health insurance

Your Medicare Update

By Mary Krueger, Medicare Specialist

It’s early 2024 and its already time to explore Medicare options for 2025. Many Medicare enrollees want to look at what is suitable for their needs in the Medicare market. If you have started looking for yourself or someone else, there are many different ways to procure coverage. Let’s explore some ideas for the 2025 Medicare Advantage programs that are being considered by medicare.gov.

Medicare Advantage

One of your options is the Medicare Advantage program. Insurance companies have slightly different copays and out-of-pocket maximums, so it’s very important to look at those. Additionally, some of your coverages are limited to in-network clinics and hospitals. Out-of-network procedures may require you to pay more or all of the bill. This is why it is critical to understand what your plan covers. Medicare pays the insurance companies for your care, so you do not need to show your Medicare card to the provider, you only need your insurance card.

Medicare Supplement (Medigap)

Your other options are the Medicare Supplement (also known as Medigap) policies which do not have networks. This seems to be the most popular option with our members with plans written through WisMed Assure. The freedom to choose where you get care (as long as the facility accepts Medicare) has been a very important benefit for those who are semi or fully retired.

Losing coverage

If you are age 65 or older, you have a right to guaranteed issue within 63 days of when you lose or end certain kinds of health coverage. When you have a guaranteed issue right, companies must sell you a Medigap policy at the best available rate, regardless of your health status, and cannot deny you coverage.

Choosing to enroll

Under federal law, you get a 6 month “Medigap Open Enrollment” period. It starts the first month you have Medicare Part B and you’re 65 or older.

Disability eligibility

Options are also available for those under age 65 who are eligible for Medicare because of a disability.

We are here to help you. Contact our Medicare Specialist Mary Krueger at 715.760.1350 or contact the WisMed Assure team at insurance@wismedassure.org, complete this quick online form or call 608.442.3810 for help with your insurance needs.

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

Peace of mind this holiday season

By Martin Hurst, Insurance Service Representative

The agents here at WisMed Assure do not focus solely on revenue, our agents go that extra mile to address individual and specific concerns and provide coverage within each customer’s budgetary needs. By putting clients’ needs first, our agents demonstrate their commitment to providing excellent service and building trust with physicians. Their expertise and attention to detail enables them to guide physicians through the complex world of insurance, explaining terms, conditions and benefits clearly and transparently. Ultimately, our agents strive to empower physicians with the knowledge and coverage necessary to protect their health and peace of mind.

As I navigate my first year here at WisMed Assure, the agency has prioritized providing me with direct training with our agents. Tom Strangstalien is one of the agents I have had the opportunity to sit down with to discuss Life and Disability policies. Recently, Tom and I reviewed disability quotes for a physician. Tom carefully considered the physician’s lifestyle, occupational practice and potential risks to tailor the policy to their unique needs.

Additionally, he broke down the various policy options, highlighting the specific benefits and limitations of each. He focused on the importance of comprehensive coverage that would provide adequate support if the physician ever faced a disability, without worry of the financial burden. After reviewing the quotes for this physician, he noted that the physician was concerned the monthly premium was exceeding their budget. This was to be expected as their initial meeting was to create the “ideal policy” without worrying about the premium cost. With this concern in mind Tom navigated to the riders page with the cost for each listed next to the rider and asked what I would keep or remove from the policy to reduce the overall cost. We went back and forth on keeping or removing certain riders, we looked at 90- or 180-day elimination periods, possibly decreasing the time covered in relation to retirement age of 65 or 67, to see the impact this would have on premiums. At the end of our meeting, we were able to give this physician several options that had the potential of saving them $4,000 in monthly premiums. This is an example of what each agent does here daily and is the reason I am grateful to work alongside so many unique and caring individuals.

As you’ll see in this edition of the Antidote, the WisMed Assure and WisMed Financial team is focused on building and maintaining relationships with clients, and always keeping the best interest of the client at the center of all we do. These real client stories help illustrate the WisMed difference. Contact us at 608.442.3810 or insurance@wismedassure.org.

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

Helping clients with strategies, not just quotes

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Chris Noffke

Managing the costs of employee benefits while still providing robust resources for your employees can be a challenge. If your insurance agent just gives you a few quotes to compare, you might not be getting the best plans for your team.

Recently, my team and I met with a health care clinic that offers benefits for employees and has been struggling with rising premiums. Their agent had been showing them health insurance quotes, but not looking at strategies to reduce costs. We were able to find an option for them that saved almost $20,000 without reducing benefits for their employees. By using unique funding options, we were able to reduce overall premium costs without increasing costs for employees.

As the Wisconsin Medical Society’s insurance agency, WisMed Assure is a niche insurer specializing in insurance for health care professionals. Our team understands cybersecurity needs for health businesses, medical professional liability coverage and exactly how a disability insurance policy needs to be written for a physician. And we have unique contracts available only to our clients.

To illustrate the power of the niche programs we have built for WisMed clients and members, we recently worked with a small healthcare practice that received a group disability quote from another agent with a 4% reduction in renewal pricing. That may have looked good on the surface, but with the same top insurance carrier, due to WisMed Assure’s volume and relationship, we were able to offer a 5% decrease with a 3-year rate lock. The savings to this client in working with WisMed Assure was substantial.

When you work with us, you’re not alone in the insurance process. We’re hands on and help you with:

  • Open enrollment materials
  • Benefits booklets
  • Claims and payment issues
  • Help you use your money more wisely

Don’t deal with the average agent, talk to a professional dedicated to physicians. Please email me at chris.noffke@wismedassure.org or call 608.442.3734.

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

Making Part D of Medicare brighter

By Mary Krueger, Medicare Specialist

As many of you on Medicare know, October 15 to December 7 is the Annual Election Period for Medicare Part D and Medicare Part C (Medicare Advantage). This often coincides with a flurry of research needed and concerns expressed by client recipients and this year was no exception.

For many, a prescription drug deductible is an easy choice, but the issue of very expensive prescriptions is a familiar plea. Therefore, searching for solutions is top priority.

One of those requests came from a physician and his wife who had vastly different prescription needs. One was taking a simple generic drug that would not meet the deductible but the other needed to find a way to reduce the cost of their estrogen cream and heart medication.

In this case, the best option was prescription discount cards (GoodRx and SingleCare) along with their Medicare Part D plans. These discount cards are a great way to research costs online to find more economical ways to get prescription medications. In this case, the savings amounted to more than $72 per month on one and $31 per month on the other medication.

Additionally, I assisted a family that saved more than $8,210 in a year for experimental MS drugs using a discount card.

Free discount cards have been a great help for many of my customers and are worth exploring in addition to the Part D plans. Not only can these cards help you personally, but they can be a great resource for your patients.

If you need assistance with your Medicare choices, let me know. We are here to help you! Contact Mary Krueger at 715.760.1350 or mary.krueger@wismedassure.org.

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

Innovation and improvements 

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Chris Noffke

June marked my eighteenth year in the insurance industry; my entire career has been focused on employee benefits and helping clients save money and improve employee confidence in benefits. When I was asked to join the WisMed Assure team, I was given the chance to be innovative and truly build something the way I felt it should be and that’s exactly what my team and I are doing!

When I was hired in 2016, I was asked to help strengthen our employee benefits programs and services. At that time, we did not offer many services, nor did we provide a lot of in-depth consulting regarding health insurance. Now we have launched a new pooled Dental insurance plan with Delta Dental of Wisconsin, a pooled disability plan, an association health plan with WPS and The Alliance and added a dozen new services and assessments. We continue to add services and programs to provide the best coverage for our clients.

I am very excited to announce our next innovation. WisMed Assure will be adding a second Association Health Plan eligible for all health care companies in the Madison/Dane County area. Our new Association Health Plan will offer Group Health Cooperative (GHC) of South-Central Wisconsin as the insurance carrier, providing access to GHC clinics and all the UW Health clinics in Dane County plus UW hospital. This benefit offering will be available starting on September 1, 2023. We are proud to have an additional plan option that will better serve our clients in Dane County and surrounding areas.

This option provides HMO rates to our members and those of the health care community. If you’ve ever thought, “We’re a low utilizing group, we don’t really use our health care,” this is a great opportunity to explore. These plans are medically underwritten and can provide a glimpse into your company’s utilization.

If you would like to see how our rates look, please email me at chris.noffke@wismedassure.org or call 608.442.3734. Wishing you the best of your remaining summer!

Note: This article is for informational purposes only and should not be considered as insurance advice related to your specific policy or situation. Please consult with a qualified insurance advisor or professional before making any policy decisions. Full disclaimer and contact information.

WisMed Assure can assist you with your Medicare decisions

By Mary Krueger, Medicare Specialist

Many Medicare eligible participants are familiar with Medicare, but the process is confusing to them so we’re here to assist you with those issues. Here are the answers to some common questions.

Do I need to sign up for both Part A and B or just Part A? 

Whether you choose Part A, B or both depends on the plan you’re on, the benefits you’re looking for and if you have any spend down accounts that can be used. Checking all your options will save you money and find the coverage that suits your needs.

Is it really necessary to get a prescription drug program or can I skip it because I don’t use any prescriptions?

Great question! Even if you do not use any prescriptions, you are required to obtain credible coverage for prescription coverage. Without it, you will acquire a lifetime penalty.

I am already on a Medicare program. Is there any help you can give me?

Yes! We compare your coverages and costs. Perhaps you’ve moved and your new address has a favorable discount or you have increased needs for prescriptions; these issues and others are addressed either during your open enrollment period each fall or at your renewal. We do the shopping for you!

Click here to learn about income related monthly adjustment amount (IRMAA).

For help with your Medicare questions, contact Mary Krueger at 715.760.1350 or mary.krueger@wismedassure.org.

Winter 2023 Issue

Long-term care insurance – but what if I don’t need it?

By Tom Strangstalien, Insurance Advisor

We all know the risks of a long-term care event devastating our family’s finances as well as our mental and personal well-being. Roughly half of those who reach the age of 65 will require some form of long-term care assistance during their lifetime.

Read more…

Rising health insurance premiums

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Health insurance premiums are constantly on the rise. According to the Centers for Medicare & Medicaid Services, “U.S. health care spending grew 2.7 percent in 2021, reaching $4.3 trillion or $12,914 per person.” Everyone from employees to employers are feeling the squeeze of high-cost premiums.

Read more…

Exercise your financial muscles to get financially fit

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

“Those who work their land will have abundant food, but those who chase fantasies have no sense.” This ancient advice from Proverbs illustrates the importance of financial fitness.

Read More…

Medicare questions to ask

By Mary Krueger, Medicare Specialist

Before enrolling in Medicare, there are several decisions Medicare recipients need to make regarding their existing coverages or changes in their health insurance needs.

Read More…

Small business claims that can be surprisingly expensive

By Society Insurance Human Resources, reposted with permission from Society Insurance

While running a small business, there’s a decent chance that throughout its course you’ll have to file some sort of insurance claim (often unexpectedly). Whether due to fire, theft, on-site injury or other incident, some experts estimate that 75% of small businesses faced an insurance-worthy incident just last year.

Read more…

Medicare questions to ask

By Mary Krueger, Medicare Specialist

Before enrolling in Medicare, there are several decisions Medicare recipients need to make regarding their existing coverages or changes in their health insurance needs.

Typically, six months prior to becoming eligible (eligibility for Medicare may be because of disability or turning 65), it is a good idea to speak with a Medicare Specialist to establish an open dialog about what you want in your benefits and how much of your budget to designate for it.

Here are a few questions:

  • Will I be in a network or have the freedom to choose where I go?
  • What are the benefits of choosing a Medicare Advantage or a Medicare Supplement?
  • Who will help me if I have a claim and don’t understand the billing?
  • Will I need to get preauthorization for my surgery?

These are a few of the concerns that are voiced regularly. Medicare has been providing coverage since 1965. Plans have changed over the years and so have the benefits, which is why it makes sense to have someone who can walk you through these and many other issues with Medicare.

I have enjoyed helping in those decisions for more than 40 years, and it is my pleasure to assist in the decisions Medicare recipients make. Contact me at 715.760.1350 or mary.krueger@wismedassure.org.

Rising health insurance premiums

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

Chris Noffke

Health insurance premiums are constantly on the rise. According to the Centers for Medicare & Medicaid Services, “U.S. health care spending grew 2.7 percent in 2021, reaching $4.3 trillion or $12,914 per person.” Everyone from employees to employers are feeling the squeeze of high-cost premiums. As rising premiums keep employers frustrated, benefits-users are also enduring less and less being paid by insurance. Business owners are having to make decisions like sacrificing benefits to save money on premiums to afford higher wages. Many employers are asking if they should self-fund. 

Having a really big company with lots of the employees covered by the health plan means these employers have more money being paid into the premium pools – the basic rule of large numbers. In Wisconsin, any group with more than 50 employees is considered a large group and is not qualified for the Affordable Care Act marketplace plans. While companies with as few employees as 50 may qualify for a self-funded benefit, it could also be a liability that causes a business bankruptcy. An employer can hedge their premium dollars against only having a few high-cost health care claims per year. These same strategies don’t work for smaller companies, because they may not have many employees enrolled in the health plan (especially if the employer contributions are too low) which means they have even fewer premium dollars to cover when their work family does have a high-cost claimant(s).

For example, if a smaller group (50 employees for this scenario) has a high-cost claimant who costs $50,000 a year, that means a lot of your collected premiums are needed just to cover this one claimant. Assuming an average employee premium of $1,000 a month per employee (averaging employee and family), your employer premiums are $50,000 a month ($600,000 a year). That means one employee used one-twelfth of your premium funds.

In our example we have only covered $50,000 in claims and we still have 49 remaining insureds who may each spend the $12,914 average. The math, 49 persons at $12,000 means $588,000 potential you may have to pay. This is not yet taking into account that there are multiple people in your employee’s families who may have claims.

It is not just claims you pay for when you are self-funded, you are also responsible to pay for a selected insurance company or third party administer (TPA) to process your groups’ claims, your use of a network for discounts, a pharmacy benefit manager, stop loss insurance, Patient-Centered Outcomes Research Institute (PCORI), terminal liabilities, aggregate accommodations and other administrative costs just to name a few.  This all may not make sense yet or it might sound like another language. Just let me know and we can talk. Give me a call at 608.442.3734. While true self-funding may not be the best answer for your company, utilizing strategies, other funding arrangements and even our association health plan may be a solution.

Fall 2022 Issue

Affordability testing

By Chris Noffke, GBDS, CSFS, Vice President of Employee Benefits

The Affordable Care Act (ACA) brought a lot of extra work to employers and insurance companies. Whether you are pro-health care reform or against it, per the Health Affairs article, the ACA has not made insurance more affordable.

Read more…

Don’t forget to call your mom – and your insurance agent

By WisMed Assure Service Team

With the intention of easing administrative burden for WisMed Assure client physicians, several of our Medical Professional Liability carriers have significantly reduced or suspended asking for renewal applications over the past few years. While this does save time, renewal applications were an opportunity to touch base, review and discuss any changes to your practice that could impact your premium or coverage.

Read More…

Year-end tax planning for 2022

By Mark Ziety, CFP®, AIF®, Senior Advisor, WisMed Financial

Want to put thousands of dollars back into your pocket? Who doesn’t. Choices you make during your employer’s open enrollment period and for year-end tax planning can really add up.

Read More…

Graded premium disability? Yes, you can!

By Tom Strangstalien, Insurance Advisor

I recently worked with a young physician to set him up with personal disability protection to provide some financial security if life throws him and his family a curve ball. Prompting our planning was that one of his peers in the general surgery specialty sustained a serious hand injury, ending his ability to perform hands-on surgery.

Read more…

5 ways to develop inclusive hiring practices

By Society Insurance Human Resources, reposted with permission from Society Insurance

Inclusive hiring practices recognize diversity and embrace a wide range of perspectives that candidates from all walks of life bring to the organization. And according to research from Monster, “Four in five (86%) candidates globally say diversity, equity and inclusion in the workplace is important to them.”

Read more…