Author Archives | Kevin Guss

About Kevin Guss

Kevin J. Guss is a Consultant with our Private Client Benefit Services, specializing in providing individual health coverage (on and off-exchange), Medicare supplements, life, LTC and disability insurance to clients of J.W. Terrill and strategic partners. With more than 22 years of industry experience, Kevin counts many retired professional athletes, celebrities, business leaders and prominent members of the community among his clients. He has a Group Benefits Associate designation from the Wharton School of the University of Pennsylvania, a Past President of St Louis Association of Health Underwriters and a current board member of the MO Association of Health Underwriters.

Enrollment Periods in Individual Health Coverage

October 16, 2013

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With full implementation of the Affordable Care Act (ACA), individual health insurance is changing. No longer are we subject to medical underwriting; carriers cannot decline us for past health issues or pre-existing conditions. However, with the removal of underwritten rating criteria there is the risk of free-rider driven adverse selection. This occurs when those with health conditions buy a policy, while the healthy among us wait until an illness or injury forces them to purchase coverage.

While there are many reasons premiums will increase under ACA, there are some rules in place to help protect rates against free-rider behavior. Specifically, individual health coverage can now only be purchased during annual and special enrollment periods. For 2014, the annual (or initial) enrollment period is 10/01/2013 – 03/31/2014. After this first ACA annual enrollment period closes, the yearly sign-up window will narrow to 10/15 – 12/07 thereafter.

Special enrollment periods are the only other time we can purchase individual coverage. These 60 day enrollment windows open when we gain or lose a job, if we’re newly eligible or ineligible for an ACA premium subsidy, when we gain or lose a spouse or dependent, if we lose other coverage (through no fault of our own), if we move to a new region or state, if we gain citizenship or legal residence, or if other exceptional circumstances occur (as determined by the Federal Exchange for Missouri residents).

With all of the changes in the individual health marketplace, we’re glad to discuss enrollment period rules and any other coverage questions. The new rules driven by the ACA makes planning your health coverage more difficult and more important.

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October 15th Medicare Part D Enrollment

October 14, 2013

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With Medicare Part D annual open enrollment arriving on Oct. 15, it’s worth noting that a new study by the Kaiser Family Foundation indicates that only 13% of enrollees change coverage during this period. The KFF study also notes that Part D plans have been successful in lowering costs by narrowing pharmacy networks, offering lower co-pays at preferred pharmacies, and increasing the number of cost-sharing co-pay tiers. These efforts will keep the average premium increase to around 5% for most enrollees in 2014.

It’s also worth pointing out that a significant out-of-pocket coverage gap or “donut hole” remains in Part D plans, even after efforts to reduce it through Affordable Care Act legislation have been implemented.

To read the full report, please go here. For questions or to discuss Part D coverage in greater detail, please contact the benefits team at JW Terrill.

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Medicare Eligibility – Did You Know?

April 1, 2013

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Medicare Part A may not require a premium for most enrollees. But that doesn’t mean that it’s free for everyone. If an enrollee hasn’t worked (and paid into Social Security) for 40 quarters in their lifetime or been married to someone that worked 40 quarters, Uncle Sam is charging $451 per month in 2012 for Part A hospitalization coverage. Those that have worked 30 – 39 quarters pay $248 per month in 2012.

An older immigrant, an unmarried domestic partner that’s never worked outside the home, or someone that’s worked for cash “under the table” may be surprised to find that the Medicare Part A that’s free for their friends has a significant cost for them. Add in the $99.90 monthly premium for Part B, a Medicare supplement and Part D Rx plan, and the health insurance costs for those that haven’t planned appropriately can be a budget nightmare.

See here for a link to the Department of Health & Human Services for supporting information: http://answers.hhs.gov/categories/161 and please check with Social Security if you or someone you know needs to review and confirm Medicare eligibility. This is not a detail that should be left unchecked.

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Significant Claims Increases Coming with the Affordable Care Act

March 27, 2013

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The Society of Actuaries has released a report estimating that claims expenses on individual health policies will rise 32% by 2017, after full implementation of the Affordable Care Act. Otherwise known as ObamaCare, this law prohibits insurers from declining coverage on those with pre-existing conditions, eliminates most age and gender rating criteria, adds maternity to all plans and removes lifetime benefit limits. 

In addition to affecting near term premium rates, a rise in claims expenses will require a higher set aside for future claims and administration costs, thus contributing to long term rate inflation that far exceeds the historic trends.

The Obama administration, chief architects of the legislation, responded by explaining that this report doesn’t take into account federal premium subsidies and other measures in the law that are designed to offset cost increases, according to Ricardo Alonso-Zaldivar of the Associated Press.

For a more detailed analysis from the Society of Actuaries, please go here: http://www.soa.org/News-and-Publications/Newsroom/Press-Releases/ACA-Driven-Changes/ or contact your benefits team at J.W. Terrill.

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Beware the Student Health Policy!

September 10, 2012

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It’s that time of year – kids are returning or starting college in the next couple weeks.  As they head out on their academic adventures, there are some items to consider when planning for your student’s healthcare;

1)       Look closely at any healthcare related fees that are included with tuition.  Some fees are mandatory; such as a fee for an on-campus student health clinic.  Some fees may be optional; such as premiums for student health insurance.

2)       Even if there’s a health insurance premium included in tuition, consider keeping your student on your employer-based health insurance plan.  Federal law requires most employer-based health plans to allow parents to keep dependents covered up to age 26.  And the coverage your employer offers is often far better; many student med plans exclude coverage for prescription drugs, include very high deductibles and out-of-pocket exposures, and may limit a plan’s doctor and hospital network to a handful of local providers.

3)       If employer-based coverage is unavailable for your student, consider an individual health insurance policy from a reputable carrier like Anthem Blue Cross, Coventry or United HealthCare.  With a high deductible health policy you can put in place an inexpensive catastrophic plan for any health issues that may exceed the capabilities of a school’s student health clinic.  While also giving your student a health insurance policy that can continue after college and into their work years.

Of course, if questions arise about your student’s health coverage, please call the individual benefits team at J.W. Terrill.  We’re always glad to help!

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Medicare Premiums: Rules For Higher-Income Beneficiaries

April 19, 2012

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As we all return from spring break and tax time concentrates our focus, I thought I’d pass along some helpful information on Medicare Part B premiums.  If you or someone you know is on Medicare and this year’s tax return will show a lower income than last, this information will be particularly useful.

Please click here:  http://www.ssa.gov/pubs/10536.html#a0=4

Note under the “What if my income has gone down?” section that the Social Security Administration has a process in place to review and lower Part B premiums if an enrollee is presently paying income adjusted premiums at higher than standard rates.  And, the “What if I disagree?” section can help with an appeal, too.

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Individual Health Insurance Update: Medicare Part B & D Premiums

January 13, 2012

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It’s that time of year!  Medicare Part B and D enrollees should have received notice in early December of changes to their premiums.  Changes are effective 01/01/12 and will show on an enrollees next Social Security check, or premium invoice.  These premiums can represent a significant cost for retirees and it’s important to always add them into one’s personal health expense budget calculations.  The good news for 2012 is that premiums are dropping by more than 10%.  For Part B, here’s the new premium table:

If your Annual Income is:

You pay
File Individual Tax Return File Joint Tax Return  
$85,000 or below $170,000 or below $ 99.90
$85,001-$107,000 $170,001-$214,000 $139.90
$107,001-$160,000 $204,001-$320,000 $199.80
$160,001-$214,000 $320,001-$428,000 $259.70
Above $214,000 Above $428,000 $319.70

And, for Part D prescription drug coverage, here’s the new premium surcharge table: 

If your Annual Income is:

You pay
File Individual Tax Return File Joint Tax Return  
$85,000 or below $170,000 or below Your Part D premium
$85,001-$107,000 $170,001-$214,000 $11.60 + Plan Premium
$107,001-$160,000 $204,001-$320,000 $29.90 + Plan Premium
$160,001-$214,000 $320,001-$428,000 $48.10 + Plan Premium
Above $214,000 Above $428,000 $66.40 + Plan Premium

To read the original press release from the Department of Health & Human Services, please go to: http://www.hhs.gov/news/press/2011pres/10/20111027a.html 

If you know a Medicare enrollee that is in a higher income tier and they’ve had a significant decrease in their gross income, they should contact the Social Security Administration to have their premiums reviewed for a downgrade adjustment.  For more details, and SSA contact information, start here:  http://www.socialsecurity.gov/pubs/10536.html

 

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