Marketplace Health Insurance – Page 3 – Total Benefit Solutions Inc

Elevate Your Productivity with Better BenAdmin

September 18, 2023September 18, 2023Wendy Lopez

In a fast-paced world, time is of the essence. We’re all too familiar with the feeling of being buried under a mountain of administrative tasks, wishing for an extra set of hands or a few more hours in the day. Well, wish no more! Enter Better BenAdmin, the game-changer powered by EBM (Efficiency-Boosting Machine). Seamless Schedule Management Scheduling headaches? Not anymore. Better BenAdmin effortlessly handles your calendar, ensuring that appointments are well-organized and conflicts are a thing of the past. No more double-bookings or time wasted on manual scheduling. Effortless Email Handling Say goodbye to the endless email backlog. Better BenAdmin sorts, filters, and responds to emails with precision and… Read More

Choosing the Right Health Insurance: HMO vs. PPO

September 15, 2023September 15, 2023Wendy Lopez

When it comes to health insurance, understanding the differences between various plans is crucial for making an informed decision. Two common types of health insurance plans are Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). While both offer coverage for medical expenses, they have distinct features that can significantly impact your healthcare experience and costs. In this blog, we’ll explore three key differences between PPOs and HMOs to help you decide which one aligns better with your needs. 1. Network Flexibility: PPO: Preferred Provider Organizations are known for their expansive networks of healthcare providers. This includes a wide array of specialists and the option to seek care from out-of-network… Read More

Annual Health Insurance Check-Up: Don’t Miss Out!

September 5, 2023September 5, 2023Wendy Lopez

Health insurance is vital for your well-being, providing financial protection and access to essential healthcare. But it’s not a one-time decision. Did you know that reviewing your health insurance plan annually is crucial to ensure it still fits your needs and budget? In this blog, we’ll explore why this check-up is essential and provide key enrollment dates. Plus, we’re here to assist you every step of the way! Why an Annual Review Matters: Enrollment Dates: Let’s talk about the enrollment dates you need to remember: How We Can Help: Navigating health insurance can be complex, but you’re not alone. Our expert team is ready to assist you in reviewing your… Read More

Reasons Why You Need a Health Insurance Broker

September 2, 2023September 1, 2023Wendy Lopez

Navigating the world of health insurance can feel like a daunting journey through an intricate maze. That’s where a trusted health insurance broker comes in, acting as your guiding light and advocate. Here’s why you need one in your corner: 1. Expert Guidance: Your Healthcare GPS: Think of a health insurance broker as your personal healthcare GPS. They simplify the bewildering maze of insurance options, helping you choose the path that suits your needs best. With their expertise, you won’t feel lost in the insurance wilderness. 2. Advocacy: Your Fighter: Insurance claims, disputes, and paperwork can be a real hassle. But with a broker, you have a dedicated champion in… Read More

Open Enrollment 2023: Your Top 5 FAQs Answered

August 30, 2023August 29, 2023Wendy Lopez

Everything You Need to Know About Open Enrollment Are you ready for open enrollment? It’s that time of year when you have the opportunity to review and make changes to your health insurance plan. To help you navigate this important period, we’ve compiled a list of the top five frequently asked questions about open enrollment in 2023. Let’s dive in! 1. When is open enrollment?In Pennsylvania, open enrollment for individual health coverage typically runs from November 1 through January 15. The timing of open enrollment can vary depending on the organization or employer. It’s crucial to check with your specific company or health insurance provider to determine the exact dates… Read More

Medicare Covers Diabetes Supplies & Services for Your Health

August 26, 2023July 24, 2023Wendy Lopez

Discover the power of Medicare, a federal health insurance program in the US designed for individuals aged 65 and older, as well as certain younger people with disabilities, providing access to essential medical services and supplies. Don’t miss the invaluable “Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs” booklet available on Medicare.gov/publications. This comprehensive guide highlights coverage options for individuals with diabetes, including supplies and services, preventive programs, and access methods. Plus, it features a must-have checklist for your next doctor’s visit, empowering you to ask the right questions about treatments, preventive services, covered supplies, and lifestyle recommendations. Take control of your diabetes management and overall well-being with this… Read More

What’s New in the 2023 ACA Open Enrollment?

August 21, 2023August 21, 2023Wendy Lopez

The 2023 Affordable Care Act (ACA) Open Enrollment period is upon us, marking a significant milestone as Health Insurance Marketplaces open their doors for the tenth year. From November 1, 2022, to January 15, 2023, individuals and families have the opportunity to secure comprehensive healthcare coverage. In this blog post, we’ll delve into the key changes and updates for this year’s open enrollment, focusing on insights gathered from the Kaiser Family Foundation’s informative article titled “Nine Changes to Watch in Open Enrollment 2023” [source: www.kff.org/policy-watch/nine-changes-to-watch-in-open-enrollment-2023/]. As the ACA Open Enrollment enters its tenth year, changes abound, ensuring improved access, affordability, and assistance for individuals and families seeking healthcare coverage. Staying… Read More

Exploring PEOs: Efficiency and Compliance Solutions

August 8, 2023August 14, 2023Wendy Lopez

In today’s business landscape, optimizing operations and compliance is an ongoing challenge. Enter PEOs – Professional Employer Organizations. PEOs offer outsourcing solutions that reshape how companies handle HR and administrative tasks. Let’s dive into the world of PEOs and unveil their potential advantages and drawbacks. A “PEO,” or Professional Employer Organization, forms a strategic partnership where businesses team up with experts to manage HR and admin functions. This collaboration lets companies offload tasks like payroll, benefits, and compliance, ideal for small to mid-sized businesses aiming to streamline while focusing on core activities. Pros of PEOs: Cons of PEOs: In conclusion, PEOs provide a promising avenue for businesses aiming to bolster… Read More

IRS Addresses COVID-19 Testing and HDHP Treatment

August 3, 2023August 3, 2023Wendy Lopez

As a result of the COVID-19 pandemic, high deductible health plans (“HDHPs”) can provide coverage for COVID-19 testing and treatment before the minimum deductible is satisfied without jeopardizing an individual’s ability to have tax-favored contributions made to their health savings account (“HSA”). This relief remains in effect pending future IRS guidance.On June 24, 2023, the IRS issued Notice 2023-37, announcing that this relief will sunset with respect to plan years ending on or before December 31, 2024. In addition, IRS Notice 2023-37 states that HDHPs may continue to provide first-dollar coverage for preventive care with an “A” or “B” rating by the United States Preventive Services Task Force (“USPSTF”), prior… Read More

Unlock Your Best Health: 5 Must-Know Tips & Tools!

August 2, 2023August 2, 2023Wendy Lopez

Five major tips and resources for maintaining overall health and wellness: Remember, it’s important to personalize these tips to your individual needs and consult with healthcare professionals before making significant changes to your lifestyle. We’re committed to providing exceptional support, so please don’t hesitate to reach out to our dedicated Total Benefit Solutions health insurance specialists at (215)-355-2121. We’re here to answer any questions or address any concerns you may have.

Orlando Health Patients Face Coverage Loss Amid Contract Dispute

August 1, 2023August 1, 2023Wendy Lopez

UnitedHealthcare’s contract with Orlando Health is set to expire on July 31. If an agreement is not reached before the deadline, most services will no longer be covered for individuals on various plans, starting from August 1. The affected plans include employer-sponsored and individual plans, Medicare Advantage (including the Group Retiree PPO plan), and Medicaid (including the Dual Special Needs Plan). Both parties have been engaged in months of negotiations to establish new terms. With less than two weeks remaining, tensions have escalated, and accusations of delaying negotiations, disseminating misleading information, and proposing unreasonable terms have been exchanged by both sides. United Healthcare has taken proactive measures to notify approximately… Read More

Top 10 Ways to Make Your Health Benefits Work for You

July 31, 2023July 31, 2023Wendy Lopez

Unleash the Full Potential of Your Health Coverage! Are you making the most of your health benefits? The Employee Benefits Security Administration (EBSA) administers crucial health benefit laws that cover employer-based health plans. These laws safeguard your rights to essential information about your health plan, guide you on qualifying for benefits and making claims, ensure continued health benefits during job transitions, and offer protections for special medical conditions. Start by exploring your health coverage options, delving into different plans, and matching them with your needs. Not sure if your plan covers mental health or substance use disorder services? We’ve got you covered with essential information on these benefits too! Your… Read More

Why Short Term Heath Insurance is not “ JUNK” insurance.

July 29, 2023July 29, 2023Ed MacConnell

Short-term health insurance, also known as temporary health insurance, is a type of health coverage designed to provide temporary medical insurance for a limited duration, typically ranging from a few months to a year. While short-term health insurance may not be suitable for everyone, it does offer certain benefits for specific situations. When people label Short Term health as “ JUNK” it is clear they do not understand that many people still need short term health insurance coverage. The ACA solved many problems when it comes to access to coverage, but first problem is the COBRA prohibition which specifically disallows ACA tax credits for people who can get on COBRA.… Read More

Making HSAs Work Smarter

July 25, 2023July 24, 2023Wendy Lopez

In the dynamic world of employee benefits, leaders have come to grasp the immense potential benefits hold in achieving their key goals. One approach that has gained significant traction is the combination of High Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs), a powerful duo that not only reduces benefits costs but also empowers employees with greater control over their healthcare expenses. However, despite the evident advantages, the journey to unlocking the full potential of HDHPs + HSAs is far from over. There lies an untapped opportunity to optimize plan design and elevate employee education, enabling companies to enhance their workforce’s well-being while achieving cost-effectiveness. If you are eager… Read More

Are Health Insurance Premiums Tax Deductible?

July 24, 2023July 24, 2023Wendy Lopez

Health insurance premiums can be tax-deductible under certain conditions in the United States. However, please note that tax laws and regulations can change, so it’s essential to consult a tax professional or the latest IRS guideline for the most up-to-date information. Typically, if you are self-employed or have health insurance coverage through your employer and pay your premiums with after-tax dollars, you may be eligible to deduct the premiums on your federal income tax return. This deduction is generally reported on Schedule 1 of Form 1040, which is used to calculate your Adjusted Gross Income (AGI). Keep in mind that there are specific requirements and limitations for deducting health insurance… Read More

What is Health Insurance for?

July 20, 2023July 20, 2023Wendy Lopez

Health insurance is a type of insurance coverage that helps individuals and families manage the costs of medical expenses and healthcare services. It provides financial protection against the high costs of medical treatments, hospitalizations, prescription drugs, and other healthcare-related services. Health insurance is designed to help people access the medical care they need without facing significant financial burdens. Health insurance provides a safety net against unexpected and costly medical events, allowing individuals to seek necessary medical care without facing crippling financial burdens. It also promotes preventive care, encouraging people to get regular check-ups and screenings to detect potential health issues early. It’s important to note that the coverage and cost-sharing… Read More

Will health insurance cover a swimming pool?

July 18, 2023July 18, 2023Wendy Lopez

Health insurance typically does not cover the cost of a swimming pool for personal use. Health insurance is designed to provide coverage for medical services, treatments, and supplies that are necessary for the diagnosis and treatment of illnesses or injuries. Swimming pools are a comfort item and are generally not considered medically necessary. However, there may be some exceptions in certain cases where a swimming pool is prescribed as part of a medical treatment plan for specific conditions such as physical therapy or rehabilitation. In such cases, coverage for a swimming pool may be possible, but it would require a thorough evaluation and approval process by the insurance company. It’s… Read More

Cracking the Code: Navigating Health Cost Surge in 2023

July 10, 2023July 10, 2023Wendy Lopez

Managing Health Costs in 2023 Multiple industry and benefits sources are predicting health insurance premium increases in the range of five to eight percent for 2023. An analysis by Aon is forecasting a 6.5% increase. The Society for Human Resource Management (SHRM) is expecting a bump of 5.6%, based on a prediction by Mercer. The International Foundation of Employee Benefit Plans says employers are anticipating a 7.5% increase. The country’s oldest actuarial consulting firm, Buck, has forecast an increase in the range 5.8% to 6.9%. If you have any questions or concerns about this news please contact your Total Benefit Solutions, Inc health insurance specialists at (215)-355-2121

Request to lower an Income-Related Monthly Adjustment Amount (IRMAA)

July 7, 2023July 7, 2023Wendy Lopez

If you’ve had a life-changing event that reduced your household income, you can ask to lower the additional amount you’ll pay for Medicare Part B and Part D. Life-changing events include marriage, divorce, the death of a spouse, loss of income, and an employer settlement payment. Amended income tax returns Call +1 800-772-1213 and tell the representative you want to lower your Medicare Income-Related Monthly Adjustment Amount (IRMAA) if you had an amended income tax return. Fax or mail your request Fill out the Medicare Income-Related Monthly Adjustment Amount-Life-changing Event (SSA-44) (PDF) form. Fax or mail your completed form and evidence to a Social Security office. For support completing this task call +1 800-772-1213… Read More

What are the preferred plans for insured employees?

July 6, 2023June 28, 2023Wendy Lopez

Preferred Provider Organization plans remain the most common plan type. Nearly half (49%) of insured employees enrolled in a PPO in 2022. That compares to 29% enrolled in an HDHP, 12% enrolled in an HMO, nine percent in a Point-of-Service (POS) plan, and one percent in a conventional (indemnity) plan. If you have any questions or concerns about this bulletin, please contact your Total Benefit Solutions Inc health insurance account manager at (215) 355-2121

How much do employees contribute towards their insurance expenses?

July 5, 2023June 30, 2023Wendy Lopez

Average Contributions Most employees do make a contribution toward their insurance costs. Covered workers, on average, contribute 17% of the premium for single coverage and 28% of the premium for family coverage. These numbers are similar to those reported by KFF in its EHBS in 2021. The average contribution for workers at small firms is $7,556, which is more than a third higher than the average for those at large firms ($5,580). Workers at private, for-profit firms contribute a higher percentage of the premium versus those at public firms, regardless of coverage type. A fortunate one-third of employees (33%) at small firms are enrolled in coverage where the employer pays… Read More

Increases in Premium Found in Health Benefits Survey

July 4, 2023June 28, 2023Wendy Lopez

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

What Additional Changes Are Being Made to Part D?

July 3, 2023June 30, 2023Wendy Lopez

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

How Is the Medicare Part D Benefit Changing in 2025?

June 30, 2023June 28, 2023Wendy Lopez

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

How Is the Medicare Part D Benefit Changing in 2024?

June 29, 2023Wendy Lopez

In 2024, costs in the catastrophic phase will change: the 5% coinsurance requirement for Part D enrollees will be eliminated and Part D plans will pay 20% of total drug costs in this phase instead of 15%. The 5% coinsurance requirement for Part D enrollees in the catastrophic phase will be eliminated In 2024, once Part D enrollees without low-income subsidies (LIS) have drug spending high enough to qualify for catastrophic coverage, they will no longer be required to pay 5% of their drug costs, which in effect means that out-of-pocket spending for Part D enrollees will be capped. In 2024, the catastrophic threshold will be set at $8,000. This… Read More

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