Is The Covid 19 vaccine covered by Medicare in 2024?

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

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The Benefits of Short-Term Health Insurance

Short-term health insurance is a type of health insurance that provides coverage for a limited period of time, typically anywhere from 30 days to 12 months. These plans are designed to provide temporary coverage for individuals who are in between jobs, waiting for employer-sponsored coverage to begin, or who are not eligible for other types of health insurance. Affordable Premiums Short-term health insurance plans typically have lower premiums than traditional health insurance plans. This is because short-term plans are designed to provide coverage for a limited period of time and do not have to meet the same requirements as other types of health insurance. This makes them a more affordable… Read More

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Horizon BCBSNJ Updated COVID-19 Resource Guide

Updated COVID-19 Resource Guide Due to the COVID-19 public health emergency (PHE) ending on May 11, 2023, Horizon BCBSNJ has announced that certain provisions that had been put in place for members and customers during the PHE will go back to pre-COVID-19 coverage beginning May 12, 2023, including: Vaccines Members will not have to pay anything out of pocket for the COVID-19 vaccine and boosters when they use an in-network provider. COVID-19 Testing and Treatment Members will continue to have coverage for lab PCR and Rapid COVID-19 tests and treatment when received in network; however, members may have to pay their copay, deductible and/or coinsurance. If members have out-of-network coverage… Read More

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ACA special enrollment period opens soon for people losing Medicaid coverage

The Centers for Medicare and Medicaid Services (CMS) will open an ACA special enrollment period (SEP) for people losing Medicaid coverage due to the end of the COVID-19 public health emergency (PHE). The PHE ends May 11. The ACA SEP aims to maintain continuity of coverage as people transition from Medicaid into a Marketplace-qualified health plan. It runs March 31 to July 31, 2023. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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The End of COVID-19 Public Health Emergency: How will telemedicine be affected?

On Jan. 30, 2023, the Biden Administration announce it will end the public health emergency (and national emergency) declarations on May 11, 2023. Telemedicine What’s changing: Some flexibilities associated with providing health care via telehealth during the public health emergency will end. What’s the same: Expanded telehealth for Medicare beneficiaries was once tied to the public health emergency but, due to recent legislation, will remain unchanged through December 31, 2024. Most private insurers already covered telemedicine before the pandemic. In Medicaid, states have broad authority to cover telehealth without federal approval. Most states have made, or plan to make, some Medicaid telehealth flexibilities permanent. Have any questions regarding this notice?… Read More

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The End of COVID-19 Public Health Emergency: How will COVID treatments be affected?

On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. COVID Treatment What’s changing: People with public coverage may start to face new cost-sharing for pharmaceutical COVID treatments (unless those doses were purchased by the federal government). Medicare beneficiaries may fact cost-sharing requirements for certain COVID pharmaceutical treatments after May 11. Medicaid and CHIP programs will continue to cover all pharmaceutical treatments with no-cost sharing through September 2024. After that date, these treatments will continue to be covered; however, states may impose utilization limits and nominal cost-sharing. What’s the same: Any pharmaceutical treatment doses (e.g., Paxlovid) purchased… Read More

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Notice: White House announces COVID-19 PHE and National Emergency will be allowed to expire

On January 30, 2023, the White House announced its plan to allow the COVID-19 Public Health Emergency (PHE) and National Emergency periods to expire on May 11, 2023. We have provided example scenarios in the Compliance Alert that demonstrate the impact of the national emergency period expiration. We encourage you to review each example to determine the impact on your specific plan(s). Although we encourage you to review the entire Compliance Alert, we have provided a summary of the content for your review: Public Health Emergency During the PHE, group health plans are required to cover the cost of COVID-19 tests and testing-related services without cost-sharing or prior authorization or… Read More

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The End of COVID-19 Public Health Emergency: How will PCR and rapid tests be affected?

On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. PCR and rapid tests ordered or administered by a health professional What’s changing: Although most insured people will still have coverage of COVID tests ordered or administered by a health professional, these tests may no longer be free. What’s the same: Uninsured people in most states were not eligible for the temporary Medicaid pathway for COVID testing and therefore will continue to pay full price for tests unless they can get tested through a free clinic or community health center. Have any questions regarding this notice? Don’t… Read More

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The End of the COVID-19 Public Health Emergency: How will vaccines be affected?

On Jan. 30, 2023, the Biden Administration announced it will end the public health emergency (and national emergency) declarations on May 11, 2023. Vaccines What’s changing: Nothing. The availability, access, and costs of COVID-19 vaccines, including boosters, are determined by the supply of federally purchased vaccines, not the public health emergency. What’s the same: As long as federally purchased vaccines last, COVID-19 vaccines will remain free to all people, regardless of insurance coverage. Providers of federally purchased vaccines are not allowed to charge patients or deny vaccines based on the recipient’s coverage or network status. Although a federal rule temporarily required private insurers to reimburse out-of-network providers for vaccine administration… Read More

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Emergency Periods Related to COVID-19 to End May 11 2023

On January 30, 2023, the Biden Administration announced its intent to end the Public Health Emergency and the National Emergency related to the COVID-19 pandemic on May 11, 2023. They are currently set to expire after February 28, 2023 and on April 11, 2023, respectively. This announcement came in response to two bills in the House of Representatives proposing to end the national emergencies at an earlier date. As previously reported, various employee benefit plan requirements are directly impacted by the Public Health Emergency and the National Emergency. Employers sponsoring health and welfare programs will need to make some decisions with respect to their programs. End of the Public Health… Read More

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HHS Extends Public Health Emergency Until October 13

On July 15, 2022, the Secretary of Health and Human Services (“HHS”) renewed the COVID-19 pandemic Public Health Emergency, effective July 15, 2022. This will once again extend the Public Health Emergency period for an additional 90 days and as a result, numerous temporary benefit plan changes will remain in effect. Employers should continue to adhere to the national pandemic-related benefit changes and expanded timeframe for providing COVID-19 testing and vaccinations and other plan requirements. State and local emergency measures may expire at different times and could impact employee benefit plans (such as insured group health plans) and other state/or local programs (such as paid leave) differently than the timeframes… Read More

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HHS to Extend Public Health Emergency Once Again

The Department of Health and Human Services (HHS) has repeatedly renewed the public health emergency since it was originally declared in January 2020. The most recent extension was set to expire July 15. However, it will now be extended again, commencing on Friday, July 15. The administration will give states 60 days’ notice before ending the emergency to allow sufficient time to prepare for changes to certain programs and regulatory authorities. HHS last extended the public health emergency in May of 2022. The designation of a public health emergency allows regulators to clear the way for vaccines, therapeutics, and diagnostics for use against the coronavirus. Should the designation expire, people… Read More

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COVID-19 Vaccines Now Available for Young Children

A recent CDC announcement recommends that children six months through five years of age should get an age-appropriate dose of the Pfizer‑BioNTech or Moderna COVID-19 vaccine. Independence covers the cost of administering vaccines and booster shots with no cost-share (such as co-pays, deductibles, coinsurance) for members regardless of where the vaccine is given. For Medicare Advantage members, the cost and administration of the vaccine and booster shots will be covered by Original Medicare so long as the health care provider administering the vaccine participates in the Medicare program. Please click here to learn more about the COVID-19 vaccines and boosters. As always, please contact your Total Benefit Solutions Inc health… Read More

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Clarification of the Special Enrollment Period (SEP) for Government Entity-Declared Disaster or Other Emergency

The memo clarified that the COVID-19 pandemic does not currently qualify for the SEP for Government Entity-Declared Disaster or Other Emergency (disaster SEP); however, it does qualify for the Exceptional Circumstances SEP. What you need to know: As a result of this guidance, do not submit enrollments for clients impacted by COVID-19 using the disaster SEP. Going forward, any new enrollments submitted for this reason will be declined.

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Pennie: Losing Medical Assistance Coverage When The Public Health Emergency Comes to an End?

Under the federal COVID-19 Public Health Emergency (PHE) declaration, Pennsylvania has maintained coverage for most Medical Assistance (MA) recipients unless they moved out-of-state, passed away, or requested to be disenrolled.   When the federal PHE comes to an end, anyone who is found to be no longer eligible during the renewal process for Medical Assistance or who fails to complete their MA renewal will be disenrolled from Medical Assistance coverage – that is where Pennie comes in!  Pennie and the Department of Human Services (DHS) are working to ensure that qualified Pennsylvanians can access coverage either through Medical Assistance (MA), the Children’s Health Insurance Program (CHIP), or affordable, high-quality coverage available… Read More

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Horizon NJ: Covid-19 Resource Guide Update

Horizon has worked to address coverage matters and adjust business practices to help our members and customers during the COVID-19 public health emergency. Many of the accommodations we made are described in the COVID-19 Resource Guide. Recent key updates include the reinstatement of actively at work and waiting period requirements. As always, please contact your Total Benefit Solutions Inc health insurance specialists with any questions or concerns at (215)355-2121.

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Oxford/UHC: New Reward Program Encourages Pediatric Covid 19 Vaccinations

COVID-19 vaccines are an important step in helping to lessen the spread of the disease. While many adult New Yorkers have been vaccinated, vaccination rates among children remain relatively low. To encourage pediatric vaccination, we are offering New York-situs subscribers whose dependents are enrolled in a fully insured UnitedHealthcare or Oxford plan a $100 pre-paid Target Gift Card. The New York Pediatric COVID-19 Vaccination Reward program is in effect May 5, 2022 through October 1, 2022. Criteria for the New York UnitedHealthcare and Oxford Pediatric COVID-19 Vaccination Reward program Dependent child(ren) must be enrolled on an active subscriber’s New York UnitedHealthcare or Oxford fully insured plan. Dependent must be eligible for the… Read More

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Fully Insured vs Level Funding: What’s the Difference?

With fully insured plans, premiums are paid directly to the insurer. Claims accountA claims account is exactly what it sounds like. A portion of the monthly payment is used to pay for claims submitted by plan members. Stop-loss InsuranceStop-loss is an employer’s safety net. This protects the employer against higher-than-expected claims. With level-funding, employers will never have to pay more than the amount they are responsible for funding the claims account each year. After that, stop-loss insurance kicks in. Administrative costsAdministrative services are provided to the employer so they can spend their time focusing on their business while a third-party administrator handles plan management such as paying claims, customer service,… Read More

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2021 MLR Rebate Checks Recently Issued to Fully Insured Plans

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Amerihealth New Jersey: Using the E-Bill feature VIDEO

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Group Business: Independence Blue Cross and AmeriHealth NJ COBRA and Mini-COBRA Premium Assistance

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2021 Second Quarter Compliance Bulletins Compilation

This document is a valuable resource, putting all of the latest health care reform news and updates in one location! 

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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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IRS Guidance Clarifies DCAP Relief

The IRS released Notice 2021-26 to address taxation of Dependent Care Assistance Programs (“DCAPs”) as it relates  to the relief afforded under Section 214 of the Consolidated Appropriations Act, 2021 (“CAA”) and the increased DCAP limit under the American Rescue Plan Act of 2021 (“ARPA”).

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CMS Announces Medicare Plan Finder Improvements

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