Author: MDG Benefits Admin
2026 Medical Cost Outlook
—
by
PwC’s latest annual analysis forecasts that group health insurance costs will increase by 8.5% in 2026—the third straight year at this elevated trend. This sustained rise means health care expenses are now similar to those seen 15 years ago, after a brief dip post-pandemic. Researchers gathered data from actuaries at 24 major U.S. health plans,…
Medicare Part D: Prescription Drug Benefit
—
by
Medicare Part D is a voluntary prescription drug program available to Medicare beneficiaries. To encourage employers to continue offering prescription drug benefits to Medicare-eligible retirees, Medicare provides an employer subsidy through the Retiree Drug Subsidy (RDS) program. The RDS is available to certain employers that sponsor group health plans providing retiree drug coverage. Eligible retirees…
Benefits 101: A Guide to PPO Plans
—
by
When navigating the world of health insurance, you will likely encounter the term PPO (Preferred Provider Organization). A PPO plan – whether medical or dental – is about balancing the cost and convenience of care. With a PPO plan, you get the flexibility to see a wide range of doctors. You’ll save money by staying…
Medicare Part D Notices Are Due Before Oct. 15, 2025
—
by
Each year, Medicare Part D requires group health plan sponsors to disclose to individuals who are eligible for Medicare Part D and to the Centers for Medicare and Medicaid Services (CMS) whether the health plan’s prescription drug coverage is creditable. Plan sponsors must provide the annual disclosure notice to Medicare-eligible individuals before Oct. 15, 2025—the…
What Brokers Should Be Doing Now to Get Clients ACA-Ready
—
by
How to position yourself as a trusted ACA compliance advisor For brokers and benefits advisors, Q4 planning doesn’t start in October. It starts now. September marks a critical moment in the annual ACA compliance cycle, when employers begin thinking about year-end strategies, benefits renewals, and how to avoid last-minute reporting panic. That makes now the perfect…
Navigating Your Health Plan: A Guide to Your Explanation of Benefits (EOB)
—
by
Ever found a confusing document in your mailbox after a doctor’s visit, wondering if it’s a bill, especially with an “amount you owe” at the bottom? You’re not alone! That document is most likely an Explanation of Benefits (EOB) from your health insurance company. It’s crucial to remember: an EOB is NOT a bill. Think…
Pay-or-Play Affordability Percentage Will Increase for 2026
—
by
On July 18, 2025, the IRS released Revenue Procedure 2025-25 to index the contribution percentage in 2026 for determining the affordability of an employer’s health plan under the Affordable Care Act (ACA). For plan years beginning in 2026, employer-sponsored coverage will be considered affordable under the ACA’s “pay-or-play” rules if the employee’s required contribution for…
Health Insurance Terms You Should Know
—
by
Health care terms, medical bills, and forms can be hard to understand. Here are some common health care terms, and what they mean. Allowed Amount This is the maximum payment the plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.” For example, if you…
Upcoming Changes for Employee Benefits
—
by
Employers will see several changes to their health and welfare benefits due to comprehensive new tax and spending legislation. This includes notable improvements to Health Savings Accounts (HSAs), Dependent Care Flexible Spending Arrangements (DCFSAs), and employer-provided student loan payments, as well as the introduction of some new fringe benefit choices. These updates introduce significant changes…
ACA Update: Enhanced No-Cost Cancer Screenings for Women Coming in 2026
—
by
Big changes are coming to women’s preventive care coverage! Starting with plan years on or after December 31, 2025, group health plans and health insurance issuers must expand their no-cost coverage for women’s preventive care. This expansion includes additional breast cancer imaging or testing needed to complete an initial mammogram, as well as patient navigation…