#Medicare – Total Benefit Solutions Inc

Medicare Secondary Payer Rules: 15 Things You Need to Know to Avoid Penalties

May 20, 2026May 20, 2026Ed MacConnell

Let’s be honest: most small business owners would rather read the fine print on a shampoo bottle than dive into the federal register. But when it comes to Medicare Secondary Payer (MSP) rules, “ignorance is bliss” is a high-speed ticket to a financial car crash. At Total Benefit Solutions Inc, we spend our days navigating the labyrinth of health insurance regulations so you don’t have to. We’ve seen it all, from small shops accidentally triggering massive fines to large corporations tripping over the “Section 111” paperwork monster. If you are providing group health insurance for employers, you are already in the crosshairs of these rules. To help you stay on… Read More

Medicare Secondary Payer Rules: 15 Things You Need to Know to Avoid Penalties.

May 13, 2026May 13, 2026Ed MacConnell

So, your business is growing, your team is aging like a fine wine, and suddenly, you’ve got employees hitting that magical number: 65. Congratulations! You’ve reached the level of the “Medicare Secondary Payer” (MSP) boss fight. If that sounds intimidating, it’s because it can be. Medicare Secondary Payer rules are essentially the government’s way of saying, “We aren’t paying for this if someone else can.” At Total Benefit Solutions Inc, we spend our days navigating these regulatory minefields so you don’t have to step on a $1,000-per-claim landmine. Whether you’re offering group health insurance for employers or looking into affordable group health insurance options, understanding MSP is non-negotiable. Here are… Read More

Big News: We’ve Joined the American Association for Medicare Supplement Insurance (AAMSI)!

May 11, 2026May 13, 2026Ed MacConnell

If you’ve been hanging around Total Benefit Solutions Inc for more than five minutes, you know we don’t do things halfway. Whether we’re fighting a denied claim until the insurance company basically begs us to stop calling (we won’t) or navigating the labyrinth of federal regulations, we’re all in. That’s why I’m beyond excited to share some major news. I’ve officially joined the American Association for Medicare Supplement Insurance (AAMSI). You can even check out my shiny new profile right here. Now, I know what you’re thinking: "Ed, another acronym? Really?" But hang with me for a second, because this isn’t just a badge for my email signature. It’s a… Read More

Member of American Association of Medicare #medicare Supplements #medicaresupplements

Why Everyone Is Talking About the New Medicare GLP-1 Bridge (And You Should Too)

May 7, 2026May 8, 2026Ed MacConnell

If you’ve turned on a television, scrolled through social media, or even just sat in a doctor’s waiting room lately, you’ve heard the names. Ozempic. Wegovy. Zepbound. These GLP-1 medications (Glucagon-like peptide-1 receptor agonists) have basically become the “iPhone” of the medical world, everybody wants one, but the price tag can make your eyes water. For years, if you were on Medicare, the conversation usually ended with a polite but firm “No.” Federal law literally forbade Medicare from covering drugs specifically for weight loss. It was a frustrating “Catch-22” (a situation where you can’t win because of contradictory rules): you were encouraged to get healthy, but the most effective tools… Read More

TEMPORARY SEP

December 1, 2025November 28, 2025Aris Herrera

Temporary SEP for year one of the Medicare Plan Finder MA Provider Directory For your awareness, CMS has a new Special Election Period (SEP) for 2026 – Code: DIR SEP. This SEP allows beneficiaries who enrolled directly through the Medicare Plan Finder (MPF) to make a plan change if the MPF Provider Directory included incorrect information and is only valid for 1/1/26-12/31/26 enrollments. The intent of this SEP is to allow an individual who relied on the MPF Provider Directory to make a change to their MA plan election to stay with their preferred providers. To use this SEP, beneficiaries must call 1-800-MEDICARE to have a representative confirm that their… Read More

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Upcoming Important Dates

September 23, 2025September 25, 2025Aris Herrera

Mark Your Calendars! Here Are The Important Upcoming Dates You’ll Want To Keep In Mind. As always if you have any questions or concerns, please don’t hesitate to contact the experts at Total Benefit Solutions, Inc (215)-355-2121

Medigap Plans: Comparing Costs

May 27, 2025May 22, 2025Ed MacConnell

When selecting a Medigap policy, it’s important to compare offerings from multiple insurance companies, especially if you’ve already chosen a specific standardized plan. While policies with the same letter designation provide identical benefits, premium costs can differ between insurers. For example, Policy A from Company 1 offers the same coverage as Policy A from Company 2, but the two companies may set different pricing. At Total Benefit Solutions, Inc we look at many factors besides price including length of time in market, ease of use and client service availability. When choosing a Medigap, ask what factors the Medigap insurance company uses to set your premium. The following factors may affect… Read More

Medicare Annual Pre-Enrollment Checklist

September 30, 2024Ed MacConnell

Before making an enrollment decision, it is important that you fully understand your benefits and rules. Download this handy form below when planning your Medicare enrollment. Please contact us at (215)355-2121 to schedule your annual Medicare review.

Individual Health Insurance help is available for employer groups!

September 6, 2024September 6, 2024Ed MacConnell

Why do group clients need help with an Individual health insurance expert? Here are some scenarios when groups need individual solutions:

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

Wellcare PDP Plans: Contract Termination: Important Change!!

August 25, 2024August 24, 2024Ed MacConnell

Total Benefit Solutions, Inc has been notified by Wellcare PDP plans that our contract is being terminated without cause beginning immediately. Due to the changes in coverage mandated by the Inflation Reduction Act, Wellcare is terminating our agreement for the purposes of not paying bew or renewal business commissions. What does that mean for our clients?Beginning immediately, we will no longer be able to enroll new customers onto Wellcare PDP plans. Further moving forward, we will be unable to provide service to our existing clients already on Wellcare or who choose to renew with a Wellcare PDP plan for 2025. Our experts are standing by to answer your questions or… 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

CMS Releases 2025 Medicare Part D Bid Information and Announces Premium Stabilization Demonstration

August 2, 2024August 2, 2024Ed MacConnell

The Centers for Medicare & Medicaid Services (CMS) is releasing preliminary technical Medicare Part D bid information for contract year 2025 to help Part D plan sponsors finalize their Part D and Medicare Advantage (MA) offerings and prepare for Medicare Open Enrollment. Additionally, CMS is announcing a voluntary demonstration to support implementation of the redesigned Part D benefit and improve stability for people with Medicare in 2025. The preliminary average Part D premiums will be released later this summer. CMS will release the 2025 landscape in mid-to-late September, as in past years, once all offerings are finalized. Final average MA premiums and deductibles, along with other key information, are released annually in September with the… Read More

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

man in white medical scrub suit standing beside girl in blue denim jacket

Medicare: Did You Know Part A?

June 26, 2024June 26, 2024Ed MacConnell

If an individual does not qualify for premium free Part A what they pay for Part A will vary depending on how long they or their spouse worked and paid Medicare (FICA) taxes. Have more questions? Ask the Medicare health insurance specialists at Total Benefit Solutions, Inc for more information (215)355-2121.

Wellness Rewards Incentive

March 14, 2024Mirasol Bandong

Medicare participants covered by Jefferson Health Plan will get a personalized mailer regarding their Wellness Rewards program. Members of this program can earn spending money as a reward for completing health-related tasks. Among the health-related pursuits that are eligible for incentives are: Visit https://www.jeffersonhealthplans.com/medicare/ to review Medicare Advantage plans and benefits that works for you. Have more Medicare questions? For more information contact your Total Benefit Solutions, Inc health insurance professionals at (215)355-2121

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

What is the Part D Donut Hole in 2024?

November 1, 2023November 1, 2023Ed MacConnell

The Medicare Donut Hole, officially called the Coverage Gap, refers to a stage in Medicare Part D plans where beneficiaries have to pay more for prescription drugs. Historically, after reaching a certain spending threshold, beneficiaries faced higher out-of-pocket costs for drugs until catastrophic coverage began. The Donut Hole was designed to encourage the use of more cost-effective medications and generic alternatives. As of 2024, the Donut Hole is not completely ending, but the percentage beneficiaries pay for prescriptions during this stage has been reduced. When a beneficiary and their plan have spent a total of $5,030 in 2024, they enter the Donut Hole. In this phase, they pay 25% of… Read More

New Federal Rules: HHS 2023 Penalty Hike

October 25, 2023October 25, 2023Ed MacConnell

In the world of healthcare compliance, staying up to date with federal regulations and guidelines is crucial to avoid costly penalties. One such regulation that affects healthcare providers and group health plans is the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, commonly known as the “Inflation Adjustment Act.” This act directs federal agencies to adjust civil monetary penalties to account for inflation. In a recent development, the Department of Health and Human Services (HHS) issued final rules on October 6, 2023, updating the civil monetary penalties for inflation. Understanding the Updated Penalties The adjusted penalties are applicable to penalties assessed on or after October 6, 2023. It’s… Read More

Financial Support Soars for Mental Health Integration

October 19, 2023October 19, 2023Ed MacConnell

Mental health is an essential component of overall well-being, and every American deserves access to quality mental health and substance use disorder treatment. Access to mental health care can be a transformative step in managing and coping with mental health concerns, allowing individuals to lead more fulfilling lives. This article explores the importance of integrating mental health services into other care settings and highlights the Collaborative Care Model (CoCM) as a promising approach to enhance access to mental health care. Expanding Access Through Integration Integrating mental health into broader healthcare settings is a pivotal strategy to increase accessibility and support for patients. The Collaborative Care Model, often abbreviated as CoCM,… 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

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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