Market Report
Oregon and Washington
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We continue to monitor the health insurance markets, and other lines of coverage, and regulatory & compliance activity, so we can offer you the solutions that work best for you from what is available. Health Insurance markets continue to evolve as regulators, and insurance companies determine that certain changes are necessary, to meet modern healthcare needs. We review plan changes form most major plans in Oregon and Washington, a few months prior to the open enrollment periods. This allows us to understand the updates, and prepare to help you with plan reviews and changes if needed, at the open enrolment periods.
Individual health insurance has seen some stability in recent years, including minimal rate changes, increased advanced/refundable premium tax credits, and tax credits for those with higher income was introduced in 2022. Also the family glitch may allow about 1-5 Million Americans change to marketplace enrollment, with financial help, for family members, if the dependent premium on the employer group plan is determined to be unaffordable.
Medicare Advantage plans are doing well with stable annual premiums, reasonable out of pocket costs, and extras like preventive dental, vision, hearing, over the counter bank cards, and more. Medicare Supplement plans are also popular because most medical costs are paid by Medicare and the plan, but premiums can be higher than Medicare Advantage. Medicare Supplement premium will begin to increase gradually, annually, due to age, starting at about age 69. There are still about 10,000 people turning age 65 daily in the US, and we have heard little concern from our customer about options, costs, and rates.
Employer health insurance programs have seen some rate increases lately. Group health insurance pricing can be impacted by the average age of enrolled employees, and plan selections. There are numerous types of products for employers with a range of premiums to appeal to all budgets. The 24 month small business health care tax credit is still available, and we have the qualified plans, and guidance available for you.
In addition to health insurance and dental plans, we offer life insurance, and disability income protection plans, for individuals and employers. We also have administrative and compliance services for employers, like ERISA Wrap-Document, 125b Pre-tax programs, Cafeteria plans, COBRA, Equivalent Oregon Paid Leave Programs, and more.
We hope that you will see things that can help you in our newsletter. We are available for you at any time during the year, and at each of the Individual, Medicare, or your Employer Annual Enrollment Periods. Please read our customer testimonials, give us your feedback, or testimonial HERE, and share this information with those who may benefit from our specialized programs and services, and thank you for trusting us for your health insurance.
Topics of Interest
- Medicare Planning and Enrollment
- Employer Health Insurance, and Dental
- Employer Compliance
- Employer Coverage Affordability
- Online Account Administration for Employers
- Life Insurance
- Disability Insurance
- Project Access Now Premium Assistance Program
- Paid Leave Oregon
- 1095A Tax Forms
- End Of COVID-19 Public Health Emergency
- International Travel
- Aflac
- Things to know/ What's New
Agency Featured Programs
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WiredEnroll is our popular online small employer quoting and enrollment system that allows us to provide you with live, web based, group health insurance and dental options from participating carriers, and then enroll you and your employees in group health insurance and dental plans, electronically.
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HealthSherpa is our online comparison and enrollment tool for individual health and dental plans in Oregon. This tool allow us to review marketplace plans in your area, and enroll you electronically in the health and dental plans you want, including financial help make your premiums more affordable, if you quality.
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Individual Disability Insurance Quoting Portal is a good way to see how much a disability income replacement plan may cost you. The premium may be about 2% of your gross income, but the benefits can replace the majority of your pre disability income, to retirement age, upon disability from illness or injury. Feel free to request a quote HERE.
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Washington Health Plan Finder is the online health insurance marketplace that we use to help those in Washington, to compare individual health and dental plans, and enroll in you the plans you want, with the advanced tax credit, if you qualify. The Browse & Compare feature was recently reactivated HERE.
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Employer Benefit Programs Custom Web Sites. We are now making customer benefit web sites for our employer customers. The web sites have the traditional employee packet materials including benefit summaries, forms, provider search links, notices, and more. These web sites give our employer customers, and their employees with quick and easy access to all that they need to understand and use their programs.
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Medicare Planning and Enrollment
Medicare will be a regular topic in our communications. Medicare is the Federal Health Insurance program for people who are 65 or older, certain younger people with disabilities, or people with end-stage renal disease (ESRD), and is managed by the Social Security Office.
Medicare Advantage Prescription Drug Plans (MAPD), Medicare Supplement Plans (MediGap), and Medicare Prescription Drug Plans (PDP), are offered by private health insurance companies. Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. This is why those eligible for Medicare usually purchase a Medicare Advantage Plan or Medicare Supplement plan with a Medicare Prescription Drug Plan.
We offer numerous Medicare Advantage plans, Medicare Supplement plans, and Medicare Prescription Drug Plans, and are here to help when you are ready. The Social Security Office and Medicare can be busy, and it may take additional time for processing your Medicare and Social Security requests, due to the high volume of people enrolling in Medicare. We recommend that you begin planning and preparing for your Medicare, as much as 6 to 12 months in advance of turning age 65. Learn about Medicare and how to prepare for your plan review and enrollment at our Medicare Informational website HERE.
Other Medicare Information
- If you become Medicare eligible and will continue to work, it will be important for you to know if your employer has 20 or more employees or if they have fewer than 20 employees. The number of employees at your employer affects Medicare.
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If you want to stay on your employer health plan when you turn age 65, and the employer has fewer than 20 employees, then it is recommended and in your interest to enroll in Medicare Parts A & B, and let the health insurance company know that you have Medicare. Many people who become Medicare eligible will leave their employer plan and purchase their own Medicare Advantage or Supplement plans.
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If you want to stay on your employer health plan when you turn age 65, and your employer has 20 or more employees, then you may want to have Medicare Part A only, let the health insurance company know you have Medicare Part Part A, and defer your Medicare Part B until you retire and want to get a private plan.
- If you enroll in Medicare Part A and B and defer your social security income, then you will want to notify Social Security of your choices, and they will bill you for Medicare Part B premium, and bank draft may be available.
- Low Income Subsidy or other programs can help lower Medicare costs. Those who qualify for a low income subsidy may also have a special enrollment period from January to September each year.
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Employer Health Insurance and Dental
Millions of people have employer sponsored health insurance, and group health insurance continues to be a popular benefit among employees, and a useful tool for employers to attract and retain employees. Group health insurance is mandatory for employers with 50 or more employees, but group health insurance is not mandated for employers with fewer than 50 employees. Group health plans can be more affordable than expected, if basic base plans are purchased, employees contribute to the premium, and employers take advantage of the small business health care tax credit, and favorable IRS tax treatment. The more affordable health plans may include a narrow but substantial provider network, and higher deductibles & co-pays. Some employers sponsor a basic health plan, split the premium with employees, and then offer buy-up options for employees who want, or need higher levels of coverage. Many employers are asking employees to work at least 30 hours per week over 60 days, to be eligible, but there are a variety of eligibility and contribution options for employers. We have quick and easy group quotes available at your request, and employers may purchase group health and dental plans at any time of the year.
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Small Business Health Care Tax Credit
The Small Business Health Care Tax Credit can provide a tax credit up to 35% for non-profit Organizations and up to 50% for Profit Organizations, for up to 24 months. We can show you qualified plans, and help you to get a letter of plan certification that you can give to your tax advisor to see is you are eligible for the tax credit. The tax credit is based on certain factors of your business and payroll. There is a Small Business Tax Credit Estimator HERE. Let us know if you have questions or need support with the tax credit, or identifying the tax credit qualified plans.
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Employer Compliance
Employers who provide Health Insurance, Dental, and other benefits to employees, are required by the Employee Retirement Income Security Act (ERISA), and the Affordable Care Act (ACA), to distribute certain documents to employees about their rights within the benefit plans. Employers may also need to perform certain non-discrimination testing, retain certain documents, and follow certain procedures. ERISA provides protections for participants and beneficiaries in employee benefit plans, including providing access to plan information. The US Department of Labor (DOL) is responsible for administering and enforcing these provisions of ERISA. The risks for non-compliance include business disruption, penalties starting at about $110 per day per employee, and may also trigger a DOL audit. Insurance company contracts, certificates and benefit summary do not meet the DOL requirements and the requirements apply to employers with one employee. We offer easy and affordable ERISA and IRS favorable tax treatment compliance services from various administrative partners, so contact us for a compliance advisement, and to review your compliance options, so you can have the compliance status that you need.
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Employer Coverage Affordability
In 2023, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 9.12% of your household income. The lowest-cost plan must also meet the minimum value standard. If you’re the employee, affordability is based on only the premium you’d pay for self-only (individual) coverage. For coverage starting January 1, 2023, if you’re offered job-based coverage through a household member’s job, affordability is based on the premium amount to cover everyone in the household. Total household income includes incomes from everybody in the household who’s required to file a tax return. If the premiums aren’t considered affordable for the employee and the household, they may qualify for savings in a Marketplace plan. But, if the premium is considered affordable for the employee, but not for other members of the household, then only the other household members may qualify for savings. Contact us if you would like to review your group health insurance premiums, to see if they are considered affordable.
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Online Account Administration for Employers
Adding and removing employees to your benefit programs, or making changes and updates is easy, with online administration available through most health and dental insurance carriers. Most insurance companies allow us to support you with online administration with your request, as your authorized representative. We can help you with employee additions or terminations when you are busy or when want our support. You will get quicker processing, and issuing of ID cards. Online Administration can also help to update your membership before your next billing statement is issued. With years of experience with membership & billing, we can show you how to get online access with your insurance carriers, and how to add us as a user, if that may help you. Many of our employer group customers are finding that this is a helpful additional service that we provide. Feel free to contact us to set up online membership & billing, if you have not already done so.
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Life Insurance
Life Insurance is a contract between an insurance company and policyholder, where the insurance company promises to pay the beneficiary a sum of money upon the death of the insured person. Life Insurance may be purchased as an Individual, and Employers may also purchase Life Insurance for Employees. Life Insurance benefits are typically tax-free and can help to fund end of life expenses, debts, childcare expenses, college tuition, business obligations, and other costs. We offer Group and individual Life Insurance from various carriers, and are here to help you get the policy you need.
Individuals can usually purchase from $50,000 to $1 Million of Life Insurance coverage, and may be able to purchase a life insurance benefit that is from 1x to 10x annual gross income. Rates vary based on age, gender, health history, family history, tobacco use, and other factors. Term life insurance is usually the lowest cost. Universal Life Insurance is another option that can provide a lifetime of coverage, but premiums are usually higher than term plans. A formal application, and paramedical exam are usually required and decisions from the Life Insurance underwriters usually take about a week or two.
Employers may also purchase group life insurance. The Group Life Insurance is typically flat $25,000 or $50,000 with matching Accidental Death & Dismemberment coverage. Some employers may purchase Life Insurance benefits equal to 1-3 times employee salary, or more.
Request Individual Quotes HERE.
Request group Life Insurance Quotes HERE.
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Disability Insurance
Many Americans can't afford to miss one paycheck, and most are not financially prepared to be off work if they get sick or injured. Disability insurance protects your paycheck by replacing a portion of your income if an illness or injury prevents you from performing the substantial and material duties of your occupation you have education, training, or experience to perform. Disability Income Replacement Plans may be purchased as individuals, and employers may also purchase disability insurance for employees, and for business partners.
Individuals may purchase individual Disability Income policies that may replace about 66.75% of pre-disability income, and will be tax free income. There are numerous optional riders that you can select to enhance the coverage.
Employers can sponsor group Long-Term and Short-Term Disability insurance for employees. This program is usually paid 100% by the employer. This program typically pays about 60% of employee pre-disability gross income, and is taxable. Employees are encouraged to review group disability insurance provided by their employer, to determine if the net benefit, after taxes would be sufficient to meet their financial obligations, while they are not working. If the taxable employer disability benefit is not enough to meet financial needs, then employees may be able to get their own partial disability policy privately, so if they are disabled, they may receive an income that is closer to their pre-disability income.
This is the 28th Year the United States has recognized and celebrated March as National Disability Awareness Month! We are here to help you review your private or business Disability Income Protection needs, and provide you with solutions that can meet this often overlooked gap in most peoples insurance needs.
Request Individual Disability Quote HERE
Request Group Disability Quote HERE
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Project Access Now
Do you need help paying for your individual marketplace health insurance premiums? Project Access NOW can help! The Project Access NOW Premium Assistance program will pay health insurance premiums and other expenses for qualifying individuals. To qualify, individuals/households must have an income between 138-300% of federal poverty level, live in Multnomah, Washington, or Clackamas county, have a silver plan through the marketplace from a participating carrier, and use all of the marketplace tax credit offered.
Contact Sarah Selix to schedule a phone appointment with one of our agents who can check your legibility, and submit an application to to this program, if you qualify.
Call Sarah Selix at 503-282-0827
Email: sarah@laughlinagency.com
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Paid Leave Oregon
Paid Leave Oregon is a new program that ensures that employees and families have the time and support they need to care for themselves and their loved ones when life's important moments affect their health and safety. The new Paid Family and Medical Leave Insurance allows eligible employees to take time away from work to bond with a child during the first year after birth, adoption, or foster care placement, care for a family member or friend who has a serious health condition, take medical leave for an employee's own serious health condition, and take safe leave for an employee experiencing issues related to domestic violence, harassment, sexual assault, or stalking. The medical conditions covered are similar to what is covered by the Oregon Family Leave Act, but there are some differences. The program is funded through a payroll based contribution. Payroll contributions begin January 1, 2023.
If you are an employer, then we recommend that you give employees the model notice poster, and register your intent to participate in the state program at https://www.frances.oregon.gov/employer. Employers may also purchase an Equivalent Plan that can get benefits to employees quicker, give access to details about employees off work, and delay payment of the tax until later in September 2023. If you would like to consider purchasing an Equivalent Leave Program from an insurance company, for the benefits it offers employers, then we have plans available for you.
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1095 Tax Forms
It will soon be time to gather tax forms related to health insurance, and include them in your tax filing. If you are an individual marketplace consumer, then it is recommended that you keep tax returns current to avoid potential disruption of the Advanced Premium Tax Credit (APTC), or Cost Sharing Reduction benefits (CSR).
Form 1095-A is furnished by the Health Insurance Marketplaces to the IRS and to Individuals who enroll in a qualified health plan through the Health Insurance Marketplaces. The form allows individuals to reconcile the credit on their tax returns with the advanced payments of the premium tax credit, and file an accurate tax return. We can usually get this form to you at your request, if you have not already received it from the marketplace.
Form 1095-B is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage.
Form 1095-C is filed and furnished to any employee of an Applicable Large Employer (ALE) who is a fill-time employee for one or months of the calendar year. ALE members must report that information for all twelve months of the calendar year.
Form 8962: This is the Advanced Premium Tax Credit reconciliation form that is used to reconcile your premium tax credit, on your tax return. This form will determine if you have excess APTC, or if you will have repayment for some or all of the APTC you received for the prior calendar year. There are various APTC repayment calculators.
Advanced Premium Tax Credit Resources
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End Of COVID-19 PUBLIC HEALTH Emergency
The Federal Government recently announced that the COVID Public Health Emergency and the COVID National Emergency will end on May 11, 2023.
The end of the COVID-19 public health emergency will lead the loss of Medicaid coverage for millions of Americans, and could deal additional blows to payers as they face a drop in covered lives.
In addition, fears of an economic recession loom for digital health companies after years of record funding, with investors this year prioritizing safety over risk. Funding levels should stabilize this year for mental and behavioral health companies, along with family planning and femtech remaining key areas of interest. And, while telehealth use has fallen from record highs at the beginning of the pandemic, patients are still turning to virtual care, with volumes expected to shift from urgent visits to chronic care management.
Providers will also start to weave artificial intelligence into their workflows, including in areas like revenue cycle management, clinical decision support and patient engagement. Healthcare providers will also face pressure this year to invest in and adopt better technology to combat cyberattacks, which have risen in volume and severity over the past few years.
During the PHE, we temporarily expanded our benefit coverage to make it easier for our members to get the care they needed during the pandemic. After May 11, 2023, these benefits will return to being covered under normal health plan benefits, meaning that any applicable cost shares, such as copays and coinsurance, will apply.
- COVID-19 vaccinations, including boosters, will continue to be covered at no cost if received from an in-network provider.
- COVID-19 tests, if ordered by an in-network provider, will include a cost share, such as a copay or coinsurance.
- Medicare will no longer provide up to eight free over-the-counter at-home COVID-19 tests per month. Purchasing these tests from pharmacies or other participating entities will be an out-of-pocket cost.
In addition to the above, the declared National Emergency (NE) extended a large number of Health Plan filing deadlines for ERISA plans. These include HIPAA special enrollment deadlines, COBRA election and premium payment deadlines, and claims and appeals filing deadlines. For each of these categories during the NE, the Covered Individual had an additional year of time to file or request coverage for the categories above. Effective July 10, 2023, this extension will end for all categories above regardless of when the event occurred. Deadlines for special enrollment will return to the time specified in your Plan Document, deadlines for COBRA elections will be no more than 60 days, and COBRA premiums will be due no later than 30 days after their due date. Claims must be filed no later than one year from the date they were incurred, and appeals must be filed no later than 180 days from the date of the denial of the claim.
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TRAVEL INSURANCE
Now that the health care emergency is coming to an end, we expect that more people will be travelling abroad. International Travelers can obtain short-term travel medical insurance products before they travel abroad. These products provide coverage for a variety of risks that are not necessary covered by other types of insurance. Benefits include medical coverage, emergency medical evacuation, lost luggage benefits, emergency reunion with family members, repatriation, return or mortal remains, and more. Give us a call about a month before you leave the United States, and we can help you review the coverage options and rates for an International Medical Travel Plan. You can review travel medical plan options and rates HERE.
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AFLAC
Business owners select AFLAC to take care of the people who care for their business. 61% of employees rank health benefits as one of their top-three factors for a job search. Help meet your employees' needs and bring in top talent with supplemental coverage at no direct cost to you. Make your benefits package better with AFLAC supplements insurance. From meeting employee needs to maintaining productivity, offering quality coverage sets your business up for success. AFLAC programs support employees, add flexibility, pay benefits, and help protect productivity. Call us today and we can introduce you to our experienced AFLAC representatives, who can explain your options and set up plans for your company and employees.
What Types of Supplemental Insurance Does Aflac Provide?
Aflac supplemental insurance policies offer a full suite of products for individuals, families, and businesses. Policies help with everything from routine preventative care to critical illnesses. AFLAC options include:
- Accident
- Cancer/Specified-Disease
- Critical Illness
- Dental
- Supplemental Dental
- Hospital
- Life
- Short-Term Disability
- Vision
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Carrier and Industry News
- Providence Health Plan has a new premium payment system. If you are a Providence employer, Individual, or Medicare member, and have a current automatic bank draft set up for your premium payments, then be sure to reset that as instructed by the plan. Let us know if you need help with premium payments or resetting your bank draft.
- Delta Dental Celebrated World Oral Health day on March 8th
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Disability Awareness Month is March. This is the 28th Year the United States has recognized and celebrated March as National Disability Awareness Month! We are here to help you review your private or business Disability Income Protection needs, and provide you with solutions that can meet this often overlooked gap in most peoples insurance needs.
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Medicaid Redeterminations. Medicaid redetermination, also called renewal or recertification, is the process where states re-determine an individual’s eligibility for Medicaid. Medicaid redeterminations were paused in early 2020 due to the COVID-19 public health emergency (PHE). However, with the passage of recent legislation, states will resume the redetermination process and can end Medicaid coverage for individuals who are no longer eligible. Starting April 1, 2023, states will be starting the recertification process at different times and have until May 2024 to recertify their members. Now may be time for your members to renew Medicaid coverage so they don’t risk losing it.
What to do if you receive a Medicaid Re-Determination Notice
- If you receive a notice from the Medicaid agency that you need to recertify for eligibility, contact our office for support.
- If you are deemed ineligible for Medicaid, that is considered a qualifying life event, and you will have the opportunity to enroll in a different plan.
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Coredocuments.com is a compliance document vendor for employers. They provide ERISA Wrap Document, 125b Pre-tax program services, and other compliance services for employers for reasonable fees. There are a lot of administrators that offer different levels of service and fees, but Core Documents is an affordable solution for your compliance needs. We can help employers with Core Document programs and setup.
Standard Insurance Equivalent Oregon Paid Medical and Family Leave programs have been popular, since Standard ins a leader in this space fir first approved programs in the state. An equivalent leave program, defers payments until September, allows employers to have more information about employees who are off work, to manage staffing needs, less bureaucracy by having a private plans, and payouts to those on claim is expected to be much quicker than the state program. There is a reasonable added premium to have private equivalent plan. give us a call, and we have this solution waiting for you.
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