AARP Medicare | Total Benefit Solutions Inc

What Are Medicare Guaranteed Issue Rights?

August 24, 2021August 23, 2021Ed MacConnell

Guaranteed Issue Rights (Also Called “Medigap Protections”) are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company: Must sell you a Medigap policy Must cover all your pre-existing health conditions Can’t charge you more for a Medigap policy because of past or present health problems In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage. In other cases, you have a “trial right” to try a Medicare Advantage Plan (Part C) and still buy a Medigap policy if you change… Read More

CMS Announces Medicare Plan Finder Improvements

June 8, 2021June 10, 2021Ed MacConnell

Source: medicare.gov This week, the Centers for Medicare & Medicaid Services (CMS) announced plans to improve and update the Medicare Plan Finder (MPF) and the Health Plan Management System (HPMS). HPMS is the system that Medicare Advantage and Part D plans use to provide data about their plan offerings to Medicare, and the MPF is the online tool that allows beneficiaries to evaluate, compare, and enroll in those plans. The changes will be in place for the start of the Medicare Open Enrollment Period starting on October 15 for 2022 plans. Many of the forthcoming MPF changes reflect suggestions that Medicare Rights and other advocates have made over the years to increase the tool’s… Read More

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Aetna Small Group (2-100) Insured & Small Group Aetna Funding Advantage FAQ
Health Plan options for business owners during COVID-19 pandemic

May 20, 2021May 21, 2021Ed MacConnell

Aetna is mindful of the many challenges our small business customers and their employees are facing as a result of the COVID-19 pandemic. Many are experiencing slower sales, reductions in hours, layoffs and more. The attached Frequently Asked Questions (FAQ) includes our current responses to questions we know are top of mind for many of Small Group Insured and Small Group Aetna Funding Advantage Self-Insured customers. These responses will remain in effect until June 30, 2021 unless otherwise specified. We will continue to evaluate and update our responses as the situation evolves. Downlaod FAQ: Commercial Small Group COVID-19 FAQ

5 reasons you may want to switch Medigap policies

May 7, 2021May 7, 2021Ed MacConnell

Switching Medigap policies 5 reasons you may want to switch Medigap policies You’re paying for benefits you don’t need. You need more benefits. You want to change your insurance company. You want a policy that costs less. Can I switch policies? In most cases, you will not have a right under federal law to switch Medigap policies, unless one of these applies: You’re eligible under a specific circumstance or guaranteed issue rights You’re within your 6-month Medigap open enrollment period You don’t have to wait a certain length of time after buying your first Medigap policy before you can switch to a different Medigap policy. Note As of January 1, 2020,… Read More

Heard of Reference Based Pricing Health Insurance?

April 12, 2021April 13, 2021Ed MacConnell

Reference-based pricing is a payment system that replaces or enhances a health plan’s traditional “usual and customary” pricing for contracted claims. Rather than calculating the average charge of providers in a geographic area or a pre-contracted cost, a health plan utilizing reference-based pricing instead arbitrates its allowable amount for medical claims based on its chosen method (most commonly Medicare rates, or a certain percentage above those rates), which is a price that the payor deems reasonable. In other words the employer, the payor brings their rates with them into the health care agreement, not the other way around. This represents a much more independent framework for determining sensible health care… Read More

How Does Level Self Funded Health Insurance Work?

April 7, 2021April 7, 2021Ed MacConnell

We have received a lot of questions regarding the new level funding health benefit programs so we prepared this video to make it a little easier to understand. Ask us today if Level Funding your group’s health insurance might be a good for for your health plan! Contact your Total Benefit Solutions Account manager at (215)355-2121.

Does Medicare Cover Oral Surgery?

April 5, 2021April 2, 2021Ed MacConnell

From our partners at HealthLine: If you’re eligible for Medicare and considering oral surgery, you have options to help cover the costs. While original Medicare does not cover dental services that are required specifically for tooth or gum health, it may cover oral surgery for medical conditions. Some Medicare Part C (Medicare Advantage) plans also offer dental coverage. Let’s explore which types of oral surgery Medicare covers and why. Click here for the full story. Questions about this story or Medicare coverages? Please contact your health insurance specialists at Total Benefit Benefit Solutions, Inc (215)355-2121

ARPA Extends Open Enrollment for Individual Coverage in PA

April 1, 2021April 1, 2021Ed MacConnell

Pennie (PA Individual Exchange) has communicated that they will be extending the open enrollment period from May 15 until August 15, 2021. This extension is to help consumers be able to take advantage of the benefits of the American Rescue Plan. Some of the key benefits of this plan are below: There is no longer a cap on who is eligible for Pennie’s income-based tax credits, which help reduce monthly premium costs. Previously only people whose household income was under 400% of federal poverty level (about $51,000 for an individual), could qualify for a tax credit. Now, anyone may be eligible for a tax credit. The size of the tax… Read More

What is Minimum Essential Coverage or MEC health insurance?

March 30, 2021March 31, 2021Ed MacConnell

The Affordable Care Act states that all individuals must have health benefits and all employers with 50 or more full-time employees must provide coverage to all eligible employees or they are subject to fines/penalties. This can be known as “pay or play” or employer shared responsibility. We offer Minimum Essential Coverage plans which both penalties are satisfied for the employee and the employer. MEC plans are substantially less expensive than traditional medical insurance and serve as a low-cost solution for most companies. To contain healthcare costs, many employers and other plan sponsors are considering Minimum Essential Coverage, or MEC, health insurance. MEC plans can keep your workforce healthier. Preventable diseases, gone… Read More

New COBRA Subsidy Begins April 1st under COVID Relief

March 15, 2021March 16, 2021Ed MacConnell

Congress passed the American Rescue Plan Act of 2021 (“the Act”) on March 10, 2021 and it was signed into law on March 11, 2021. The Act includes a 100% COBRA subsidy available to certain COBRA qualified beneficiaries who lose group health plan coverage as the result of an involuntary termination or reduction in hours. This is different from the original House legislation, which included an 85% subsidy (with the COBRA beneficiary responsible for 15% of the COBRA premiums). Employers will be able to claim a credit against payroll taxes to reimburse the cost of the subsidy. The COBRA subsidy begins April 1, 2021 (the first day of the month… Read More

Onboarding Employees with Total Benefit Solutions

February 10, 2021February 25, 2021Ed MacConnell

This quick and simple video shows you how easy it is to enroll your employees onto your group health insurance and benefits when you are working with Total Benefit Solutions, Inc! Make it easier for you call us today at (215)355-2121

Review us on Google

January 16, 2021February 25, 2021Ed MacConnell

At Total Benefit Solutions we strive to provide our clients with the best service and support when shopping, enrolling and servicing their health insurance all year long. We appreciate having the opportunity and as always “We Work for Your Benefit”. If you have worked with us, please help us get some feedback by reviewing us on Google. You’ll need to be logged in to your Google account to do so. Click here to rate us!

Medicare Part D Notification Requirements

September 20, 2018Kimberly Leonardi

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” prior to October 15th, 2018. Please follow this link for more information: Medicare Part D Notification Requirements As always, if you have any questions or concerns about this notification or your specific policy, please contact us at 215-355-2121

Prevent Osteoporosis with Screenings

September 4, 2018Kimberly Leonardi

10 Facts About Osteoporosis By Kathleen Hall This silent disease significantly raises your risk for fractures and disability. 1. Losing bone density is a normal part of aging. We reach peak bone mass between ages 25 and 30, and then slowly lose begin to start losing bone mass at age 40. For women, reduced levels of estrogen after menopause accelerate bone density loss. “Women lose 1.5 to 2 percent of their bone density per year in the first 10 years after menopause,” says Laura Ryan, MD, clinical associate professor of medicine in the division of endocrinology, diabetes, and metabolism at The Ohio State University Wexner Medical Center in Columbus. 2. You don’t lose… Read More

The Four Stages of Medicare Part D (2018)

August 9, 2018Kimberly Leonardi

The Four Stages of Medicare Part D Coverage

Your Medicare Card Is Changing!

March 22, 2018March 22, 2018Ed MacConnell

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires that Social Security Number-based Health Insurance Claim Numbers (HICN) be removed from Medicare cards by April 2019; this is in an effort to lessen the current risk of beneficiary medical identity theft. A unique Medicare number, called the Medicare Beneficiary Identifier or MBI, will replace the current HICN. Beginning in April 2018, the Centers for Medicare and Medicaid Services (CMS) will begin the process of mailing new Medicare cards and will meet the statutory deadline for replacing all cards by April 2019. Educational Resources: CMS Transition to New Medicare Numbers and Cards – Fact Sheet CMS Website –… Read More

8 things to know about Medigap policies

December 26, 2017December 26, 2017Ed MacConnell

Medicare Supplements or Medigap Plans A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share. A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy… Read More

Can I Work and Have Medicare?

September 10, 2017Ed MacConnell

Some individuals, maybe even you, will still be actively employed upon becoming eligible for Medicare. Can you enroll in Medicare while you’re still in the work force, and if not, will you get a penalty? If the employer has fewer than 20 employees, you’ll probably want to enroll in Parts A, B, and D upon becoming eligible for them. In this situation, Medicare usually becomes your primary coverage. If the employer has 20 employees or more, you may want to delay Parts A, B, and/or D if you have sufficient group coverage and know you won’t incur late enrollment penalties. Medicare usually pays second to group coverage from larger employers.… Read More

Compliance Bulletin & Reform Center

March 13, 2017March 10, 2017Robert MacConnell

Health Care Compliance and Reform Education Center A fundamental change in the way the United States handles health care has arrived. Benefit rules and coverage change faster today than they used to in ten years! Our Compliance and Health Reform Education Center is where we will keep a copy of our health care reform bulletins throughout the year, in an easy to view format where you can download a brief summary or watch a short informative video. Click here to visit totalbenefitscomply.com Please contact your Total Benefit Solutions account manager at (215)355-2121 if you have any further questions.

MEDICARE PART D: CMS NOTIFICATION REMINDER

March 10, 2017Robert MacConnell

Employers sponsoring a group health plan need to report information on the creditable status of the plan’s prescription drug coverage to the Centers for Medicare and Medicaid Services (CMS). Watch a video overview Download a bulletin

Individual and Family Open Enrollment-2017 Important Updates

October 25, 2016Ed MacConnell

As many people know by now there are many big changes with individual and family plans for open enrollment 2017. For anyone who is currently enrolled on one of the following your plan will NOT be renewed for 2017 and you will have to pick a new plan and/or a new insurer: Aetna: all plans cancelling in PA/NJ/NC/FL Aetna plans only remain in Delaware in our service area United Healthcare: All ACA plans cancelling. Short term plans are still available Oscar: All plans in NJ cancelling Health Republic: All plans in NJ cancelling Highmark and Capitol Blue Cross: No longer paying broker compensation Geisinger: No longer paying broker compensation Independence Blue… Read More

Reminder to Distribute Creditable Coverage Notice

September 18, 2016September 26, 2016Ed MacConnell

Employers who sponsor 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. Download medicare-part-d-reminder-to-distribute-creditable-coverage-notice-

Aetna to pull out of most Obamacare exchanges

August 16, 2016Ed MacConnell

From cnn.com: The insurer will stop offering policies on the exchanges in 11 of the 15 states where it currently operates, according to a press release it issued Monday evening. Aetna (AET) will only sell Obamacare products in Delaware, Iowa, Nebraska and Virginia… Click here for the story on CNN

Aetna Small Group: New Small Group ACA termination policy effective October 1, 2016

August 14, 2016August 10, 2016Ed MacConnell

New Small Group ACA termination policy effective October 1, 2016 RE: renewal policy changes from Aetna…. Starting October 1, we must receive written confirmation of customer renewal acceptance in advance of the customer renewal date for all Aetna small groups. This means that beginning with all October 1 renewal dates, we must receive written confirmation in advance of the policy renewal date. Written confirmation may include signed renewal acceptance from the customer delivered by mail, fax or email. Note: premium payment received in advance of the renewal date will also be considered renewal acceptance. If we haven’t received written acceptance of the renewal, or renewal alternates, from the customer in this… Read More

Category: AARP Medicare