CONSENT FOR HEALTH INSURANCE BROKER ASSISTANCE

CONSENT FOR BROKER ASSISTANCE FORM AS REQUIRED UNDER THE 2023 CMS-9899-F AMENDMENT OF 45 CFR § 155.220 Click here to complete the consent form This consent form outlines your rights. Please read it carefully. As a licensed Health Insurance Broker, Ed MacConnell  of  Total Benefit Solutions Inc  has completed the annual Affordable Care Act certification by the Marketplace in your state. With this yearly training, and an individual or family’s formal consent, brokers are authorized to search for and assist households with their Marketplace account. The purpose of this form is to receive your informed written consent. Terms of Consent I give my permission to Total Benefit Solutions Inc, and/or their staff… Read More

Continue Reading

Employer 2024 Penalties Associated with the ACA (Affordable Care Act)

Add New Post Employers with a large number of part time employees have unique challenges when it comes to ACA compliance. Those with 50 or more full-time or full-time equivalent employees must meet two important requirements of the Affordable Care Act (ACA), or be subject to penalties A and B, A PENALTY: Employers who fail to offer a Minimum Essential Coverage (MEC) plan that provides certain wellness and preventive care to full-time employees may face a penalty of $2,970 per fulltime employee (minus the first 30). B PENALTY: A penalty of $4,460 per full-time employee who enrolls in a subsidized plan throughout a government exchange if the employer fails to… Read More

Continue Reading

Shop for Affordable Short Term Health Care Coverage

Lower Cost Health Insurance is available if you qualify!

Continue Reading

Cheapest Health Insurance in Pennsylvania (2024 Plans)

Premium costs on Pennsylvania’s health insurance marketplace, Pennie vary by Catastrophic, Bronze, Silver or Gold tier. In Pennsylvania, Highmark Blue Cross Blue Shield offers the most affordable Bronze and Catastrophic plans, while UPMC Health Plan and Jefferson Health Plans provide the lowest-priced Gold and Silver plans in 2024, respectively. Of course, just because one plan costs less to buy does not make it the best plan to meet your needs. The health insurance experts at Total Benefit Solutions, Inc can shop the entire market for you, taking into account the healthcare needs of your family and guide you to the best plan for you. Contact us today at (215)355-2121.

Continue Reading

Special Election Period may be available to members affected by severe weather

The Federal Emergency Management Agency (FEMA) have declared a weather-related emergency or major disaster in your state. Medicare beneficiaries affected may be eligible for a Special Election Period (SEP).  For marketing materials that comply with CMS marketing requirements, please visit the UnitedHealthcare Toolkit.  Who is eligible?  Beneficiaries who do not live in the impacted areas but receive assistance making healthcare decisions from someone who lives in one of the affected areas are also eligible; and  What does this mean for beneficiaries?  Enrollment Overview If a consumer contacts you as a result of this SEP, you may help them enroll in one of our plans and may be eligible for a… Read More

Continue Reading

Decisions for someone who is nearing age 65

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

Continue Reading

What is the Part D Donut Hole in 2024?

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

Continue Reading

How should employers distribute Medical Loss Ratio (MLR) Rebate Checks?

Recently a number of clients have received notices and/or checks for their organization’s Medical Loss Ratio, or MLR rebates. Below is some helpful information for understanding how these rebates can be used or distributed. According to the U.S. Department of Labor’s Technical Release No. 2011-04, the employer’s responsibility for distributing the rebate to participants is dependent on who paid for the insurance coverage. If the employer paid the entire cost of the insurance coverage, then no part of the rebate would be attributable to participant contributions. However, if participants paid the entire cost of the insurance coverage, then the entire amount of the rebate would be attributable to participant contributions and… Read More

Continue Reading

What is your Medicare Part D ANOC?

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

Continue Reading

Medicare Part D Notification Requirements

Employers sponsoring a group health plan with prescription drug benefits are required to notify their Medicare-eligible participants and beneficiaries as to whether the drug coverage provided under the plan is “creditable” or “non-creditable.” This notification must be provided prior to October 15th each year. Also, following the plan’s annual renewal, the employer must notify the Centers for Medicare & Medicaid Services (“CMS”) of the creditable status of the drug plan. This information summarizes these requirements in more detail. What are the Notification Requirements About? Medicare Part D, the Medicare prescription drug program, generally imposes a lifetime penalty for late enrollment if an individual delays enrolling in Part D after initial eligibility… Read More

Continue Reading

How income affects your Medicare drug coverage premiums

You could pay a higher monthly premium for Medicare drug coverage (Part D) depending on your income. This includes Part D coverage you get from a Medicare drug plan, a Medicare Advantage Plan with drug coverage, or a Medicare Cost Plan that includes drug coverage. This is true even if your drug coverage is through your employer. Download this bulletin to learn more about extra Medicare drug coverage premiums As always if you have any questions or concerns about this bulleting please contact your Medicare health insurance experts at Total Benefit Solutions, Inc (215)355-2121

Continue Reading

How can I get help with my Medicare Part A and Part B premiums?

(En español) States must help pay some of the Medicare costs for beneficiaries who have limited income and resources. Under these programs, states help pay for Medicare Part A and Part B premiums, deductibles and copayments. Some of these programs also pay additional Medicare expenses for elderly and disabled people. To find out if you are eligible for state help, contact your local medical assistance office. A representative can tell you the specific requirements and help you apply. If you have any questions or concerns please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)355-2121.

Continue Reading

A Voluntary Benefits Strategy

The Issue One of our clients approached us during a pre-renewal meeting to ask how they can further control costs without drastically impacting the well-being of their employees…click here to continue

Continue Reading

HOW PEOS ARE HELPING SMBS MEET MARKET DISRUPTORS HEAD ON

The modern world is driven by convenience and customization, SMBs included. Digitization, remote-friendly roles, and a generational shift in the workforce all impact today’s employee experience. When this experience is lacking, it can be costly to companies in more ways than one.    click here to read the story from PEO insider Total Benefit Solutions Inc is dedicated to providing a comprehensive selection of solutions for the small business owner including the comparison of PEO’s to the typical employee benefits experience. Contact us today at (215)355-2121 to inquire about the possibility of using a PEO for your organization.

Continue Reading

What’s Medicare Supplement Insurance (Medigap)?

Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in  Original Medicare. You must have Original Medicare – both Part A (Hospital Insurance) and Part B (Medical Insurance) – to buy a Medigap policy. Ask us today if you have questions about Medigap enrollment, rates or coverage at (215)355-2121.

Continue Reading

Independence Blue Cross aims to get more Black patients screened for colorectal cancer

The COVID-19 pandemic drove a significant reduction in the number of Black patients who were getting screened for colorectal cancer, and Independence Blue Cross is aiming to change that in its home turf of Philadelphia… https://www.fiercehealthcare.com/payers/philly-blues-program-aims-get-more-blacks-screened-colorectal-cancer

Continue Reading

Why Short Term Heath Insurance is not “ JUNK” insurance.

Short-term health insurance, also known as temporary health insurance, is a type of health coverage designed to provide temporary medical insurance for a limited duration, typically ranging from a few months to a year. While short-term health insurance may not be suitable for everyone, it does offer certain benefits for specific situations. When people label Short Term health as “ JUNK” it is clear they do not understand that many people still need short term health insurance coverage. The ACA solved many problems when it comes to access to coverage, but first problem is the COBRA prohibition which specifically disallows ACA tax credits for people who can get on COBRA.… Read More

Continue Reading

CMS Issues Final Rule, Making changes to MA and Part D

In April, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule regarding the Medicare Advantage (MA) and Part D programs. The Final Rule includes changes related to various aspects of those programs, including utilization management (UM) programs, Star Ratings, marketing and communications, health equity, provider directories, and network adequacy. Click here to read the bulletin

Continue Reading

Medicare Cheat Sheet: Download Today

Medicare insurance can seem complex on your own. We’re here to help! Medicareful is our easy-to-use Medicare plan finder that compares some of the available plans in your area and connects you with a Total Benefit Solutions, Inc. licensed sales agent who will guide you through enrollment. Whether it’s a Medicare Supplement, Medicare Advantage Part C Plan, or a Medicare Part D drug plan, we’ve got you covered. https://medicareful.com/totalbenefitsolutions Download our Medicare cheat sheet below to help you keep track of your most important points while shopping for a Medicare supplement! Contact Total Benefit Solutions, Inc today at 215-355-2121 or www.totalbenefits.net to get started. 

Continue Reading

2023 Patient-Centered Outcomes Research Trust Fund (“PCORTF”) Fees

This update serves as a reminder that the annual Patient-Centered Outcomes Research Trust Fund (“PCORTF”) fees are due by July 31, 2023. As background, at the end of 2019, the Federal Government reauthorized the annual payment of fees by health insurers and group health plans into the PCORTF until 2029. (Such payments were previously set to expire for plan years ending on or after October 1, 2018 and before October 1, 2019, and beyond.) The fee is due by July 31 of the calendar year immediately following the last day of the plan year in which the applicable plan ended. The PCORTF fees fund the Patient-Centered Outcome Research Institute (PCORI), established by Congress… Read More

Continue Reading

Video: Medicare Supplements vs. Medicare Advantage Plans. What’s the difference?

Continue Reading

Alert: 2023 mid-year IBC Group Medigap rate increase

Independence Blue Cross (Independence) recently received approval from the Pennsylvania Insurance Department to increase monthly premium rates effective July 1, 2023 for: The following plans did not have a rate increase: H with Rx, F(HD), N, and G(HD). Please review the 2023 Mid-Year Medigap Rate Increase – Medigap Security & Security 65 document for more information on call scripting and see below for related links for rate change letters and rate sheets.

Continue Reading

Members receive letter about NationsBenefits security breach 

Some Aetna Medicare plans include benefits administered by a company called NationsBenefits or one of its affiliates (“the company”). Specifically, the company administers the hearing aid benefit, as well as the Extra Benefits Card benefit, on some plans. Recently, NationsBenefits learned that a third-party vendor they used to securely exchange files with certain health plans, experienced a data security incident. The security breach impacted members whose plans include the NationsHearing hearing aid benefit or the Nations Extra Benefits Card benefit. What you need to know: Member communication: Impacted members will receive a letter from NationsBenefits. View a sample of the member letter. Letters began mailing on April 27.  The letter explains what happened, what… Read More

Continue Reading