7 tips for choosing your health benefits for 2023

Amid higher inflation, you may be looking at ways to adjust your lifestyle and spending habits. But when it comes to health care, it’s important to keep your well-being and budget in mind.  


Annual or open enrollment season is here – a time when more than 12 million people in Pennsylvania and millions of Americans across the country will have the opportunity to select or switch their health insurance plan for the coming year.   


Open enrollment is a good chance to review how often you’re using health services and decide whether you’ll stick with the plan you’ve got or switch to another being offered. It’s also an opportunity to assess your overall care costs to ensure you’re choosing a plan that will work best for next year’s budget. 


Enrollment timing: For people with coverage from their employer, open enrollment typically happens for two weeks sometime between September and December. Medicare members can enroll or make changes to coverage from Oct. 15-Dec. 7. Most selections made will take effect on Jan. 1, 2023.  


Here are seven tips to help in choosing a health plan through work, the Exchange Marketplace or Medicare: 


1.Consider all your options. Take time to understand and compare the benefits, services and costs of each plan, so you can figure out which will work best for you. A good first step may be to watch a quick refresher video on health insurance lingo, including premiums, deductibles, copays, coinsurance and out-of-pocket maximums.  


  • Medicare members: As you weigh your options, ensure you’re familiar with the difference between Original Medicare and Medicare Advantage. If you need a review, visit MedicareEducation.com — an online resource with answers to questions about eligibility, plan choices, cost basics, prescription coverage and more.  


2. Check your prescription benefits. Knowing how to get the most out of your prescription benefits may help you manage costs. For example, check into discounts and lower-cost alternatives, including generics, which may be available. You may also be able to fill your prescriptions at a participating network pharmacy or with home delivery by mail — two more money-saving options.  


  • Medicare members: You may be surprised to learn Original Medicare doesn’t generally cover prescription drugs. Consider adding Part D or a Medicare Advantage plan with prescription drug coverage to help keep your medication costs in check.  


3. Check for mental health coverage. In addition to in-person mental health care, you may have access to a large virtual network of therapists and psychiatrists. Some health insurers also offer advocacy services to help you find the right type of behavioral health care.  


  • Medicare members: Some plans offer virtual mental health care with a $0 copay, including UnitedHealthcare Medicare Advantage. 


4. Don’t forget about specialty benefits. Additional benefits, such as dental, vision, hearing or critical illness insurance, are often available and may contribute to overall well-being.  


  • Medicare members: You may be surprised that Original Medicare doesn’t cover most dental, vision and hearing services, but many Medicare Advantage plans do.  


5. Look into wellness programs. Many health plans offer incentives that reward you for taking healthier actions, such as completing a health survey, exercising or avoiding nicotine.  


  • Medicare members: Many Medicare Advantage plans also offer gym memberships and wellness programs for members at no additional cost. 

6. Anticipate next year’s health expenses. If you’re expecting a significant health event in the next year, such as surgery or the birth of a child, compare the differences in plan designs for that specific situation, including any out-of-pocket costs.  


7. Consider a plan with virtual care services. If you’re busy or just prefer connecting with a doctor from the convenience of your home, consider choosing a plan that includes 24/7 virtual care. You may have access to virtual wellness visits, urgent care and chronic condition management.  


  • Medicare members: Most Medicare Advantage plans provide access to virtual care, which can be an easier, more affordable way to talk with doctors about common health issues on a smartphone, tablet or computer. 


For more helpful articles and videos about open enrollment, visit uhcopenenrollment.com 




Lebanon VA expands health care eligibility for Veterans

Health care eligibility for certain Vietnam, Gulf War, and Post 9/11 Veterans was greatly expanded on October 1, the U.S. Department of Veterans Affairs (VA) Lebanon VA Medical Center announced Friday.

The PACT Act was signed into law on Aug. 10, 2022, by President Biden, and authorizes one of the largest health care and benefits expansions in the history of the VA.

“This expansion will bring generations of new Veterans into VA health care, and increase the health care benefits of many more, which will result in the one outcome that matters most: better health outcomes for Veterans,” said Robert W. Callahan, Jr. CEO and director of the Lebanon VA Medical Center. “I highly encourage these Veterans to apply now for the health care they’ve earned and deserve.”

Eligible to apply for enrollment are Vietnam era Veterans who served in the following locations and time periods:

· Service in the Republic of Vietnam between Jan. 9, 1962, and May 7, 1975

· Service in Thailand at any U.S. or Royal Thai base between Jan. 9, 1962, and June 30, 1976

· Service in Laos between Dec. 1, 1965, and Sept. 30, 1969

· Service in certain provinces in Cambodia between April 16, 1969, and April 30, 1969

· Service in Guam or American Samoa (or their territorial waters) between Jan. 9, 1962, and July 30, 1980

· Service in Johnston Atoll (or a ship that called there) between Jan. 1, 1972, and Sept. 30, 1977

Gulf War Veterans who served on active duty in a theater of combat operations after the Persian Gulf War may be eligible to enroll in VA health care as of Oct. 1. This enrollment includes Veterans who, in connection with service during such period, received the Armed Forces Expeditionary Medal, Service Specific Expeditionary Medal, Combat Era Specific Expeditionary Medal, Campaign Specific Medal, or any other combat theater award established by Federal statute or Executive order.

Also as of Oct. 1, Post-9/11 Veterans who have not previously enrolled in VA health care now have a one-year window in which they may be eligible to enroll if they:

· Served on active duty in a theater of combat operations during a period of war after the Persian Gulf War, or

· Served in a combat against a hostile force during a period of hostilities after Nov. 11, 1998, and

· Were discharged or released between Sept. 11, 2001, and Oct. 1, 2013

Lebanon VA Medical Center (VAMC) is one of 170 medical centers in the nation with the sole purpose of providing medical care to America’s Veterans. Lebanon VAMC serves Adams, Berks, Cumberland, Dauphin, Lancaster, Lebanon, Perry, Schuylkill, and York counties.

Where are health benefits costs headed in 2022?

Two years after the pandemic closed businesses nationwide, more employers could begin to make changes to their health insurance benefits.

The COVID-19 pandemic made businesses both large and small put a pause on making significant changes to their health plans.

In early 2021, Harrisburg employee benefit and investment advisory firm Conrad Siegel reported that in a survey of 100 organizations, only 7% of respondents anticipated making changes to their health care benefits.

Workforce issues resulting from the pandemic have made employers continue to hold off on making sudden changes to their benefits. However, that could change this year with increased pressure from health care inflation, said Robert Glus, a partner and consulting actuary at Conrad Siegel.

“Health care is a big deal and attracting and retaining employees is one of the biggest challenges right now. It’s not attractive to have to cut benefits or increase deductibles,” said Glus.

Despite that desire to stay competitive for future hires, Glus added that employers will be unable to continue to stomach increases in benefit costs now that the utilization of health care is normalizing.

“The pandemic was an awful situation but for health care costs and premiums it wasn’t a bad thing—it kept costs lower,” he said “Now, we are going to get all of that pressure. There will be tons of pressure on costs and trends and people will have to react to it.”

Glus said that in recent months, the biggest cost increase he has seen in the market was the jump in purchases of COVID tests at the end of 2021. That spike in cost was particularly high for self-funded groups.

“The amount of testing that was going on was a huge driver of cost at the end of 2021 and into 2022,” he said. “That is just one of the drivers. Things that add even one to two percent to your health care expense can be significant.”

Possible added benefits pressure this year could cause employers to find themselves looking to be more efficient and bring down cost. For employers trying not to drive up what their employees pay, that could mean things like contracting with local health systems to bring up efficiency, but decrease flexibility.

Glus said that for some organizations it may be worth it to ask the question: “Is narrowing the ‘where’ in health care worth the limitations?”

“You can take benefits away so much in terms of deductibles and copay but at some point, you need to look at efficiency even if it means limiting where someone can get coverage,” he said.

Transparency rules in the pipeline

In late 2020 the Trump administration issued a Transparency in Coverage rule meant to improve price and quality transparency in the market.

Implementation of that rule has been pushed back by the Biden Administration, but Glus said that it is something that employers should keep on their radar.

The new rule requires most health insurers to provide personalized information regarding out-of-pocket costs for covered services. The goal of the rulemaking, set to go into effect starting 2023, is to encourage consumers to shop around for health care services and providers.

Glus said that while there is an opportunity for the new rulemaking to make it easier to shop for services and compare costs, additional transparency does not necessarily promise lower costs.

“Instead of there being a race to the lower cost, oftentimes when we talk about insurances and providers, there is a race to the top,” he said. “If it is all public, and it all gets out there in a way where an insurance company can see how much is being reimbursed from one provider to the next, it will be interesting if it drives cost down or up.”

Companies continue to maintain health plans into the pandemic’s third year 

During the second year of the pandemic, area businesses continued to steer away from making large changes to their health plans while trying to minimize increasing benefit costs for employees. 

This month, the Lancaster-based Central Penn Business Group on Health (CPBGH) released its annual Healthcare Benefits Survey. The survey features participating employers from 86 companies spanning Adams, Berks, Cumberland, Dauphin, Lancaster, Lebanon and York counties. 

The survey found that this year that the average cost for health care coverage was slightly lower for single coverage and slightly higher for family coverage, but both individual employees and covered families paid slightly more for their coverage in 2021. 

“We have been watching health care costs increase for the last four decades – everyone is paying more, yet most of the strategies utilized to help control costs have not worked,” said Diane Hess, advisor to and former executive director of the CPBGH. “I do believe though that being in the middle of a pandemic is not the time to make the drastic changes necessary to affect costs and quality, so I do not expect to see major changes in plan offerings or plan costs next year either.” 

The most prominent way to manage cost among the survey’s respondents was increasing employee premiums with 73% of participating companies noting that they had increased employee cost share for coverage. Hess said that for an employer looking for an immediate impact on the company’s bottom line, increasing premiums continues to be an easy to implement option. 

“Strategies such as employee education and plans to improve employee health through wellness initiatives may or may not have the desired impact and you also do not see immediate results,” she said. 

The average out-of-pocket costs for both a single person and a family were up from 2020 with the average out-of-pocket for an individual being $5,723 and $11,559 for a family. 

The average deductible among the survey’s respondents was $2,315 for an individual and $4,608 for a family. Those deductibles were higher among smaller employers and lower among larger employers with over 200 employees. 

Employers also reported an average medical plan cost increase by 5.07% this year and predict a higher rate of increase of 9.2% next year. 

Lancaster-based High Company’s, one of the respondents on the survey and an employer of over 1,500 people, has managed to avoid cost increases on its health plans since 2019, but is looking at a 4% increase in 2022, said Liz Ford, compensation and benefits director at High Company. 

“For us, [cost savings] is really about understanding our data—it’s a lot of small changes that add up over time,” said Ford. “There is no big magic silver bullet for cost savings for us. It’s about being smart about plan design, prescription formulary and educating employees about where to go.” 

The survey’s respondents employ over 26,000 people. 43% of respondents had between 50 to 199 employees, 27% had between 1 and 49 employees and the remaining 30% had over 200. 

A large majority, 96%, of companies with over 200 employees self-insured their plans. For High, this allows the company to have better access to employee health data. It also means that it is up to the company to educate employees on how to save on out-of-pocket expenses. 

“Like all employers, our deductibles have gotten higher,” said Ford. “Being self-funded, it’s about making them aware of the things they can do to reduce expenses. We communicate to them to get their lab work done in an independent lab and use more virtual care.” 

Highmark, Capital Blue Cross offer new products for Medicare Advantage shopping period 

Area insurers have rolled out their Medicare Advantage (MA) plans for 2022, boasting a wide range of offerings for a growing base of Medicare beneficiaries seeking new options in the space. 

This month, Capital Blue Cross and Highmark Blue Cross Blue Shield both launched products for the MA shopping period between Oct. 18 and Dec. 7.  

MA plans, also known as Part C coverage, are offered by Medicare-approved private companies and are generally split into Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. 

Member feedback from last year’s cycle showed that Medicare beneficiaries are interested in more flexible over-the-counter benefits as well as all-in-one plans offering supplemental benefits such as flexible debit cards for over-the-counter supplies, said Mike Londre, director of marketing for government programs at Harrisburg-based Capital Blue Cross. 

“We are always listening to our members and the communities we serve to identify ways to enhance and improve our products to best serve them and help improve their health and well-being,” said Londre. “Member service expectations also have increased, and we continue to meet those expectations. Many Medicare beneficiaries prefer a local, community-focused health plan like Capital Blue Cross headquartered near them and with local member services.” 

For Pittsburg-based Highmark, this year’s MA rollout was themed around variety, something that the insurer heard loud and clear from its beneficiaries this year. 

“People wanted more options,” said Ellen Galardy, senior vice president of consumer market strategy and senior products for Highmark. “I wonder if they wanted to feel like they were back in the driver seat after COVID took so much choice from us.” 

Highmark’s 2022 MA products in the Midstate include $0 premium Community Blue Medicare HMO plans with $0 specialist copays, and a $0 premium Community Blue Medicare PPO Signature plan with a $22 Part B premium buy-back. 

The Part B buy-back, first piloted in Lancaster for the past two years, is now being expanded to Dauphin, York and Adams counties. Through the plan, beneficiaries are refunded part of what they pay for the product, which equates to $22 a month. 

“We found two primary audiences for the plan. Someone who explored zero-dollar options in the past and is looking for a plan that balances their monthly income budget,” said Galardy. “The other group are first turning Medicare eligible; your retirees looking to transition into a plan.” 

Highmark has also seen the importance of expanding its plans to services that don’t normally fit as a Medicare plan, such as its “pop-up house” benefit, given to Freedom Blue standard and deluxe plan members. The plan gives beneficiaries a certain number of hours for non-medical care at home. 

Both Highmark and Capital Blue Cross expanded options for beneficiaries with diabetes. Highmark  moved its diabetic testing supplies, such as test strips, to its zero-dollar plans and is now offering Onduo, a diabetes management program to beneficiaries on all plans. Capital Blue Cross’ BlueJourney MA products now include a Part D insulin saver program with monthly supply copays as low as $5. 

Capital Blue Cross’ plans for 2022 include a $0 premium HMO, a $0 premium PPO and a $19 premium PPO. The insurers’ new products for 2022 are expected to enhance quality of care, reduce costs and provide greater access to doctors and hospitals through a new partnership with WellSpan Health. 

Capital Blue Cross announced in September that it would be collaborating with the York-based hospital system to increase access for beneficiaries in Adams, Cumberland, Franklin, Lancaster, Lebanon and York counties. 

“Capital Blue Cross has built a trusted reputation in part by offering our members access to high-quality healthcare they know and feel comfortable with,” said Capital Blue Cross President and CEO Todd Shamash. “We are proud to partner with WellSpan in this unique manner. WellSpan is a natural fit with our member-focused approach to Medicare coverage – providing quality, affordable care coupled with peace of mind and friendly, local service.” 

Pa. resumes COVID-19 unemployment compensation, good news for gig and self-employed workers

Following a gap in benefits after the federal government delayed approval of December’s COVID relief and government funding bill, the state Department of Labor & Industry announced it can now resume payments for its temporary federal unemployment programs.

That means L&I will resume payments for both the Pandemic Emergency Unemployment Compensation and Pandemic Unemployment Assistance programs starting this week. Late last month the department announced that more than 509,000 workers in the state could see gaps in their unemployment assistance payments as it awaited guidance and approval from the federal Department of Labor.

On Friday, L&I said it resumed payments through the PUA program and would begin accepting filings for 11 claim weeks on the same day.

The PUA program provides unemployment compensation for workers who lost their jobs during the pandemic but are not typically eligible for unemployment compensation, such as gig workers, freelancers and self-employed workers.

“We know that more than 400,000 Pennsylvanians and their families are relying on these PUA benefits to get through this terrible pandemic and have worked as quickly as possible to complete the implementation and resume payments,” said Jennifer Berrier, acting secretary for the department.

On Saturday, L&I also announced that it would resume payments through the PEUC program beginning Sunday, with claimants able to file for an additional 11 claim weeks on the same day.

PEUC provides additional claim weeks to workers who have exhausted their regular unemployment compensation benefits.

“Since receiving the information we needed from the federal Department of Labor two weeks ago, L&I has worked as quickly as possible to update our processing system so PEUC claimants can resume filing for benefits,” said Berrier.

Employers, have you reviewed your retirement plan lately?

Employers who aren’t giving their retirement plans as much attention as their health plans could be missing vital benefits when it comes to finding new employees.

Providing the right health plan to employees is important and scrutinized on every level but when it comes to retirement, employers need to be just as diligent ensuring that benefits grow alongside employees, said Steven Maher, partner and senior wealth adviser at Hanover-based Domani Wealth.

Steve Maher, partner and senior wealth adviser at Domani Wealth. PHOTO PROVIDED

It is not uncommon for clients to visit Maher with plans for retirement, only for him to have to tell them that they will need to work full-time jobs into their 70’s to fund it.

Today, employers have more tools than ever to ensure that their staff save what they need to be ready for the day they retire– it just may take an employer to benchmark their plans and be sure that they are keeping up with the marketplace to do so.

“Employers need to focus both on what they provide today and what that employee’s situation will look like in 20 to 50 years,” he said. “You want your employee looking in the mirror and thanking the organization for providing the tools and resources to have a successful retirement.”

If someone hasn’t updated their retirement benefits in some time, Maher said they may not realize just how many benefits that were once seen as high end offerings for Fortune 500 companies, are now within reach for most employers.

401(k) plan features such as automatic escalation and enrollment allow employers to automatically deduct elective deferrals from wages and increase an employee’s contribution amount to a set percentage every year.

Maher also recommends offering financial wellness programs in concert with financial advisers, opening the workplace up to conversations on savings, saving for college and general holistic financial needs.

“With a lot of the tools available, you can be a small business in central Pennsylvania and have the same bells and whistles as some Fortune 500 companies,” he said.

The financial adviser said that he has yet to see many of his clients need to suspend their 401(k) matches as a result of the COVID-19 pandemic. If an employer is looking at the possibility they cannot continue offering their benefits, he recommends talking to a third-party administrator before making the decision.

“There may be a way to delay or suspend your match and not necessarily completely get rid of it,” he said. “With a 401(k), it can be complex in how you match and there are different ways for you to suspend that match.”