Total Benefit Solutions – Page 9 – Total Benefit Solutions Inc

Can consumers who qualify for COBRA continuation coverage opt out of it and get coverage through the Marketplace instead?

November 2, 2022September 23, 2022Ed MacConnell

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. As always, please contact your Total Benefit Solutions health insurance specialists with any questions or concerns at (215)355-2121.

Open Enrollment Tips from Total Benefit Solutions!

November 1, 2022October 26, 2022Ed MacConnell

As always, please contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

Inflation Reduction Act: Eliminates Cost Sharing for Adult Vaccines in Medicare Part D and Improves Access to Adult Vaccines in Medicaid & CHIP

October 28, 2022September 14, 2022Ed MacConnell

Medicare Part D: Eliminates cost sharing for adult vaccines covered under Medicare Part D that are recommended by the Advisory Committee on Immunization Practices (ACIP), such as for shingles Medicaid and CHIP: Requires state Medicaid and CHIP programs to cover all approved vaccines recommended by ACIP and vaccine administration, without cost sharing Have any questions regarding this notice? Don’t hesitate to contact your Total Benefit Solutions health insurance specialists today at (215)355-2121.

New Jersey State Temporary Disability Rates Released

October 27, 2022October 27, 2022Ed MacConnell

2023 Contribution Rates Released The Maximum Employee Contribution Rate, Employee and Employer Taxable Wage Base Officially announced on October 21th, 2022, by the NJ Department of Labor and Workforce Development. The 2023 DisabilityEmployEE Contribution Rate has been withdrawn and will be set at 0%; The 2023 Disability EmployEE Taxable Wage Base for will be $156.800 The 2023 Disability EmployEE Maximum Contribution will be $0.00 or Zero for this year. The 2023 Disability EmployER Maximum Taxable Wage Base Is $41,100. The 2023 Family Leave Insurance EmployEE Contribution rate will be .06% of the taxable wage base Contributions and Wages – January 1st, 2023 Taxable Wage & Rates EmployER EmployEE Annualized Wage… Read More

What Are Medicare Guaranteed Issue Rights?

October 26, 2022July 25, 2022Ed MacConnell

Please contact your Total Benefit Solutions Inc Medicare health insurance specialists today at (215)355-2121 with any questions.

CIGNA Supplemental Benefits Now Available Online

October 26, 2022October 25, 2022Ed MacConnell

CIGNA’s Medicare supplements and dental/vision plans are available to quote and enroll online for your convenience! Just click the link below to get your quotes and as always contact your Total Benefit Solutions, Inc health insurance specialists at (215)355-2121 if you have any questions or concerns! Click here

Inflation Reduction Act: Expands Eligibility for Full Benefits Under the Medicare Part D Low-Income Subsidy Program

October 25, 2022September 9, 2022Ed MacConnell

The Part D Low-Income Subsidy (LIS) Program helps beneficiaries with their Part D premiums, deductibles, and cost sharing. Beneficiaries qualify for full or partial benefits depending on their income and resources. Current law: Beneficiaries qualify for full LIS benefits if they have income up to 135% of poverty and lower resources (up to $9,900 individual, $15,600 couple in 2022) Beneficiaries qualify for partial LIS benefits if they have income between 135-150% of poverty and higher resources (up to $15,510 individual, $30,950 couple in 2022) Inflation Reduction Act: Expands eligibility for full LIS benefits to individuals with incomes between 135% and 150% of poverty and higher resources (at or below the… Read More

When can I buy a Medigap plan?

October 24, 2022July 25, 2022Ed MacConnell

Blue KC: Employer/Group Open Enrollment Dates – Mark Your Calendar

October 21, 2022September 28, 2022Ed MacConnell

Blue KC is pleased to offer two open enrollment deadlines – one for physical ID cards and one for digital ID cards – to provide flexibility to new and renewing groups. Benefit information and open enrollment files/eligibility updates must be submitted to Blue KC based on the following schedule to ensure new ID cards are available to members by January 1, 2023: November 1, 2022 – Paperwork Deadline November 21, 2022 – Eligibility File – Physical ID Card December 16, 2022 – Eligibility File – Digital ID Card Please note: Small groups that make plan changes after this timeframe will receive updated ID cards once their plan changes have been… Read More

Inflation Reduction Act: Limits Monthly Copayments for Insulin in Medicare

October 20, 2022September 8, 2022Ed MacConnell

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.

Additional Guidance on New Prescription Drug Reporting Requirement

October 18, 2022September 20, 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 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.

Inflation Reduction Act: Capping Medicare Part D Out-of-Pocket Spending and Other Part D Benefit Changes

October 17, 2022September 7, 2022Ed MacConnell

Changes would lower beneficiary spending, reduce Medicare’s liability for high drug costs, and increase Part D plan and manufacturer liability for high drug costs. Beneficiaries: Eliminates 5% coinsurance for catastrophic coverage in 2024 Caps out-of-pocket drug spending at $2,000 beginning in 2025 Allows spreading out of out-of-pocket costs over the year Limits premium growth to no more than 6% per year for 2024-2030 Medicare: Lowers share of costs above the out-of-pocket spending cap (“reinsurance”) Part D Plans: Increases share of costs above the out-of-pocket spending cap Modifies share of costs below the out-of-pocket spending cap Drug Companies: Requires a price discount on brand-name drugs above the out-of-pocket spending cap Modifies… Read More

Did you know about Humana’s Neighborhood Centers?

October 16, 2022October 12, 2022Ed MacConnell

Humana Neighborhood Centers give participants a safe, friendly place to enjoy personalized health and wellness programming, connect with peers and get compassionate customer service from our world-class support team. Whether they’re visiting one of our in-person centers or taking part in our virtual offerings, members can always expect a warm, welcoming experience that provides whole human care. Watch the video below and contact your Total Benefit Solutions, Inc health insurance and supplememnt specialists for more information at (215)355-2121. Click here for more about Humana Neighborhood Centers

Reminder: New Cost-Sharing Disclosure in 2023

October 13, 2022September 19, 2022Ed MacConnell

Another compliance deadline is quickly approaching. For plan years that begin on or after January 1, 2023, group health plans must provide for advance disclosure of cost-sharing information to enrollees seeking health services, upon request and to the extent practicable. The format of the disclosure is through an internet-based self-service tool, telephone, or paper format (upon request). The tool allows the enrollee to compare the amount of cost-sharing that he or she would be responsible for with respect to a discrete covered item or service by billing code or descriptive term. The required information relates to geographic region and in-network and out-of-network providers and initially addresses 500 items and services.… Read More

3 Types of Medigap Rating Structure

October 12, 2022August 2, 2022Ed MacConnell

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

Inflation Reduction Act: Requires Drug Manufacturers to Pay Rebates for Drug Price Increases Above Inflation

October 11, 2022September 7, 2022Ed MacConnell

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

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

New Jersey New Poster Requirements

October 7, 2022October 7, 2022Ed MacConnell

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

Part D Senior Savings Model: Is there a cap on the number of units monthly to get the $35 copay?

October 7, 2022August 22, 2022Ed MacConnell

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.

Inflation Reduction Act Requires the Secretary of HHS to Negotiate Medicare Drug Prices

October 5, 2022August 24, 2022Ed MacConnell

Modifies 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

Key Differences: Medigap Open Enrollment, AEP, and ICEP

October 4, 2022July 28, 2022Ed MacConnell

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.

Part D Senior Savings Model: Will there be a plan with higher premiums for insulin at a lower cost?

October 3, 2022August 22, 2022Ed MacConnell

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.

Inflation Reduction Act: Establishing the Negotiated “Maximum Fair Price” for Medicare

September 30, 2022August 31, 2022Ed MacConnell

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

How to File a Medicare Appeal

September 30, 2022September 29, 2022Ed MacConnell

Medicare beneficiaries have the right to file an appeal when they or their physicians disagree with a treatment or claim denial. Luckily Medicare provides a step by step instruction guide to filing those appeals. Please click the link below to downlead the Medicare appeals guide. As always please contact your Total Benefit Solutions Inc Medicare health insurance specialist at (215)355-2121 if you have any additional questions or concerns.

Blue KC: Members Can Soon Access Rx Savings Solutions and Find Care in One Place

September 29, 2022September 23, 2022Ed MacConnell

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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