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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

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

Disaster Special Election Periods in several states

July 15, 2024July 12, 2024Mirasol Bandong

This is an important announcement for customers in Arizona, California, Florida, Iowa, Kansas, Maryland, Minnesota, New Mexico, North Carolina, Oregon, Texas and West Virginia and for those with business in these states. The counties below are under a federal or state designated SEP due to an emergency. Applications for disaster SEP are only accepted as long as the SEP declaration is in place. For the most recent information, if a deadline is not specified below, please use Producers’ University’s Ongoing SEP tracker. Applications for SEPs submitted after the declaration date of that SEP will not be accepted. IMPORTANT : Please be aware The SEP begins on the date of the incident’s start, if that occurs earlier, or 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

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

How Is the Medicare Part D Benefit Changing in 2024?

June 29, 2023Ed MacConnell

In 2024, costs in the catastrophic phase will change: the 5% coinsurance requirement for Part D enrollees will be eliminated and Part D plans will pay 20% of total drug costs in this phase instead of 15%. The 5% coinsurance requirement for Part D enrollees in the catastrophic phase will be eliminated In 2024, once Part D enrollees without low-income subsidies (LIS) have drug spending high enough to qualify for catastrophic coverage, they will no longer be required to pay 5% of their drug costs, which in effect means that out-of-pocket spending for Part D enrollees will be capped. In 2024, the catastrophic threshold will be set at $8,000. This… Read More

ACA special enrollment period opens soon for people losing Medicaid coverage

March 17, 2023March 16, 2023Ed MacConnell

The Centers for Medicare and Medicaid Services (CMS) will open an ACA special enrollment period (SEP) for people losing Medicaid coverage due to the end of the COVID-19 public health emergency (PHE). The PHE ends May 11. The ACA SEP aims to maintain continuity of coverage as people transition from Medicaid into a Marketplace-qualified health plan. It runs March 31 to July 31, 2023. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is Limited Medical Insurance?

January 29, 2023January 29, 2023Ed MacConnell

A limited medical plan is a form of supplemental health insurance that can be used with or without a major medical plan. Limited medical plans have a set amount of money for treatment that they give to you to pay for common medical expenses. They recognize that common services like wellness visits can sometimes turn into a financial strain for people. Since this type of insurance does not cover everything due to a predetermined limit on what you receive, you will want to look closely at the benefits before choosing a plan. It can be helpful to pair a limited medical plan with a major medical plan. Doctors visits and… Read More

10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Requirement

December 27, 2022December 27, 2022Ed MacConnell

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends, in exchange for enhanced federal funding. Primarily due to the continuous enrollment requirement, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped. But, when the PHE ends, millions of people could lose coverage that could reverse recent gains in coverage. The current PHE is in effect until January 11, 2023, and the Biden administration has said it will give states a 60-day… Read More

What are Qualified Medical Expenses?

November 16, 2022October 20, 2022Ed MacConnell

Qualified Medical Expenses are generally the same types of services and products that otherwise could be deducted as medical expenses on your yearly income tax return. Some Qualified Medical Expenses, like doctors’ visits, lab tests, and hospital stays, are also Medicare-covered services. Services like dental and vision care are Qualified Medical Expenses, but aren’t covered by Medicare. Qualified Medical Expenses could count toward your Medicare MSA Plan deductible only if the expenses are for Medicare-covered Part A and Part B services. Each year, you should get a 1099-SA form from your bank that includes all of the withdrawals from your account. You’ll need to show that you’ve had Qualified Medical… Read More

What Are Medicare Guaranteed Issue Rights?

October 26, 2022July 25, 2022Ed MacConnell

Please contact your Total Benefit Solutions Inc Medicare health insurance specialists today at (215)355-2121 with any questions.

Medicare & Coronavirus

July 27, 2022July 14, 2022Ed MacConnell

Medicare covers the COVID-19 vaccine at no cost to you. Medicare covers the vaccine for anyone who has Medicare due to their age, a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). Be sure to bring your Medicare card. To learn more about Medicare and the COVID-19 vaccine and boosters, click here. If you have Medicare and have a disability or face other challenges in getting to a location away from home for a vaccination, Medicare will pay a doctor or other care provider to give you the COVID-19 vaccine in your home. You may need to give them your Medicare Number for billing, but there’s… Read More

What’s Not Covered by Part A & Part B?

July 25, 2022July 14, 2022Ed MacConnell

Medicare doesn’t cover everything. Some of the items and services Medicare doesn’t cover include: Long-Term Care (also called custodial care ) Most dental care Eye exams related to prescribing glasses Dentures Cosmetic surgery Acupuncture Hearing aids and exams for fitting them Routine foot care To find out if Medicare covers a test, item, or service you need, click here. The professionals at Total Benefit Solutions, Inc are here to help you understand your Medicare Health Insurance choices. Call us today at (215)355-2121.

Time to Prepare for Medicare Part D Notice Requirements

July 20, 2022July 6, 2022Ed MacConnell

An important deadline is approaching quickly – October 15 for the Medicare Part D notice requirement. The creditable-coverage notice must be given to all Part D-eligible individuals who are covered under, or apply for, an employer’s prescription drug benefits plan. This requirement applies to Medicare beneficiaries who are active employees and those who are retired, as well as Medicare beneficiaries who are covered as spouses under active or retiree coverage. Click here for a video explaining Medicare Part D notices. Please contact your Total Benefit Solutions Inc Medicare health insurance specialists at (215)355-2121 if you have any questions or concerns.

Clarification of the Special Enrollment Period (SEP) for Government Entity-Declared Disaster or Other Emergency

July 8, 2022June 29, 2022Ed MacConnell

The memo clarified that the COVID-19 pandemic does not currently qualify for the SEP for Government Entity-Declared Disaster or Other Emergency (disaster SEP); however, it does qualify for the Exceptional Circumstances SEP. What you need to know: As a result of this guidance, do not submit enrollments for clients impacted by COVID-19 using the disaster SEP. Going forward, any new enrollments submitted for this reason will be declined.

6 Questions to ask your Benefits Broker

June 10, 2022June 10, 2022Ed MacConnell

Medicare Coverage for Treatment of PTSD

May 6, 2022May 5, 2022Ed MacConnell

Post-traumatic stress disorder (PTSD) is a mental condition that can develop after someone directly or indirectly experiences a traumatic event. It doesn’t always occur immediately following the event and may not be caused by an event some would traditionally consider traumatic. This can make identifying or diagnosing PTSD difficult. But, if PTSD isn’t identified and treated, it can be a part of the sufferer’s life for potentially the rest of their life. To Learn more Click Here, or for more information on how Medicare can help with coverages call Total Benefits Solutions at (215) 355-2121

Medicare Freezes Late Enrollment Penalties for Qualifying Enrollees

April 29, 2022April 29, 2022Ed MacConnell

Many people enroll in Medicare as soon as they can, unless they have creditable coverage from an employer or other source. Why? Often, it’s because they’re looking to avoid Medicare late enrollment penalties. This year, due to ongoing issues at the Social Security Administration, Medicare has decided to extend a grace period for anyone who isn’t enrolled in Parts A and B but is eligible to do so. This will assist a number of people who would have otherwise been hit with a late enrollment penalty.Click Here For more info on this Article! Or call into Total Benefits Solutions at (215) 355-2121

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