Medical Insurance – Page 2 – Total Benefit Solutions Inc

Medicare Diabetes Prevention Program

August 25, 2023August 25, 2023Wendy Lopez

If you have been diagnosed with prediabetes, it’s essential to take proactive steps to manage your condition and reduce the risk of developing type 2 diabetes. The good news is that there are programs available designed specifically to assist individuals like you in preventing or delaying the onset of type 2 diabetes. These programs often encompass a comprehensive approach that includes education, lifestyle modifications, and support systems tailored to your specific needs. Let us help, don’t miss this opportunity to take control of your health and potentially prevent the development of type 2 diabetes. Download this PDF for more information! As always if you have any questions or concerns about… 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

HOW PEOS ARE HELPING SMBS MEET MARKET DISRUPTORS HEAD ON

August 19, 2023August 19, 2023Ed MacConnell

The modern world is driven by convenience and customization, SMBs included. Digitization, remote-friendly roles, and a generational shift in the workforce all impact today’s employee experience. When this experience is lacking, it can be costly to companies in more ways than one. click here to read the story from PEO insider Total Benefit Solutions Inc is dedicated to providing a comprehensive selection of solutions for the small business owner including the comparison of PEO’s to the typical employee benefits experience. Contact us today at (215)355-2121 to inquire about the possibility of using a PEO for your organization.

Decoding Medicare Supplement Charts

August 15, 2023August 15, 2023Wendy Lopez

So, you’re on the quest to unravel the complexities of Medicare supplement plans, and in your journey, you’ve stumbled upon the elusive “Medicare Supplement Comparison Chart.” It’s like a mosaic of options, donning a variety of colors and fonts, yet each one is strangely reminiscent of the other. But what exactly are these charts? What secrets do they hold? Well, that’s what we’re here to uncover today. Cracking Open the Chart Imagine this: you’re face-to-face with a Medicare Supplement Comparison Chart. But what’s beneath the surface? Every column you see represents one of the ten available Medigap plans up for grabs – think Plans A, B, C, D, F, G,… 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 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

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

The Benefits of Short-Term Health Insurance

May 5, 2023May 5, 2023Ed MacConnell

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

ACA special enrollment period opens soon for people losing Medicaid coverage

March 17, 2023March 16, 2023Ed MacConnell

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.

What is State Mandated Disability or TDB?

March 9, 2023March 9, 2023Ed MacConnell

New Jersey Temporary Disability Benefits (TDB) and Family Leave Insurance (FLI). The New Jersey Temporary Disability Benefits (TDB) law, enacted in 1948 and later amended in 2008 to include Family Leave Insurance (FLI), allows for NJ covered workers to take paid time off for their own non-occupational related injury or illness (under TDB) or to care for a family member with a serious health condition or bond with a new child (under FLI). Which employers are subject to the law? Most New Jersey employers subject to the provisions of the Federal Unemployment Tax Act (FUTA) are also subject to NJ TDB law and are required to provide coverages for their employees working in… Read More

Notification Reminder for Forms 1095-C and 1095-B

February 9, 2023February 9, 2023Ed MacConnell

Under the Affordable Care Act (“ACA”), the deadline for applicable large employers (“ALEs”) to furnish Form 1095-C and 1095-B to certain individuals (such as full-time employees in the case of Form 1095-C) is January 31 with respect to the preceding calendar year. The Internal Revenue Service (“IRS”) released final regulations on December 12, 2022 with respect to ACA reporting requirements. These final regulations provided an automatic extension of 30 days to furnish these statements to individuals. This means that Wednesday, March 2, 2023 is the deadline to furnish individuals with 2022 Forms 1095-C and 1095-B. This extension is automatic; employers or other reporting entities are not required to file a… Read More

DOL Penalties Increase for 2023

February 2, 2023January 26, 2023Ed MacConnell

The Department of Labor (“DOL”) has published the annual adjustments for 2023 that increase certain penalties applicable to employee benefit plans. As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns today at (215)355-2121.

What is Limited Medical Insurance?

January 29, 2023January 29, 2023Ed MacConnell

A limited medical plan is a form of supplemental health insurance that can be used with or without a major medical plan. Limited medical plans have a set amount of money for treatment that they give to you to pay for common medical expenses. They recognize that common services like wellness visits can sometimes turn into a financial strain for people. Since this type of insurance does not cover everything due to a predetermined limit on what you receive, you will want to look closely at the benefits before choosing a plan. It can be helpful to pair a limited medical plan with a major medical plan. Doctors visits and… Read More

What is a drug formulary?

January 14, 2023January 14, 2023Ed MacConnell

The drug formulary is a list of medications that have been selected by an insurance company for their medical effectiveness, positive results, and value. The formulary includes generic medications and a defined list of brand medications. Sometimes it includes specialty mediations. Most formularies will have exclusions, or drugs not covered by your plan. You maximize your benefits when you purchase formulary medications. Your health insurance specialists at Total Benefit Solutions, In. can help you understand your plan’s formulary and how to find or search that list. Contact us today at (215)355-2121 if you have questions about your health insurance plan’s drug coverage.

Blue KC: 2023 member guides and handbooks now available

January 11, 2023January 9, 2023Ed MacConnell

The 2023 commercial and ACA member guides and Medicare Advantage member handbook are now available. Clients will receive these documents through a variety of touchpoints. Please keep them handy as a quick reference to Blue KC plan benefits and features and to share them with clients as needed. Employer/Group Medicare Advantage ACA Individual and Family Plans Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Requirement

December 27, 2022December 27, 2022Ed MacConnell

At the start of the pandemic, Congress enacted the Families First Coronavirus Response Act (FFCRA), which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency (PHE) ends, in exchange for enhanced federal funding. Primarily due to the continuous enrollment requirement, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped. But, when the PHE ends, millions of people could lose coverage that could reverse recent gains in coverage. The current PHE is in effect until January 11, 2023, and the Biden administration has said it will give states a 60-day… Read More

Get connected with the IBX Smartphone App

November 2, 2022November 2, 2022Ed MacConnell

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.

Total Benefit Solutions, Inc appoints with Lasso Medicare Medical Savings Accounts Plans for 2022-2023 Open Enrollment Season

October 11, 2022Ed MacConnell

What 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

Turning 26: Your Guide to Health Insurance

September 23, 2022Ed MacConnell

Turning 26: Your Guide to Getting Your New Health Insurance:https://totalbenefits.net/turning-26-your-guide-to-health-insurance/

CMS Updates Medicare Enrollment Rules for 2023

September 17, 2022September 15, 2022Ed MacConnell

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

Medicare Creditable Coverage Part D notification requirements

September 15, 2022September 15, 2022Ed MacConnell

FROM INDEPENDENCE: Each year, the Centers for Medicare & Medicaid Services (CMS) requires plans that offer prescription drug coverage to their Medicare‑eligible employees, retirees, and dependents to notify them by October 15 as to whether that coverage is “creditable” or “non‑creditable.” What customers must do Customers must take the following steps to comply with this requirement: Review the materials provided to determine whether their prescription drug coverage is creditable or non‑creditable. Disclose to their Medicare‑eligible members (employees and their dependents) whether their prescription drug coverage is creditable or non‑creditable prior to the Medicare Part D Annual Election period, running from October 15 through December 7 of this year and at other times during the future.… Read More

Additional Guidance on New Prescription Drug Reporting Requirement

September 15, 2022September 14, 2022Ed MacConnell

As previously reported in 2021, Section 204 of the Consolidated Appropriations Act, 2021 (“CAA”) requires plan sponsors of group health plans to submit informationannually 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 requirement that provides some helpful clarification. Click the link below to download this bulletin. As always please contact your Total benefit Solutions, Inc health insurance specialist at (215)355-2121 if you have any further questions or concerns.

Medigap Guaranteed issue rights

August 12, 2022July 28, 2022Ed MacConnell

Guaranteed Issue Rights (Also Called “Medigap Protections”) are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company: Must sell you a Medigap policy Must cover all your pre-existing health conditions Can’t charge you more for a Medigap policy because of past or present health problems In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health coverage. In other cases, you have a “trial right” to try a Medicare Advantage Plan (Part C) and still buy a Medigap policy if you change your mind.… Read More

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