Saving money on healthcare opportunities

Opportunities To Save MONEY on Family Health Plans in 2023

Has this happened to you? As an employee you have been offered coverage through your company health plan, and the employer is paying a portion, up to 100% of your coverage, and that coverage is also open to your spouse and children – but they had to pay as much as 100% of the premium. Affordability of employer health insurance for family members was based on the cost to enroll only the employee, regardless of the cost of family coverage. Even if the cost to enroll family members was significantly more than the cost to enroll the employee, the coverage was still considered “affordable” for the family members, making them ineligible for financial assistance through marketplaces like Pennie. That hit many people’s bank accounts very hard each month. In 2023 that has changed for the better!

The New Solution

Under this new rule, starting with 2023 coverage, family employer plans will only be considered “affordable” if the actual cost to enroll each member of the family is within the ACA affordability standards.  In other words,

...when employer coverage for family members costs too much, the family members may qualify for financial assistance through Pennie, instead of being forced to pay full price.

Pennie’s application has been updated to include a new question for all members of a tax household with an offer of family coverage through a spouse or parent’s employer. Each tax dependent will be asked to provide the premium of the lowest cost family plan (employee + spouse + other dependents). Pennie will then determine for each family member whether that employer coverage is affordable to determine whether each person may be eligible for savings through Pennie.  The employer coverage may be affordable for some family members but not others, resulting in only some family members being eligible for financial savings.


A BIG change for families that can make their health coverage more affordable on Pennie

When purchasing health insurance, whether it is through an employer plan or through Pennie or directly through an insurer, it is sometimes hard to understand where the term “affordable” fits into the “Affordable Care Act”.  When a family has an individual who is covered through an employer plan and other members of the family were able to get coverage through that plan (even if they had to pay full price – which is most often the case anymore) then no one in the family qualified for an Advanced Premium Tax Credit through Pennie, or the Federal Marketplace.  That is now changing!

FOR AWARENESS: 

Under new federal rules, Pennie can now provide savings to more Pennsylvanians!

Learn more below:

What happened? 

In October, the Biden administration finalized a rule changing how affordability is calculated for family members with an offer of health insurance through their spouse or parent’s employer.

What was the problem?

Until now, affordability of employer health insurance for family members was based on the cost to enroll only the employee, regardless of the cost of family coverage. Even if the cost to enroll family members was significantly more than the cost to enroll the employee, the coverage was still considered “affordable” for the family members, making them ineligible for financial assistance through marketplaces like Pennie.

This so-called “family glitch” forced family members to choose between two expensive options, the employer family plan or a full price marketplace plan.

What is the new solution?

Under this new rule, starting with 2023 coverage, family employer plans will only be considered “affordable” if the actual cost to enroll each member of the family is within the ACA affordability standards. In other words, when employer coverage for family members costs too much, the family members may qualify for financial assistance through Pennie, instead of being forced to pay full price.

Pennie’s application has been updated to include a new question for all members of a tax household with an offer of family coverage through a spouse or parent’s employer. Each tax dependent will be asked to provide the premium of the lowest cost family plan (employee + spouse + other dependents). Pennie will then determine for each family member whether that employer coverage is affordable to determine whether each person may be eligible for savings through Pennie.  The employer coverage may be affordable for some family members but not others, resulting in only some family members being eligible for financial savings.

Communication to the Impacted Population at Pennie: 

Pennie will be emailing and calling those customers and applicants who previously indicated on their application they had an offer of family coverage from their spouse or parent’s job. These customers will be asked to update their application to provide the additional information about the cost of employer-sponsored coverage, to determine if they may be newly eligible for financial savings.

The “family glitch fix” question will be available to all Pennie customers who submit a new 2023 application, or who update their existing 2023 application, ensuring they get access to the financial savings they qualify to receive.


Ways To Help With The High Cost Of Prescription Drugs

Have you ever felt that your money was being ripped out of your hands when you had to fill prescriptions at pharmacies? While there are no fool proof answers to the problem, whether you have individual insurance, Medicare prescription insurance, or even many group plans, the costs are prohibitive for many of the most commonly prescribed brand name and high-cost generic drugs. There are some options to look at however though some may mean having to do a bit of work.

It takes people making noise to make a difference.

Most people are now familiar with drug discount programs like Good RX, Single Care, and Script Saver. Many have also heard of “Cost Plus Drug”, an online pharmacy began by Mark Cuban that is actually starting to team up with insurance companies in Pennsylvania like Capital Blue Cross**. This may be something that you would want to write to your current health insurance or prescription drug plan about. It takes people making noise to make a difference. I keep running into too many people being willing to say, “What can I do about it?”. You can make noise about the ridiculous pricing of medications in the United States not only to your insurer but also to your representatives in both the state and federal Congress! They will listen if enough people complain but they won’t do anything if you keep silent!

Another big suggestion I constantly make to my clients is to form a relationship with a small independent pharmacist. You cannot help yourself more than by doing that. A small, independent pharmacist has more control over their costs than a pharmacist in a “big box store” that is corporately owned. Studies over the years have consistently shown that small, independent pharmacists overall cost the public less versus the major corporate pharmacies and big box stores when it comes to more expensive drugs. The reason for this is that they can set their own pricing. They will never come out the lowest in cost on Medicare.gov comparisons because you can’t negotiate pricing on that site.

Form a relationship with a small pharmacy

My suggestion is to form a relationship with a small pharmacy and then ask them what they would charge you if you didn’t use your prescription drug card from your insurance at all for your medications. It may not work out the best for very low-cost drugs, because the big box stores negotiate those low-cost drugs at little to no cost to consumers as a way to attract business. Unfortunately, they often have very high pricing for mid-level and higher drugs. Smaller pharmacies may offer home delivery, medication consultations, will talk with your doctor about alternative medications that may be less costly, and have the time to spend with you because they are not under corporate pressures.

Call or email me with any questions. I hear over and over again that the cost of medications are just too high and the government is not doing enough, fast enough, to make the costs less for Americans.

Just a few months since announcing our collaboration with Mark Cuban Cost Plus Drug Company (Cost Plus Drugs), we’re expanding it! Starting January 1, 2023, Cost Plus Drugs will begin accepting Capital Blue Cross prescription drug coverage.

Capital Blue Cross was the first health plan in the country to collaborate with Cost Plus Drugs, helping our members and communities gain greater access to low-cost prescription drugs and transparent pricing. Now, our prescription drug plan members will be able to add their Capital ID card number to their Cost Plus Drugs online account to apply their benefits. Using Cost Plus Drugs is easy.

Cost Plus Drugs is affiliated with billionaire Mark Cuban, who’s working to disrupt the drug industry by offering substantially discounted pricing on a wide range of commonly used generic drugs. Discounts can be as large as 80% below retail!

All costs (except expedited shipping) are included in the cost of each drug on the Cost Plus Drugs website. Pricing is consistently based on: the cost they pay for a drug; plus 15% (to pay for running their business); a pharmacy charge for dispensing the drug; and a charge for standard shipping.