Physical vs. Office Visits

Overview:

One of the most important ways to minimize your health care costs is to be knowledgeable about your visits to the doctor. Most visits usually fall under two different types: physical or office. What is the difference between physical vs. office visits, and how do they work? Physical visits remain one of the most important ways to keep costs down. The sooner your doctor discovers a potential issue, the sooner they can treat it. That also increases the likelihood that the treatment will be less expensive than if you delay treatment. Insurance considers these visits preventative. An office visit, in contrast, is a visit when you visit your doctor for a specific symptom or concern. Treatment received at an office visit is usually not preventative, and so you will be responsible for some of the costs, depending on what all your insurance covers.

Physical vs. Office Visits:

A physical visit is your routine annual check up. The ACA mandates that these visits are free once a year. The physical’s purpose is to discover health problems before they become serious. A physical does not include tests or treatment. If you don’t want to pay anything out of pocket for a physical, you should speak to your doctor about only performing screenings that insurance considers preventative. If you don’t, your doctor may run extra tests that insurance does not cover as preventative.

An office visit, in contrast, is when you visit the doctor for treatment of specific issue. These are the visits you schedule when you don’t feel well. During these visits, the doctor provides their opinion and treatment plan, and you are responsible to pay for the service. That payment usually takes the form of a copay or a payment toward your annual deductible. If you have already met your deductible during the year, your insurance may cover most if not all of the fee.

It is possible that you can have both a physical and an office visit at the same time. If you go in for your physical, but your doctor treats you for a medical issue, you will be billed for both services. Insurance will cover the preventative aspects of the physical, and you will be charged for the office portion of the visit.

Out-of-Pocket Expenses:

Even though your insurance will cover the costs of your physical, you may be responsible for a small copay. You will ultimately be responsible for any services that your insurance will not cover. The best way to reduce your out-of-pocket expenses then is twofold. First you should schedule a physical visit once a year. This will help to catch small problems before they become big ones. Second, you should speak with your provider about what they cover. Some plans limit the number of office visits, tests, or physicals you can receive per year. You can also check with them before you visit the doctor to make sure that your service will be covered. If you know what services you need, having the insurance company give you an estimate is a great way to manage your out-of-pocket costs and create a plan.

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Senate ACA Replacement: The BCRA

Overview

On June 22nd, Republicans in the Senate released their plan to repeal and replace the ACA. This proposal is called the Better Care Reconciliation ACT (BCRA). The BCRA, as it currently stands, keeps several provisions of the ACA. The BCRA is the response to the House’s bill, the AHCA, which we wrote about here. Ultimately, the BCRA is a budget reconciliation bill, and so it cannot repeal the ACA in full. What it can do, is to make changes to the ACA’s tax credits and federal spending dedicated to the ACA. As with the AHCA, the Senate has not voted on the bill yet, and so there is still time to make changes. However, based on what the Senate has released, here’s what we know so far.

What’s New?

First, the BCRA seeks to remove the employer and individual mandates. Like the AHCA, the BCRA  cannot repeal these mandates. However, it does reduce the penalty imposed for violating the mandates to zero. This means that, even though the mandates remain, there is no penalty for disregarding them.

The BCRA would also eliminate a provision in the AHCA to allow insurance carriers to add a 30% late enrollment charge for those seeking to enroll outside of enrollment periods. Further, the BCRA seeks to replace the ACA’s insurance subsidies with tax-credits. These tax credits are designed as an incentive to enroll in coverage by helping to partially fund the purchase of insurance.

State waivers are another important aspect of the the new bill. In response to the House’s AHCA, which allowed States to apply to waive essential health benefits (provisions that all plans must include), the BCRA eliminates that option. Instead, the new bill expands Section 1332 of the ACA. This section allows States to change what they consider essential health benefits. These changes must meet the basic protections of the ACA. The BCRA lowers the standards for reasons that a state can apply for a waiver. This means that states can fundamentally change what is considered an essential health benefits in their state.

Finally, there are also important changes to HSA’s in the bill. Currently, the IRS sets a yearly limit on how much a participant can contribute to an HSA. Under the BCRA, the contribution limit, starting in 2018, would be the maximum out-of-pocket the law allows. In this case, that would be $6,550 for those with an individual plan, and $13,100 for those with family coverage.

What Stays the Same?

Under the BCRA, many provisions of the ACA would remain intact. Importantly, individuals under the age of 26 will continue to have the option of coverage under their parents’ plan. Further, the ACA’s requirement that pre-existing conditions be covered will still be in place. The prohibition of lifetime and yearly annual limits for essential health benefits has also stayed. Finally, the clauses requiring guaranteed availability and renewability, along with non-discrimination rules and the prohibition against health status underwriting remain in place.

As we talked about earlier, the individual and employer mandates are also still in place, although due to the lack of penalty for violating these provisions, the BCRA renders them effectively void.

Conclusion

The BCRA is the next step in the Republicans’ attempt to fulfill their promise to repeal and replace the ACA. Because the Senate has not voted on the BCRA, it is not law. Once they vote, there are still more steps. First, the Senate will have to send the bill to the House, which could make further changes. Then, it would come back to the Senate for a final vote. Finally, the President would sign it into law.

For the time being, the ACA is still the law. We’ll be watching to see what changes are made, if any, and keep you up to date as the bill moves along. As always, if you have questions about the BCRA, the AHCA, or the ACA, please reach out to us. You can reach us via email at info@morganplan.com, or by phone at 612-492-9320.

 

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Emergency Room vs. Urgent Care

Overview

One of the most consistent goals we see among our clients is to save their employees money when it comes to healthcare. Although premiums are the most obvious place to look at controlling cost, there are others. We’ve posted a quick guide to saving on costs before. But now, we thought it was time to take a more in-depth look at strategies. The first of these important strategies is to choose your provider wisely. Often, when choosing where to go, people choose the emergency room over urgent care clinics. There are many reasons for this. One of the major reasons people choose the ER over urgent care is because they aren’t familiar with the difference between the two. This can result in large medical bills for non-life-threatening conditions. Making the right decision about where to go can not only save you time, it can save you money too.

The Emergency Room

When choosing between the ER and Urgent Care, severity of the illness or injury is the most important factor. If experiencing a potentially life-threatening event (severe chest pains, spinal injuries, severe burns, seizures, etc) the ER is right place to go. ER doctors treat patients according to the severity of their injuries. This means that those with less severe injuries tend to wait longer as patients with more critical injuries or illnesses are treated first. A visit to the ER typically costs around $1,400, given the tests and care provided.

Urgent Care

In contrast, Urgent Care clinics exist to provide care for injuries and illnesses that are not life-threatening (such as sprains, fever, infection, dehydration, etc). These clinics take patients as they come. A trip to Urgent Care is also usually much cheaper than a trip to the ER. A visit to Urgent Care tends to cost around $200. Like most ER’s, Urgent Care clinics are usually open seven days a week. They are also usually open longer than normal business hours. Urgent Care exists for those times when your doctor’s office is closed, or you can’t wait for an appointment. They’re a great resource that are significantly cheaper than an ER visit.

Conclusion: When to Go Where

When your primary doctor isn’t available or you’re experiencing life-threatening symptoms, it’s important to know where to go. If your illness or injury is non-life threatening, an Urgent Care clinic is probably your best option. These areas are staffed with doctors and nurses who can treat and diagnose your injury or illness. Urgent Care clinics are cheaper, faster, and provide quality care. For times when you experience a life threatening injury, the ER is the best option. ER’s are staffed 24/7, and have access to the best specialized care. In cases where treatment means the difference between life and death, the ER is best option.

The next time you experience an injury or illness and need care, make sure you make the right choice. You know you body. If you think your injury or illness is life-threatening, don’t hesitate to dial 911 and get to the emergency room. In other cases, when you need care urgently for a non-life threatening injury or illness, try and head to an Urgent Care clinic. It’ll save you money over and ER visit, and if the doctor’s there decide you need emergency care, they can get you there fast.

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Changes to Overtime Laws

Overview: Overtime Changes

Earlier this month, Congress passed a law that will change how employers handle overtime. The Working Families Flexibility Act makes changes to overtime compensation. Although not yet passed by the Senate, we know the details of the bill, and how it could impact you. The new law focuses on private employers. It amends the legal requirements for compensating employees. Now, rather than allowing for overtime pay only, the new bill allows employers to provide compensation  in the form of paid time off. If the bill becomes law, it will mean employers will have new options for handling their employees’ overtime.

What are the details?

Currently, the law requires employers to compensate employees who work overtime in the form of overtime wages. The new bill would change the requirements, allowing employers the option to give overtime compensation either as wages or as paid time off. The new bill sets the ratio for paid time off as 1.5 hours of paid time off for every 1 hour worked. Further restrictions for this new compensation exist. An employee would have to have worked a total of over 1,000 hours, and been employed for at least 12 months to be eligible. Both employees and the employer would also have to agree to this compensation. Employers also can’t coerce employees into such an agreement. Finally, employees must use any time off accrued by the end of the year. At the end of the year, the employer must pay the employee for the balance of time.

What do you need to do?

Currently, the Working Families Flexibility Act is not law. It still needs to go to the Senate for debate and approval. If the bill does become law, it means that private employers may need to rethink their current policies. Benefits packages are an important way to attract and maintain employees. Your overtime policy is another part of your benefit package. If you have questions about how the new bill, or other questions regarding you benefits package, please reach out to us. We can be reached by phone at 612-492-9320, or by email at info@morganplan.com.

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