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Group Retiree Plans: What Employers Need To Know

Because of the baby boom, a lot of employees are currently entering retirement. What does this mean for employers? Furthermore, what does it mean for employees? Well, companies that offer retiree health insurance face a dilemma. Fortunately, there are some great flexible group retiree health insurance options. These solutions can help mitigate employer risk while also offering up comprehensive coverage for retirees.
So how do retiree health coverage companies work? Well, they help to reduce the medical inflation that puts pressure on retirees. They provide solutions that can help both employers and employees. But how is it done? Well, a good group retiree insurance plan will often integrate with Medicare. The use of Medicare allows companies to take advantage of Medicare’s coverage and also its cost-containment. Furthermore, most group retiree plan companies will separate the active employee medical plan and the retiree plan, as the different groups have different needs which require divergent coverage. This will also allow both plans to be more efficient in terms of their coverage and is especially effective for retirees who have varying medical needs with aging. A good group retiree insurance plan will help to fulfill all obligation to retirees and provide comprehensive coverage that will alleviate any worries associated with retiring.
These insurance plans will help aid those in retirement by paying Medicare-eligible deductibles, co-payments and medical expenses that Medicare doesn’t include. This will help the burden often associated with entering retirement by lowering costs. Retiree health insurance companies should be able to provide a lot of options and features when it comes to different plans. Some of these offerings should include the availability to support different group sizes. Depending on the size of the group, the retiree health insurance plan company should be able to accomodate for and customize a plan for your organization. Furthermore, the spouses of retirees must be considered, for those entitled to Medicare and the coverage will be guaranteed.
A group retiree health company should also help control overall costs associated with the plan. This can often be accomplished by dividing plans into the categories of voluntary and non-contributory. Further distinctions may be made that will help best accommodate coverage as well as control cost. Additionally, prescription drug plans may be accessed through separate providers. This will help to integrate billing features. Employers should be able to choose a unique and customized prescription drug plan that will help facilitate coverage for all retirees.
This integration should also apply to Medicare. In this feature, Medicare will pay first and the group plan will pay after.
There are a variety of companies you could choose from for your organization’s group retiree health plans and benefits. But, none stand up to Benistar, the industry standard in retiree benefits and group prescription drug plans. Benistar is the best option for fulfilling an obligation to retired employees and making everyone happy, employer and retiree alike.

The Ins and Outs of a Group Medical Plan: For Retirees

If you are retired you have probably at least heard of a group health plan. But what are the ins and outs of the group retiree health plan? Well, the answer is somewhat complex. If you are retired and have medicare and a group health plan from your employer, medicare pays first for your medical bills and then your group health plan will pay second. It’s important to understand that how your group retiree medical plan work depends on the specifics of that coverage. These specifics are partly to be determined by union or employer or the union or employer of your spouse. However, with a good healthcare provider, you will be able to receive coverage for what you need.

There are some other things to know regarding a group retiree medical plan. You will want to find out what happens to your employer coverage after you retire. Employers are not obligated to provide retiree coverage and a lot of time they will cut benefits or even not provide certain coverages. This can be catastrophic if any health problems arise in retirement, which they often do. You will want to be sure of what is going to happen with your coverage and what the price and benefits of it will be.

You will also want to find out how your coverage will affect your spouse. Sometimes, your employer will limit how much coverage your partner receives. If this is the case, you or your spouse may have to pay a lot of out of pocket costs. You want to find a retiree medical plan that mitigates any out of pocket costs.

Another thing you may also want to consider is if you are eligible for medicare. And if you are, you will need to see how it interacts with your group retiree medical plan. Sometimes, if you are eligible for medicare, retiree medical plans will not cover what you need. You want a retiree medical plan that can work with medicare. It is also important to know if you are enrolled in medicare part a or part b. Both have different components and you will want to select the one that fits and works the best for you and your family.

You will also want to know what effect your continued coverage as a retiree will have on your health coverage and also that of your spouse. A lot of times continued coverage may differ from the health coverage you have had for years. You certainly do not want to get any surprises in terms of coverage (as this could be very expensive and frustrating) so make sure you know what the deal is with your group retiree medical plan and health coverage in general.

If you are interested in learning more about group retiree medical plans, Benistar is a Leader in Post-65 Retiree Medical and Prescription Drug Plan Administration. Call or click today to find out if it is the right fit for you.

Your Complete Dictionary to Retirement

Retirement is a world of confusion, especially if you don’t know what the words people use to describe it mean. Especially in the world of finance and savings, there’s a whole lot of words germane to just retirement. You may have heard some of these words, or if you’ve spoken to a financial advisor to develop your retirement plan. But if you are like the majority of most americans, you probably don’t understand a good number of the words used in reference to retirement and subsequent financial planning. In this informative blog post, the retirement experts at Benistar will take you through the most common retirement terms. There are seventeen terms that are most commonly used to talk about financial retirement themes. They include:401 (k), required minimum distribution, annuities, rollover IRA, bank loan funds, Roth 401 (k), defined benefits pension, Roth IRA, defined contribution plan, Individual retirement account, life cycle fund and SIMPLE IRA.

As you can see IRA is a big theme. So what is an IRA? Well, an IRA is an individual retirement account, an investing tool used by individual people to earn and keep track of retirement savings. Traditional and Roth IRAs are created by individual taxpayers. Traditional IRAs stand out as they are tax deductible, in most cases. Traditional IRAs are a great option in preparing for retirement, if you qualify for them. The other form of individual taxpayer IRA is a Roth IRA, which is not tax deductible. However, eligible distributions of this type of IRA are tax-free. A Rollover IRA is a transfer of money from a retirement account into an IRA.

There quite a few other terms you may have heard in the introduction. One is 401 (k), a retirement behemoth. A 401 (k) is, in layman’s terms, the option for an employee to take compensation in cash or to have it deferred to to a 401 (k) account, an account used in anticipation of retirement. A Roth 401 (k) is a 401 (k) in which you pay taxes initially. A required minimum distribution is the minimum amount of money that must be withdrawn from an account each year, especially in terms of retirement-related accounts, such as an IRA. Bank loan funds are mutual funds that buy loans created by banks and other various financial institutions. A Defined Benefits Plan is something you may encounter in the workplace- it is when the sponsor gives employees a lump sum upon retirement, instead of a deferred income stream.

Furthermore, an annuity is a lump sum of cash that is deferred to be distributed via a monthly stream of monetary income for a set period of time. Defined contribution plans are those in which a certain amount of money is set aside every year by the company, in anticipation of the retirement of the employees. Lastly, a Lifecycle Fund is a mutual fund in which the money in an account is systematically adjusted to be proportional to the lifespan of the fund itself. If you still think you may need a little help in preparing for retirement, look no further than the experts at Benistar. They can make sure you’re adequately prepared for retirement and will help you save a buck in the process.


Retiree Coverage or Medicare Primary: Which is Better?

retiree coverage or medicare primary

Every year thousands of people turn 65 and face choices for their healthcare insurance. Figuring out Medicare alone is hard enough, but when you have retiree options to consider from an employer as well, things can get tricky.

Should you accept that employer coverage or go with Medicare and a Medigap plan? Which route is the best way to go?

Here are some things to consider:

Medicare is Primary Either Way                                                      

Original Medicare Parts A and B will usually be primary to a group health plan from a former employer. In this case, whether you choose to stick with that employer coverage or find your own Medicare Supplement coverage, you’ll need to enroll in both Medicare Parts A and B.

While Part A is paid up for most people at age 65, you will pay premiums for Medicare Part B. New enrollees in 2018 pay $134/month, and some people with high incomes pay more.

Since Medicare already foots about 80% of your healthcare costs, retiree plans that help cover some of the other 20% are generally affordable. After all, they are only covering what’s left over after Medicare pays most of the bill.

Your former employer often foots the bill for some or all your monthly premiums too, making retiree coverage an attractive option.


Retiree Plans Often Have Better Drug Coverage

Retiree group health plans generally have built in drug coverage. This coverage may provide all of your medications to you at minimal copays. Be sure to get a copy of the plan’s drug formulary, and look up your medications to see how much you might spend on your copays.

Part D drug plans, on the other hand, often have deductibles. Medicare drug plans also have the coverage gap, or donut hole, in the middle. This is a phase that kicks in if your drug spending goes beyond a certain limit each year. In 2018, that limit is $3750.

People on Medicare Part D begin to pay 35% of the cost of their brand name drugs when they reach the gap. They pay 44% of the cost of generics. If you are someone taking several brand name medications, you may find that this puts you into the gap sometime during that calendar year.

People who have heavy expenses during the coverage gap will often find that the drug coverage under the retiree plan is more attractive. That coverage doesn’t have the same kind of gap that Part D does.

You can easily estimate what your annual drug expenses will be on Part D by using Medicare’s Plan Finder Tool. Compare this annual cost to what you would spend annually on your drug copays under the employer plan. This comparison may help you begin to lean toward one route or the other.

If you decide to keep your retiree coverage, find out whether that coverage is creditable for Part D. This means: is it as good as or better than Part D benefits. Most drug coverage under retiree plans is creditable. Later on, if you ever leave that plan and decide to go with Part D instead, you won’t owe a late penalty as long as the employer coverage was creditable.

Retiree Plans May Have Extras that Medicare Does Not

It’s a shame that Congress didn’t include routine dental, vision and hearing coverage in Medicare’s original benefits. After all, this is often a time of life when we need these benefits the most.

While Medicare doesn’t cover these things, some retiree group health plans include routine dental, hearing or vision coverage.  Check your plan’s summary to see if you can get benefits through the retiree plan for these things. If your plan has benefits for these things, that may be a savings over you having to purchase it for yourself to go along with your Medicare.


Danielle Kunkle Roberts is the co-founder of Boomer Benefits, an insurance agency that helps baby boomers navigate their entry into Medicare.

Where Your Coverage Counts

don trudeau

Healthcare services are notoriously opaque and that’s why you want someone on your side, like Benistar, presided over by healthcare expert Don Trudeau, who will help explain what you are covered for and will help you fight for your own coverage. But do you know what procedures you will need included in your healthcare plan? This is a hard thing to anticipate as a lot of health care costs don’t entail maintenance/prevention, they often entail accidents or previously unforeseen conditions. Well, in the case, you’ll want to consider the most popular and most important procedures/offerings your healthcare should cover. This is where your health care coverage really counts and where your dollars are put into action. In order to best understand where your coverage counts and what procedures are essential to be covered for, we’ll delve into what the healthcare industry considers essential.

In the healthcare marketplace, the following procedures/types of care are considered essential and are covered by most major, high-quality providers: outpatient care, emergency room trips, inpatient care in the hospital, care for infant delivery (both before and after), mental health and substance abuse treatment (this is relatively new, so some providers cover inpatient treatment, whereas covers behavioral health treatment, counseling and psychotherapy), prescription drugs, physical therapy and occupational therapy, tests completed in a laboratory, preventive measures (screenings, vaccines, maintenance for chronic diseases and counseling) and pediatric services (aka treatment for children). It is important to realize that plans vary from state to state as specific states have guidelines regarding health care coverage, plans and costs. Furthermore, health care coverage may vary slightly within different locations in the same state. However, the ten essentials are pretty steadfast, as they were initiated under the Affordable Healthcare Act. The act mandated that all individual and small group plans (available to companies that have under 50 employees) must cover the aforementioned essentials.

Though the ten essentials do comprise a lot of procedures and therapies you’ll need, there are some things healthcare providers may not cover because they are not included in the ten essentials. You will want to know what they are, as if they are important to you, you may want to consider contacting healthcare professionals at Benistar to talk you through and to the plan that’s perfect for you, your needs and probably the needs of your family, too. Benistar and their President Don Trudeau are committed to making sure you get the coverage you need.

Things not covered via the ten essentials include: travel vaccines, alternative treatments such as acupuncture, cosmetic surgery, nursing home care (of particular importance to those in the winter of their life), dental, vision and hearing, weight loss therapies and surgery, preventative tests, a lot of medications (though prescriptions are listed as part of the ten essentials, healthcare providers do not often provide all prescriptions, instead choosing one prescription of each varying class- you’ll want to connect with Benistar for optimum prescription benefits) and a few less important therapies. Benistar and their President Don Trudeau will make sure you are covered for the care you need, and will work with you even if the treatment is not listed under the ten essentials.

Healthcare and your subsequent coverage may seem incomprehensible, but with the help of Don Trudeau and Benistar, you’ll find you have coverage where it counts.

The Flexibility of the EGWP

benistar egwp

The Flexibility of the Employer Group Waiver Plan

There are several ways Benistar can help employers provide prescription drug benefits to their Medicare-eligible retirees. One way we do this is by providing flexibility in the plans that we offer, doing our best to reduce member disruption and noise for the employer. By attempting to match plan designs as closely as possible, we are able to provide a smoothest transition to both employer and retiree.

Subsidies and Discounts

The EGWP is particularly competitive in the marketplace because it offers government subsidies and discounts that are built into the premium. Two notable components are the Coverage Gap Discount Program and Catastrophic Reinsurance. CMS requires companies that wish to sell Part D drugs to give a 50% discount to Part D members inside the coverage gap. Catastrophic reinsurance is an 80% subsidy provided by CMS once the member hits a specific out-of-pocket expenditure.

The Coverage Gap

One of the most problematic issues with Part D is the coverage gap (often called “the donut hole”). The coverage gap is when a retiree has reached their initial coverage limit and has to start paying an increased out of pocket for his or her prescription drug costs. This is when the 50% discount from manufacturers kicks in. While the discount may help offset a significant portion of the expenditures from that point on, drug costs involving members who make it to this point are often-times becoming a serious financial issue for the member. With drugs costs always rising, these additional expenditures can be substantial.

A plan that exposes members to this additional out of pocket cost is known as a base plan. Benistar offers solutions that can help to keep the out of pocket costs low for retirees during this period by offering full-coverage and generic-only options. Full-coverage plans allow members to continue paying their initial coverage copay’s throughout the donut hole. Generic-only plans provide similar benefit to generic drugs while in the donut hole. Both types of plans work to both keep member cost low and keep patients healthy.


The standard open formulary for Benistar’s Part D program is among the broadest Medicare formularies. Benistar’s ability to offer such generous plans stems from our excellent partnerships with carriers and large book of business.

Employer Contribution

The EGWP allows plan sponsors the freedom to choose how much they contribute to the cost of the premium. Plan sponsors can either pay for the full premium, for a portion of the premium or they may choose to have retirees enter the plan on a voluntary non-contributory basis. Unlike with the Retiree Drug Subsidy, the EGWP contribution level does not impact savings from subsidies and discounts. This means that regardless of how the premium is split between employer and member, premiums are still eligible for the cost savings and subsidies under the EGWP.

NEW rules for Medicare Shared Savings Program

Benistar shares announcement from the website released June 5, 2015

The CMS finalizes rules for Medicare Shared Savings Program

Continued Growth in ACO Program is a Core Component of Delivery System Reform

The Centers for Medicare & Medicaid Services (CMS) today released a final rule updating the Medicare Shared Savings Program to encourage the delivery of high-quality care for Medicare beneficiaries and build on the early successes of the program and of the Pioneer Accountable Care Organization (ACO) Model.  This final rule is an effort to provide support for the care provider community in creating a delivery system with better care, smarter spending, and healthier people.

The Medicare Shared Savings Program final rule will both enhance the focus on primary care services and provide additional flexibility in the program, which should grow participation.  CMS is making these modifications to the proposed regulations after considering comments received from the December 2014 Notice of Proposed Rulemaking.

“Accountable Care Organizations have shown early but exciting progress in improving quality of care, while providing more patient-centered care at a lower cost,” said CMS Acting Administrator Andy Slavitt.  “The ACO rules today strengthen our ability to reward better care and lay the groundwork for more providers to become successful ACOs.”

The final rule issued today improves the program over the proposed rule in a number of areas, including but not limited to:

  • Creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;
  • Streamlines the data sharing between CMS and ACOs, helping ACOs more easily access data on their patients in a secure way for quality improvement and care coordination that can drive critical improvements in beneficiaries’ care;
  • Establishes a waiver of the 3-day stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3; and
  • Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’ intent to propose further improvements to the benchmarking methodology later this year.

The Medicare Shared Savings Program was created by Section 3022 of the Affordable Care Act to promote better health for Medicare fee-for-service beneficiaries by encouraging physicians, hospitals, and other health care providers to improve patient health and experience of care and to reduce growth in costs.  The program is voluntary and accepts applications on an annual basis in which organizations agree to participate for three years.

Over 400 ACOs are participating in the Medicare Shared Savings Program, serving over 7 million beneficiaries. Early results released last November indicated the Medicare Shared Savings Program ACOs starting in the first two years of the program improved quality of care for beneficiaries, as ACOs improved performance in 30 of 33 quality measures.

According to an independent evaluation report released by CMS earlier this month, the Pioneer Accountable Care Organization (ACO) Model generated over $384 million in savings to Medicare over its first two years – an average of approximately $300 per participating beneficiary per year – while continuing to deliver high-quality patient care.  The Pioneer ACO Model is the first that meets the tests to have its elements incorporated into other Medicare programs.

ACOs are a part of the Department’s broader initiative to create a health care system that results in better care, smarter spending, and healthier people. The Administration earlier this year announced the goal of tying 30 percent of Medicare payments to quality and value through alternative payment models, such as ACOs, by 2016 and 50 percent of payments by 2018.

For more information on the Medicare Shared Savings Program, please visit: