Individual Health Insurance – Page 3 – Total Benefit Solutions Inc

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

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

Navigating Health Insurance for “gig” Economy Entrepreneurs

July 11, 2023July 11, 2023Wendy Lopez

For self-employed individuals or today’s gig workers, obtaining health insurance can be a bit different compared to traditional employer-sponsored plans. Empower yourself with a range of valuable choices to explore! Take a moment to peruse the document below, where you’ll find a comprehensive list of options available to you. 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.

Insights into Self-Funding and Deductibles: A Look at Healthcare Trends for Large Firms

July 8, 2023July 7, 2023Wendy Lopez

Self-Funding Popular – Especially for Large Firms Many larger firms self-fund their health plans or pay for some workers’ health services directly – rather than through the use of health insurance. Nearly two-thirds (65%) of covered workers are in self-funded plans. That includes 20% of workers at small firms and 82% at large firms. Deductibles for Most Most employees with health insurance have a cost share before their insurance begins to pay benefits. Among those with single coverage, the average annual deductible is $1,763, similar to the $1,669 average in 2021. For most plan types, the single coverage deductible is higher for employees at small firms. The average is $2,543… Read More

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

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 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

Delta Dental Plans Association: Survey shows patients rate their experiences with dentists a 9.5

June 26, 2023Wendy Lopez

OAK BROOK, Ill., June 22, 2023 /PRNewswire/ — Delta Dental announced key findings from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Dental Plan Survey, which provides feedback from Delta Dental patients about their oral health care experiences. Delta Dental is the only carrier utilizing the survey nationwide to continuously enhance patient experiences with its outstanding network of dentists. This trusted anonymous survey tool is used in the health care industry to evaluate a patient’s experience throughout their dental care journey and includes questions related to care from dentists and staff, access to dental care, and dental plan information and services. Recent CAHPS Dental Plan Survey findingsMore than 20,000 Delta Dental adult… Read More

The health plan categories: Bronze, Silver, Gold, & Platinum

March 24, 2023March 23, 2023Ed MacConnell

Plans in the Marketplace are presented in 4 health plan categories: Bronze, Silver, Gold, and Platinum. FYI: Health plan categories are based on how you and your plan split the costs of your health care. They have nothing to do with quality of care. How you and your insurance plan split costs Which health plan category is right for you? Bronze Silver Gold Platinum Note: Plans in all categories provide free preventive care, and some offer selected free or discounted services before you meet your deductible. 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 cost sharing reduction (CSR)?

March 22, 2023Ed MacConnell

A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace®, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings. Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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.

Small Group – Form 1095-B: Who receives it and why

February 27, 2023February 21, 2023Ed MacConnell

Form 1095-B is a health insurance tax form used to report certain information to the IRS and taxpayers about individuals who are covered by Minimum Essential Coverage (MEC). What are the IRS reporting requirements? The ACA requires individuals to obtain and report that they had MEC or otherwise qualify for an exemption from the requirement. However, there is no longer an individual tax penalty following the 2017 Tax Cuts and Jobs Act. Individuals may need Form 1095-B to demonstrate MEC for nontax-related purposes. The ACA also requires certain employers to offer all full-time employees and their dependents MEC to meet affordability and minimum value standards. This is known as the… Read More

ACA: Special Election Cheat Sheet

February 9, 2023February 9, 2023Ed MacConnell

Download our SEP Cheat Sheet. Know your health insurance SEP to get enrolled outside of the annual open enrollment period. As always contact your Total Benefit Solutions health insurance experts for more specific information about your situation at (215)355-2121 http://www.totalbenefits.net

Pennie: 1095-A Tax Form Available for Customers

January 24, 2023January 20, 2023Ed MacConnell

The 1095-A tax form has been delivered to Pennie customers for their 2022 tax returns. The 2022 1095-A Form: Health Insurance Marketplace Statement has been delivered to customers’ Pennie Secure inboxes. Important: The 1095-A reflects a Pennie customer’s 2022 enrollment information. Click here to learn more about 1095-A forms. Have any questions regarding your Pennie account or the 1095-A tax form? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

What is vision coverage?

January 23, 2023January 13, 2023Ed MacConnell

A health benefit that at least partially covers vision care, like eye exams and glasses. All the plans in the Health Insurance Marketplace include vision coverage for children. Only some plans include vision coverage for adults. If adult vision coverage is important to you, check the details of any plan you’re considering. If your plan doesn’t include adult vision coverage, you can buy a “stand-alone” vision plan to reduce your vision care expenses. The Marketplace doesn’t offer stand-alone vision plans. To shop for stand-alone vision plans, contact an insurance agent or broker, or search for plans online. You can also contact your state’s Department of Insurance. As always, don’t hesitate… Read More

Dental coverage in the Marketplace

January 19, 2023January 11, 2023Ed MacConnell

In the Marketplace, you can pick a health plan with or without dental benefits. If you pick a health plan without dental benefits, you can still get a separate dental plan. Important: You can’t buy a Marketplace dental plan unless you’re buying a health plan at the same time. Dental coverage is available in 2 ways: Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

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

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