Medicare Part D Notice Due Before October 15th
- You have flexibility in the form and manner of providing the Notice
- You may use the model notice form published by the Centers for Medicare & Medicaid Services (CMS) (although you are not required to do so).
- You are not required to send the Notice as a separate mailing. You can provide it with other participant information materials (although note that certain formatting requirements may apply)
- A separate disclosure must be provided if you know that the spouse or dependent resides at a different address than the participant.
- You may distribute the Notice electronically if you follow the same electronic disclosure requirements that apply to summary plan descriptions (SPDs), except you should inform the participant that he/she is responsible for providing a copy of the disclosure to his/her Medicare-eligible spouse and/or dependents eligible for coverage under the plan (otherwise, you will need to separately send them a hard copy notice) And you must post the Notice on your website (if you have one) with a link on your home page to the Notice.
- If you have not yet finished your 2013 offerings, the Notice should still be provided now based on your current 2012 offerings. If the status of those offerings changes from creditable to non-creditable (or vice versa), you will need to provide an additional Notice within a reasonable period of time (maximum 60 days) after the change occurs. You should indicate on your Notice that it will not be updated if coverage changes but it remains creditable or non-creditable (as applicable)
Upper-income Seniors Face Medicare Hike
Source: https://www.benefitspro.com
By Ricardo Alonso-Zaldivar - Associated Press
President Barack Obama's new plan to raise Medicare premiums for upper-income seniors would create five new income brackets to squeeze more revenue for the government from the top tiers of retirees.
The administration revealed details of the plan on April 12th after Health and Human Services Secretary Kathleen Sebelius testified before the Congress on the president's budget. The details had not been provided when the budget was released earlier in the week.
The idea of "means testing" has been part of Medicare since the George W. Bush administration, but ramping it up is bound to stir controversy. Republicans are intrigued, but most Democrats don't like the idea.
The plan itself is complicated. The bottom line is not: more money for the government.
Obama's new budget calls for raising $50 billion over 10 years by increasing monthly "income-related" premiums for outpatient and prescription drug coverage. The comparable number last year was $28 billion over the decade.
Currently, single beneficiaries making more than $85,000 a year and couples earning more than $170,000 pay higher premiums. Obama's plan would raise the premiums themselves and also freeze adjustments for inflation until 1 in 4 Medicare recipients were paying the higher charges. Right now, the higher monthly charges hit only about 1 in 20 Medicare recipients.
House Budget Committee Chairman Paul Ryan, R-Wis., asked Sebelius about the new proposal last Friday, noting that it would raise significantly more revenue. Part of the reason for the additional federal revenue is that Obama's 2014 budget projects an additional year of money from the proposals. The rest of the answer has to do with the administration's new brackets.
Starting in 2017, there would be nine income brackets on which the higher premiums would be charged. There are only four now.
If the proposal were in effect today, a retiree making $85,000 would pay about $168 a month for outpatient coverage, compared to $146.90 currently.
Under current law, the next bump up doesn't come until an individual makes more than $107,000. Under Obama's plan, it would come when that person crosses the line at $92,333. If the plan were in effect today, the beneficiary would pay about $195 a month for outpatient coverage under Medicare's Part B, rather than $146.90.
The top income step — currently more than $214,000 — would be lowered to $196,000. And individuals in the new top tier would pay 90 percent of the cost of their outpatient coverage, compared to 80 percent currently.
The administration did not provide a comparable table for the effects on married couples.
The impact on monthly premiums for prescription drug coverage is hard to calculate, since different plans on the market charge varying premiums.
Sebelius told lawmakers the Medicare proposals in the budget are intended to strike a balance between cutting health care spending to reduce the deficit and maintaining services for people who depend on them.
"This proposal would improve Medicare's long-term financial stability by reducing the federal subsidy for people who can afford to pay more for their coverage," said Medicare spokesman Brian Cook.
The Affordable Care Act Three Years Post-Enactment
Source: https://www.kff.org
Three years ago, on March 23, 2010, the Affordable Care Act (ACA) was signed into law. Although the date for full implementation of most provisions of the law is January 1, 2014, the ACA has already had an impact on the goals of expanded coverage of the uninsured, improved access and better care delivery models, broader access to community-based long-term care, and more integrated care and financing for beneficiaries who are dually eligible for Medicare and Medicaid. Although the ACA remains controversial, with many debates about its future as well as provisions already implemented, implementation is proceeding.
Much remains to be put in place leading up to 2014. This brief summarizes ACA-related activities to date in terms of tangible benefits and policy changes on the ground with respect to private insurance and Exchanges, Medicaid coverage, access to primary care, preventive care, Medicare, and Medicare and Medicaid dual eligible beneficiaries.
Private Insurance and Exchanges
- Young adults up to age 26 can stay on their parents’ insurance policies. Young adults can qualify for this coverage even if they are no longer living with a parent, are not a dependent on a parent’s tax return, or are no longer a student. Census data show that over two million young adults have gained coverage, contributing to the decline of 1.3 million in the number of uninsured Americans in 2011.
- Many states are moving forward with building new health insurance marketplaces. To date, 17 states and the District of Columbia are establishing state-based health insurance exchanges while another seven states will partner with the federal government to run their exchanges. These states are making critical decisions about how insurers will participate in the exchanges, what types and how many plans will be offered, and what types of consumer assistance will be available to help people enroll in coverage. States are also building the IT infrastructure for the exchanges to be ready when open enrollment begins on October 1. In the remaining 26 states, the federal government will operate a federally-facilitated exchange, and residents will get the same benefits and tax subsidies as in states operating their own Exchanges.
- Coverage exclusions for children with pre-existing conditions were prohibited as of September 23, 2010. Insurers are no longer permitted to deny coverage to children due to their health status, or exclude coverage for pre-existing conditions. Protections for adults will take effect in 2014. In addition, lifetime limits on coverage in private insurance have been eliminated and annual limits are being phased out.
- Medical loss ratio and rate review requirements are improving value and lowering premium growth for consumers. Medical loss ratio standards require insurers to spend 80-85% of premium dollars on direct medical care instead of on administrative costs, marketing, or profits, or pay rebates back to consumers. Failure to meet these standards has resulted in insurer payments of over $1 billion in rebates to consumers. In addition, expanded review of insurance premium increases by states and the federal government has led to some rate increases requested by insurers being denied, withdrawn, or lowered, which has slowed overall premium growth.
- All health plans must provide a standardized, easy-to-read Summary of benefits and Coverage (SBC). The SBC gives consumers consistent information about what health plans cover and what limits, exclusions, and cost-sharing apply. It includes illustrations of how coverage works by estimating what a plan would pay and what consumers would be left to pay for common health care needs such as an uncomplicated pregnancy or management of diabetes. Kaiser Family Foundation tracking polls indicate the SBC is one of the most popular provisions in the ACA.
Medicaid coverage
- More than half the Governors have announced support for the Medicaid expansion. Twenty-seven Governors intend to implement the Medicaid expansion. Another seven are still weighing their options. Seventeen Governors have stated their opposition to the expansion.
- Seven states have expanded Medicaid to adults since the enactment of the ACA, helping to build on the very limited base of coverage available to low-income adults today. While the enhanced federal funding for the ACA Medicaid expansion to low-income adults does not take effect until January 1, 2014, seven states – CA, CO, CT, DC, MN, NJ, and WA – have used the ACA option to expand Medicaid earlier at their regular match rate, or used Section 1115 waiver authority to do so. Nearly all these states previously covered low-income adults using state-only dollars, but transitioning that coverage to Medicaid enabled them to preserve and, in some cases, expand adult coverage by securing federal matching funds.
- Medicaid and CHIP have remained primary sources of coverage for low-income children and pregnant women. To help preserve the existing base of coverage in the period leading up to the coverage expansions in 2014, the ACA required states to maintain the Medicaid and CHIP eligibility, enrollment, and renewal policies they had in place when the ACA was enacted. Notwithstanding the recent recession and state budget pressures, eligibility for these programs has remained largely stable, and the programs have remained primary sources of coverage for low-income children and pregnant women. The preservation of Medicaid and CHIP coverage has been important to progress in reducing the number of uninsured Americans – which declined by 1.3 million in 2011.
- Nearly all states are modernizing and streamlining their Medicaid enrollment systems. Taking advantage of a time-limited 90% federal match rate available for systems development, almost all states are already moving forward with major improvements to their information technology (IT) infrastructure to prepare for the ACA’s new streamlined, coordinated enrollment system. In addition, an increasing number of states – now totaling 37 – have implemented an electronic online application in Medicaid or CHIP, and the number of states with an online renewal process rose from 20 in 2011 to 28 in 2012. Over two-thirds of states now provide online accounts.
- Ten states have adopted the ACA’s new Medicaid option to provide health homes for those with chronic conditions or serious mental illness. Another five states plan to implement health homes. Health homes are among the ACA’s broader set of initiatives to improve care and better manage spending for people with complex and high-cost needs. Building on patient-centered medical homes, health homes incorporate comprehensive care management, health promotion, transitional care, and other services and supports to provide more integrated, “whole person” care for Medicaid beneficiaries with multiple chronic conditions or a serious and persistent mental illness.
- States are taking advantage of new and expanded opportunities to provide home and community-based long-term services. Many people with long-term care needs prefer to receive services at home or in the community rather than in institutional settings, and home and community-based services (HCBS) are often less expensive. The ACA expands states’ opportunities to rebalance their long-term care programs toward community-based care and provides new federal funding for this purpose. A total of 46 states, including DC, have received federal grant money to transition Medicaid beneficiaries from institutions back to their homes or community-based settings through the “Money Follows the Person” demonstration program, which the ACA extended. Sixteen of these states first undertook a demonstration this past year. A growing number of states – 25 currently – are responding to other new flexibility and federal financial incentives the ACA provided to increase access to HCBS.
Access to Primary care
- Primary care providers get increased Medicare and Medicaid payment rates under the ACA. The ACA provides for a 10% bonus payment on top of the regular Medicare fee schedule amount for many primary care services provided by primary care physicians (and other practitioners) from 2011 through 2015. The law also requires states to raise their Medicaid payment rates in 2013 and 2014 to Medicare payment levels for many primary care physician services. As a result, Medicaid primary care fees will increase by 73%, on average, in 2013 although the size of the increase will vary by state. The Medicaid increase is fully federally funded up to the difference between states’ July 1, 2009 fees and Medicare fees in 2013 and 2014.
- Because of new ACA investments in the health center program, health centers’ patient capacity has expanded. The ACA created a five-year $11 billion Health Center Trust Fund to support health center growth in preparation for the coverage expansion beginning in 2014. Drawing on this fund, health centers are serving an additional 1.5 million patients, and they have been able to maintain their capacity to serve another 2.2 million patients whom they were earlier able to reach only because of a (now-expired) temporary increase in federal funding when the recession was at its deepest. In addition, over 700 health centers received grants for capital improvements from funds provided by the ACA for this purpose.
- Thousands of new primary care providers have been added to the ranks of the national health Service Corps (nhSC), bolstering the health care workforce in medically under served communities. The ACA provided increased funding of $1.5 billion for the NHSC, which provides loan repayment to medical students and others in exchange for service in low-income under served communities. Health centers, which serve millions of people in these communities, rely heavily on the NHSC to recruit their physicians, dentists, and other health care professionals. As a result of the ACA investment and earlier investments by the American Reinvestment and Recovery Act of 2009, the number of NHSC clinicians is at an all-time high – triple the number in 2008.Today nearly 10,000 NHSC providers are providing primary care to approximately 10.4 million people at nearly 14,000 health care sites in urban, rural, and frontier areas.
- Additional efforts to expand the primary care workforce are also underway. New training and retention programs have also been created to develop and strengthen the primary care workforce. The ACA has increased the number of graduate medical education residency programs, including establishing 11 Teaching Health Centers to support primary care training in ambulatory care settings. Other efforts include investments in training for nurses and physician assistants, and financial support for nurse-managed clinics.
- KFF resource:
Access to Preventive Services
- Preventive benefits with no patient cost-sharing are now required in Medicare and private insurance (except for grandfathered plans). The benefits that must be covered include services found to be effective by the USPSTF, immunizations for adults and children endorsed by the CDC Advisory Committee on Immunization Practices, and pediatric services recommend by HRSA’s Bright Futures for Children. Private plans must cover additional preventive services for women without cost-sharing, including all FDA-approved contraceptive methods (non-profit, religious employers that object to that requirement are exempt) and at least one annual well-woman visit. HHS estimates that, as a result of the ACA, 71 million children and adults with private insurance, and 34 million Medicare beneficiaries have received no-cost preventive care. Enhanced federal matching funds in Medicaid are available to states providing all USPSTF-recommended preventive benefits without cost-sharing, but, to date, few states have made the changes required to gain the higher match rate.
- The ACA supports population-based prevention activities through a new Prevention and Public health fund. This Fund has been used to make over $1 billion in critical investments in programs aimed at reducing the burden of chronic disease and improving the overall health of communities. Funding has supported Community Transformation Grants in 36 states to reduce the incidence of heart attacks, strokes, cancer, and other diseases; rebuilding the immunization infrastructure; tobacco cessation programs; and substance abuse and suicide prevention activities.
- KFF resource:
Medicare
- Medicare beneficiaries enrolled in Part d drug plans are receiving additional help with their “doughnut hole” prescription drug costs. The ACA required drug manufacturers to offer a 50% discount on brand-name drugs in the coverage gap phase of the Medicare drug benefit, known as the “doughnut hole,” beginning in 2011. It also required Part D plans to offer additional coverage for brand-name and generic drugs for enrollees who reach the coverage gap, and phases out the gap by 2020. In 2013, plans pay for 21% of the cost of generic drugs and 2.5% of the cost of brands, on top of the 50% manufacturer discount. According to HHS, as of March 2013, 6.3 million Medicare beneficiaries have saved over $6.1 billion on prescription drugs in the Medicare Part D doughnut hole since the ACA was enacted.
- New initiatives testing delivery system and payment reforms are being developed and implemented rapidly around the country, including Accountable Care organizations (ACos) and bundled payments. The ACA established a new Center on Medicare and Medicaid Innovation charged with reducing costs in Medicare, Medicaid, and CHIP while preserving or enhancing quality of care. The Innovation Center develops, tests, and supports new delivery models to increase coordination of care and improve quality, along with new payment systems to encourage more value-based care and move away from fee-for-service payment. For example, the Innovation Center has approved more than 250 ACOs to participate in the Medicare Shared Savings Program in 47 states and territories; these ACOs cover more than four million beneficiaries in traditional Medicare.
- Medicare savings in the ACA have helped extend the solvency of the Medicare Part A trust fund. The ACA included Medicare savings measures that were projected to reduce growth in Medicare spending over time. The measures included reduced payments to Medicare Advantage plans, smaller updates in payment levels to hospitals and other providers, and increased premiums for higher-income beneficiaries. These changes, along with a payroll tax increase for higher-income taxpayers, contributed to the extended solvency of the Medicare Part A trust fund. Medicare spending per beneficiary is projected to grow more slowly than private health insurance spending per capita over the next decade, and premiums and cost-sharing for many Medicare-covered services are lower than what they would be without the ACA.
Medicare and Medicaid Dual Eligible Beneficiaries
- Many states have responded to the ACA initiative to develop and test models that align Medicare and Medicaid financing for dually eligible beneficiaries. About 9 million seniors and younger people with significant disabilities are dually eligible for Medicare and Medicaid. Many have complex medical and long term care needs and they account for a disproportionate share of spending in both programs. A total of 26 states responded to a CMS solicitation for proposals to test models that align Medicare and Medicaid financing for this population; four of these states now have memoranda of understanding approved to implement demonstrations in 2013, and another 21 proposals are pending CMS’s approval.
Is There Room in the Medicare Reform Debate Climate?
Source: https://medicarenewsgroup.com
by Bob Rosenblatt
Medicare has been considered the blue-ribbon, A-plus health insurance plan since its inception in 1966, when it began covering millions of disabled and elderly.
But this perception may change in a big way on Jan. 1, 2014, when the Affordable Care Act (ACA) brings a new protection to consumers covered by private coverage. These policies will have annual out-of-pocket spending limits, offering protection for those facing big medical bills. The average maximum annual amount will be $6,400 for a single person and $12,800 for a family.
Suddenly, Medicare will be the lone health insurance policy without any protection on the catastrophic end, meaning there is no limit to the amount a patient may be forced to pay out-of-pocket.
This is already sparking a new policy debate on what sort of protections should be offered to Medicare beneficiaries against the threat of huge financial losses from medical bills. This question is becoming entangled with the discussion of Medicare’s fiscal future and the desire to slow its spending.
Debate “over these changes will be contentious,” warned the Kaiser Family Foundation in a recent study.
A Medicare beneficiary may face severe financial risk from medical costs. For a hospital stay, there is a deductible of $1,184 for a hospital stay of 1-60 days; $296 per day for days 61 to 90; $592 per day for days 91 through 150; and all costs for each day beyond 150. For outpatient visits to a doctor under Part B, there is a $147 annual deductible, and then a 20 percent co-payment for further expenses. In addition, there is the cost of the Part B premium at $104.90 per month (higher for individuals with income over $85,000 a year), and another premium if drug coverage under Part D has been selected. In addition, many beneficiaries also buy Medicare supplementary insurance, known as Medi-gap, back-up insurance to help with co-payment costs.
Add together the co-payments, deductibles and premiums, and it can become a financial struggle for many people, Kaiser Family Foundation Vice President Tricia Neuman told a Congressional health subcommittee of the House Ways and Means Committee in February, in a report titled, “Changing Medicare's Benefit Design: Implications For Beneficiaries.”
“Even with Medicare, and supplemental insurance, beneficiaries tend to have relatively high out-of-pocket health costs,” she said. “In 2009, half of all Medicare beneficiaries spent 15 percent or more of their income on health-related expenses, including premiums, cost sharing for Medicare-covered services, and services not covered by Medicare; more than one-third of all beneficiaries (39%) spent at least 20 percent of their income on medical expenses that year.”
The majority of people on Medicare derive their income from their monthly Social Security check. Social Security’s annual cost-of-living increase is pegged to the general rate of inflation in the economy. This provision, in effect since 1974, is designed to provide a measure of income security over time, so that the value of a retiree’s check keeps pace with expenses.
But the flaw here is that the cost of medical care is rising faster than the general rate of inflation, and thus it is eroding the value of the Social Security check. According to a 2011 Kaiser Family Foundation report, “Medicare the expense of Medicare—the total cost of the monthly premiums, the deductibles and co-payments—was equal to 27 percent of the average Social Security retirement check in 2010. By the year 2030, the report says, Medicare costs will consume 36 percent of the average Social Security check.
“The benefit structure has long been criticized for being too complex, and for promoting overutilization of care which, in turn, translates into higher costs for seniors,” Sen. Orrin Hatch (R-Utah) said in a recent call for a cap on out-of-pocket costs. “Streamlining the cost-sharing will make it easier for seniors to navigate Medicare more efficiently while also reducing costs. Most importantly, it will give seniors financial security in cases of high out-of-pocket costs.”
He sought to bring back into the debate the proposal put forth by the deficit reduction Simpson-Bowles Commission, which had been appointed by President Obama. In 2010, the commission called for a combined annual deductible of $550, instead of the separate Part A and Part B deductibles. It also called for a 20 percent co-payment schedule, and an annual out-of-pocket limit of $7,500. This would have saved the federal government approximately $110 billion over a 10-year period.
Putting an annual limit on financial exposure would save money for some of the sickest people on Medicare, but it would force nearly everyone else to pay more, Neuman said in the Congressional hearing.
She also said that a variation of the Simpson-Bowles plan would have offered some beneficiaries a 5 percent savings (an average of $1,570 a year) but 71 percent would have faced larger bills (an average increase of $180 a year).
The views of these proposals depend on politics. Conservatives, who worry about the deficit, say measures are needed to slow down Medicare’s growth, while limiting the financial threat to the Medicare beneficiaries with the biggest bills.
Liberals oppose any measure they say would shift expenses to already hard-pressed beneficiaries.
Liberals want more affluent people to pay more. The liberal Center for American Progress has offered this proposal: the out-of-pocket maximum should be $5,000 a year for those with incomes below 400 percent of the federal poverty level; $7,500 a year for people with income between 400 percent and 600 percent of the poverty standard; and $10,000 when income exceeds 600 percent of the poverty level.
AARP, the powerful lobby on behalf of those ages 50 and older, has been studiously neutral in discussions of this issue, offering ammunition to both sides of the argument in a brief by its Public Policy Institute.
“If an annual out-of-pocket spending cap were included in this redesign, Medicare beneficiaries—particularly those with high utilization—would have more financial protection from expenses caused by severe and often unexpected illnesses,” AARP said. “In addition, increased cost-sharing could make beneficiaries more price- sensitive in using health care services, resulting in lower utilization and greater Medicare savings. These savings would improve the long-term stability of the Medicare program for both current and future beneficiaries.”
Then, arguing for the other side, the AARP analysis said, “Medicare beneficiaries, especially those with modest incomes or no supplemental coverage, could find it difficult to afford these cost-sharing requirements. These beneficiaries may decide not to get the medical care that they need in order to avoid paying coinsurance or deductible amounts, which could lead to poorer health outcomes and higher Medicare costs in the long run.”
With AARP viewing the issue as an on-the-one-hand, on-the-other hand hard choice, Congress and the president are certain to tread delicately as they maneuver around this politically explosive issue.
Senior Worries
A new report by the Employee Benefit Research Institute (EBRI) finds that a retired couple aged 65 might need $387,000 to cover medical expenses for the remainder of their lives. With Medicare covering only 59 percent of health care costs for seniors, retirees should expect to pay an even larger share in the future because of looming Medicare cutbacks and reductions to employer-sponsored retiree benefits, the EBRI report said.
PPACA’s 2013 provisions near implementation
Source: Benefitspro.com
By: Katie Kelley
Apart from the latest debates on political opinions over health care changes, it’s important to know what necessary steps are required to get HR and their employees on the right track for 2013.
The Patient Protection and Affordable Care Act outlines changes set to kick in over several years. Benefits managers and human resource advisors are nearing the implementation of the 2013 provisions, and while these changes might not be as newsworthy as the 2014 provisions that are dominating headlines, they do hold credence to employees and their health plans.
According to Troy Filipek, a principal and consulting actuary for Milliman, the best way to prepare for compliance next year is to employ contingency planning as well as develop open lines of communication with employees.
Filipek says employers need to be proactive for 2013 while thinking ahead for 2014.
“There are a lot of changes that are occurring, and there are things employers can benefit from just by considering these options. Talk to your advisors and obviously if you do decide to make a change, talk to your employees or your retirees because with anything you make changes to, it’s important that your people are well advised on it, why you’re doing it and how it’s going to impact them.”
Sharon Cohen, a principal at Buck Consultants and an expert in pretax benefits and health care, shared a similar viewpoint, but also noted that it’s imperative for employers and benefits managers continue with what’s required by law right now—despite any changes that may still occur. “The provisions will start taking effect and the government is moving forward. I wouldn’t count on this all going away before I would take action.”
Medicare subsidy taxation
The major PPACA provision impacting Medicare Part D closes the ‘donut hole’ or gap between coverage limits and out-of-pocket spending on the cost of prescription care, but the law also changes the retiree drug subsidy program.
“The big change for 2013 with the RDS program is that in the past, from 2006 forward, the allowance that these employers receive from the government for the subsidies used to be non-taxable income,” Filipek says. “That has changed since the enactment of the [PPACA].”
Now, Filipek explains, the money that employers receive from the government for these subsidies is subject to taxation.
“It’s a pretty big change,” he says. “A lot of employers have already felt the impact of it because once the law passed, based on the accounting standards, you had to recognize the future impact of that in your financial statements.”
Options include continuing coverage and working with the newly taxed subsidies or dropping coverage and allowing retirees to enroll in individual part D plans. Additionally, Filipek says, employers can maintain group coverage and work with a pharmaceutical benefit manager or health plan in the Part D program to develop a custom benefits package through a Part D Employer Group Waiver Plan plus secondary wrap plan design, which are plan options gaining traction in the marketplace.
Regardless of what decision is made, it’s imperative that both brokers and HR professionals “make sure it’s seamless for the retiree and easy for them to understand,” Filipek says.
“It’s important to communicate with the retirees because these are not people who are coming into the workplace every day where it’s easier to communicate with them. You have to find ways for outreach to them and their spouses.”
The RDS program is designed for employers to continue offering prescription drug coverage to retirees since Part D went into effect six years ago. The government provides a subsidy to employers who maintained a benefit rather than dropping coverage and having their retirees sign up for Medicare Part D individually.
“That program has been what a lot of employers have done since 2006 when Part D started. They had to make a decision to continue offering pharmacy coverage or end their coverage and have retirees sign up for Part D,” Filipek says. “Most opted to continue coverage and get the Retiree Drug Subsidy but that is starting to change with some of the PPACA provisions taking effect.”
FSA caps
HR advisors will need to prepare and communicate newly implemented salary reduction contributions regarding flexible spending accounts that go into effect next year, which impose a cap of $2,500 on these accounts.
“Any employer that has a calendar year beginning Jan. 1, will have to have implemented that provision,” Cohen says. “The salary reduction dollars are capped at $2,500 though, right now, with open enrollment periods typically starting in October and in November—that is a communication that employers who previously had a higher maximum on their FSAs now need to communicate to their employees.”
It’s important to note that only a small percentage of individuals who have FSAs made available to them actually use them. Regardless, employers must inform employees of the change and how it could affect their health coverage long term.
“This is a change that now needs to be communicated to employees,” Cohen says.
But there will be a grace period on contributions that go unused and HR directors will have the opportunity to amend plans through the end of 2014, the limit will be necessary beginning Jan. 1.
“For benefits managers, it would have been last year or the beginning of this year that they would have needed to make design changes to accommodate this,” Cohen says. For those who run on a different plan year other than January, the design considerations must be determined now in order to offer concrete options for open enrollments, she says.
W-2 insurance reporting
The PPACA requires that beginning in 2013, W-2 reporting will need to list employer-sponsored health coverage for the calendar year of 2012. Although this is not a 2013 provision, employees will notice the changes beginning in January of next year, and it’s necessary for HR to convey this to individuals.
“Employees have concern that their tax-free health coverage will be taxable, which will not be the case,” Cohen says. “The communications challenge for employers is to now let employees know that this is just information reporting and is not going to be taxed.”
This provision affects employers of larger companies with 250 or more employees, but those who receive life insurance as a retiree are also required to report their expenses as well.
SBC notification and exchanges
Beginning Sept. 23, during open enrollment periods, and continuing through next year, employers were required to offer employees a four-page summary benefits coverage of the packages made available to an employee for a company’s group health plan.
“[This is] a four page document that tells individuals what benefits are offered under the plan, how much they cost and it has to be in a uniform format that the government has put out,” Cohen says. “The idea is that it makes it easier for individuals who are purchasing coverage to compare the different coverages.”
In order to become compliant with this, it’s important for employers and HR to work with their benefits managers and access the guidance that has been introduced by government agencies including the Internal Revenue Service the Department of Labor, and the U.S. Department of Health and Human Services.
“They have provided templates and instructions,” Cohen says. “This requirement is for health plans large or small.” Cohen also notes this will be the same format of the state insurance exchanges, when they are up and running in 2014.
The state insurance exchanges also require contingency planning for the following year of 2014, when they are established within each state. Beginning next year it’ll be necessary to offer employees notice of these state insurance exchanges, by March 1, in compliance with the DOL guidance that takes precedent in this notification.
“States are still considering if they will adopt the exchange or if the federal government will run the exchange for them,” she says. “They will very soon have to put out some guidance, but right now we don’t have specifics around the exchanges.”
Cohen notes there’s no preparation necessary on behalf of HR or brokers for this provision; it’s simply wait-and-see.
Medicare wage expense
The Federal Insurance Contribution Act Medicare tax rate will increase among individuals with earnings greater than $200,000 and $250,000 for couples filing joint returns. This provision was set in place as a revenue-raising activity. It’s dependent on the employer to collect the tax of 0.9 percent, but this “will not increase the employer’s share of Medicare tax,” according to Sam Hoffman, a partner at Foley and Lardner, who specializes in health care.
“What employers really have to focus on is to set up the payroll system to increase the tax for employees who meet these limits,” Hoffman says. “Most people have thought it through.”
Hoffman doesn’t believe there’s a great need for strong communications campaigns because the 0.9 percent increase will be noted on pay stubs for individuals affected by this. However, employers should have prepared their payroll systems if they haven’t done so already to ensure this provision is met beginning next year. HR also should prepare themselves for questions that could arise in this arena.
“It is the responsibility of the employer to increase the withholdings of individuals earning more than $200,000 a year,” Cohen says. “Typically, the employer’s payroll system will need to be programed for that increase. It’s not so much the responsibility of HR as it is payroll, but there is a communications issue.”
For preparation purposes, Cohen echoes a strong necessity for both HR and brokers to be completing preparation as soon as possible.
“Most of these things, if they haven’t been implemented, they should be hurrying now,” she says.
Tax deduction limits
The income-tax deductions for health expenses sit at 7.5 percent of the adjusted gross income, but as of next year this will be raised to 10 percent of the AGI. Although, during a four year period of 2013 to 2016, those turning 65 (and their spouses) won’t be subject to this provision.
While this scarcely affects employers and HR, it will largely affect individuals and their taxes, which can require benefits managers to step in and work with individuals on a better understanding of this provision.
“This is more for individuals who file on an individual basis,” Cohen says. “It doesn’t normally affect an employer’s group health plan.”
Substantial adjustments have been taken in the form of reflections of these soon-to-be taxed subsidies. “Starting in 2013, it will be a practical effect that these moneys are going to be taxed,” Filipek says.Hoffman also paralleled a related sentiment that if you’re an employee under a group health plan, this is irrelevant, however, “if you buy your own health insurance then you’ll need to notate the cost to yourself and how to itemize those deductions.”
He notes that a lot of brokers, advisors and even employers are currently in the process of reevaluating their options for offering retirees prescription drug coverage. As far as what steps are necessary to take in order to be prepared for the coming year’s changes, Filipek feels it’s important for employers and their advisors to simply understand that there are a variety of choices available.
Medicare Part D Notice Due
This is a reminder to employers who are required to provide an annual Medicare Part D Notice. Sponsors of group health plans that provide prescription drug coverage generally must provide the Notice to all participants who are eligible for Medicare. The Notice must be distributed prior to the start of the election period (which runs from October 15 to December 7), so you may want to include the Notice in your open enrollment packages. You must send the Notice out no later than October 14, 2012.
You must provide the Notice to all Part D eligible individuals enrolled in or seeking to enroll in your plan, including spouses and dependents. Because employers may not know which individuals are Part D eligible (some individuals might be eligible because of a disability, some might be eligible due to age, etc.), many employers distribute the Notice to all individuals eligible to enroll in the plan to ensure that no Part D eligible individual is missed.
Here are some basic rules for the Notice:
- You have flexibility in the form and manner of providing the Notice.
- You may use the model notice form published by the Centers for Medicare & Medicaid Services (CMS) (although you are not required to do so).
- You are not required to send the Notice as a separate mailing. You can provide it with other participant information materials (although note that certain formatting requirements may apply).
- A separate disclosure must be provided if you know that the spouse or dependent resides at a different address than the participant.
- You may distribute the Notice electronically if you follow the same electronic disclosure requirements that apply to summary plan descriptions (SPDs), except you should inform the participant that he/she is responsible for providing a copy of the disclosure to his/her Medicare-eligible spouse and/or dependents eligible for coverage under the plan (otherwise, you will need to separately send them a hard copy notice) and you must post the Notice on your website (if you have one) with a link on your home page to the Notice.
- If you have not yet finalized your 2013 offerings, the Notice should still be provided now based on your current 2012 offerings. If the status of those offerings changes from creditable to non-creditable (or vice versa), you will need to provide an additional Notice within a reasonable period of time (maximum 60 days) after the change occurs. You should indicate on your Notice that it will not be updated if coverage changes but it remains creditable or non-creditable (as applicable).
In addition to the Notice, you must annually disclose to CMS the creditable coverage status of your prescription drug plan, using the online Disclosure to CMS Form (available here). The Form is due no later than 60 days after the beginning of the plan year, within 30 days after termination of a prescription drug plan, or within 30 days after any change in creditable coverage status.