What Additional Changes Are Being Made to Part D?

As of 2023, the out-of-pocket cost of insulin products is limited to no more than $35 per month in all Part D plans. In addition, adult vaccines covered under Part D, such as the shingles vaccine, are covered with no cost sharing. Starting in 2024, people with Medicare who have incomes up to 150% of poverty and resources at or below the limits for partial low-income subsidy benefits will be eligible for full benefits under the Part D Low-Income Subsidy (LIS) Program. The law eliminates the partial LIS benefit currently in place for individuals with incomes between 135% and 150% of poverty. Also starting in 2024, the calculation of the… Read More

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How Is the Medicare Part D Benefit Changing in 2025?

Changes in 2025 include a new $2,000 out-of-pocket spending cap, elimination of the coverage gap phase, a higher share of drug costs paid by Part D plans in the catastrophic phase, along with a new manufacturer price discount and reduced liability for Medicare in this phase, and changes to plan costs and the manufacturer price discount in the initial coverage phase. Out-of-pocket drug spending will be capped at $2,000 Beginning in 2025, Part D enrollees’ out-of-pocket drug costs will be capped at $2,000. This amount will be indexed to rise each year after 2025 at the rate of growth in per capita Part D costs. (This cap does not apply… Read More

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What Does the Medicare Part D Benefit Look Like in 2023?

The standard design of the Medicare Part D benefit currently has four distinct phases, where the share of drug costs paid by Part D enrollees, Part D plans, drug manufacturers, and Medicare varies (Figure 1). (The Part D enrollee shares reflect costs paid by enrollees who are not receiving low-income subsidies.) If you have any questions or concerns please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)355-2121.

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Aetna members can soon use their OTC benefit at CVS

Starting July 1, members who have an over-the-counter (OTC) benefit administered by OTC Health Solutions, can purchase eligible OTC items in person at all CVS stores (except for CVS pharmacies inside Target or Schnuck stores), in addition to ordering them by phone and online. This will make it even easier for members to take advantage of this popular benefit. Members can use the store locator link, or call 1-833-331-1573 (TTY: 711) to find a store.  Contact your Total Benefit Solutions, Inc health insurance specialist at (215)-355-2121 if you have any questions or concerns.

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Delta Dental Plans Association: Survey shows patients rate their experiences with dentists a 9.5

OAK BROOK, Ill., June 22, 2023 /PRNewswire/ — Delta Dental announced key findings from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Dental Plan Survey, which provides feedback from Delta Dental patients about their oral health care experiences. Delta Dental is the only carrier utilizing the survey nationwide to continuously enhance patient experiences with its outstanding network of dentists. This trusted anonymous survey tool is used in the health care industry to evaluate a patient’s experience throughout their dental care journey and includes questions related to care from dentists and staff, access to dental care, and dental plan information and services. Recent CAHPS Dental Plan Survey findingsMore than 20,000 Delta Dental adult… Read More

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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. 

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Medicare Advantage plans denying more inpatient claims

MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe. Medicare Advantage plans denying more inpatient claims MA plans have adopted more restrictive criteria commonly used by commercial health insurance carriers, found consulting firm Crowe Healthcare systems have found themselves in precarious financial standing due to a dramatic increase in the number of inpatient claims being denied by health insurers based on the lack of medical necessity, according to data collected by accounting and technology firm Crowe. These level-of-care reimbursement disputes are especially rising in frequency among Medicare Advantage plans. Read the full story by clicking the link below. https://www.healthcarefinancenews.com/news/medicare-advantage-plans-denying-more-inpatient-claims As always if you have any… Read More

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What is the Medicare Advantage Open Enrollment Period (OEP) and why is it important?

The Medicare Advantage Open Enrollment Period (OEP) is different than the annual election period in the fall. The MA OEP happens annually from January 1st to March 31st. The OEP allows beneficiaries who are enrolled in a Medicare Advantage Plan to make a one-time change. Beneficiaries can use the Medicare OEP to: The Medicare OEP does not allow a beneficiary to change from one Part D plan to another Part D plan. The reason for the OEP is that Medicare beneficiaries are often confused about Medicare Advantage plans. They don’t understand how these plans work or they may not realize the plan has a network. Some Medicare beneficiaries try to make their… Read More

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What Are Medicare Guaranteed Issue Rights?

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

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Why Use Medicareful to Find Your Plan?

Medicare insurance can seem complex on your own. We’re here to help! Medicareful is an easy-to-use Medicare plan finder that compares some of the available plans in your area and connects you with a 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

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Get ready for the Medicare Annual Enrollment Period with our centralized guide to AEP.

Every year, the AEP is your opportunity to enroll in or switch to a Medicare plan that fits your ever evolving health care needs. This special enrollment window only runs October 15 to December 7, so it’s important to be prepared to accomplish anything you’d like to during that time. If reviewing or changing your coverage seems a little daunting with all the different plans and benefits on the market and decisions to make, don’t worry! You don’t have to go it alone. Get Your Guide to the Medicare Annual Enrollment Period and Get ready for the Medicare Annual Enrollment Period with our centralized guide to AEP. Click here to… Read More

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CMS Updates Medicare Enrollment Rules for 2023

On April 22, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed implementation of parts of the Consolidated Appropriations Act, 2021 (CAA) to simplify Medicare enrollment. According to Medicare.gov, these changes will go into effect January 1, 2023. Generally speaking, the new Medicare enrollment rules will allow for a more straightforward enrollment process that reduces potential gaps in coverage. They also allow for more Special Enrollment Periods and extend some Part B coverage to certain beneficiaries. But, what are the specifics? All facts and figures can be found in CMS’ fact sheet on the provisions, unless specifically linked elsewhere. Current Medicare Enrollment Rules Currently, when Medicare coverage actually starts after enrollment… Read More

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What Are Medicare Guaranteed Issue Rights?

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Top 10 Questions to Ask Your Benefits Broker

Analyzing these ten critical questions in relation to your organization’s needs will help you make a more informed decision about your benefits broker

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CMS Announces Medicare Plan Finder Improvements

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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

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5 reasons you may want to switch Medigap policies

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Heard of Reference Based Pricing Health Insurance?

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How Does Level Self Funded Health Insurance Work?

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.

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Does Medicare Cover Oral Surgery?

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ARPA Extends Open Enrollment for Individual Coverage in PA

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What is Minimum Essential Coverage or MEC health insurance?

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New COBRA Subsidy Begins April 1st under COVID Relief

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Onboarding Employees with Total Benefit Solutions

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

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