Medicare Part D’s new $2,000 annual cap on out-of-pocket prescription costs.

There are significant changes coming to Medicare Part D plans in 2025. In 2024 once your out-of-pocket spending on prescriptions tops about $3,300, you qualify for Medicare’s “catastrophic coverage” and pay nothing for your covered Part D drugs for the rest of the year. (In 2023, once you hit catastrophic coverage, you still owed 5% of your drug costs.) But come 2025, people with Part D plans won’t have to pay more than $2,000 in out-of-pocket costs, thanks to a provision in the Inflation Reduction Act of 2022.  This new rule applies only to medications covered by your Part D plan, though, and does not apply to out-of-pocket spending on… Read More

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Special Enrollment Period Extended: Florida Emergency Declaration – Hurricane Idalia

Please be advised that a state of emergency was extended for certain Florida counties. This declaration allows for a one-time Special Enrollment Period (SEP), in the event beneficiaries were unable to make an election during another qualifying election period. Please reference the following guidelines for the incident period. This DST-SEP applies to the Florida counties listed below. Important Compliance Information Who is eligible: This SEP opportunity is ONLY available to beneficiaries who:​ Details : Impacted Counties: Alachua, Baker, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, DeSoto, Dixie, Duval, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hardee, Hernando, Hillsborough, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Nassau, Orange, Osceola, Pasco, Pinellas,… Read More

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UnitedHealthcare – RxDC Information Required by Deadline

Please assist us in answering the required questions in the CAA Pharmacy Data Collection request information that is located in the employer/broker portal. It will make sure that UnitedHealthcare can successfully submit the data report. In order for us to prepare the data for submission to CMS by June 1, 2024, we must get the information by April 10, 2024, thus your prompt answer is extremely important. To read more 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… Read More

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Aetna – Data Collection Requirement for Rx Data Collection Reporting Submission

The deadline for submitting Prescription Drug Data Collection (RxDC) reporting for the reference year 2023 is June 1, 2024. Certain data items that were not necessary for the first submission must be included in this one. As a result, Aetna has created a procedure to help our plan sponsors submit these reports. Important Update: Data Collection Requirement for Prescription Drug Data Collection Reporting Submission Read more 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 concerns you… Read More

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IRS News Release: Nutrition, Wellness, and General Health Expenses

The Internal Revenue Service (IRS) is informing taxpayers that costs associated with wellness, diet, and overall health are unlikely to be covered by Internal Revenue Code section 213 reimbursement for medical expenses. The IRS published a press statement and a list of commonly asked questions the IRS: The IRS is worried that individuals might not be aware of the situations in which spending related to diet or wellness can qualify as medical costs. The IRS reminded people in a news release on March 6, 2024, that personal expenses cannot be reimbursed through FSAs, HSAs, or HRAs in a way that is tax-favored. Employers should be wary of vendors who advertise… Read More

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Increases in Premium Found in Health Benefits Survey

The latest survey by the Kaiser Family Foundation (KFF) concerning employer-sponsored health benefits found modest increases in employers’ and employees’ costs in 2022. In its 24th Employer Health Benefits Survey (EHBS), KFF found the average annual premiums for employer-sponsored health insurance in 2022 were $7,911 for single coverage and $22,463 for family coverage. These amounts were up from $7,739 and $22,221 in the previous year, respectively – an increase of $172.00 for single coverage and $242.00 for family coverage. The average family coverage premium is up 20% over the past five years and up 43% during the past 10 years. Small vs. Large Employers In 2022, workers insured through their employers at both… Read More

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Alternatives to Health Insurance Benefits

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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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What is Modified Adjusted Gross Income (MAGI)?

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What is a Qualified High Deductible Health Plan?

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What Is a Health Savings Account?

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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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COVID-19 PPE Now a Qualified Medical Expense

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Heard of Reference Based Pricing Health Insurance?

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Impact of Key Provisions of the American Rescue Plan Act of 2021 COVID-19 Relief on Marketplace Premiums

there are millions of uninsured people who could be getting subsidized coverage on the ACA Marketplaces, but have not taken advantage of this financial help. In many cases, it may be that the financial help available to them is not sufficient to make the premium or the deductible affordable

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ARPA Extends Open Enrollment for Individual Coverage in PA

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Health Insurance: What Do You Pay for?

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Departments Issue Guidance Re: FFCRA and CARES Act

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Are you an applicable large employer, or not? That’s the question!

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What is a minimum essential coverage (MEC) plan?

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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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Aflac Workforce Survey and CDHP

   

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How do Tiered Network plans like the Keystone HMO Proactive and Horizon Omnia plans work?

Tiered or Narrow Network Plans: Under the Affordable Care Act, insurance carriers have introduced “tiered network”, or narrowed network plans. Keystone Proactive HMO Plans from Independence Blue Cross  have a unique  ” 3 tiered” network of providers. Although each carrier has different types of networks and benefit levels, the plans have the same general concept, steering the members by giving them a choice of providers that offer medical services at a lower out of pocket expense. Choosing a more expensive provider or facility may cost the member more out of pocket costs. United Healthcare offers 2 tiers in their “Navigate” plans, and Aetna uses “Savings Plus” designated providers to split… Read More

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Total Benefit Solutions is your Marketplace Navigator

What do you get with Total Benefit Solutions as your Marketplace Navigator? A broker who is Unbiased and objective  Trained Local Certified Licensed Insured Up to date Representing you Part of a team of dedicated professionals Click here for more information and to see our “Marketplace Navigator” brochure: Individual Enrollment Navigator Brochure  

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