Medicare Advantage – Total Benefit Solutions Inc

Main Line Health may part ways with Medicare Advantage network in Pennsylvania

November 22, 2024November 22, 2024Loramei Romeo

Main Line Health in Pennsylvania has a long relationship with Cigna Healthcare Medicare Advantage (MA). Unfortunately, negotiation has not been reached between Cigna Healthcare Medicare Advantage and Main Line Health in Pennsylvania, because of this effective on January 1, 2025, Main Line Health in Pennsylvania will not be a part of MA network. Customers have been notified via letter. A new Primary Care Physician (PCP) recommendation will be included to customers who are assigned to PCP from Main Line Health. To change to another PCP customers can contact Cigna Healthcare MA. Customers would be reassigned to the recommended PCP if they do not contact Cigna Healthcare. Customers with a PCP… Read More

Guide to more savings and benefits & Letters to MA customers

November 18, 2024November 18, 2024Loramei Romeo

Guide to more savings and benefits The discounts for the Medicare supplements insurance provides savings that can be used by customers to reinvest in additional coverage. The discount is up to 20% with combined household discounts which are, discount for more than one member of the household holds a policy is 14% and discount when a customer lives with one or more people is 6%. The supplemental benefits are fit for client’s needs in cancer treatment, choice accident, dental, vision, hearing, hospital indemnity, lump sum cancer, lump sum heart attack, and stroke. Letters mailed to Medicare Advantage customers There are different versions of Benefits at a Glance (BAAG), letters regarding… Read More

Departments Issue Final MHPAEA Regulations

October 11, 2024October 11, 2024Mirasol Bandong

The final rules for the Mental Health Parity and Addiction Equity of 2008 (MHPAEA) were released on September 9, 2024, by the Department of Health and Human Services, Labor, and the Treasury in order to guarantee that those seeking treatment for mental health (MH) or substance use disorder (SUD). MHPAEA provides nonquantitative treatment limitations (NQTLs) cannot be applied to MH/SUD unless they are equivalent and applied no more strictly for MH/SUD benefits than for medical/surgical benefits. The final rules amend the definitions of definition of “medical/surgical”, “mental health benefits”, and “substance use disorder benefits” by removing a reference to the state guidelines. The most recent edition of the Diagnostic and Statistical… Read More

New Medicare Part-D Changes Affecting Employers for 2024-25

September 13, 2024September 13, 2024Mirasol Bandong

Dear Valued Client: We wanted to alert you to an upcoming change that could have a significant impact on Medicare-eligible employees and dependents who currently have group health coverage. Starting in 2025, Medicare Part D plans will have a $2,000 out-of-pocket limit. As CMS explains, this change, which is part of the Inflation Reduction Act, also includes measures like a $35 cap on insulin and new authority for Medicare to negotiate prices for certain high-cost drugs. The new $2,000 cap for Part D is particularly important because it could alter the status of many employer group health plans that currently provide drug coverage. Each year, employers must determine whether their prescription drug… Read More

2025 Part D Changes and Employer Sponsored Group Health Plans

September 9, 2024September 5, 2024Mirasol Bandong

Employers must inform the Centers for Medicare and Medicaid Services (“CMS”) and participants and beneficiaries who qualify for Medicare Part D of the creditable or non-creditable status of the group health plan prescription drug plan(s). When prescription medication coverage meets or exceeds Medicare Part D, it is considered creditable. Any coverage that falls short of Medicare Part D’s quality standards is deemed non-creditable As previously reported, the Inflation Reduction Act of 2022 (“IRA”) changed aspects of the Medicare Part D program to enhance and improve Medicare Part D coverage. The changes include: As a result of these changes, some employer sponsored prescription drug coverage may no longer qualify as creditable… Read More

IBC Medicare Members Save money with your IBX Care Card

September 3, 2024September 3, 2024Ed MacConnell

Your IBX Care Card comes preloaded with a quarterly balance. Your card will be automatically reloaded every quarter (every three months). Be sure to spend your allowance each quarter, as any unused balance will not roll over to the next quarter. Please keep your card in a safe location, as you may use the same card for as long as you remain a member of a participating plan. Click here for more information about the IBX Care card for Medicare members or contact us today at (215)355-2121

Cigna Changes to MA ID cards

August 26, 2024August 23, 2024Mirasol Bandong

As with the 2025 plan year, our Medicare Advantage ID cards will be altered. By utilizing our digital portals to obtain a member’s current PCP, treating providers will be encouraged to use them more efficiently, which will prevent needless treatment delays brought on by the referral process. See what’s changing below, so you’re ready to answer any customer questions this upcoming AEP. What’s changing? 2024 2025 What is staying the same? When are these changes occurring? Members in HMO plans are still required to maintain a PCP New enrollees with a 1/1/2025 effective date will start receiving ID cards without PCP information as soon as 10/15/2024. The PCP network name… Read More

Important Changes to Medicare Drug Coverage for 2025

August 24, 2024August 31, 2024Ed MacConnell

The Inflation Reduction Act (IRA) has resulted in significant changes to Part D including: Elimination of the Coverage Gap or “donut hole”A new $2,000 out-of-pocket spending capA shift in cost sharing responsibility in the catastrophic coverage phaseA new cost sharing smoothing option called the Medicare Prescription Payment Plan These changes have an enormous impact on your Medicare coverage in 2025 for nearly all those on Medicare including Medicare beneficiaries who are still choosing their employer plans. Please review your ANOC carefully for your 2025 coverage and contact your Total Benefit Solutions Inc health insurance experts if you have any questions or concerns about how these changes impact you and your… Read More

Tower Health is back!

July 26, 2024July 23, 2024Mirasol Bandong

Tower Health is back in Cigna Medicare Advantage network in Pennsylvania! After productive negotiations with Tower Health in Pennsylvania, Cigna is happy to announce that they are back in their Medicare Advantage network effective June 1, 2024. This includes Phoenixville and Pottstown Hospital, all Primary Care Physicians (PCPs), specialists, ancillary providers, and other hospitals that were previously in-network. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

New Medicare plans could wind up forcing seniors to switch or buy new plans or face a significant penalty

July 25, 2024July 25, 2024Ed MacConnell

Many seniors who remain working past 65 are still on their employer’s health plan instead of government-run Medicare. However, a new update to Medicare coverage under the Inflation Reduction Act means seniors who delay joining Medicare could face additional hurdles when it comes to drug coverage. Who Does It Affect?Currently, seniors are able to avoid late penalties for Medicare Part D as long as their company’s plan pays on average just as much as the traditional Medicare prescription drug plan. These numbers are scheduled to change drastically in 2025. Starting January 1, most employer plans will no longer be accepted as a way out of the late penalties because they… Read More

Medicare Part D’s new $2,000 annual cap on out-of-pocket prescription costs.

July 3, 2024July 2, 2024Mirasol Bandong

There are significant changes coming to Medicare Part D plans in 2025. In 2024 once your out-of-pocket spending on prescriptions tops about $3,300, you qualify for Medicare’s “catastrophic coverage” and pay nothing for your covered Part D drugs for the rest of the year. (In 2023, once you hit catastrophic coverage, you still owed 5% of your drug costs.) But come 2025, people with Part D plans won’t have to pay more than $2,000 in out-of-pocket costs, thanks to a provision in the Inflation Reduction Act of 2022. This new rule applies only to medications covered by your Part D plan, though, and does not apply to out-of-pocket spending on… Read More

Medicare Supplement plan closure

April 15, 2024April 15, 2024Mirasol Bandong

AmeriHealth will stop accepting new enrollments for any Medicare Supplement plans as of April 1, 2024, the date the plans go into effect. Medicare Supplement Plans A, C, D, F, G, G-HD, and N were provided by AmeriHealth. Members who are presently enrolled in these plans will continue to receive services from AmeriHealth, guaranteeing that their coverage will not be stopped. To read more about the article click HERE We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any… Read More

2025 Medicare Advantage and Part D Rate Announcement

April 11, 2024Mirasol Bandong

The Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). The objectives set forth by CMS for Medicare and Part D align with our overall program vision for the agency, which includes advancing health justice, promoting affordability and the Medicare program’s sustainability, and driving comprehensive, person-centered care. Medicare Advantage and Part D Rate Announcement We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to… Read More

Update on Legislation – EmblemHealth

March 29, 2024March 28, 2024Mirasol Bandong

President Joe Biden presented his budget proposal on March 11th, 2024, for the federal fiscal year that would start on October 1st. Along with raising taxes on people earning more than $400,000 annually, the budget would also help extend talks with pharmaceutical corporations to prolong the Medicare program’s financial viability. click HERE to read the whole article. We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

United Healthcare and Mount Sinai Renew Relationship

March 28, 2024March 27, 2024Mirasol Bandong

In accordance with a new multi-year agreement between UnitedHealthcare and Mount Sinai Health System, individuals participating in employer-sponsored and individual plans, such as the Oxford Health Plan, will once again have network access to the system’s hospitals. Additionally, the agreement guarantees continuous, uninterrupted access to the doctors at Mount Sinai. for more information click HERE We are dedicated to providing exceptional service, so please do not hesitate to contact our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121 or fill out the contact form below. We are available to answer any questions or address any concerns you may have.

Claim Processing Delays and Invoice Updates

March 27, 2024March 26, 2024Mirasol Bandong

On February 21, 2024, MVP stopped doing business with Change Healthcare and its subsidiaries, as well as all digital interactions. This was due to a cyber security breach. In compliance with national and state regulations, MVP is implementing innovative business solutions and restoring affected service functionality as needed. Processing Delays for Provider Claims : New York State Department of Financial Services encourage issuers and pharmaceutical benefit managers (PBMs) to take into account granting provider requests to halt or reverse specific administrative processes. MVP is assessing each provider’s request for suspension and tolling individually and determining whether a certification is necessary. To read more click HERE We are dedicated to providing… Read More

Cleveland Clinic will remain in our MA network in Florida and Ohio

March 25, 2024March 21, 2024Mirasol Bandong

We are pleased to announce that Cleveland Clinic will stay part of our Medicare Advantage (MA) network in Florida and Ohio after successful negotiations! This covers all specialists, ancillary providers, hospitals, and primary care physicians (PCPs). Once a contractual agreement is achieved, Cleveland Clinic services will continue to be accessible without interruption. Customers will receive letters in the upcoming weeks letting them know that Cleveland Clinic is still in network and that they don’t need to take any action right now. The PCP assignments at Cleveland Clinic are all still the same. Have any questions? call us at (215) 355-2121 or click Cigna healthcare provider directory to view the most… Read More

FTC to send nearly $100 million in refunds to consumers of Benefytt’s fraudulent health plans

March 19, 2024March 19, 2024Mirasol Bandong

Refunds are being sent by the Federal Trade Commission to customers it claims purchased fraudulent health plans that Benefytt Technologies misrepresented as Obamacare plans or Affordable Care Act. Benefytt, which operated under several identities, including Health Insurance Innovations, used deceptive websites and aggressive marketing to trick people looking for health insurance into purchasing fake policies that came with expensive monthly premiums, according to the FTC’s August 2022 complaint. “Benefytt pocketed millions selling sham insurance to seniors and other consumers looking for health coverage,” Samuel Levine, director of the FTC’s Bureau of Consumer Protection, said in a statement at the time the original complaint was filed. Qualified for the refund: Click HERE to… Read More

Is The Covid 19 vaccine covered by Medicare in 2024?

February 24, 2024February 23, 2024Ed MacConnell

I s The Covid 19 vaccine covered by Medicare? Medicare does cover the updated (2023–2024 formula) Moderna or Pfizer-BioNTech COVID-19 vaccine for people 5 and older. If you’re immunocompromised (like people who have had an organ transplant and are at risk for infections and other diseases), you can get a 3-dose series of updated (2023–2024 formula. Have more Medicare questions? For more information contact your Total Benefit Solutions, Inc health insurance professionals at (215)355-2121

2024 Medicare Parts A & B Premiums and Deductibles

February 22, 2024February 22, 2024Ed MacConnell

On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts. The Medicare Savings Programs (MSPs) help more than 10 million people with coverage of Medicare premiums and, in most cases, other cost sharing. In their continued efforts to improve access to health care and lower costs for millions of Americans, the Department of Health and Human Services (HHS), through CMS, recently finalized a rule to streamline enrollment in MSPs, making coverage more affordable for an estimated 860,000 people. In addition, the… Read More

2023 RxDC Reporting Instructions Released

February 16, 2024Mirasol Bandong

The Centers for Medicare and Medicaid Services (“CMS”) recently updated its Prescription Drugs Data Collection (“RxDC”) reporting instructions for 2023 data. There are some noticeable differences. As previously reported, group health plan sponsors (typically employers) are required to submit information to CMS on prescription drugs and health care spending on an annual basis (“RxDC reporting”). The first reporting deadline for calendar years 2020 and 2021 was December 27, 2022 (extended to January 31, 2023). The next deadline for reporting on calendar year 2023 is June 1, 2024, which, despite being a Saturday, is a firm date. It should be noted that carriers, pharmacy benefit managers (“PBMs”), and third-party administrators (“TPAs”)… Read More

Decisions for someone who is nearing age 65

December 12, 2023December 12, 2023Ed MacConnell

As you near age 65, you need to learn about Medicare coverage choices and make several important enrollment decisions. This fact sheet will give you a list of the steps you shouldtake and tell you about resources to help you make your Medicare enrollment decisions. There can be penalties if you do not enroll on time, so it is best to complete these tasksat least 3 months BEFORE you turn 65. Please note you can enroll on Medicare Parts A & B with Medicare about 90 days before your 65th birthday. IF YOU ARE STILL WORKING and your company has less than 20 employees you still MUST enroll on Medicare… Read More

Medicare Supplement Insights: Protecting Your Wallet

October 9, 2023October 9, 2023Ed MacConnell

In a world where healthcare costs are a growing concern for many, Medicare Supplement coverage has emerged as a reliable solution to bridge the gaps in original Medicare. As we delve into the latest data from 2021, including insights from the National Association of Insurance Commissioners (NAIC), the California Department of Managed Health Care, and the Medicare Current Beneficiary Survey (MCBS) from 2020, a compelling narrative about the significance of Medicare Supplement plans unfolds. Key Takeaways: 1. A Majority Embrace Medicare Supplement: In 2020, a staggering 54% of original Medicare enrollees without additional insurance coverage, such as Medicaid or employer-provided insurance, turned to Medicare Supplement policies for added peace of… Read More

Medicaid & CHIP Enrollment Extension!

October 3, 2023October 3, 2023Ed MacConnell

In a recent development, the Centers for Medicare & Medicaid Services (CMS) and the Departments of Labor (DOL) and the Treasury have issued a letter urging employers, plan sponsors, and carriers to consider extending the enrollment period for employer-sponsored health plans. This extension is aimed at helping individuals who have lost their Medicaid and Children’s Health Insurance Program (CHIP) coverage due to the resumption of normal eligibility and enrollment procedures. Traditionally, Medicaid coverage requires annual renewal of eligibility. However, during the COVID-19 Public Health Emergency, these renewal requirements were temporarily halted to prevent members from losing their coverage. Unfortunately, this pause in eligibility rules came to an end on March… Read More

What is your Medicare Part D ANOC?

September 30, 2023September 30, 2023Ed MacConnell

The Annual Notice of Change (ANOC) is a document that Medicare Advantage and Medicare Part D prescription drug plans are required to send to their members every year. The ANOC outlines any changes in coverage, costs, and more that will be effective in January 1. If you’re enrolled in a Medicare plan, your plan will send you an ANOC each fall. The ANOC includes information about any changes to your plan’s coverage, costs, and service area that will be effective in January 1. It’s important to review the ANOC carefully to understand how your plan’s coverage and costs may change in the upcoming year. If you have any questions or concerns about the changes, you can contact… Read More

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