provisions and employer information reporting provisions regarding health insurance and employee benefits. Calculating whether you are an Applicable Large Employer (ALE) is complex, but the IRS does offer an estimator than can help you calculate your employees and responsibility. Having a basic understanding of how employees are counted can help you plan and adjust for the future.

F ull-Time Employees

The first step in determining ALE status is to calculate full-time employees. In general, these are the key factors:

A full-time employee is one who works at least 130 hours in a calendar month or at least 30 hours per week.
A full-time equivalent employee is a combination of employees who are not individually full-time employees but when combined are equivalent to a full-time employee. For example, you have one employee who works 20 hours per week, another who only works 10. Together, these two employees are the equivalent of one full-time employee.

Typically, you count full-time employees for each month worked.

Exceptions to Full-Time Employees

Seasonal workers and employees who have coverage through a VA health program aren’t counted when determining an employer’s ALE status. Seasonal workers are defined by Department of Labor, but typically include retail workers who are only employed during the holiday season or employees who are hired for the summer.

You should note that in determining ALE status, all employees are counted with the exception of those above, regardless of whether the employees can get other coverage, including but not limited to these sources:

Federally recognized Indian tribe

Members of health care sharing ministry
Medicaid or Medicare
Spouse’s employer

Determine Your Workforce Size

The size of your workforce in the previous calendar year determines whether you are an ALE in the current calendar year. The number of full-time employees you have in 2018 is counted towards your 2019 determination. To determine your workforce size, count the number of full-time (and equivalents) employees you had each month. Add those numbers up. Divide the total by 12 to get your average workforce size. If it’s more than 50, then your business is responsible for the two provisions.

Ask for Professional HR Assistance

Health insurance can be a complex minefield, but it doesn’t have to be difficult. Even if your organization doesn’t have a dedicated HR person, you can find help with Sackett Insurance. For more information about ACA compliance, contact us online , like us on Facebook , find us on LinkedIn and subscribe to our blog .

3 Ways to Improve Your Posture For Your Health

Fri, 06 Jul 2018 03:10:28 GMT

Why Good Posture Improves Your Health

If you remember your parents telling you to sit up straight, you should know that they were only thinking about your health. Slouching is not good for your back muscles, it also lowers your energy levels. Americans today spend way too much time sitting. When you have poor posture, it stresses your joints and makes you appear sloppy. Fortunately, with conscious thought you can improve your posture.

Benefits of Good Posture

Why should you work on your posture? Good posture:

Prevents fatigue by using your muscles efficiently, which lets your body use less energy.
Reduces back and muscle pain.
Decreases the stress on the spine, joints, ligaments and muscles in the back and shoulders.
Prevents abnormal joint wear.
Keeps your body in alignment, which lets your muscles work better.
Makes your appearance better and projects self-confidence.

How to Achieve Good Posture

If you’ve been slouching and standing improperly for years, it might take time to correct your stance. But in the long run, you’ll feel better. Here are some tips that can help you get started.

Stand Tall

Check your posture against the wall to see if you’re standing right. Put your shoulders and bottom against the wall. The back of your head should lightly touch the wall. The first time you do this, it might feel unnatural. If it’s uncomfortable, you might want to talk to a physiotherapist who can assess joint and muscle problems. Practice standing tall, with your earlobes lined up with the middle of your shoulders. Relax your arms and avoid tilting forward.

Check Your Workstation

Having poor posture when you work will take its toll on your body. Your feet should be flat on the floor when you are sitting. Make sure your desk is at the right height for your body. The right seat height is level with your knees. While you’re sitting at your desk, your ears should line up with your shoulders. Draw your shoulder blades back and down to keep your chest up and out. This prevents rounded shoulders.

Get Up and Walk Around Regularly

Change positions about every 15 to 20 minutes to keep your blood flowing and avoid muscle stiffness. Stretch or take a walk. Be intentional about having good posture.

Good posture is good for your health, but you should keep up with regular doctor checkups. Learn how Sackett & Associates Insurance Services can help you find health insurance coverage that fits your needs. Get more information by liking us on Facebook , finding us on LinkedIn , subscribing to our blog or sending us a message through our online portal .

Sackett Insurance Services - Blog

When Can You Change Your Medicare Plan? Understanding Special Enrollment Periods

When Can You Change Your Medicare Plan After Enrollment

Annual Enrollment Period (October 15 – December 7)

Medicare Advantage Open Enrollment Period (January 1 – March 31)

How a Medicare Special Enrollment Period Works

Flexibility Exists After Medicare Enrollment

When You Can Change Your Medicare Plan Depends on Understanding the Rules

How Small Employers Can Budget for Mid-Year Health Insurance Rate Increases

How Small Employers Can Budget for Health Insurance Rate Increases

How Can Small Employers Plan Ahead for Group Health Insurance Cost Increases?

How Does Your Small Business Health Insurance Contribution Strategy Affect Costs?

Can Small Businesses Reduce Health Insurance Costs Without Cutting Coverage Quality?

Should Small Businesses Consider Alternative Health Insurance Funding Models?

Why Does Working With the Right Health Insurance Broker Matter?

Small Employers Can Take Control of Group Health Insurance Cost Increases

How To Get Health Insurance for Your Employees as a Small Business in Santa Rosa

How Small Businesses in Santa Rosa Can Offer Health Insurance ﻿

What Is Group Health Insurance?

Contribution and Eligibility Rules

How Your Business Size Affects Health Insurance Options

How Can You Control Health Insurance Costs?

Minimum Participation and Other Requirements for Group Health Plans

Why Should You Work With a Local Broker To Choose a Health Plan?

Benefits Management Software

What Additional Health Benefits Should You Consider?

Dental and Vision Plans

Mental Health Support

Employee Assistance Programs (EAPs)

Next Steps for Offering Health Insurance to Your Employees

What Employers Should Know About Group Health Plan Trends and Costs in 2026

How Small Businesses Can Cut Health Insurance Costs 2026

Rising Costs of Employer-Sponsored Health Plans

New Group Health Insurance Plan Designs

Mental Health and Wellness Benefits

The Role of Telehealth in Health Plans

How To Manage Group Health Insurance Costs

1. Evaluate Tiered Networks

2. Offer Wellness Incentives

3. Use HSAs and HRAs

4. Benefits Management Software

5. Consider Self-Funding

Preparing for Changes in 2026

2026 Medicare Open Enrollment Trends in Sonoma County

What Local Enrollment Data Reveals About Medicare Choices in Northern California

Why Sonoma County Medicare Trends Look Different

Medicare Advantage vs Medicare Supplement in 2026

Prescription Drug Changes Drove Most Plan Decisions

Plan Exits Created Forced Enrollment Activity

Provider and Hospital Access Remained Central

Sonoma County Compared to State and National Trends

What the 2026 Data Means for Medicare Beneficiaries

About the 2026 Northern California Medicare Open Enrollment Report

What To Do If You Missed the Medicare Advantage Open Enrollment Period

Missed Medicare Enrollment? Here’s What to Do Next

When You Miss the Initial or Standard Medicare Enrollment

Missing Your Initial Enrollment Period

Missing Medicare’s Annual Open Enrollment

Special Enrollment Periods for Qualifying Life Circumstances

Common Reasons You May Qualify for an SEP

What Coverage Looks Like When You Miss Enrollment

What To Do While Waiting for Your Next Enrollment Window

Review Your Current Needs

Compare Plan Types

Watch for the Next Enrollment Period

Why Working With a Medicare Broker Makes a Difference

Staying Confident and Covered With Sackett Insurance

Preparing for 2026 ACA Subsidy Changes After Expiration of Temporary Tax Credits

ACA Subsidy Expiration: How Californians Can Prepare for 2026

Why ACA Tax Credits Will Shift in 2026

What Health Insurance Premium Increases May Look Like

Why Premiums Are Rising Beyond Subsidy Changes

How To Prepare for the 2026 Marketplace

1. Estimate Your 2026 Income Now

2. Reevaluate Your Coverage and Compare Plans

3. Talk With a Broker About Alternative Coverage

Two Checkpoints To Stay Ahead of 2026 ACA Subsidy Changes

Position Yourself for a Smoother 2026 With Help From Sackett Insurance

Missed Medicare’s Fall Deadline? Here’s What You Can Still Do

Missed Medicare Enrollment? Here’s What You Can Do Next

How Small Businesses in Santa Rosa Can Offer Health Insurance

How Group Health Insurance Helps Small Business Teams Thrive