Dear Valued Client: We wanted to alert you to an upcoming change that could have a significant impact on Medicare-eligible employees and dependents who currently have group health coverage. Starting in 2025, Medicare Part D plans will have a $2,000 out-of-pocket limit. As CMS explains, this change, which is part of the Inflation Reduction Act, also includes measures like a $35 cap on insulin and new authority for Medicare to negotiate prices for certain high-cost drugs. The new $2,000 cap for Part D is particularly important because it could alter the status of many employer group health plans that currently provide drug coverage. Each year, employers must determine whether their prescription drug… Read More
Continue Reading2025 Part D Changes and Employer Sponsored Group Health Plans
Employers must inform the Centers for Medicare and Medicaid Services (“CMS”) and participants and beneficiaries who qualify for Medicare Part D of the creditable or non-creditable status of the group health plan prescription drug plan(s). When prescription medication coverage meets or exceeds Medicare Part D, it is considered creditable. Any coverage that falls short of Medicare Part D’s quality standards is deemed non-creditable As previously reported, the Inflation Reduction Act of 2022 (“IRA”) changed aspects of the Medicare Part D program to enhance and improve Medicare Part D coverage. The changes include: As a result of these changes, some employer sponsored prescription drug coverage may no longer qualify as creditable… Read More
Continue ReadingIBC Medicare Members Save money with your IBX Care Card
Your IBX Care Card comes preloaded with a quarterly balance. Your card will be automatically reloaded every quarter (every three months). Be sure to spend your allowance each quarter, as any unused balance will not roll over to the next quarter. Please keep your card in a safe location, as you may use the same card for as long as you remain a member of a participating plan. Click here for more information about the IBX Care card for Medicare members or contact us today at (215)355-2121
Continue ReadingWellcare PDP Plans: Contract Termination: Important Change!!
Total Benefit Solutions, Inc has been notified by Wellcare PDP plans that our contract is being terminated without cause beginning immediately. Due to the changes in coverage mandated by the Inflation Reduction Act, Wellcare is terminating our agreement for the purposes of not paying bew or renewal business commissions. What does that mean for our clients?Beginning immediately, we will no longer be able to enroll new customers onto Wellcare PDP plans. Further moving forward, we will be unable to provide service to our existing clients already on Wellcare or who choose to renew with a Wellcare PDP plan for 2025. Our experts are standing by to answer your questions or… Read More
Continue ReadingImportant Changes to Medicare Drug Coverage for 2025
The Inflation Reduction Act (IRA) has resulted in significant changes to Part D including: Elimination of the Coverage Gap or “donut hole”A new $2,000 out-of-pocket spending capA shift in cost sharing responsibility in the catastrophic coverage phaseA new cost sharing smoothing option called the Medicare Prescription Payment Plan These changes have an enormous impact on your Medicare coverage in 2025 for nearly all those on Medicare including Medicare beneficiaries who are still choosing their employer plans. Please review your ANOC carefully for your 2025 coverage and contact your Total Benefit Solutions Inc health insurance experts if you have any questions or concerns about how these changes impact you and your… Read More
Continue ReadingNew Medicare plans could wind up forcing seniors to switch or buy new plans or face a significant penalty
Many seniors who remain working past 65 are still on their employer’s health plan instead of government-run Medicare. However, a new update to Medicare coverage under the Inflation Reduction Act means seniors who delay joining Medicare could face additional hurdles when it comes to drug coverage. Who Does It Affect?Currently, seniors are able to avoid late penalties for Medicare Part D as long as their company’s plan pays on average just as much as the traditional Medicare prescription drug plan. These numbers are scheduled to change drastically in 2025. Starting January 1, most employer plans will no longer be accepted as a way out of the late penalties because they… Read More
Continue ReadingMedicare 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
Continue ReadingMedicare Supplement plan closure
AmeriHealth will stop accepting new enrollments for any Medicare Supplement plans as of April 1, 2024, the date the plans go into effect. Medicare Supplement Plans A, C, D, F, G, G-HD, and N were provided by AmeriHealth. Members who are presently enrolled in these plans will continue to receive services from AmeriHealth, guaranteeing that their coverage will not be stopped. To read more about the article 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 or address any… Read More
Continue Reading2025 Medicare Advantage and Part D Rate Announcement
The Centers for Medicare & Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). The objectives set forth by CMS for Medicare and Part D align with our overall program vision for the agency, which includes advancing health justice, promoting affordability and the Medicare program’s sustainability, and driving comprehensive, person-centered care. Medicare Advantage and Part D Rate Announcement 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… Read More
Continue ReadingAetna – 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
Continue ReadingIs 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
Continue Reading2024 Medicare Parts A & B Premiums and Deductibles
On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts. The Medicare Savings Programs (MSPs) help more than 10 million people with coverage of Medicare premiums and, in most cases, other cost sharing. In their continued efforts to improve access to health care and lower costs for millions of Americans, the Department of Health and Human Services (HHS), through CMS, recently finalized a rule to streamline enrollment in MSPs, making coverage more affordable for an estimated 860,000 people. In addition, the… Read More
Continue Reading2023 RxDC Reporting Instructions Released
The Centers for Medicare and Medicaid Services (“CMS”) recently updated its Prescription Drugs Data Collection (“RxDC”) reporting instructions for 2023 data. There are some noticeable differences. As previously reported, group health plan sponsors (typically employers) are required to submit information to CMS on prescription drugs and health care spending on an annual basis (“RxDC reporting”). The first reporting deadline for calendar years 2020 and 2021 was December 27, 2022 (extended to January 31, 2023). The next deadline for reporting on calendar year 2023 is June 1, 2024, which, despite being a Saturday, is a firm date. It should be noted that carriers, pharmacy benefit managers (“PBMs”), and third-party administrators (“TPAs”)… Read More
Continue ReadingDecisions for someone who is nearing age 65
As you near age 65, you need to learn about Medicare coverage choices and make several important enrollment decisions. This fact sheet will give you a list of the steps you shouldtake and tell you about resources to help you make your Medicare enrollment decisions. There can be penalties if you do not enroll on time, so it is best to complete these tasksat least 3 months BEFORE you turn 65. Please note you can enroll on Medicare Parts A & B with Medicare about 90 days before your 65th birthday. IF YOU ARE STILL WORKING and your company has less than 20 employees you still MUST enroll on Medicare… Read More
Continue ReadingMedicare Supplement Insights: Protecting Your Wallet
In a world where healthcare costs are a growing concern for many, Medicare Supplement coverage has emerged as a reliable solution to bridge the gaps in original Medicare. As we delve into the latest data from 2021, including insights from the National Association of Insurance Commissioners (NAIC), the California Department of Managed Health Care, and the Medicare Current Beneficiary Survey (MCBS) from 2020, a compelling narrative about the significance of Medicare Supplement plans unfolds. Key Takeaways: 1. A Majority Embrace Medicare Supplement: In 2020, a staggering 54% of original Medicare enrollees without additional insurance coverage, such as Medicaid or employer-provided insurance, turned to Medicare Supplement policies for added peace of… Read More
Continue ReadingMedicaid & CHIP Enrollment Extension!
In a recent development, the Centers for Medicare & Medicaid Services (CMS) and the Departments of Labor (DOL) and the Treasury have issued a letter urging employers, plan sponsors, and carriers to consider extending the enrollment period for employer-sponsored health plans. This extension is aimed at helping individuals who have lost their Medicaid and Children’s Health Insurance Program (CHIP) coverage due to the resumption of normal eligibility and enrollment procedures. Traditionally, Medicaid coverage requires annual renewal of eligibility. However, during the COVID-19 Public Health Emergency, these renewal requirements were temporarily halted to prevent members from losing their coverage. Unfortunately, this pause in eligibility rules came to an end on March… Read More
Continue ReadingWhat is your Medicare Part D ANOC?
The Annual Notice of Change (ANOC) is a document that Medicare Advantage and Medicare Part D prescription drug plans are required to send to their members every year. The ANOC outlines any changes in coverage, costs, and more that will be effective in January 1. If you’re enrolled in a Medicare plan, your plan will send you an ANOC each fall. The ANOC includes information about any changes to your plan’s coverage, costs, and service area that will be effective in January 1. It’s important to review the ANOC carefully to understand how your plan’s coverage and costs may change in the upcoming year. If you have any questions or concerns about the changes, you can contact… Read More
Continue ReadingEmployer’s Guide to Medicare Compliance
Medicare is a critical healthcare program in the US, covering seniors and certain disabled individuals. Employers offering group health insurance to Medicare-eligible individuals must meet specific requirements. In this blog, we’ll discuss three key Medicare requirements for employers: Employers must ensure compliance with these Medicare regulations to provide necessary healthcare information and process claims correctly. This ensures employees receive the coverage they’re entitled to. For comprehensive information and resources, refer to our PDF document below. Meeting these obligations supports employee well-being and eases healthcare coverage complexities. As always, if you have any questions or concerns about this bulletin, please contact your Medicare health insurance experts at Total Benefit Solutions, Inc.… Read More
Continue ReadingCOBRA and Medicare: Complementary Health Insurance Explained
In today’s rapidly changing job landscape, it’s not uncommon for individuals to find themselves eligible for both Medicare and COBRA simultaneously. This dual eligibility can be a bit bewildering, but understanding how these two crucial insurance options interact is vital to making informed decisions that could impact your finances and peace of mind. Let’s delve into the intricacies of how COBRA works with Medicare and explore the options available to you. COBRA Unveiled First, let’s demystify COBRA. The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal program designed to provide a safety net for workers and their families. It allows you to maintain the health coverage provided by your… Read More
Continue ReadingUnlocking Medicare’s Potential: Top 3 Broker Benefits
It’s that time of year again – the Annual Open Enrollment period for Medicare is almost here, and it’s a crucial opportunity you won’t want to miss. If you’re eligible for Medicare, this is your chance to make important decisions about your healthcare coverage. Here are some compelling reasons why you should take advantage of this opportunity: Expert Guidance: Navigating the world of Medicare can be a complex and overwhelming task. Fortunately, during the Annual Open Enrollment period, you can access personalized advice and guidance from experienced brokers who understand the ins and outs of Medicare. These professionals can help you make informed decisions tailored to your unique healthcare needs.… Read More
Continue ReadingWho Needs Extra Protection During Flu Season?
The flu season is upon us once again, and it’s time to make sure you and your loved ones are protected. The flu is more than just a pesky inconvenience; it can be a serious illness that leads to hospital visits and even death. By getting vaccinated, not only are you protecting yourself from getting sick, but you’re also playing a significant role in preventing the flu from spreading to others. Where to Get Your Flu Shot Getting a flu shot is convenient and accessible. You can receive one at your doctor’s office, your local pharmacy, or various clinics in your area. Plus, if you’re covered by Medicare, you’re in… Read More
Continue ReadingHow income affects your Medicare drug coverage premiums
You could pay a higher monthly premium for Medicare drug coverage (Part D) depending on your income. This includes Part D coverage you get from a Medicare drug plan, a Medicare Advantage Plan with drug coverage, or a Medicare Cost Plan that includes drug coverage. This is true even if your drug coverage is through your employer. Download this bulletin to learn more about extra Medicare drug coverage premiums As always if you have any questions or concerns about this bulleting please contact your Medicare health insurance experts at Total Benefit Solutions, Inc (215)355-2121
Continue ReadingHow can I get help with my Medicare Part A and Part B premiums?
(En español) States must help pay some of the Medicare costs for beneficiaries who have limited income and resources. Under these programs, states help pay for Medicare Part A and Part B premiums, deductibles and copayments. Some of these programs also pay additional Medicare expenses for elderly and disabled people. To find out if you are eligible for state help, contact your local medical assistance office. A representative can tell you the specific requirements and help you apply. If you have any questions or concerns please contact your Total Benefit Solutions, Inc Medicare health insurance specialist at (215)355-2121.
Continue ReadingNavigating the 2024 CMS Final Rule: What You Need to Know
The Centers for Medicare and Medicaid Services (CMS) have set the stage for significant changes with their Final Rule provisions for 2024, slated to take effect on September 30, 2023. These updates will play a pivotal role as we gear up for the 2024 Annual Enrollment Period (AEP). The main points of the new rules Stay Informed: For more insights on these changes and additional updates, please visit the full 2024 CMS Final Rule here. As always if you have any questions or concerns about this bulleting please contact your Medicare health insurance experts at Total Benefit Solutions, Inc (215)-355-2121
Continue ReadingMedicare Diabetes Prevention Program: PDF Download
Medicare covers a health behavior change program to help you prevent or delay type 2 diabetes. The program includes 22 group sessions with a behavior coach who works with you to make lasting diet and exercise changes. You’ll also get support to keep you motivated. For a comprehensive understanding of Medicare prevention programs, download this informative PDF today! As always if you have any questions or concerns about this bulleting please contact your Medicare health insurance experts at Total Benefit Solutions, Inc (215)-355-2121
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