FEDlogic's June Newsletter

Changes for High Deductible Health Plans in 2025, FAQ's for HR, and Benefits for Same-Sex Couples

Changes to High Deductible Health Plan Creditable Coverage Status for 2025

With the advent of significant changes to Medicare Part D in 2025, many high-deductible health plans (HDHPs) may no longer meet the requirements for creditable coverage. This shift necessitates proactive measures from employers to ensure their Medicare-eligible populations are informed and prepared.

Understanding Creditable Coverage

Medicare Part D, the prescription drug benefit, mandates that individuals maintain "creditable coverage"—insurance that is expected to pay, on average, as much as standard Medicare prescription drug coverage would. Employers must annually disclose whether the plans they offer meet this standard. If a plan loses its creditable status, employees might face penalties unless they enroll in a Part D plan.

2025 Medicare Part D Changes

The Inflation Reduction Act of 2022 introduced several updates to Medicare Part D aimed at reducing prescription drug costs. One of the pivotal changes for 2025 is the reduction of the maximum out-of-pocket cost to $2,000, which is significantly lower than the 2024 limit of $8,000. This reduction raises the bar for what qualifies as creditable coverage, potentially disqualifying many HDHPs.

For 2025, the IRS has adjusted the limits for HDHPs and Health Savings Accounts (HSAs) as follows:

HSA Contribution Limits: $4,300 for individuals with self-only HDHP coverage (up from $4,150 in 2024) and $8,550 for family HDHP coverage (up from $8,300 in 2024).

HDHP Minimum Deductibles: $1,650 for self-only coverage (up from $1,600) and $3,300 for family coverage (up from $3,200).

HDHP Out-of-Pocket Maximums: $8,300 for self-only coverage (up from $8,050) and $16,600 for family coverage (up from $16,100).

These adjustments, while beneficial for maintaining HDHP and HSA advantages, might not suffice to keep these plans creditable under the new Medicare Part D standards.

What Should Employers Do?

Employers must notify Medicare-eligible employees about their plan’s creditable status by October 15 each year. Given the impending changes, it’s crucial to:

Assess and Determine Creditable Coverage: Employers should evaluate their current plans using either the actuarial determination method or the simplified determination method, which CMS has retained for 2025. Note that future guidance will clarify whether the simplified method will be available for 2026.

Update Employee Communications: Clearly inform employees about their plan's status and the potential penalties for not enrolling in a creditable Part D plan. This is especially important for those covered under non-creditable plans, such as certain HDHPs.

Consider Plan Adjustments: If necessary, modify plan offerings to maintain creditable coverage status or provide additional options that meet the new requirements.

Adhere to Medicare Secondary Payer (MSP) Rules: Ensure that any communications or incentives comply with MSP regulations, which prohibit employers from encouraging employees to opt out of employer-sponsored plans in favor of Medicare.

Consult with FEDlogic Experts: Referring affected employees to FEDlogic to consult with an expert can be highly beneficial. FEDlogic experts can help employees understand all their options, navigate the application process for Federal and state benefits, and ensure they make informed decisions about their healthcare coverage.

The 2025 changes to Medicare Part D present significant implications for HDHPs and other employer-sponsored plans. By staying informed and proactive, employers can help their Medicare-eligible employees navigate these changes and avoid unnecessary penalties. As the healthcare landscape evolves, clear communication and strategic planning remain vital to maintaining compliance and supporting employee well-being. FEDlogic is here to serve as an extension of your HR team to help your employees understand and navigate their Federal and state benefits options.

Hot Topic: Benefits for Same-Sex Couples

On June 26th, 2015, the U.S. Supreme Court issued its landmark ruling in Obergefell v. Hodges, granting same-sex couples the constitutional right to marry nationwide. This decision ensured that same-sex marriages are recognized across all states and U.S. territories. Additionally, the ruling extends to certain non-marital legal relationships like civil unions and domestic partnerships. Consequently, the Social Security Administration (SSA) now acknowledges same-sex marriages and some non-marital legal relationships, including those established abroad, when assessing eligibility for Social Security benefits, Medicare, and Supplemental Security Income (SSI) payments.

Why Does Marital Status Matter?

Marital status is crucial in determining entitlement to various Social Security benefits, including disability, retirement, survivors, Medicare, and SSI. A worker or their spouse could qualify for benefits or a higher benefit amount based on their marital relationship. Additionally, children or stepchildren might be entitled to benefits based on their relationship to the worker. However, for some surviving spouses, divorced spouses, and adults who developed a disability during childhood, benefits could end if they marry. Marriage can also affect SSI eligibility or payment amounts.

Survivor’s Benefits for Same-Sex Partners and Spouses

More surviving same-sex partners may now qualify for Social Security survivor’s benefits. If an individual was in a same-sex relationship with a partner who passed away, the surviving partner may qualify for benefits based on their partner’s record. Partners and spouses may qualify for survivor’s benefits if:

  • They would have been married at the time of their partner’s death if state laws hadn’t prevented them from doing so, or

  • They would have been married longer if not for unconstitutional state laws that prevented them from marrying earlier.

Benefits for Family Members

Family members may also be entitled to benefits when a worker starts to receive Social Security retirement or disability benefits. For example, SSA can pay benefits to a spouse, unmarried minor children, or children with disabilities. If a worker becomes the parent of a child (including an adopted child) after they begin receiving benefits, they should report this life-changing event to SSA to ensure the child receives benefits if they are eligible.

Supplemental Security Income (SSI)

SSI is a federal program that provides monthly payments to people with limited income and resources. The law requires regular reviews of cases to ensure recipients receive the correct payment amount and continue to be eligible. Social Security considers marital status when determining eligibility and payment amounts for SSI. Applicants and recipients must report any marriage, separation, divorce, or death that could affect eligibility or payment amounts. A spouse’s income and resources may count when determining eligibility and SSI payment amounts. A married couple in which both spouses are eligible for SSI and live in the same household would receive a couple’s benefit amount, which differs from the amount paid to two individuals.

Changes in the number of people in the household, including children, can affect an SSI payment, potentially resulting in a higher payment. Therefore, it is important to report changes promptly.

FEDlogic offers consultations that are unlimited, confidential, and free for up to 24 months after employment ends. A consultation with one of our experts can help you navigate and understand the process. All FEDlogic experts provide unbiased guidance and support as you explore your eligibility for benefits. Every situation is unique, and we assure each individual that they will be treated with compassion and respect. By staying informed and proactive, employees can ensure they receive the benefits to which they and their families are entitled.

New Client Spotlight: Martin Automatic

FEDlogic is proud to feature Martin Automatic as one of our newest client partners.

Martin Automatic, Inc. is a leading designer and manufacturer of equipment for the printing services industry. Martin Automatic is headquartered in Rockford, Illinois, and was founded in 1968. Since then, they have grown into a 160,000-square-foot manufacturing and office building complex and continue to grow their team. They are proud of their dedication to their loyal employees and their ability to serve their customers with integrity.

Thank you for placing your trust in FEDlogic. We look forward to serving your families.

Check out the FEDlogic LinkedIn page for this and all new client features.

Frequently Asked Questions from HR

Often, the folks in Human Resources are the first ones to know about the situations employees and their families are facing in which FEDlogic can help. We appreciate the education our HR contacts provide to employees and their household members. We frequently receive questions from our HR partners about best practices for making successful referrals to FEDlogic for consultations. Those questions and their answers are below.

  1. Which Topics Can FEDlogic Help With?

FEDlogic can help with many more topics than just Medicare for an employee or dependent turning 65. There are so many public benefits that the majority of people do not know even exist. FEDlogic can help with:

Retirement Benefits
Survivors Benefits for Spouses, Divorced Spouses, and Children
Disability Benefits
Benefits for Children with Disabilities, Including Disabled Adult Children
COBRA Alternatives
Medicaid
Medicare
Tribal Benefits
Veterans Benefits
Healthcare.gov
And More…

  1. Who Should I Refer for a Consultation with a FEDlogic Expert?

FEDlogic is available to all employees of the client’s organization, whether they are full-time, part-time, seasonal, temporary, or contracted. Additionally, FEDlogic is also available to their entire household, whether or not it is a family unit, a multigenerational household, or roommates. As long as they reside at the same address as an employee of the client, they can access FEDlogic.

  1. How Should I Refer an Employee for a Consultation?

We want referrals to FEDlogic to be easy. Employees can learn about how FEDlogic can help and how to contact us through FEDlogic employee flyers placed in common areas and break rooms and posted to employee benefits portals. Referrals can be made through conversations with employees and their family members in the HR office and by providing a flyer with contact information. They can even be made by HR directly through our HR-specific email address, [email protected], when the employee prefers an expert to make the first call.

To request a consultation in which FEDlogic will make the first call, we will need:

  • The employee/household member’s full name, phone number, and email address.

  • A brief description of the topic the employee or household member would like to discuss.

  • Written verification that the employee or household member has expressed interest in speaking with a FEDlogic expert and that they are expecting the call.

It is critical that the employee or household member knows an expert will be reaching out and wants to have a consultation. Contacts without their consent are usually not successful and result in the employee believing the expert is a telemarketer or scammer, making it harder to regain the trust and credibility necessary to help them.

  1. Do I Need to Be on the Call with the Employee or Household Member?

No. HR doesn’t need to be on the call with the employee unless they prefer it. Most of the time, the employee or household member is most comfortable speaking with an expert alone or with a spouse or family member.

  1. Can I Call FEDlogic on Behalf of an Employee?

HR may absolutely contact FEDlogic to learn more about a benefit or program or to ask if a specific situation would be appropriate to refer for a consultation. However, we do recommend that the employee or household member consult with the expert directly instead of having the information relayed through HR. It saves time and prevents detailed and specific information from being relayed incorrectly.

  1. Can FEDlogic Give Me Details about an Employee’s Consultation?

While FEDlogic consultations are confidential, we can share a list of the employees at the client organization who have had consultations with FEDlogic experts. FEDlogic will not divulge the details of a consultation without the consent of the employee or household member.

  1. How Long Do Employees Have Access to FEDlogic?

Employees and their household members have access to FEDlogic for up to 24 months after their employment ends. While that may sound like a long time, that time frame allows us to help employees and household members navigate alternative options to COBRA and the process of applying for Disability benefits, which can take months before a decision is received.

FEDlogic’s Monthly Webinar Series

Join us on the last Wednesday of each month at 1:00pm CST for our monthly webinar series. Our webinars are designed to provide your employees with valuable insights and knowledge on various topics related to Federal and state benefits.

June’s webinar includes an overview of Federal benefits, how FEDlogic can help, and an in-depth feature on Retirement and maximizing benefits.

We explore a different topic nearly every month. Don't miss this opportunity to learn about the FEDlogic experience with your employees and teammates. For those unable to attend the live sessions, the webinars are recorded and available to access through the employee resources page on our website.

Register now and secure your spot for our upcoming webinars in 2024 by clicking on the image below!

Contact Our Service Team

By Phone
877-837-4196

Business Hours: 8:00am-5:00pm Central Time, Monday through Friday

Voicemails and emails received during non-business hours should be returned within 36 business hours.

HR Assistance Inbox
[email protected]

Contact Our Operations Team

For a Proposal
[email protected]

Engagement Opportunities
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DISCLAIMER: The information, education, and advice provided by FEDlogic, LLC (“FEDlogic”) shall be intended for educational purposes only. Each individual’s circumstances are inherently different from those of another, and therefore, the advice given to an individual may result in unintended consequences to another. The information provided by FEDlogic shall not constitute legal, financial, or accounting advice and further shall not be interpreted as advice from the Federal government. While FEDlogic makes every effort to ensure that the information provided by its consultants is up-to-date, useful, and accurate, FEDlogic makes no guarantees and may not be held liable nor responsible for any inaccuracy or detrimental consequence resulting from the information provided. Notwithstanding the foregoing, any errors or omissions discovered by FEDlogic, its agents, or its customers will be addressed and resolved as soon as possible.