Download the free IBX app for your iPhone or Android to help you make the most of your Independence Blue Cross health plan. With new and improved features, the IBX app gives you easy access to your health care coverage 24/7, wherever you are. As always contact your Total Benefit Solutions, Inc health insurance professionals if you have any questions about this bulletin. Click here to read more.
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As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.
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Already on the health insurance Marketplace and need some help? Assigning Total Benefit Solutions, Inc is easy! Download the document and follow the steps. We will get notified and start helping you right away! Need more direction? Give us a call (215)355-2121
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A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness. As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.
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Pennie’s Open Enrollment Period for 2023 Coverage is Around the Corner: Pennie’s Open Enrollment Period will run from November 1, 2022, to January 15, 2023. As a reminder, existing Pennie customers will be receiving auto-renewal notices this week with information on their 2023 plans. Great news! Thanks to the Inflation Reduction Act, enhanced savings continue to be available for Pennie customers and those enrolling in coverage through Pennie! As always if you have any questions or concerns please contact your Pennie health insurance experts at Total Benefit Solutions Inc (215)355-2121
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Please contact your Total Benefit Solutions Inc Medicare health insurance specialists today at (215)355-2121 with any questions.
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Beginning in 2023, limits copayments to $35 per month per prescription for covered insulin products in Medicare Part D plans and for insulin furnished through durable medical equipment under Medicare Part B, with no deductible. For 2026 and beyond, limits monthly Part D copayments for insulin to the lesser of: $35 25% of the maximum fair price (in cases where the insulin product has been selected for negotiation) 25% of the negotiated price in Part D plans Please call your Total Benefit Solutions Medicare health insurance specialists with any questions or concerns at (215)355-2121.
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Shorthand for the “Health Insurance Marketplace®,” a shopping and enrollment service for medical insurance created by the Affordable Care Act in 2010. In most states, the federal government runs the Marketplace (sometimes know as the “exchange”) for individuals and families. On the web, it’s found at HealthCare.gov. Some states run their own Marketplace at different websites. Fill out a Marketplace application and you’ll find out if you qualify for lower monthly premiums or savings on out-of-pocket costs based on your income. You may find out if you qualify for Medicaid or the Children’s Health Insurance Program (CHIP). You can shop for and enroll in affordable medical insurance online, by phone,… Read More
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As previously reported in 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit information annually about prescription drugs and health care spending to Centers for Medicare and Medicaid Services (“CMS”) on behalf of the Departments of Health and Human Services (“HHS”), Labor (“DOL”), and the Treasury (collectively, the “Departments”). The first deadline is December 27, 2022. CMS recently updated guidance related to this reporting requirements that proves some helpful clarification. Have any questions regarding this notice? Please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.
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The amount you pay for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance. If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit. When shopping for a plan, keep in mind that the plan with the lowest monthly premium may not be the best match for you. If you need much health care, a plan with slightly higher premium but a lower deductible may save you a lot of money. After you enroll in a plan, you must pay your first… Read More
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Attained-Aged: Premium based on current age when policy is issued. Premium goes up as you get older AND may go up due to a rate increase. All Medigap Freedom plans are Attained-Aged rated. Issued-Aged: Premium based on the age you are when you buy (are issued) the Medigap policy. Premium DOES NOT go up as you get older AND may go up due to a rate increase. Community: Same premium is charged to everyone who has the Medigap policy, regardless of age. Premium DOES NOT go up as you get older AND may go up due to a rate increase. Call your Total Benefit Solutions, Inc Medicare health insurance specialists… Read More
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Requires drug manufacturers to pay a rebate if drug prices increase faster than the rate of inflation (CPI-U) for: Single-source drugs and biologicals covered under Medicare Part B All covered drugs under Medicare Part D except those where average annual cost is <$100 2021 is the base year for measuring cumulative price changes relative to inflation The rebate amount is based on units sold in Medicare multiplied by the amount that a drug’s price in a give year exceeds the inflation-adjusted price Price changes are measured based on the average sales price (for Part B drugs) or the average manufacturer price (for Part D); these measures include prices charged in… Read More
Continue ReadingWhat is a Medicare Medical Savings Account (MSA) Plan? – A Medicare Medical Savings Account (MSA) plan is a type of Medicare Advantage plan that combines a high-deductible health plan with a medical savings account. Enrollees of Medicare MSA plans can initially use their savings account to help pay for health care, and then will have coverage through a high-deductible insurance plan once they reach their deductible. Medicare MSA plans can provide Medicare beneficiaries with more control over health care utilization, while still providing coverage against catastrophic health care expenses. Ask your Total Benefit Solutions, Inc. Medicare health insurance specialist of a Medicare Medical Savings Account could be worth considering… Read More
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The professionals at Total Benefit Solutions, Inc are here to help you find the right coverage for you or your small business! our health insurance experts Are certified, licensed and experienced to help you deal with ACA plans (Obamacare), Medicare supplements, short term medical and small group health plans too! Call us today at (215)355-2121.
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On August 1, 2022, the New Jersey Division on Civil Rights (DCR) finalized regulations to increase the visibility and effectiveness of posters required by the State of New Jersey. Among other things, these regulations require employers to display posters informing people of their rights under New Jersey’s Law Against Discrimination (“NJLAD”) and Family Leave Act (“NJFLA”). The regulations went into effect immediately. The NJLAD protects New Jersey employees from discrimination in the workplace. It prohibits all employers in the State of New Jersey from discriminating against and harassing employees (and prospective employees) based on their protected status (including, but not limited to, race, national origin, age, sex, gender identification, sexual… Read More
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Generally, the maximum $35.00 copayment under the Model applies to one month’s supply of insulin. This may be limited by a physician’s prescription or by plan rules on drug dosage to ensure patient safety. Please note that if an enrollee uses multiple types of insulin or has multiple prescriptions for select insulins covered under the Model, each prescription would have a copayment of a maximum $35.00 for a one month’s supply. Have any questions or concerns regarding this notice? Don’t hesitate to call your Total Benefit Solutions Medicare specialists today at (215)355-2121.
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An excepted benefit Health Reimbursement Arrangement (HRA) allows employers to finance additional medical care, like vision or dental coverage, coinsurance and copayments for individual health insurance coverage, short-term limited-duration insurance, or other health care costs not covered by their primary group plan. Excepted benefit HRAs cannot be used to reimburse individual health insurance coverage premiums, group health plans premiums (other than COBRA or other group continuation coverage), or Medicare premiums. However, an excepted benefit HRA can be used to reimburse premiums for individual health insurance coverage or group health plan coverage that consists solely of excepted benefits. This type of HRA, like the individual coverage HRA, allows rollover of unused… Read More
Continue ReadingModifies the current law “non-interference” clause to require the HHS Secretary to negotiate drug price with manufacturers for some drugs covered under Medicare Part B and Part D. Which drugs qualify for negotiation? The Secretary selects drugs to be negotiated from the 50 “negotiation-eligible” drugs with the highest total Medicare Part D spending and the 50 “negotiation-eligible” drugs with the highest total Medicare Part B spending. Which drugs are excluded from negotiation? “Negotiation eligible drugs” include brand-name drugs or biologics and exclude the following drugs: Drugs that have a generic or biosimilar available Drugs less than 9 years (for small-molecule drugs) or 13 years (for biological products) from their FDA-approval… Read More
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Medigap Open Enrollment Period: six (6) month period starting the first of the month a beneficiary turns 65 or enrolls into Part B, whichever is later. Once in a lifetime EXCEPT for Guaranteed Issue situation or beneficiaries under 65. Annual Election Period (AEP): Medicare Advantage or PDP ONLY. Every year from October 15th to December 7th. Initial Coverage Election Period (ICEP): Medicare Advantage Only. With most ICEPs, occurs 3 months prior, the month of and 3 months after a beneficiary’s 65th birthday. The professionals at Total Benefit Solutions, Inc are here to help you understand your Medicare health insurance choices. Call us today at (215)355-2121.
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The Part D Senior Savings Model allows drug manufacturers to offer their discounts in the coverage gap, even when a Part D plan enhances cost sharing. This allows plans to offer a fixed, consistent cost sharing on insulin. This structure is estimated to save enrollees who take insulin $446 in annual out-of-pocket costs. Part D sponsor plan premiums vary and beneficiaries should find a Part D plan that provides coverage they want at the lowest total annual cost, premiums and out-of-pocket costs combined. As always, please contact your Total Benefit Solutions Medicare health insurance specialists at (215)355-2121 with any questions or concerns.
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The upper limit for the negotiated price of a drug (the “maximum fair price”) is equal to the lower of: The drug’s enrollment-weighted negotiated price (net of all price concessions) for a Part D drug; The average sales price for a Part B drug; or A percentage of the non-federal average manufacturer price (i.e., the average price wholesalers pay manufactures for drugs distributed to non-federal purchasers), depending on FDA approval date: 75% for small-molecule drugs more than 9 years but less than 12 years beyond FDA approval; 65% for drugs between 12 and 16 years beyond FDA approval; and 40% for drugs more than 16 years beyond FDA approval Financial… Read More
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In October, Rx Savings Solutions will integrate with the Find Care tool on MyBlueKC.com and the MyBlueKC mobile app. Rx Savings Solutions is a secure, online tool that helps eligible members find ways to save money on prescription drugs. Once integrated, the two tools will allow members to view medical and pharmacy in one place and better use both tools. The integration is one way we’re helping reduce the total cost of care for members, employers, and health plans. Eligible members can follow this path to Rx Savings Solutions: MyBlueKC.com Click Find Care in the left column Click Find Doctors, Specialists & Hospitals Click Medication Finder Have any questions regarding… Read More
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We’ve partnered with Cigna + Oscar to deliver small business health insurance that brings together Cigna’s most popular provider networks and Oscar’s tech-driven approach to customer service and care navigation. Cigna + Oscar plans are available in the Philadelphia 5 county area beginning with effective dates starting January 1 2023. Your Total Benefit Solutions, Inc health insurance specialists are available to help you quote and compare plans. Call us today to get your quote and compare these newest plans to your current renewal. You might be surprised at the competitive cost and plan designs! (215)355-2121
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Step therapy is when a Part D plan requires enrollees to first try certain drugs to treat a medical condition before the plan will cover another drug for that condition. The Model doesn’t change Part D sponsors’ formulary requirements. Enrollees can find out if the insulin or insulins they use have any additional step therapy requirements or limits by looking at the Part D plan’s formulary. Have any questions regarding this notice? Please contact your Total Benefit Solutions Medicare health insurance specialists at (215)355-2121.
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Consumers who qualify for COBRA coverage can opt out of it and enroll in Marketplace coverage. However, voluntarily terminating COBRA continuation coverage does not make a consumer eligible for a Special Enrollment Period (SEP) based on loss of the COBRA continuation coverage. Note that all qualified enrollees eligible for COBRA continuation coverage can get the Marketplace subsidy, not just the employee who qualifies for the COBRA benefit, as long as they are not actually enrolled in the COBRA continuation coverage. Please contact your trusted Total Benefit Solutions health insurance specialists with any questions or concerns at (215)355-2121.
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