Nachlis Insurance Services | Medicare Supplements Chart

Medigap Benefits	Medigap Plans
	A	B	C	D	F Most Popular	G Most Popular	K	L	M	N
Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Part B coinsurance or copayment	Yes	Yes	Yes	Yes	Yes	Yes	50%	75%	Yes	Yes***
Blood (first 3 pints)	Yes	Yes	Yes	Yes	Yes	Yes	50%	75%	Yes	Yes
Part A hospice care coinsurance or copayment	Yes	Yes	Yes	Yes	Yes	Yes	50%	75%	Yes	Yes
Skilled nursing facility care coinsurance	No	No	Yes	Yes	Yes	Yes	50%	75%	Yes	Yes
Part A Deductible	No	Yes	Yes	Yes	Yes	Yes	50%	75%	50%	Yes
Part B Deductible	No	No	Yes	No	Yes	No	No	No	No	No
Part B Excess Charge	No	No	No	No	Yes	Yes	No	No	No	No
Foreign travel exchange (up to plan limits)***	No	No	80%	80%	80%	80%	No	No	80%	80%
Out-of-pocket limit***	n/a	n/a	n/a	n/a	n/a	n/a	$7,060	$3,530	n/a	n/a

Qualifying for Disability Insurance

It’s important to protect your ability to earn a living now when your healthy, because life’s is unpredictable, and you never know what could happen tomorrow. While accidents account for many disabilities, sickness such as cancer or heart disease is another major cause of disability. Since Individual disability insurance requires medical underwriting, the best time to purchase a policy is when you are healthy and can qualify.

Dental & Vision for 65 & Under

Dental & Vision for Medicare Recipients

Accident Plans

Accidents can happen anytime. Accident Insurance is very affordable and provides benefits in addition to your regular health insurance and/or disability insurance, in the case of an accidental injury. Accident Insurance can go a long way to protect you from financial hardship due to a great deal of medical, recovery and out-of-pocket expenses that follow accidental injuries.

Hospital Indemnity Plans

Unlike a traditional major medical plan that reimburses you or pays directly to a provider for approved hospital stays and medical care, a Hospital Indemnity Plan is a limited benefit plans that pays a lump-sum payment directly to the insured. Also, unlike a comprehensive plan on the Marketplace, you can enroll in this non-ACA option any time of the year.

When paid directly to the insured, cash payments help with out-of-pocket expenses and covers you when you are off work due to a hospital stay. There are no plan maximums, however the coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected. Some plans include optional benefits, such as preventive wellness, diagnostic testing and physician office visits.

Critical Illness, Cancer, Heart or Stroke Plans

This type of insurance is a special type of insurance coverage that pays cash directly to you to help reduce the personal financial impact of the cost of fighting common types of critical illnesses, such as cancer, heart attack, stroke and more. With the advancements in modern medical technology, Critical Illness insurance is an increasing popular supplemental health insurance policy that allows you to focus more on recovery and less on the financial burden of a critical illness event or diagnosis.

Telemedicine – Health and Wellness Plans

This Health and Wellness Option is very affordable and gives you access to a variety of discounted health services that include prescriptions, counseling, as well as telehealth solutions. Our telehealth solutions are easy-to-use and intended for non-emergency illnesses and general care. Members and their families have direct access to state-licensed and fully credentialed doctors, via phone or video consultations, to receive treatment (including prescriptions) and advice for common ailments, including colds, the flu, rashes and more.

Administration

Missing a compliance deadline can be costly for any business, but especially for small business owners who often wear many hats and do not have the resources to stay on top of these requirements.

As employee benefit experts, our goal is to lessen the administrative burden of your benefit programs so you can focus on other important business matters.

We can help with the following administrative functions and tasks associated with your benefit programs:

COBRA – enrollment, filings and employee communication

HIPAA – PHI compliance

ERISA – wraps, filings, SMM, SAR, notices

FMLA

Health Savings Accounts (HSAs)

Health Reimbursement Accounts (HRAs)

Flexible Spending Accounts (FSAs)

Self-Funded Plans or Partially Funded Plans

Affordable Care Act (ACA) Compliance

Nachlis Insurance Services will assist you in complying with the requirements of the Affordable Care Act in many ways. We are continually monitoring and updating ourselves on the ever changing law and have designed our services to keep our clients compliant and informed.

We will design benefit coverage to meet the requirements of the ACA
We assist with tracking hours
We ensure eligible employees are offered coverage
We assist with the reporting process and necessary tax forms
We handle employee notices

Additional Highlights of the ACA

Do you have to offer benefits to your employees?
Employers who have more than 50 full-time equivalent employees must offer those employees benefits that pay for 60% of the minimum essential benefits. If you are in non-compliance, you will incur a penalty of $2,880 (projected 2023) per year multiplied by the number of full-time employees, and excludes the first 30 employees. Additionally, the penalty is increased each year by the growth in insurance premiums. However, note you may also incur a penalty when at least one of your employees receives a premium tax credit in the Health Insurance Marketplace (Exchange).

Underwriting Guidelines
Insurance companies can not increase rates or deny coverage because of a pre-existing condition.
Dependents can remain on policies until they turn 26 years old.
Insurance companies can not consider gender when setting rates.
Employer renewals must be based on the same rates as new business.
The waiting period for employer benefits should not exceed 90 days.

Traditional Group Employee Benefits

Major Medical Group Health

HMO’s (Health Maintenance Organization) offer a comprehensive package of covered health care services in return for a prepaid monthly amount (or “premium”). The HMO may charge a small co-payment depending upon the type of service provided. Members are required to obtain services from doctors and hospitals affiliated with the HMO.

PPO’s (Preferred Provider Organization) will save employees the most money if they use providers within the PPO network. Deductibles must be met on this plan before some services will be covered. PPOs require a co-pay for physician visits and some other healthcare services. The great thing about a PPO is it’s rich network of quality doctors and healthcare facilities, and the ability to utilize healthcare services outside of your deductible. For example, doctors visits.

Group Life – Term and Permanent

According to many surveys, life insurance is a highly coveted staple benefit for your employees. Whether employer paid or voluntary, life insurance provides your employees with peace of mind are likely to be more productive when they feel secure that their loved ones will be taken care of, in the event of illness or an untimely death.

Group Dental and Vision

As with life insurance, dental and vision are highly desired benefits that employees consider, even over salary, when seeking a job. And not only are these benefits good for your employees, but they are also good for your business, as routine dental and vision care have proven effective in helping employees to stay healthier and more productive in the workplace.

Group Disability (Short and Long Term)

Disability coverage is another staple benefit ranked in the top 5 of most important benefits employees desire. Savvy employers attract and retain top talent by offering both STD and LTD insurance as part of the employer paid benefit package or as a voluntary (worksite) benefit.

Group Medicare

A service provided to our clients’ retirees and other eligible employees, we help tackle the challenges of ever increasing premiums and health care costs by guiding them to the best Medicare Supplement or Advantage Plan that leaves them with the least expenses, and has the lowest premium.

Voluntary Benefits

Ancillary benefits, also known as voluntary or worksite benefits, create a financial safety-net for your employees by augmenting employer-paid benefits. These value-add benefits can be purchased by an employee through pre-taxed payroll deductions, at a discounted group rate, at little or no additional cost to the employer.

The financial health, or absence of financial related stress, of your employees is an important part of the overall “employee wellness” picture. Worrying about finances can result in a wide range of (serious) health issues for employees. Offering supplemental, voluntary benefits such as life, disability, dental or vision, if not already part of the core offering, or the ability to “buy up” or purchase additional coverage at reduced “group employer rates” rates provides employees with financial security, and gets employers one step closer to a healthier, more productive workforce.

Types of Voluntary Benefits

Life Insurance (Term & Permanent)
Dental/Vision
Disability
Cancer/Heart/Stroke – Pays cash benefits directly to the employee to help with the struggle of fighting critical illness
Accident – Pays cash benefits to help with medical and out-of-pocket expenses that follow accidental injuries
Hospital Indemnity – Pays a lump sum cash payment to help with out-of-pocket expenses and covers you when you are off work due to a hospital stay.
Gap Plans– Supplements a high deductible major medical and comprehensive benefit package, paying copays and deductibles.

With the negative impact of the pandemic on engagement and performance, these programs are rapidly expanding and taking on a new purpose when it comes to helping employees have the personal energy needed to survive and thrive through tough times. Nachlis Insurance Services can help you evaluate, implement and manage various types of financial wellness benefits for your company.

Tax Advantaged Plans

Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are examples of tax-advantaged employee benefit plan options designed to reduce payroll taxes, which in turn save both employers and employees money on healthcare, and other qualified expenses, such as childcare. Nachlis Insurance Services can help you implement, administer, and comply with any of the following innovate tax-advantaged benefit programs. The plans are similar in some ways, but also vary, each having unique advantages and savings opportunities.

Health Savings Account (HSA)

Many group health plans benefit by having a Health Savings Account (HSA) feature that combines a high deductible/lower premium health insurance plan (PPO) with a savings account. Both employer and employee can contribute, tax-free to the savings account, which can help fund the deductible and other qualified medical expenses. Then, the insurance will begin paying claims, once the deductible is satisfied.

Health Reimbursement Account (HRA)

A Health Reimbursement Account (HRA) combines high deductible/low premium health insurance with a tax favored savings account. Employers contribute to the savings account, which can be used for to fund co-pays and other qualified expenses prior to the deductible being met.

Flexible Spending Account (FSA)

A Flexible Spending Account (FSA) is a cafeteria plan under Section 125 of the tax code and allows for benefits to be paid with pre-tax dollars which results in tax savings to both the employee and the employer. The average working employee in America spends thousands of dollars annually on certain types of medical benefits, daycare expenses and transportation services. By participating in an FSA, the employee funds the plan through regular pre-tax payroll deductions, which reduces his/her taxable income, and increases the percentage of pay they take home. The account allows them to pay for these benefits and services with the pre-taxed dollars, in essence giving them a discount on these services. The administrator of the FSA account can issue a debit card that is tied to the FSA making it easy to use the account when needed.

Defined Contribution Plans

The benefits of selecting a Defined Contribution Plan are many for both the employer and employee. An employee is more involved in their own healthcare choices and can choose a plan that is tailored around his/her needs, which reduces risk on employers. Also, both employer and employee save a significant amount of money on premiums and taxes, while retaining health benefits that are just as good, if not better than a traditional group plan. Different than the “one size fits all” model, the idea of a defined contribution health plan allows employees to choose a health insurance plan of their choice with funds (a fixed dollar amount – a “defined contribution”) given to them (set aside) by the employer.

Note these are brief descriptions. Please contact us for more details on any of these tax-saving benefit options.

Employee Wellness

The Affordable Care Act (ACA) mandates that health insurers include preventative and wellness benefits to help reduce healthcare costs for all parties. As a result most group health insurers include wellness benefits in their comprehensive coverage, designed to improve lives and keep members healthy. Your group health plan will generally include services like preventative medical screenings, free or discounted gym memberships, diet advice, disease management, telehealth, mental health services and much more.

To meet the increasing demand for employer-sponsored wellness programs, Nachlis Insurance Services also works with several top wellness vendors who can provide additional, affordable strategies for those employers wanting to take wellness to a higher level.

Benefit Management & Ongoing Service

At Nachlis Insurance Services, we don’t just sell you a plan and disappear. We follow through to help with benefit implementation, employee communications, and we also assist with new hires, terminations, and any billing, claims or other issues that may arise. We strive to do as much as we can, so you don’t have to.

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Retirement Plans

Why offer a retirement plan?

Offering a retirement plan like a 401(k) plan can help your business meet increasing employee expectations and needs, increasing your ability to attract and retain top talent. Especially in an inflationary environment where your employees’ purchasing power and ability to save has been drastically reduced, offering a 401(k) plan will allow your employees save through easy pre-taxed, payroll deductions. And, Employers can match contributions, while also benefiting from certain tax breaks.

How does a 401(k) work?

The employee determines a set amount to have set aside into his or her 401(k) account.
The employer usually offers a variety of different investment options (stocks, bonds, money market investments, or a mix of these), in which the employee will choose from to fund the account.
While there are annual contribution limits, the employer may choose to match a portion of the employee’s contribution.

Popular 401(k) Options

Traditional 401k – good for any private or public company
Safe Harbor 401k – avoids discriminatory testing, good for high income earning employees and owners who want to invest aggressively in their retirement.
Profit Sharing 401k – employer has more design flexibility, good for self-employed professionals or businesses with less than 100 employees
Roth 401k – good for high income earning employees, contributions are after-tax, however income earned on the investment is tax free.

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Medicare Supplement Plans

Medicare Supplement Insurance policies complement your Original Medicare Parts A and B. They cover some, if not all, of the expenses that Part A and B do not cover, like co-pays, deductibles and other charges.

There are many different types of Medicare Supplement policies available, however they are regulated so the benefits for these various policies (known as Plan A through N), are all the same regardless of the carrier. However, premiums can vary greatly among carriers.

To learn more about Medicare Supplements and how they work, visit our Medicare Basics page.

Medicare Part D (Prescription Drug Coverage)

Prescription drug coverage offered by private carriers contract with Medicare. Because premiums vary greatly, you should carefully weigh your prescription costs against all variables of these plans. Selecting the wrong plan can wind up costing you thousands. Some Medicare Advantage plans may offer prescription coverage as well.

Please note that you should sign up for Part D (even if you do not have prescriptions) when you first turn 65, as waiting may result in a costly monthly penalty added to your premium.

To learn more about Medicare Part D Plans and how they work, visit our Medicare Basics page.

Medicare Advantage

Medicare Advantage Plans are offered by private carriers and replace your original Medicare Parts A and B, as they are rolled into one plan. You can select between an HMO or PPO, and most plans may cover more of your healthcare costs and have additional benefits, such as prescription drug coverage. Some may have dental or vision benefits. Premiums vary based on coverage, carrier and geographical location.

To learn more about Medicare Advantage Plans and how they work, visit our Medicare Basics page.

For Medicare Recipients

For Individuals & Families

For Employers

Telemedicine – Health and Wellness Plans

This Health and Wellness Option is very affordable and gives you access to a variety of discounted health services that include prescriptions, counseling, as well as telehealth solutions. Our telehealth solutions are easy-to-use and intended for non-emergency illnesses and general care. Members and their families have direct access to state-licensed and fully credentialed doctors, via phone or video consultations, to receive treatment (including prescriptions) and advice for common ailments, including colds, the flu, rashes and more.

Qualifying for Life Insurance

Healthy young people tend to put life insurance on the back burner while they spend their money on buying a home, starting a family, or paying off student loans. The truth is, the longer you wait to get life insurance, the more your policy will cost you.

Most life insurance policies require medical underwriting, meaning you must disclose your health issues and most likely will be required to go through a medical exam for approval and rating. While those in their 40’s and 50’s, even to age 60, will pay more in premiums, if they are nonsmokers in good health, they shouldn’t have an issue getting an affordable policy.

Looking for guaranteed issue? Final Expense insurance is a good option. These types of policies generally don’t require a medical exam, but premiums will be higher the older you are, and some benefit payouts may be limited during the first few years of coverage for those with significant health issues.

Term Life Insurance

Term Life is one of the simplest, most cost-effective types of life insurance. Generally, it provides the largest immediate amount of protection for the lowest cost and pays a death benefit upon your death.

Term Life covers you for a set period of time, provided you pay the monthly premium, or in some instances, a lump sum in advance. The policy will pay to the named beneficiary the face amount of the policy (set benefit and/or lump sum) upon death of the insured within the stated term. Depending on the policy, it may also make payments upon terminal or critical illness.

Permanent Life Insurance

This type of life insurance policy provides a death benefit, and helps you save for the future by building a cash value. Several advantages of Permanent Life include borrowing against the policy or building a tax deferred investment income, in addition to paying a death benefit.

Whole Life, Variable Life and Universal Life are all types of cash value life insurance. Cash value insurance is also known as permanent life insurance because it provides coverage for the policyholder’s entire life.

Final Expense Plans (to age 85)

Final expense insurance is designed to help protect your loved ones from the financial burden of funeral costs related to your passing. Unlike life insurance, final expense policies have a much lower face value because they are intended to only cover costs related to a person’s final expenses. Therefore, these policies can often be purchased at low or reasonable premiums.

Features Include:

-Premiums do not increase, ever

-As long as make you premium payment, policies will remain effective

-Guaranteed death benefit

Qualifying for Long Term Care

There typically is no age limit for Long Term Care (LTC) insurance. However, insurers typically do not accept new, elderly enrollees if they are already receiving or in need of care and in poor health. Experts recommend somewhere between ages 50 and 65 is generally the most cost-effective time to buy a LTC plan. The older a senior is, the greater the cost of their monthly premiums.

Special Enrollment (Outside of Annual Enrollment)

Once you are initially enrolled in Medicare, you can make changes to your coverage once a year during the annual open enrollment.

What if you miss the deadline?

When open enrollment is closed, there are special circumstances in which one may qualify to enroll outside of the enrollment period. Listed below are the qualifying events:

-You are turning 65
-You move to a new area that is not in your current plan’s service area
-Recently moved back to the US
-You lose your current coverage (either Group or Medicaid)
-You now need a SNP (Special Needs Plan) or you no longer need a SNP

When you can sign up for Medicare, and annual open enrollment

Medicare annual open enrollment is October 15th through December 7th every year.

To sign up for original Medicare Parts A & B, along with Part D, most people will have an Initial Enrollment Period which is a 7 month period around the time they turn age 65. This period begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

Once your Initial Enrollment Period is over, if you wish to change or purchase Advantage or Part D Plans, you must act during the open enrollment period.

NOTICE: Once you are eligible for Medicare, do not wait to enroll in a Medicare Part D Plan or you could end up paying a penalty every month.

What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older. The different parts of Medicare help cover specific services:

Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Most people will pay a standard Part B premium which varies depending on income.

Gap Insurance

A Gap plan provides benefits that supplement a major medical and comprehensive benefit package. It works by paying a significant amount of the deductible on a major medical plan. More specifically, the additional benefits help to cover out-of-pocket expenses related to coinsurance, co-pays and deductibles for inpatient and outpatient services. For example, if you have a $5,000 deductible on your major medical plan, gap coverage could pay up to $4,000 of that deductible.

Final Expense Plans

Final expense insurance is designed to help protect your employees and their loved ones from the financial burden of funeral costs related to an employee’s passing. Final expense policies have a much lower face value because they are intended to only cover costs related to a person’s final expenses. Therefore, these policies can often be purchased at low or reasonable premiums.

Hospital Indemnity Plans

Unlike a traditional major medical plan that reimburses you or pays directly to a provider for approved hospital stays and medical care, a Hospital Indemnity Plan pays a lump-sum payment directly to the insured. The cash payment helps with out-of-pocket expenses and covers you when you are off work due to a hospital stay. The coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected.

Dental & Vision Plans

Employees always appreciate dental & vision coverage as part of the benefits package. We offer both dental and vision as part of the employer sponsored package or on a voluntary basis.

Dental Plans

Studies have shown that regular dental exams help employees to stay healthier and more productive in the work place. Additionally, you can detect serious underlying conditions such as heart disease and diabetes, through regular dental exams. In fact, the National Association of Dental Plans and the Centers for Disease Control have performed studies that show that employees with dental insurance have better attitudes and are less likely to suffer from depression, a common condition in today’s fast-paced world.

Dental insurance offers a variety of diagnostic, preventative care and corrective services. This includes cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.

Vision Plans

Similar to dental policies, vision plans are inexpensive and save employees money on routine eye care. Examples of care include exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK. Additionally, monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts. In addition, regular eye exams help to detect early stages of diabetes, high blood pressure, and high cholesterol.

Disability Plans

National surveys have shown that Short Term Disability and Long Term Disability remain of high importance for most employees. Thus, savvy employers attract and retain top talent by offering both STD and LTD insurance as part of the employer paid benefit package or as a voluntary (worksite) benefit.

Short Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), STD generally allows for income payments to the employee to begin after about a two-week waiting period and will continue to pay the employee until he/she recovers or maxes out the benefits–usually anywhere between one month to two years, depending on the policy.

Long Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), LTD generally allows for income payments to the employee to begin after about a 90-day waiting period. However, it could be much longer depending on the policy. The policy will pay the employee far longer than STD–for a few years, up to age 65, or even for life.

Critical Care Plans

This special type of coverage can reduce the personal financial impact of the cost of fighting critical illnesses, helping to keep up with everyday bills through that process. Some key features include cash benefits paid directly to the employee and plans to fit different levels of coverage/budgets.

Accident Plans

Accidents can happen anytime. Accident insurance helps to protect employees from financial hardship due to a great deal of medical and out-of-pocket expenses that follow accidental injuries. For example, emergency treatment, hospital stays, medical exams, transportation and lodging needs are just a few of the expenses that accident insurance can help cover. In fact, some policies can even pay benefits in as little as one day, based on time of claim submission.

Life Insurance

Employees are more productive when they feel secure that their loved ones will be taken care of, in the event of illness or an untimely death. Thus, you should consider life insurance a key part of the benefit package for your employees. And, also a valuable tool in attracting top talent.

Whether employer paid or voluntary, a good life insurance policy provides for an employee’s final expenses, taxes, and mortgage. Additionally, it may even pay for their children’s education.

Permanent Life Insurance

This type of life insurance builds cash value which is sometimes used as collateral for loans, if needed. However, most employers only offer basic term life insurance (see below), but also offer permanent life insurance on a voluntary basis. Even so, employees appreciate the opportunity to widen their safety net.

Term Policy

This type of life insurance does not build cash value. However, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Additionally, some policies may also make payments upon terminal or critical illness.

Why you should have health insurance.

With today’s high cost of medical care, it is just no longer an option to go without healthcare insurance. One accident or illness can be financially devastating. You need to protect yourself and protect your family. In fact, according to a new study 66.5% of all personal bankruptcies that were filed were due to illnesses and accidents leaving individuals unable to work and strapped with medical bills. Whether you qualify for a subsidy or not, a comprehensive health plan can help you avoid financial ruin.

Additionally, Non-ACA alternatives such as Short Term Health Insurance, and/or Critical Care or Hospital Indemnity Plans will cost you about a third of what an unsubsidized major medical plan costs, and will protect your finances so you can focus on your health and getting better, should you have an accident or unexpected illness. Click here to learn more about our NON-ACA options.

Non-ACA options, however, have limitations and in some cases, do not cover certain and/or preexisting conditions.

You can avoid the hassle of trying to find a plan on your own by letting our agent, Tracey Pal Izzi help you find a plan that meets your exact requirements. She is an experienced, trained agent who will personally guide you past all the pitfalls. She is a true insurance professional who thoroughly researches the insurance options so that you don’t have to “buy a plan in order to find out what is in it”. Best of all, her service is completely free.

What if you miss the annual open enrollment deadline?

You can still sign up for health insurance after the deadline if you meet any of the following qualifying events:

change in legal marital status
a change in the number of dependents
a change in place of residence and the current carrier is not available
significant cost or coverage change
a change in coverage of a spouse or dependant
a COBRA qualifying event
legal judgements, decrees and orders
entitlement to Medicare or Medicaid

When can I buy an ACA health insurance plan?

For Healthcare.gov (the Federal Marketplace), it’s important to know that you can only purchase your health insurance during the annual open enrollment which is November 1 to December 15th of each year, or unless you qualify for the special enrollment period. Missing this time frame means you’ll have to wait until the next year to buy your coverage. However, we offer several affordable Non-ACA options that can be purchased year round so you don’t have to go without coverage.

IMPORTANT enrollment dates for individuals residing in Pennsylvania only. For this year’s upcoming enrollment and beyond (2021), the state of Pennsylvania is leaving Healthcare.gov (the Federal Market) and switching to their own state-based exchange. The enrollment dates are slightly different for this exchange and run from November 1 to January 15th of each year.

Are you required to have health insurance under the ACA?

Currently, most people are not required to purchase health insurance. The ACA “shared responsibility payment” and the individual mandate has been eliminated by the Trump Administration for 2019 and beyond. However, some states have established their own individual mandates, so you still may be subject to your specific state tax penalty, if any.

Following is a list of the states, as of 2019, that have mandated residents purchase qualifying health insurance (which is similar to the federal essential health benefits), or face a tax penalty when they file their income taxes.

California – the penalty for Californians who go without health insurance may be 2.5% of household income or $696 per adult (this number will rise yearly with inflation), whichever is larger.

Massachusetts – the tax penalty amount varies depending on your income, age and family size, but note the maximum penalty can be no more than half the price of the lowest premium plan available on the Massachusetts healthcare marketplace. For more information on Massachusetts health insurance mandates, click here.

New Jersey – the tax penalty is $695 for adults and $347.50 for each child, with a maximum family penalty of 2.5% of annual income,. The penalty is capped at three times the adult penalty ($2,085), or the state average cost for a bronze-level plan, whichever is greater. For more information on New Jersey health insurance mandates, click here.

Vermont – Vermont has passed legislation that requires residents to have qualifying health insurance in 2020, but the penalty for non compliance has not yet been established.

Washington, D.C. – the tax penalty is $695 for adults and $347.50 for each child, with a maximum family penalty of 2.5% of income, or three times the adult penalty ($2,085), whichever is greater. For more information on Washington, D.C. health insurance mandates, click here.

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What is the Marketplace?

The public health insurance Marketplace (also referred to as an “Exchange”) is where you can purchase health insurance (also known as Obama Care) for you and your family. A plan from the marketplace is considered a comprehensive major medical plan and also contains the essential health benefits (see below) as established under the Affordable Care Act (ACA) law. When you purchase your health insurance through the marketplace, you are guaranteed issue regardless of any pre-existing condition and you may be eligible for a subsidy (premium tax credit) to help off-set high premiums. Our agent, Tracey Pal Izzi can help you determine if you qualify for a subsidy.

The essential health benefits are as follows:

Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Prescription Drugs
Mental health and Substance Abuse disorder services
Rehabilitative and habilitative services and devices
Pediatric services, including oral and vision care
Preventive and wellness services, and chronic disease management

Health Maintenance Organization Or HMO

An HMO offers lower premiums and a significant savings on routine and preventative healthcare. However, this type of health plan requires you to appoint a primary care physician and to use doctors and facilities that are affiliated with the HMO. Thus, if you use healthcare service providers outside of the HMO, there is a good chance those charges won’t be covered by your policy. But, the great thing about an HMO is that the only charges you incur, outside of your premiums, are co-pays for doctor’s visits and other services such as procedures and prescriptions.

Preferred Provider Organization Or PPO

A PPO will save you money on services if you use the preferred providers within the network. Keep in mind that deductibles must be met on this plan before some services will be covered. The good thing about a PPO is they generally will allow a certain amount of services annually outside of the deductible with a small co-pay, and most often the PPO has a large network with quality care providers and excellent prescription drug coverage.

Health Savings Account (HSA)

An HSA is a tax-advantaged bank account tied to certain high-deductible health plans. It allows you to use tax free dollars to pay for allowable health expenses, such as copays, prescription drug costs and more.

Wellness Benefits

Most insurers include wellness benefits in their comprehensive coverage, designed to improve lives and keep members healthy. Your plan from the Marketplace will generally include services like preventative screenings, free or discounted gym memberships, diet advice, disease management, telehealth, and much more.

Gap Plan

A Gap plan provides benefits that supplement a comprehensive medical plan that you purchase from the marketplace. It works by paying a significant amount of the deductible on your major medical plan. More specifically, the additional benefits help to cover out-of-pocket expenses related to coinsurance, co-pays and deductibles for inpatient and outpatient services, and provide a lump sum payment that is sent directly to you and can be used for anything you choose. For example, if you have a $2,500 to $10,000 deductible on your major medical plan, gap coverage could pay some or all of that deductible, depending on the level of benefits you select. Some of our carriers have plans that include critical illness and accident (disability) benefits, with the option to purchase additional hospital confinement coverage. Read more below on these benefits.

Critical Illness Plans

Critical Illness insurance is a special type of insurance coverage that pays cash directly to you to help reduce the personal financial impact of the cost of fighting common types of critical illnesses, such as cancer, heart attack, stroke and more. With the advancements in modern medical technology, Critical Illness insurance is an increasing popular supplemental health insurance policy that allows you to focus more on recovery and less on the financial burden of a critical illness event or diagnosis.

Accident Plans

Accidents can happen anytime. Accident Insurance is very affordable and provides benefits in addition to your regular health insurance and/or disability insurance, in the case of an accidental injury. Accident Insurance can go a long way to protect you from financial hardship due to a great deal of medical, recovery and out-of-pocket expenses that follow accidental injuries.

Short Term Health Plans

If you have missed the open enrollment period per the Affordable Care Act (ACA), and do not qualify for special enrollment, or are in between jobs, or maybe you need a more affordable alternative to the ACA, you can purchase Short Term Health Insurance any time of the year. Per the new health insurance regulations as set by the Trump Administration, there is no longer a tax penalty or individual mandate, so you do not have to worry about non compliance of the essential health benefits.

A short term health plan is a non-ACA option that is much less expensive than a comprehensive health plan, because it does not cover pre-existing conditions nor does it contain all of the essential benefits required by the ACA. The great thing about a short term policy is that it will help you avoid financial disaster in case of unexpected illnesses and accidents. And, per new federal guidelines, carriers allow for plans up to one year, and are renewable for up to three years in some states.

Hospital Indemnity Plan

Unlike a traditional major medical plan that reimburses you or pays directly to a provider for approved hospital stays and medical care, a Hospital Indemnity Plan is a limited benefit plans that pays a lump-sum payment directly to the insured. Also, unlike a comprehensive plan on the Marketplace, you can enroll in this non-ACA option any time of the year.

When paid directly to the insured, cash payments help with out-of-pocket expenses and covers you when you are off work due to a hospital stay. There are no plan maximums, however the coverage is usually a set amount per day, per week, per month, or per visit depending on the benefit level selected. Some plans include optional benefits, such as preventive wellness, diagnostic testing and physician office visits.

Vision Plans

Take care of your eyes with an individual vision plan that can be purchased anytime of the year. Monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts, and also helps to detect early stages of diabetes, high blood pressure, and high cholesterol. Individual vision plans are similar to individual dental policies, as they are inexpensive and save you money on several services:

Eye Exams
Eyeglass Frames
Contact Lenses
Discounts on LASIK
And more

Dental Plans

Studies show that good dental health can boost your overall health while preventing and detecting serious health conditions such as heart disease, diabetes, glaucoma, cataracts and more. Some studies have even shown that people who have dental insurance have a better outlook and suffer less from depression, than those who do not have coverage. Individual dental plans or policies are relatively inexpensive and can be purchased anytime of the year.

Dental plans can range from a PPO or HMO to Pre-Paid, Fee-for-Service, and Discount on a variety of diagnostic and preventative care services including:

Cleanings, exams and x-rays 100% covered
Fillings & Orthodontia
Emergency care while traveling

Types of major medical coverage

Health Maintenance Organization Or HMO

An HMO offers lower premiums and a significant savings on routine and preventative healthcare. However, this type of health plan requires you to appoint a primary care physician and to use doctors and facilities that are affiliated with the HMO. Thus, if you use healthcare service providers outside of the HMO, there is a good chance those charges won’t be covered by your policy. But, the great thing about an HMO is that the only charges you incur, outside of your premiums, are co-pays for doctor’s visits and other services such as procedures and prescriptions.

Preferred Provider Organization Or PPO

A PPO will save you money on services if you use the preferred providers within the network. Keep in mind that deductibles must be met on this plan before some services will be covered. The good thing about a PPO is they generally will allow a certain amount of services annually outside of the deductible with a small co-pay, and most often the PPO has a large network with quality care providers and excellent prescription drug coverage.

Health Savings Account (HSA)

An HSA is a tax-advantaged bank account tied to certain high-deductible health plans. It allows you to use tax free dollars to pay for allowable health expenses, such as copays, prescription drug costs and more.

Wellness Benefits

Most insurers include wellness benefits in their comprehensive coverage, designed to improve lives and keep members healthy. Your plan will generally include services like preventative screenings, free or discounted gym memberships, diet advice, disease management, telehealth, and much more.

Annual Benefit Renewals

To ensure your employees continually have the coverage they need, we think ahead and outside the box when it comes to annual renewals.

We constantly monitor the economy and benefit landscape for emerging trends that may impact your benefit programs in the future and throughout the plan year.
Every year, we re-evaluate employer and employee needs before considering final renewal strategies and carrier options.

Our proactive approach eliminates the fear of annual renewals by making sure you understand your costs for the new year and that those costs stay within your budget.

Ongoing Service

Managing your benefit programs can be time consuming and tedious. We, along with our carrier partners and vendors, assist with the ongoing maintenance of your programs by taking care of as much as we can.

New hires and terminations
Assist with any carrier billing
Assist with claims issues
And more.

Our approach to benefit management ensures your benefit objectives are met and your program(s) continue to run smooth, while allowing you time to focus on other important matters.

Plan Implementation and Enrollment

Once we secure the right benefit package for you, we follow through with comprehensive support for you and your employees. Our services include plan implementation, benefit Q&A, and ongoing communications designed to help your employees appreciate and utilize their benefits wisely.

More about online enrollment. Depending on your carrier and plan, employers and employees manage their benefit programs through a cutting edge online benefits portal that can be accessed 24/7, eliminating hours of paperwork for employers, helps with onboarding, enrollment, renewals, increases employee communications/engagement and more, Employees view side-by-side plan comparisons, make elections, access summaries, forms, providers, or download policies, handbooks, memos, ID cards and more.

Studies consistently show that benefit education is key to driving participation, productivity and increased job satisfaction.

Benefit Strategy

Our consultation process is designed to find the best benefit strategy that will provide rich, desirable benefits for your employees, yet also meet financial objectives of the company. First, we take the time to understand you, your company’s goals and your employee’s unique benefit needs. Utilizing a holistic approach, we provide superior carrier options and advice on various trends, funding strategies and tax incentives that help lower costs for both you and your employees.

Offering health benefits is a significant cost for employers. We break it down for you providing options in easy-to-understand comparisons, so you can make informed, smart decisions about your benefit offering and associated costs.

Rhondi Nachlis Licensed Health & Life Insurance Broker

Rhondi Nachlis Licensed Health & Life Insurance Broker

Rhondi Nachlis Licensed Health & Life Insurance Broker

Medicare Supplements Chart

Medigap Chart - The chart below shows national average benefits covered by Medigap policies in 2024.

Medigap Chart - The chart below shows national average benefits covered by Medigap policies in 2022.

Rhondi NachlisLicensed Medicare Broker570-851-7676

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Rhondi Nachlis
Licensed Health & Life Insurance Broker

Rhondi Nachlis
Licensed Health & Life Insurance Broker

Rhondi Nachlis
Licensed Health & Life Insurance Broker

Rhondi Nachlis
Licensed Medicare Broker
570-851-7676