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Benefits

5 Commonly Misunderstood Benefits

5 Commonly Misunderstood Benefits

HSA or FSA? Is Medicaid the same as Medicare?

Should I get pet wellness or pet insurance for my fur baby?

Benefits are crucial for both you and your family, but with so many options it’s often hard to choose which benefits offerings are best for you and your family. Some benefits might seem similar but offer different things for different situations.

Our 2024 Employee Benefits Survey revealed that nearly 40% of employees understand their insurance slightly, or not at all. Good news: 81% said knowing more about their coverage leads to feeling highly satisfied.

While you can certainly learn more by reading our extensive Summary Plan Description (SPD) document, below is high-level information on select benefits topics that can be commonly misunderstood.

  • HSA versus FSA
  • Pet wellness versus pet insurance
  • What a pharmacy benefits manager is
  • What the Family and Medical Leave is used for and when to use it
  • Medicare versus Medicaid

HSA versus FSA

Let’s first look at these acronyms. HSA stands for Health Savings Account while FSA stands for Flexible Spending Account. If you’d like a deeper dive with more details and exact differences between these two savings accounts, be sure to read this article.

While both accounts allow for contributions that can be used for medical, vision, or dental expenses, there are some unique differences, such as:
(For this example, we’ll be discussing aspects of Health Care and Limited Purpose FSAs)

  • HSAs allow you to roll over any funds you have from year to year and never expire.
  • You can use an HSA as an investment option, helping to grow your balance tax-free.
  • You can keep an HSA, regardless if you change jobs, health plans, or even retire.
  • FSAs aren’t tied to a particular health plan, unlike HSAs.
  • Your funds are immediately available with an FSA
  • FSAs are available for health plans that don’t offer high-deductible options.

These are just some of the options offered but again, there’s so much more that goes with each of these. Be sure to take a moment to read the deeper-dive article linked above.

Pet Wellness versus Pet Insurance

Many of us have furry little family members. And just like a family, you want to make sure they’re able to live a healthy and long life. This is where pet wellness and pet insurance come in, though to the uninformed, it can feel tricky to know which one offers the best options for coverage. So, let’s break down what each of these are:

  • Pet wellness refers to, as the name states, the wellness of your pet. Plans usually cover routine wellness exams, vaccines, preventing harmful parasite infestations, and blood tests.
  • Pet insurance covers things like unplanned vet visits and expenses, such as accidents or sudden illnesses.

Essentially, pet wellness focuses on prevention while pet insurance focuses on treatments for illnesses or injuries. Our friends at Wagmo offer coverage for your four-legged furry family members available during Open Enrollment, or whenever you adopt or purchase a new pet. Plus, ADP TotalSource® client employees (that’s you!) get preferred pricing. Be sure to check out their options here.

What is a pharmacy benefits manager?

Depending on your medical plan carrier, you may be enrolled in something called a pharmacy benefits manager, or PBM. A PBM is a service that helps manage your prescriptions. Their main goal is to help optimize the coverage and affordability of prescription medications.
PBMs can help:

  • Remind you of an upcoming refill.
  • Request a refill from your doctor.
  • Pharmacies and doctors initiate medication requests, such as prior authorizations or vacation refills.

Different PBMs can offer different services, so it’s important that you review their paperwork when you receive your benefits packet. Log-in to your medical carrier’s member services website or app for more information.

What is FMLA, and when do I use it?

When a person experiences the loss of a family member, it’s common for them to be offered or take bereavement leave.
But what happens if a family member is going through an illness or is in the hospital? This is where the Family and Medical Leave Act, or FMLA, comes into play. FMLA gives employees up to 12 weeks of unpaid, job-protected leave for specific family and medical reasons. This usually includes:

  • The birth or adoption of a child.
  • Caring for a family member with a serious health condition.
  • Caring for yourself if you have a serious health condition.
  • Coverage for military caregiver leave for a family member in the service.

Certain states do have options when it comes to bereavement overlapping with taking FMLA, especially in the case of a death in the family.

Depending on the reason for your FMLA, it might count as a qualifying life event, or QLE. We have an in-depth article that explains QLEs and what constitutes as one that you can find here.

What’s the difference between Medicare and Medicaid?

You probably know what Medicare is or have a baseline understanding, but Medicaid can sometimes be confused with Medicare. So, what’s the difference between the two?

  • Medicare is a type of health insurance for people 65 and older, as well as those under 65 who have certain disabilities or conditions.
  • Medicaid is a federal and state program that helps to cover medical costs for those with limited income or resources.

Medicaid offers benefits like nursing home care and personal care services that Medicare doesn’t, while Medicare is similar to the insurance you would get from your employer.

If you’d like to learn more about either Medicare or Medicaid, check out either Medicare.gov or Medicaid.gov.

We’ve partnered with Gallagher Alternative Health Solutions so you can get free personalized Medicare advice and enrollment support from licensed advisors. You can request a consultation here.

Where to go if you have benefits questions?

Now that you have more familiarity with some common benefits misconceptions, it’s important that you review which of these benefits work well for you and your family. If you need further help, ADP TotalSource has a variety of ways to learn more, including: