Pre-authorization is supposed to control costs, but for many patients and providers it feels like a roadblock to timely care. With lawmakers now paying attention, this long-standing insurance practice could be facing some big...
Latest Posts
Week 44: Employer Mandate Safe Harbors: A Practical Guide for ALEs
The ACA’s affordability test is based on household income – but since employers rarely know that figure, the IRS created three “safe harbors” instead. These methods (W-2 wages, rate of pay, and federal poverty line) make...
Week 43: The No Surprises Act Just Got a Major Overhaul
The No Surprises Act was designed to protect patients from unexpected medical bills – and it’s already prevented millions of them. But mounting arbitration backlogs and weak enforcement against insurers are putting those...
Week 42: HMO, PPO, or HSA? Clearing Up One of the Most Common Client Confusions
This week: HMO, PPO, or HSA? Employees mix these up constantly, and the confusion leads to bad plan choices and buyer’s remorse. This week we clear it up in plain language you can hand straight to clients and their teams...
Week 41: How long does COBRA last? That depends on the Qualifying Event.
How long COBRA lasts depends on the qualifying event: termination or reduction in hours usually means up to 18 months for the employee and covered dependents, while dependents may get up to 36 months for death, divorce/legal...
Week 40: Medigap vs. Medicare Advantage – What’s the Difference?
Medicare beneficiaries often face a big choice: Medigap or Medicare Advantage? Both options help cover costs Original Medicare doesn’t, but they work in very different ways – and the right choice depends on your health needs...
Week 39: How Coordination of Benefits Works When an Employee Also Has Spousal Coverage
This week: When an employee is covered by both their own job and a spouse’s plan, which one pays first? Coordination of benefits decides that, and getting it wrong means denied claims and frustrated employees. This week we...
Week 38: Can (and Should) a Company Offer Coverage to 1099 Employees?
This week: Can a company offer health coverage to its 1099 contractors, and should it? It’s one of the most common questions advisors get from small employers. This week we walk through what’s actually allowed, the tax and...
Week 37: How Long Can You Make New Hires Wait for Coverage?
This week: How long can an employer make new hires wait before coverage starts? The answer involves the ACA’s 90-day limit, orientation periods, and a few details that routinely trip employers up. This week we lay out the rules...
Week 36: Section 125 vs. Section 105(h): How Nondiscrimination Testing Differs
Section 125 and Section 105(h) nondiscrimination rules cover different ground – §125 tests cafeteria plans and “highly compensated employees,” while §105(h) tests self-insured medical plans and “highly compensated individuals.”...