Tag Archives: Small Biz Tips

Managing Your Medicare’s Out-of-Pocket Expenses

Medicare beneficiaries need to pay for a sometimes significant portion of their health care costs. Just like private health insurance, Medicare requires beneficiaries to pay premiums, deductibles and coinsurance. But there’s a lot you can do to keep these costs manageable. Here are some steps to minimize Medicare’s out-of-pocket costs.

Premiums.
Most people aren’t charged a premium for Medicare Part A hospital insurance. The standard monthly premium for Medicare Part B medical insurance is $104.90 in 2015. This amount is typically deducted from your Social Security check if you are already receiving payments, but those who have not yet claimed Social Security will receive a bill. Retirees with modified adjusted gross incomes above $85,000 for individuals and $170,000 for couples are charged higher Part B premiums.

It’s important to sign up for Medicare Part B during the initial enrollment period, which is a seven-month window that begins three months before your 65th birthday. Your Part B premiums will increase by 10 percent for each 12-month period you were eligible for Medicare Part B but didn’t sign up for it. “If you are 68 when you sign up for Medicare Part B, you will be hit with a 30 percent premium increase every year for the rest of your life,” says Ronald Kahan, a medical doctor and author of “Medicare Demystified: A Physician Helps Save You Time, Money, and Frustration.” If you didn’t sign up for Medicare Part B at age 65 due to participating in group health insurance through your job, you should sign up within eight months of leaving the job or the coverage ending to avoid the penalty.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Amenities, Perks, and Bonuses Trump Salary Raises

Yacht-size bonuses for Wall Street big shots and employee-of-the-month plaques for supermarket standouts are nothing new, but companies’ continued efforts to keep costs down have pushed employers to increasingly turn to one-off bonuses and nonmonetary rewards at the expense of annual pay raises.

“There is a quiet revolution in compensation,” said Ken Abosch, a partner at Aon Hewitt, a global human resources company. “There are not many things in the world of compensation that are all that radical, but this is a drastic shift.”

According to Aon Hewitt’s annual survey on salaried employees’ compensation, the share of payroll budgets devoted to straight salary increases sank to a low of 1.8 percent in the depths of the recession. It dropped to 4.3 percent in 2001, from a high of 10 percent in 1981. It has rebounded modestly since the recession, but still only rose 2.9 percent in 2014, the survey of 1,064 organizations found. (These figures are not adjusted for inflation.)

Aon Hewitt did not even start tracking short-term rewards and bonuses — known as variable compensation — until 1988, when they accounted for an average of 3.9 percent of payrolls. Ten years later, that share had more than doubled to 8 percent. Last year, it hit a record 12.7 percent.

Of course, companies have long rewarded top executives and rainmakers with bountiful bonuses — and that continues to be true — but compensation experts say the prevalence and types of one-time rewards and perks have spread further down the ranks than ever before. Although pay-for-performance rewards for top achievers and signing bonuses to attract talent account for most of the one-shots, they also include company wide amenities and targeted perks, like lunches out with the boss or Visa gift cards.

“It affects the C.E.O. all the way down to the guy who sweeps the factory floor,” Mr. Abosch said. Ninety-one percent of the companies surveyed have at least one broad-based reward program, up from 78 percent in 2005 and 47 percent in 1991.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

How Do You Get Patients to Engage?

With more quality and pricing data available now than ever before, insurers and employers are trying to figure out how to steer patients toward high-performing, low-cost doctors. Companies such as the Leapfrog Group and nonprofits like FAIR Health are creating tools that make medical data easier to access, but turning patients into rational consumers is still a challenge. More than half of hospital patients in the U.S. enter through the emergency room, according to a 2013 report by the RAND Corp. And some choice tools are less relevant for consumers in narrow provider networks.

The key to leveraging data is patient engagement, said Mario Schlosser, CEO of Oscar Health Insurance, at a Manhattan Institute conference Friday. For instance, Oscar users can earn money back by using the company’s free fitness tracker, but to use it, they have to sync it with the Oscar app. “Once they click on the app, we can get them to use it for other things,” said Mr. Schlosser.

In addition to offering patients a way to search for doctors, that includes collecting data and anticipating costs by asking about symptoms.

Bloomfield, Conn.-based Cigna has focused on ease of use in its Web portal and mobile application, said Michael Sturmer, the company’s senior director of consumer health engagement.

“If I can give them choice, but make it simplified choice, I can influence their decisions on providers,” he said at an event in Manhattan last month hosted by the Northeast Business Group on Health.

Still, only 10% to 20% of patients use those types of tools, he said.

According to Mr. Schlosser, sometimes it’s best to eliminate patient choice altogether by simply recommending the best doctor available in a customer’s care network.

Will this hands-on approach by insurers lead to a hands-off approach by employers? The rise of ACA exchanges and consumer-centric insurance companies like Oscar are driving some businesses to distance themselves from employee health care, said Laurel Pickering, president and CEO of the Northeast Business Group on Health.

“They want their employees to be better consumers,” Ms. Pickering said. “That’s why some are putting in private exchanges.”

But Ms. Pickering said that moving away from the employer-as-middleman will be a long process. Enrollment in private health exchanges grew to more than 3 million in 2014, according to a report by Accenture, but it is still relatively uncommon, Ms. Pickering said.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

OSHA Releases New ‘It’s The Law’ Poster

The Occupational Safety and Health Administration (OSHA) has released a new version of its “Job Safety and Health – It’s The Law!” poster.

Background
Under the Occupational Safety and Health Act (OSH Act), employers have certain responsibilities, including the obligation to:

  • Provide their employees with a safe workplace;
  • Follow all relevant safety and health standards;
  • Find and correct safety and health problems in the workplace; and
  • Inform employees about workplace hazards.

Content of New Poster
The newly designed poster informs employers of their legal obligation to provide a safe workplace. It also informs workers of their right to request an OSHA inspection of their workplaces, receive information and training on job hazards, report a work-related injury or illness, and raise safety and health concerns with their employer or OSHA without being retaliated against.

Additionally, the poster has been updated to include the new reporting obligations for employers, who must now report every fatality and every hospitalization, amputation and loss of an eye. It also informs employers of their responsibilities to train all workers in a language and vocabulary they can understand, comply with OSHA standards, and post citations at or near the place of an alleged violation.

Posting and Size Requirements
Employers must display the poster in a conspicuous place where workers can see it. Reproductions or facsimiles of the poster must be at least 8 1/2 by 14 inches with 10 point type. According to OSHA,previous versions of the poster do not need to be replaced.

Note: Employers in states operating OSHA-approved state plans should obtain and post the state’s equivalent poster.

The poster is available by clicking here. Multiple languages and resolutions are available for download.

To learn about other federal notices required to be displayed in the workplace, please visit our section on Federal Poster Requirements.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

On Demand Doctor Apps are Here

New smartphone apps can deliver doctors to your doorstep.

Heal is a smartphone app similar to the on-demand car service Uber, but instead of a car, a doctor shows up at your door. Users download the app and then type in a few details such as address and the reason for the visit. After adding a credit card and a request for a family doctor or a pediatrician, the physician arrives in 20 to 60 minutes for a flat fee of $99. Heal began in Los Angeles in February, recently expanded to San Francisco and is set to roll out in another 15 major cities this year. Heal doctors are on call from 8 a.m. to 8 p.m., seven days a week, said Dr. Renee Dua, a founder and the chief medical officer of Heal.

Heal doctors arrive with a medical assistant and a kit stocked with the latest high-tech health gadgets, including tools needed to take your vitals or shoot high-definition video of your eardrum. Heal has a roster of doctors who have affiliations with respected hospitals and programs such as the University of California, Los Angeles; Columbia; and Stanford.

“We’re bringing back old-school techniques with new-school technology,” Dr. Dua said.

Obviously, Heal doctors can offer only limited services on a house call. Among other things, they can diagnose and treat moderate ailments like bronchitis, give flu shots, stitch up a nasty cut or write a prescription (they will even pick the prescription up for an extra $19). But you will have to file the insurance paperwork.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Senate Approves Sweeping Changes to Medicare

The Senate on Tuesday overwhelmingly approved sweeping changes in the way Medicare pays doctors, clearing the bill for President Obama and resolving an issue that has bedeviled Congress and the Medicare program for more than a decade.

The 92-to-8 vote in the Senate, following passage in the House last month by a vote of 392 to 37, was a major success for Republicans, who devised a solution to a complex policy problem that had frustrated lawmakers of both parties. Mr. Obama has endorsed the bill, saying it “could help slow health care cost growth.”

The bill, drafted in the House in negotiations between Speaker John A. Boehner and Representative Nancy Pelosi, the Democratic leader, also extends the Children’s Health Insurance Program for two years, through 2017.

Without action by Congress, doctors would have faced a 21 percent cut in Medicare fees on Wednesday or Thursday. Senate leaders cleared the way for final passage by allowing votes on several amendments sought by liberal Democrats and conservative Republicans.

Medicare spent $70 billion last year under the fee schedule used to pay doctors and some other health care professionals. That accounts for about 12 percent of all Medicare spending. Ninety-eight percent of people enrolled in the traditional fee-for-service Medicare program receive at least one physician service during the year.

The legislation moves Medicare in a direction espoused by Mr. Obama and many health policy experts, toward payment based on the quality and value of care, rather than just the volume of services. Organized medicine now accepts that change in principle, and the American Medical Association lobbied strongly for the bill, demanding that Congress “fix Medicare now.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The War On Work and Sleep

There are a lot of advantages to earning more money, but getting a good night’s sleep may not be one of them.

It turns out that, in general, the more money people make, the less they sleep. That’s been true for decades in the United States, and in other countries as well. On average, adults earning the highest incomes — around $98,000 for a family of four — sleep 40 minutes less than people in the lowest-income families. And among short sleepers — those who are in the bottom 10 percent of nightly rest — high-income people are overrepresented, according to the government survey that sleep researchers trust most.

Sleeping too little is really bad for your health. Researchers have demonstrated that, for most people, sleeping less than six hours a night results in cognitive impairment. Poor sleep is also associated with a number of other health problems, and an increased risk of dying in a car accident.

In general, the factor that seems the most closely tied with how much sleep people get is how much they work. More hours of work tend to crowd out sleep. People who work two jobs sleep the least of anyone, according to a recent study, and are most likely to be in the bottom 10 percent of sleepers, sometimes called “short sleepers.”

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

The SHOP is Underperforming

The Washington Post (11/13, Harrison) reports that enrollment on the ACA’s new small-business health insurance marketplaces “has fallen well short of the administration’s expectations,” according to a Government Accountability Report released Thursday. The GAO examined enrollment totals for SHOP exchanges in the 18 states that built their own portals, finding that fewer than 12,000 small businesses signed up for plans during the first eight months. Though the Obama Administration “did not set SHOP-specific goals, the federal watchdog said that number was ‘significantly lower than expected.’” The GAO noted that enrollment numbers for the Federally-administered small-business marketplaces won’t be available from the CMS until next year.

The Washington Times (11/13, Howell) explains that the “Small Business Health Options Programs (SHOPs) were designed to let businesses with 100 or fewer employees — 50 or fewer in some states — buy plans in a special exchange set up just for them, and take advantage of a tax credit for covering their workers.” The Times adds that the GAO report comes just days after the Administration “dramatically scaled back expectations for participation in Obamacare’s individual markets.”

The AP (11/14, Murphy) reports that about 76,000 small business employees “had purchased coverage on 18 exchanges through June 1,” according to the GAO. That figure is “far short of the 2 million workers who were expected to sign up this year.”

The Hill (11/14, Ferris) adds that House Small Business Committee Chair Sam Graves (R-MO), who requested the report, “said Thursday that the data demonstrates the law’s failure for small-business owners and workers.”

Also covering the story are the Business Journals (11/14, Hoover), CNBC (11/13, Mangan), and the Daily Caller (11/14, Hurtubise).

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

 

The SHOP Falls Short on Enrollments

Remember those “other” new Obamacare exchanges—the ones that small businesses were supposed to use to sign up workers for health insurance?

Yeah, well, apparently a whole bunch of small businesses forgot about them, too.

A new Government Accountability Office report finds that a stunningly low number of workers have enrolled in insurance plans sold on small-business health exchanges run by federal and state governments.

The report suggests that the Small Business Health Options Program exchanges will fall well short of the 2 million people that had been projected to sign up by January.

As of last summer, only about 76,000 people working for about 12,000 employers had enrolled in insurance plans sold by 18 state-run SHOP exchanges, according to the GAO report released Thursday.

While the other 33 SHOP exchanges run by the federal government didn’t have enrollment data available for the GAO, officials in charge of them “do not expect major differences in enrollment trends between” the state-run SHOP exchanges and their federally run counterparts, the report noted. The federal Centers for Medicare and Medicaid Service was still compiling enrollment data from insurers and did not expect complete numbers until early 2015, the GAO said.

Obamacare’s small business health marketplaces are likely to fall well short of the 2 million enrollees projected for 2014, a GAO report suggests.

The SHOP exchanges are supposed to help small employees provide group health coverage to their workers. But most such employers clearly haven’t bothered to take the exchanges up on that offer, or aren’t aware that it’s available, raising questions about whether these exchanges can get close to the 4 million enrollees that had been projected by 2017.

One state-run SHOP—Mississippi’s—had just one person enrolled, the GAO report said. Washington state had the second-lowest enrollment with 42 people.

Two population-heavy states, California and New York, had just 9,563 and 10,023 people enrolled, respectively, in their SHOP exchanges during their first year of operation.

Vermont, the second-least populous state, had by far, the highest enrollments in a state-run SHOP: 33,696 people. That represents 44 percent of all enrollees on the state-run SHOPs.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary

 

Will Premiums Rise for Small Businesses?

Today we return to our series exploring lingering questions small-business owners have about the Affordable Care Act. Today’s question is a basic one: Will premiums for small businesses rise in 2015, and if so, how steeply?

If you asked someone in the health insurance industry earlier this year — the executives at the insurance carriers or the brokers and agents who sell their policies — the word on premiums was grim. In March, an unidentified insurance industry executive told The Hill that “everybody knows” that the way the exchange has rolled out “is going to lead to higher costs.”

Then in April, a survey of insurance brokers by Morgan Stanley found that insurance premiums for small businesses were rising, on average, 11 percent, and at least 20 percent in 15 states. In Washington state, according to the report, small group rates were rising at the astounding rate of 588 percent. The report quickly became fodder for conservative media and Republican attack ads around the country.

Now it is October, and many states are finalizing rates in the small-group market for next year. And we are learning, anecdotally, that the rate increases facing most employees insured through a small business will be considerably lower than the dire predictions. By and large, it appears that the increases will be less than 10 percent. In some cases, they will be near zero — and at least one state is claiming the average rate increase will actually be a rate reduction.

The evidence is anecdotal because, as far as we can tell, nobody is systematically collecting, let alone analyzing, small-group insurance rates for next year, though in many states they are disclosed in regulatory filings that are freely available online. Several organizations are tracking rates for the individual market, most notably the accounting firm PricewaterhouseCoopers, which has a couple of staffers working nearly full time on the endeavor and has compiled average rate information in a clickable map.

To read more, click here.

Jeffrey R. Ungvary President

Jeffrey R. Ungvary